Current State: What's Implemented Today

Last Updated: December 2025

This section documents the clinical documentation features that are fully implemented and working in Kulcare today.

Quick SummaryCopy Anchor Link

Implemented Clinical HierarchyCopy Anchor Link

Today, Kulcare implements a two-level clinical hierarchy:

Patient
   |
   +-- Longitudinal Health Record (LHR) <-- AGGREGATE VIEW
   |       |
   |       +-- Problems (PatientProblem)
   |       +-- Medications (from prescriptions)
   |       +-- Vitals/Measurements (from encounters)
   |       +-- Encounter History (flat list)
   |       +-- Health Score (computed)
   |
   +-- Encounters (via Prescription)
           +-- Vitals
           +-- Observations
           +-- Medications
           +-- Investigations
           +-- Advice
           +-- Follow-up

Note: Episode of Care is a planned feature - see Future State for details.

Feature DetailsCopy Anchor Link

1. Longitudinal Health Record (LHR)Copy Anchor Link

Route: /cms/careplan/patient/:patientId

Component: LongitudinalHealthRecord.tsx

The LHR provides a patient-centric aggregated view of all clinical data:

API Endpoints:

GET /api/v1/clinics/:clinic_id/patients/:patient_id/longitudinal_health_record
GET /api/v1/clinics/:clinic_id/patients/:patient_id/longitudinal_health_record/problems
GET /api/v1/clinics/:clinic_id/patients/:patient_id/longitudinal_health_record/vitals_trends
GET /api/v1/clinics/:clinic_id/patients/:patient_id/longitudinal_health_record/medications_timeline

See LHR Feature Details for complete implementation.

2. Care Plan / PrescriptionCopy Anchor Link

Route: /cms/prescription/:appointmentId/:patientId/*

The Care Plan feature provides comprehensive clinical documentation:

Implemented Phases (from original plan):

• Phase 1: Core Infrastructure (navigation, types, mock data, API service)
• Phase 2: Dashboard & Patient Selection
• Phase 3: Vitals & Observations
• Phase 4: AI Scribe Integration
• Phase 5: Medication Management
• Phase 6: Auto-save and Data Management
• Phase 7: Print-friendly Layouts

Key Components:

• CarePlanDashboard - Dashboard with statistics and patient list
• NewEncounter - Patient selection for new encounters
• EncounterPage - Main encounter editor with tabs
• AIScribeSidebar - Voice transcription and AI suggestions

See Care Plan Feature Details for complete implementation.

3. Encounter SystemCopy Anchor Link

Status: Fully integrated with Prescription

Encounters are the atomic clinical events where documentation is created. Currently:

• Encounters navigate to PrescriptionPage for clinical documentation
• All encounter types use the Prescription model
• Supports: in_person | teleconsultation | follow_up | home_visit
• Supports practitioner types: doctor | physiotherapist | psychologist | therapist | nurse | dietitian | other

Gap: All practitioners use the same Prescription model, which is doctor-centric. See Future State: Multi-Practitioner Documents for planned improvements.

4. AI ScribeCopy Anchor Link

Location: frontend/apps/cms/src/features/aiScribe/

The AI Scribe provides voice transcription and AI-powered documentation assistance:

• Recording controls with device selection
• Real-time transcription display
• AI suggestions for medications, diagnoses, tests
• Accept/reject/modify workflow
• Integration with encounter tabs

5. HIPAA Audit TrailCopy Anchor Link

Location: packages/api-client/src/hipaaAuditService.ts

Comprehensive audit logging for PHI access:

• Organization-wide access (Settings > Security > Audit Trail)
• Patient-specific access (Patients List > Shield Icon)
• Encounter-level access (Patient Header > Shield Icon)
• Event categorization and emergency access tracking

Database Models (Current)Copy Anchor Link

Limitations / Known GapsCopy Anchor Link

These are documented limitations that will be addressed in future releases:

1. No Episode of Care: Encounters exist independently, not grouped into treatment programs
2. Doctor-Centric Model: Prescription model doesn't fit therapists, physiotherapists, dietitians
3. Single Document per Encounter: Currently 1:1 mapping between encounter and prescription
4. No Multi-Practitioner Encounters: Single provider per encounter
5. No Data-Driven Assessments: PHQ-9, GAD-7 not yet implemented as instruments

See Future State for planned solutions.

Related DocumentationCopy Anchor Link

• LHR Feature Details - Complete LHR implementation
• Care Plan Feature Details - Care Plan/Prescription implementation
• LHR Architecture - Technical architecture details
• Architecture: Clinical Data Hierarchy - Core concepts