This is the list of outstanding issues at and request from JSS. 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.
Discharge Summary
- Show 1st lab test result only (to be delivered in 0.71. Regarding the requirement of doctors choosing which lab results to show, it is too much work to develop compared to the value hence this is not planned anytime soon.
- Printout weight both at admission and discharge. Right now this only prints on discharge weight. When we would have the ability to print initial and last value we should be able to do this. This is coming in 0.71.
- Should be able to correct OT information in the discharge summary – It will be possible to do easily in 0.71 but in a slightly different way than JSS is thinking of. 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).
- 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; Arjun can you verify this. If broken it would be fixed in 0.71.
Diagnosis codification
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 thought we would take a different approach i.e to fix the diagnosis for the diseases that are getting templatized. 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 600 diagnosis at a Nepal's government hospital. Vivek will provide this soon.
Presenting complaints codification
The issues are similar here as diagnosis.
Child Growth Chart
A comment came from the retrospective that "nutrition for child is still awaited". Not sure whether it is the same thing or something else. Arjun can you clarify this one. The growth chart will be available in release 0.74 (June) because we first need the graph support.
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 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.
Culture reports
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.
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 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
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.
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: 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.
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.
Cancer
Template has too many fields and takes a lot of time. Raman to reduce the number of fields.
Drug order generation: Apart from not having to calculate the drug dosoges 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.
X-rays not getting digitised on same day
We found that the quality of the picture wasn’t always good. 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. What is the solution
Do we not import the old data because it has errors
Do we live with some errors
Do we give doctors ability to correct the data when the patient visits next time? Will the doctors actually correct?
Best solution (not fool proof) is to do manual check of names before or after importing. We should do this for diabetes and TB.