2015-11-16 OpenMRS design call notes

Owned by Akhil Malhotra
Last updated: Nov 17, 2015

Date

Attendees

Goals

  • Showcase the Order Sets work in Progress

Discussion items

Attendees:
  • Shruthi
  • Akhil (BA)
  • Shan (a lead dev)
  • Jonathan Teich
  • Darius
  • Wyclif
  • Daniel Kayiwa
  • Vikash Gupta
  • Achinta Roy
  • Arjun
  • swathi
  • Kaweesi Joseph
Agenda
  • Order Sets, work in progress update from Bahmni
Notes
  • Using Order Sets as a functionality (to start) by giving corollary orders (that is just one use case of order sets)
  • e.g. Isoniazid (a TB drug with neurological side effects) should always be given with Pyridoxine (vitamin B6, counters the neurological side effects)
  • Instead of, or along with, giving a popup alert if you forget Pyridoxine, push for them both to be done together through the Order Set
  • (Screenshare)
  • a UI to define order sets & their members
  • member includes a concept (of class="Drug")
  • "Primary Drug"
  • currently implemented as Order Set Member Attribute
  • Prescribing drugs screen (this is a placeholder UI, not the final one)
  • search for Isoniazid and choose it
  • you see "the selected drug is part of 2 order set(s)"
  • these order sets are listed with a "Use" button next to them
  • Questions/comments:
  • Burke's design envisions hierarchical order sets. Will this eventually be possible? => Yes
  • TODO: ensure that the data model for order set member will eventually support this; don't need to do it now
  • Darius: Could you replace "primary drug" with "searchable"?
  • Jonathan: this "Primary Drug" concept [enabling the clinician to find this order set in the search results whenever they search for that drug] has some pros and cons
  • concerned about missing some order sets which contain isoniazid (for example) in the search results for isoniazid because it was not marked as Primary on all of those sets.  I don't know if order sets authors will check the Primary Drug box reliably, I'd rather make this automatic so we don't run into safety problems
  •  "Primary drug" came out of one very specific use case of corollary orders (so you would find the isoniazid-and-pyridoxine set when you searched for isoniazid but not when you searched for pyridoxine), and this isn't the general approach
  • On the 'pro' side, this keeps me from finding way too many order sets when I search for common things like saline.
  • 'pro': On the drug ordering screen, you could do a unified search across order sets & drugs rather than having to know there's an applicable set
  • e.g. you start typing "isoniazid" and a top search hit is "standard DOTS TB treatment (HREZ)"
  • >> A possible pragmatic compromise: maybe if I search for isoniazid and there are >5 order sets containing isoniazid, the search results don't return them as individual results but rather return a line saying  "order sets containing isoniazid", and the clinician can select that to see all the sets
  • Darius: in the long run this drug prescribing UI should have "shortcuts" (in addition to just searching)
  • Ways to search/index order sets should include search by: title; keywords; any concept included in the order set; a catalog or outlined list of sets
  • Metadata
  • Title/metadata/category (for an outline-like list of order sets)
  • Primary combination concept (ANY, ALL, etc.)
  • ALL (must take all orders in the set) is useful for strict protocols
  • ANY is the general case, the clinician will have checkboxes next to each order that they wish to include for the current patient
  • I think there was also ONE for a list of mutually exclusive orders...?
  • Notes on the authoring/ordering UIs
  • Authoring
  • Compact list of one-line orders; you can add, insert, delete, edit any -- choosing to do so expands that order into the larger two- or three-line form where the parameters can be modified
  • Each type of order (lab, xray, etc.) will have an expanded two- or three-line boxed form similar to what we have now for drugs
  • Ordering (using in the clinical setting)
  • Similar, with checkboxes on the left to designate which orders from the set you want to actually use
  • Other ideas -- not needed for first version
  • Blank but required fields (leaving some fields such as drug dose blank in the order set, required to be filled in at order time)
  • Subordinate order sets (order set as a member of an order set)
  • There's a copy form and a link form of this.  Copy does a one-time copy of the subordinate set's orders into the new set at authoring time, and is a time-saver for authoring; link actually brings in the subordinate set in real time at ordering time -- a tricky concept to grasp, has to be done carefully

Action items

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