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2015-11-16 OpenMRS design call notes

2015-11-16 OpenMRS design call notes

Owned by Akhil Malhotra

Last updated: Nov 17, 2015

Date

16 Nov 2015

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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