EMR needs for an anticoagulation clinic:
========================
input new patient from the keyboard,
detect / warn if duplicate patient about to be created
find patient
edit current demographic information
input health issue(s)
indication for anticoagulation
target intensity (INR 2.5-3.5)
input medications (warfarin & maybe a low molecular weight heparin
(LMWH) e.g. tinzaparin)
input soaP
set date for next lab_request
identify lab_request status (needed/printed/submitted vs standing
order)
establish connection to lab to fetch lab data
fetch data (LOINC)
populate gnumed test_type table with any "new" combinations of
organisation/code/coding_system
notify users that new lab data is available
import data into staging table
match to patients (since Canada uses no lab_request id) :-(
if lab_request originated from the clinic
offer that encounter/episode as the one to link
elif originated from some other provider
create dummy encounter/episode "unrequested test results"
update the following for actual requests +- unrequested test results
update lab_request_id (internal to the lab)
update lab_rxd_when (specimen date/time received)
update results_reported_when (was the report generated)
update request_status (final, preliminary, partial)
update is_pending
transfer data into test_results
assign fk_reviewer
permit manual entry of lab results that did not arrive by way of the
electronic interface
next, the following must be identifiable and must support a good work flow:
- for test results outside of range
instruction obtained from doctor
input medication change (including "no change")
- capture the change as "as nurse user xx" for "authorizing Doctor yy"
soaP entry references medication change and next lab_request
patient notified & notification status is captured
(might we want notification_status in test_results?)
test results outside of range are marked as having been dealt with
for all these, set reviewed_by_clinician boolean "TRUE"
- for test results within range
soaP entry specifies per-protocol next lab_request
patient notified & notification status is captured
test results within range are marked as having been dealt with
for all these, set reviewed_by_clinician boolean "TRUE"
- for overdue requests having lab_rxd_when is NULL
patient is contacted / reminded / SoaP captured
existing lab_request is CANCELLED
new lab_request is entered (or should existing be modified?)
overdue requests are marked as having been dealt with
optionally / Stage 2
- support appointments for those requiring bridging injections of LMWH
- data export / reporting tools
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