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Future State: Planned Enhancements

Status: Planning Last Updated: December 2025

This section documents the clinical documentation features that are planned for future implementation.

Roadmap Overview

FeaturePriorityDependencies
Episode of CareHighNone
Multi-Practitioner DocumentsHighEpisode of Care
Clinical MeasurementsMediumMulti-Practitioner Documents
Assessment InstrumentsMediumClinical Measurements
Enhanced LHR with EpisodesMediumEpisode of Care

Target Clinical Hierarchy

The planned hierarchy adds an Episode of Care level between LHR and Encounters:

Patient
   |
   +-- Longitudinal Health Record (LHR) <-- AGGREGATE VIEW (computed, not stored)
   |       |
   |       +-- Problems (can be linked to episodes)
   |       +-- Medications (from encounters, linked to episodes)
   |       +-- Vitals/Measurements (from encounters)
   |       +-- Assessments (from encounters, trended by episode)
   |       +-- Encounter History (grouped by episode)
   |       +-- Health Score (computed from problems, vitals, medications)
   |
   +-- Episodes of Care <-- PROGRAM CONTAINERS (stored) [NEW]
   |       |
   |       +-- Episode: "Post-ACL Rehab" (physiotherapy)
   |       |       +-- Treatment Goals
   |       |       +-- Progress Notes
   |       |       +-- Encounters (1..N physio sessions)
   |       |
   |       +-- Episode: "Anxiety Treatment" (therapy)
   |       |       +-- Treatment Goals
   |       |       +-- Safety Plans
   |       |       +-- Encounters (1..N therapy sessions)
   |       |
   |       +-- Episode: "Weight Management" (nutrition)
   |               +-- Meal Plans
   |               +-- Nutritional Assessments
   |               +-- Encounters (1..N consultations)
   |
   +-- Standalone Encounters <-- NO EPISODE (current behavior preserved)
           +-- One-off visits
           +-- Acute care
           +-- Walk-in appointments

See Architecture: Clinical Data Hierarchy for complete details.

Planned Features

1. Episode of Care

Status: Planned Priority: High

An Episode of Care is a container for related encounters representing a course of treatment.

Key Capabilities:

  • Group multiple encounters into a treatment program
  • Track treatment goals and progress
  • Manage session frequency and scheduling
  • Support episode lifecycle: active -> completed -> discharged

Example Use Cases:

  • 12-session physiotherapy rehabilitation program
  • 10-session anxiety therapy course
  • 6-month weight management program
  • Chronic disease management program

See Episode of Care Details for implementation plan.

2. Multi-Practitioner Documents (EncounterDocument)

Status: Planned Priority: High

Replace the doctor-centric Prescription model with practitioner-specific documents.

Current Problem:

  • All encounters use Prescription model designed for doctors
  • Therapists, physiotherapists, dietitians have different documentation needs
  • 1:1 mapping between encounter and document is limiting

Planned Solution:

  • Polymorphic EncounterDocument with 1:N documents per encounter
  • Document types: prescription | therapy_session | physio_session | nutrition_consultation
  • Document lifecycle: draft -> signed -> locked -> amended

Target Practitioners:

  • Doctor: Prescriptions, medical certificates (existing)
  • Therapist/Psychologist: Session notes, mood assessments, safety plans
  • Physiotherapist: Session notes, ROM measurements, exercise prescriptions
  • Dietitian: Consultation notes, meal plans, nutritional assessments

See Multi-Practitioner Documents Details for implementation plan.

3. Clinical Measurements

Status: Planned Priority: Medium

Generalize the current "vitals" concept to support all clinical measurements.

Planned Measurement Types:

  • Vitals: Blood pressure, heart rate, temperature, SpO2
  • Anthropometrics: Height, weight, BMI, body composition
  • ROM (Range of Motion): Joint flexibility measurements
  • Functional: Grip strength, balance tests, gait analysis
  • Specialty-Specific: Vision, hearing, respiratory function

Benefits:

  • Unified measurement storage and trending
  • Cross-practitioner measurement sharing
  • Episode-specific measurement tracking

4. Assessment Instruments

Status: Planned Priority: Medium

Data-driven assessment tools for standardized clinical evaluations.

Planned Instruments:

  • Mental Health: PHQ-9, GAD-7, Beck Depression Inventory
  • Pain: Visual Analog Scale, Wong-Baker FACES
  • Function: Barthel Index, Katz ADL
  • Quality of Life: SF-36, EQ-5D

Key Features:

  • Instrument definitions stored as data, not code
  • Automatic scoring and interpretation
  • Trend visualization over time
  • Integration with Episode progress tracking

5. Enhanced LHR with Episodes

Status: Planned Priority: Medium Dependencies: Episode of Care

Update the existing LHR view to display and manage Episodes:

Planned Updates:

ComponentCurrentPlanned Update
PatientSummaryDashboardHealth score, alertsAdd "Active Episodes" card
VitalsTrendChartAll vitals over timeAdd "Filter by Episode" option
ProblemListManagerAll patient problemsLink problems to Episodes
MedicationTimelineAll medicationsShow Episode context
EncounterHistoryFlat listGroup by Episode (collapsible)

Implementation Phases

Phase 1: Episode of Care Model

  1. Create EpisodeOfCare migration and model
  2. Add episode_of_care_id to encounters (optional foreign key)
  3. Create treatment_goals table
  4. Create progress_notes table
  5. API endpoints for Episode CRUD

Phase 2: EncounterDocument Model

  1. Create EncounterDocument migration
  2. Create EncounterParticipant migration
  3. Migrate existing Prescription data
  4. Create practitioner-specific document types

Phase 3: LHR Episode Integration

  1. Update PatientSummaryDashboard with Episodes card
  2. Add Episode filter to VitalsTrendChart
  3. Group EncounterHistory by Episode
  4. Enable Problem-Episode linking

Phase 4: Clinical Measurements & Assessments

  1. Create ClinicalMeasurement model
  2. Migrate vitals to measurements
  3. Create AssessmentInstrument model
  4. Implement data-driven assessment rendering

Backward Compatibility

All enhancements maintain 100% backward compatibility:

  • Existing encounters without episodes continue to work
  • Existing Prescription model remains for doctor encounters
  • LHR continues to show all data regardless of episode grouping
  • Episode linking is optional, not required
  • No workflow disruption for existing users

Multi-Practitioner Documents Implementation Plan

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Roadmap OverviewTarget Clinical HierarchyPlanned Features1. Episode of Care2. Multi-Practitioner Documents (EncounterDocument)3. Clinical Measurements4. Assessment Instruments5. Enhanced LHR with EpisodesImplementation PhasesPhase 1: Episode of Care ModelPhase 2: EncounterDocument ModelPhase 3: LHR Episode IntegrationPhase 4: Clinical Measurements & AssessmentsBackward CompatibilityRelated Documentation