Issues and Requests

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 bahmni_support_jss@googlegroups.com. Roughly for release dates --- 0.71 March; 0.72 April; 0.73 May; 0.74 June; so on. This list should also help JSS in prioritising some of this work.

Discharge Summary

While deciding discharge summary contents it is important to remember that it is not meant to be used by clinicians at JSS, because they have access to the complete patient record and not just the discharge summary. Discharge summary will be used primarily by clinicians outside JSS. Most discharge summaries do not provide information about two things - lab results while admitted and drugs given during the same. This raises few questions, how many of these admitted patients would go somewhere outside JSS; of these, how many clinicians would look at lab results and drugs given while admitted. Considering all this if it is still felt that it is worth providing this information then we would implement this at JSS in release 0.72 (some which are easily doable would be available in 0.71). Details in point 1 and 2 below.

1. If lab results indeed have to be put on discharge summary - then there are few ideas for it.
   1. Show 1st lab test result only for all the tests done
   2. Show 1st lab test results and last results
   3. Show all and let the doctor choose which ones go on the print out. This is hard to implement and would require a lot of development for comparably small benefit.
   4. Show results from first few accession and last few accession. Here few is determined by how many can fit on paper. This may miss some tests which were done in middle, but should cover most of it.
2. Should be able to correct OT information in the discharge summary print – It will be possible to do easily in a slightly different than expected. Instead of correcting procedure details from discharge, one would be able to correct it by opening the operation template. Also, the previously filled details would be shown in the form itself, instead of having to see it from the dashboard. (0.71)
3. The diagnosis has to be entered again when it was done in last visit since it doesn’t show up in the print because it doesn't below to this visit. To handle this, just enter some notes like "admitted or similar" against the diagnosis, and that will make it appear on the print. This should be already working unless it is also affected by some of the diagnosis issues we saw in 0.70. If broken it would be fixed. (0.71)
4. Rename discharge summary template in observations tab to Discharge Note so that it indicates that there are more information than discharge details in the discharge summary printout given to the patient. This can be done now. (though marking it to be done latest by 0.71)
5. It requires many clicks to go to discharge summary. The tab for it would be made visible always so that one click is reduced. (0.72) (#1883)
6. Treatment given and treatment ordered should be separated. (0.72)
7. Content under the heading for full space utilisation. 
   1. As an intermediate the text would start from where the first column of table ends and will end where last column of table ends. (0.71a) (#2022)
8. Formatting from text boxes to be retained (0.71a) (#2027)
9. Nutritional values
   
   1. Print weight both at admission and discharge. Right now this only prints discharge weight. (0.71) (0.72)
   2. Print height and BMI at admission (0.72)
   3. Units to be printed - kgs, cms (0.71)
10. Diagnoses
    1. Show in Bold (0.73) (#2055)
    2. Presumed Confirmed not to be shown (0.71) 
11. Dates of Operation and Follow up date in easy to understand format  e.g. 24 Aug 2014 (0.71a) (#2020)
12. Follow up date to have day e.g. Friday (#2053)
13. Plan for follow up - space for adding it. (0.71)
14. Dates appearing unnecessary under the concepts. e.g. 21 Mar 15 12:58PM is too much information below Discharge Summary/Advice on Discharge section (#2054)
15. Investigation Chart and Treatment to be shown in smaller font (#2056)
    
    
    Completed

• 1. Treatment given should be displayed in a way that medicine names are not repeated. (0.71)
  2. Put lab and treatment as last section. This can be done now. (though marking it to be done latest by 0.71)

Diagnosis codification

As decided in Dec 2014 that various doctors would divide this work, provide the list and correct the diagnosis for their specific areas. There has been no progress in this direction. With Diabetes, we took a different approach to see if it would work, i.e. to define diagnosis disease by disease. It worked well with diabetes and we had 5 diagnosis defined for it, which is what we have in production. 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. There is a list of 360 diagnosis at a Nepal's government hospital, which we will/have sent to JSS.

Presenting complaints codification

The issues are similar here as diagnosis.

Ability to Edit Diagnosis

This ability directly cannot be provided. But doctors would soon be able to do this in slightly different way. There would now be ability to delete a diagnosis. A corrected one can then be entered like a new diagnosis. (0.71) 

Child growth chart

A comment came from the retrospective that "nutrition for child is still awaited". The growth chart will be available in release 0.73 because we first need the graph support first.

Drawing diagrams

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 at times when 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.

Culture reports

The issue with culture report is that it is hard to automatically generate a form like for other observations, 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 breakthrough 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. Some suggestions here are uploading the file which is received and along with entering some key fields if required.

Too much information on dashboard

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 for 1 visit. What this also means is that when there is nothing in the current visit then it shows from the last visit. Irrespective it shows 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.

Patient record scanning at VP

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.

Vaibhav has started to look after the scanning at VP and the target is to complete it by March End. After that the plan is start entering data through templates at Ganiyari, first for TB and Hypertension on a pilot basis. 

Diabetes

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: Counsellors 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.

TB

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.

Cancer

1. Template has too many fields and takes a lot of time. Raman to reduce the number of fields.
2. Drug order generation: Apart from not having to calculate the drug dosages it is also useful because the number of drugs are a lot. So it is worth using even before the date issue gets resolved.Regarding the issue of multiple drugs of same type – we already have ability to specify the dosage in mg. So even if we choose 50mg we can give dosage as 65mg. We can train the billing person to change this. The ideal solution would have been to allow ordering by the medicine name but even if it is implemented it will not solve the billing problem.
   1. The nurses will need a printout of the order so they can carry it out. 
3. Ability to generate the lab orders - Release not decided yet, will publish soon.
4. Collapsible section in templates - 0.75

X-rays not getting digitised on same day

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.

Importing data from old excel sheets

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/April for TB/Diabetes.

Preventing infection by patients who have been tested positive in the lab

Provide a tab which shows the list of patients who have abnormal results or create a report. (0.72)

Generation of lab orders

This is on our backlog. We will publish the release for it soon.

ECG image extraction

This is on our backlog. We will publish the release for it soon.

Visual Indicator for IPD patients

Docs should know which patients are admitted. A benefit of it is to ensure that timely discharges from system are happening. (0.73)

Reports

• Template CSV reports with ability to configure test names (TB, OT, etc) (#1932) (0.72)
• Lab abnormal results report with ability to configure test names (#2137)
• Billing report (#1938) (0.73)
  • Report of Drugs not used in last 3 months (#1813) (0.73)
  • Total bill amount, paid amount, discount amount,etc segregated by IPD and OPD.
• Socio Economic report (#1928) (0.73)
• List of awaited results (culture samples, biopsy) with lab names (#516). This is bigger work and will take some time.