LHR Components Audit

Purpose: Comprehensive audit of all components that should be part of a Longitudinal Health Record, comparing standard requirements against Kulcare's current implementation and plans.

Component Audit SummaryCopy Anchor Link

Detailed Component AnalysisCopy Anchor Link

Fully ImplementedCopy Anchor Link

1. Patient DemographicsCopy Anchor Link

• FHIR: Patient
• Backend: Patient, ClinicPatient
• Frontend: PatientDetail page
• Data: Name, DOB, gender, contact info, blood group, address
• Status: Complete

2. Problems/ConditionsCopy Anchor Link

• FHIR: Condition
• Backend: PatientProblem
  • Fields: name, icd_code, status, severity, onset_date, resolved_date
  • Associations: patient, doctor, first_appointment, last_appointment
• Frontend: ProblemListManager.tsx
  • CRUD operations
  • Severity classification (low, medium, high, critical)
  • Status tracking (active, resolved, chronic, improving)
  • Medication linking
• Status: Complete

3. MedicationsCopy Anchor Link

• FHIR: MedicationRequest, MedicationStatement
• Backend:
  • PatientMedicine - Active medications
  • MedicationRequest - FHIR-compliant requests
  • MedicineAdherence - Tracking
• Frontend: MedicationTimeline.tsx
  • Current medications
  • Historical timeline
  • Dosage changes
  • Discontinuation tracking
• Status: Complete

4. AllergiesCopy Anchor Link

• FHIR: AllergyIntolerance
• Backend: AllergyIntolerance
  • Fields: allergen, reaction, severity, onset_date
  • Associations: patient, basic_allergy
• Frontend: Shown in PatientDetail
• Status: Complete (consider adding to LHR dashboard)

5. Vital SignsCopy Anchor Link

• FHIR: Observation (category: vital-signs)
• Backend: PatientVital, PatientVitalGroup
  • Supports: BP, heart rate, temperature, weight, height, BMI, SpO2, respiratory rate
• Frontend: VitalsTrendChart.tsx
  • Trend visualization with Recharts
  • Date range filtering
  • Abnormal value flagging
  • Multiple vital types
• Status: Complete

6. Encounter HistoryCopy Anchor Link

• FHIR: Encounter
• Backend: Appointment (acts as encounter), Prescription
• Frontend: EncounterHistory.tsx
  • List and timeline views
  • Filtering by type, date, provider
  • Links to full encounter details
• Status: Complete

7. Documents/AttachmentsCopy Anchor Link

• FHIR: DocumentReference
• Backend: MedicalRecord, Document
• Frontend: Medical Records section
• Status: Complete

8. AppointmentsCopy Anchor Link

• FHIR: Appointment
• Backend: Appointment
• Frontend: Queue, Calendar, Scheduling
• Status: Complete

9. Health Score (Custom)Copy Anchor Link

• FHIR: N/A (Kulcare custom metric)
• Backend: Computed in LHR interactor
• Frontend: PatientSummaryDashboard.tsx
• Calculation: Based on problems, vitals, medications, compliance
• Status: Complete

Partially ImplementedCopy Anchor Link

10. Lab ResultsCopy Anchor Link

• FHIR: Observation (category: laboratory), DiagnosticReport
• Backend: DiagnosticReport
  • Has model with patient, doctor, appointment associations
• Frontend: Basic display in LHR
• Gaps:
  • Trending visualization for serial labs (e.g., HbA1c over time)
  • Reference range highlighting
  • Critical value alerts
  • Integration with lab orders from Prescription
• Priority: High

11. ProceduresCopy Anchor Link

• FHIR: Procedure
• Backend: Procedure model exists
• Frontend: Not shown in LHR
• Gaps:
  • Procedure history display
  • Surgical history section
  • Link to related encounters
• Priority: Medium

12. ImmunizationsCopy Anchor Link

• FHIR: Immunization
• Backend: Immunization, ChildRecordVaccination
• Frontend: Only in ChildRecord (pediatric module)
• Gaps:
  • Adult immunization tracking
  • Immunization schedule display
  • Integration with LHR for all ages
• Priority: Medium

13. Social HistoryCopy Anchor Link

• FHIR: Observation (category: social-history)
• Backend: Basic fields in Patient (smoking, alcohol may exist)
• Frontend: Limited display
• Gaps:
  • Structured social history (smoking, alcohol, occupation, exercise)
  • Risk factor tracking
  • Lifestyle intervention history
• Priority: Medium

14. Clinical NotesCopy Anchor Link

• FHIR: DocumentReference, ClinicalImpression
• Backend: ClinicalImpression, ClinicalObservation
• Frontend: Part of Prescription
• Gaps:
  • Notes visible in LHR timeline
  • Full-text search across notes
  • Note categorization
• Priority: Medium

15. Care PlansCopy Anchor Link

• FHIR: CarePlan
• Backend: CarePlan model with care_plan_problems
• Frontend: Not visible in LHR
• Gaps:
  • Care plan display in LHR
  • Goal tracking UI
  • Care plan templates
• Priority: High (relates to Episode of Care)

16. ReferralsCopy Anchor Link

• FHIR: ServiceRequest
• Backend: ServiceRequest
• Frontend: Part of Prescription workflow
• Gaps:
  • Referral history in LHR
  • Referral status tracking
  • Specialist report integration
• Priority: Low

Not ImplementedCopy Anchor Link

17. Imaging/RadiologyCopy Anchor Link

• FHIR: ImagingStudy, DiagnosticReport
• Backend: Not implemented
• Frontend: Not implemented
• Requirements:
  • Imaging order model
  • Image/report storage
  • DICOM viewer integration (optional)
  • Radiology report display
• Priority: Low (specialty-specific)

18. Family HistoryCopy Anchor Link

• FHIR: FamilyMemberHistory
• Backend: Not implemented
• Frontend: Not implemented
• Requirements:
  • FamilyMemberHistory model
  • Relationship, condition, age at onset
  • Family tree visualization (optional)
  • Risk factor calculation
• Priority: Medium

19. GoalsCopy Anchor Link

• FHIR: Goal
• Backend: Not implemented (planned with Episode of Care)
• Frontend: Not implemented
• Requirements:
  • Goal model with targets
  • Progress tracking
  • Link to care plans and episodes
• Priority: High (part of Episode of Care)

20. Episode of CareCopy Anchor Link

• FHIR: EpisodeOfCare
• Backend: Not implemented (planned)
• Frontend: Not implemented (planned)
• Requirements: See Episode of Care Plan
• Priority: High

Priority RecommendationsCopy Anchor Link

High Priority (Should implement next)Copy Anchor Link

Medium Priority (Important for comprehensive LHR)Copy Anchor Link

Lower Priority (Nice to have)Copy Anchor Link

Data Model GapsCopy Anchor Link

Models That Need CreationCopy Anchor Link

# Episode of Care (High Priority)
class EpisodeOfCare < ApplicationRecord
  belongs_to :patient
  belongs_to :clinic
  belongs_to :primary_provider, class_name: 'User'
  has_many :encounters
  has_many :treatment_goals
  # episode_type, status, start_date, end_date
end

# Treatment Goal (High Priority)
class TreatmentGoal < ApplicationRecord
  belongs_to :episode_of_care
  belongs_to :patient
  # description, target_value, current_value, due_date, status
end

# Family History (Medium Priority)
class FamilyMemberHistory < ApplicationRecord
  belongs_to :patient
  # relationship, condition, deceased, age_at_onset
end

# Social History (Medium Priority - or extend Patient)
class SocialHistory < ApplicationRecord
  belongs_to :patient
  # smoking_status, alcohol_use, occupation, exercise_frequency
end

Models That Need EnhancementCopy Anchor Link

# Patient - add social history fields
class Patient
  # Add: smoking_status, alcohol_use, occupation, marital_status
end

# Immunization - ensure adult support
class Immunization
  # Ensure not limited to pediatric use
end

Frontend Component GapsCopy Anchor Link

Components That Need CreationCopy Anchor Link

Components That Need EnhancementCopy Anchor Link

SummaryCopy Anchor Link

Overall LHR Completeness: ~65%

Next Steps:

1. Implement Episode of Care infrastructure
2. Enhance lab results trending
3. Add care plan display to LHR
4. Create family/social history components
5. Integrate clinical notes into LHR timeline

Related DocumentationCopy Anchor Link

• LHR Concept - What LHR means and why it matters
• Clinical Data Hierarchy - LHR/Episode/Encounter relationships
• Future State: Episode of Care - Episode implementation plan
• Backend Implementation Progress - Current backend status