This is the list of outstanding issues at and request from JSS. This doesn't cover one-off smaller issues. If you do not see your issue or request here, please contact Vivek vsingh@thoughtworks.com . Roughly for release dates --- 0.71 March; 0.72 April; 0.73 May; 0.74 June; so on.
As decided Dec 2014 that various doctors would divide this work, provide the list and correct the diagnosis for their specific sections. There has been no progress in this direction. With Diabetes, we took a different approach to see if it would work, i.e to fix the diagnosis for the diseases that are getting templatised. It worked well with diabetes. But with TB this has failed, because of number of diagnosis involved in TB. Before we take a more ambitious target, the doctors should try to create diagnosis list for TB. Unfortunately TW would not be able to help much because it needs medical understanding. We will find out list of 400 diagnosis at a Nepal's government hospital. Vivek will provide this soon.
The issues are similar here as diagnosis.
A comment came from the retrospective that "nutrition for child is still awaited". The growth chart will be available in release 0.73 (May) because we first need the graph support.
Since this feature development would require a lot of effort, we would like to first verify whether this will really be used. The idea of taking picture from pre-made diagram on paper has been suggested every time this requirement comes up, but there has been no instance of doctors actually doing it. Hence we are wary of spending a lot of effort and developing something that will not be used. We should try out catalogue of paper diagrams and taking picture approach, EMR wise it has everything to support it right now.
The issue with culture report is that it is hard to automatically generate a form like for other obs, because of it is two (multi) dimensional nature. This is same as issue we are facing with Leprosy. But we do think that we may have a design break through and we might be able provide a real solution for this soon (before 0.75). But in the meanwhile if there is a simple solution then we should go for it. file upload, or registration entering.
Different doctors have different views on how much information should be shown on the dashboard. The key areas of contention are lab results and drug orders. We are showing information from 1 visit. What this also means is that when there is nothing in the current visit then it shows from the last visit. But we are showing everything from the chosen visit. This information becomes a lot for in-patients. Our recommendation is that we show only one-last accession and last day’s drug order. We will get this done in 0.71 release. Lets see if the users still feel that there is too much information on dashboard.
Some of controls can be optimised to use the space available to them on the dashboard which are not using currently. https://trello.com/c/maPX33ck/1870-display-controls-should-use-the-space-available-from-hidden-controls . lets see afterwards what to do to make it better further.
Although earlier the idea was to do scanning to ensure that the patient record is available at the sub-centre and hospital both, and to do this we started with one disease at a time. But scanning is happening randomly now, without a plan and repeated persuasion to follow the original plan has not worked in VP.
We are concerned about potential loss of data as the patients travel between Ganiyari and subcenter since now we keep the documents at the subcenter. This process is not foolproof and need significant supervision. There is no quality check in place to see if the process is working or not.
One option is to stop the current process and restart it when we have an offline solution for the sub centre. This should be available in 4-6 months time frame. Shortcut for patient paper records. Printout of scanned records.
Template: Some doctors do not want to use the template even though repeatedly the items in the checklist are not actually followed when doing it on paper. We had discussed in December whether we can ask the counsellors to fill a larger part of the template. At that time Yogesh wasn’t comfortable with the idea and wanted the doctors to do it.
Option1: Counselors fill larger part of the template
One problem with this approach is that currently the doctors don’t capture this information even on paper. How will the counselors or transcribers get this information?
Option2: Reduce the number of fields in the template
Also we should perhaps call template, checklist instead.
Template: Same issue as diabetes
Drug order generation: Here the real benefit comes from the fact that doctors do not have to do the calculation of drug dosages. Currently there is an issue with date of the drug order that will be fixed in 0.72. Ability to change duration on all medicines.
We found that the quality of the picture wasn’t always good, making the quality of taken image even worse. In order for this to not affect patient care, it was agreed that doctors would see the physical film and the X-ray technician would upload the picture the next day. Has anything changed?
We also found that X-rays are sometimes photographed as mirror images. Raman wanted the ability to turn the image around, but it seems too difficult to do, as just rotating in 2D would not help.
What is the ETA on digital x-ray machine? This can solve all these issues.
There are errors in the data and this has lead to wrong history for certain patients. While we can put in some additional checks, this will not be completely error free.
Best solution (not fool proof) is to do manually check the names before or after importing. We should do this for diabetes and TB since they have been already imported. This would be done soon, sometime in March for TB/Diabetes.
The lab paper on which the signature is done and handed over to the patient on completion of lab test, could contain a checklist which says: "should the patient wear a mask?". This would act as reminder. This checklist can be used during the lab in charge validation or lab result handover process. Eventually an event based alert would be useful in the EMR itself, but it is not planned right now.