LHR Completion Plan: FHIR Resource Coverage

Goal: Complete all FHIR resource coverage in LHR before adding Episode of Care

Current StatusCopy Anchor Link

Target: 95% coverage (18/19 components, excluding Imaging which is specialty-specific)

Phase 1: Quick Wins (Low Effort, High Value)Copy Anchor Link

Components where backend exists, just need frontend integration.

1.1 Add Allergies to LHR DashboardCopy Anchor Link

• FHIR: AllergyIntolerance
• Backend: Already exists (AllergyIntolerance model)
• Task: Add Allergies card to PatientSummaryDashboard
• Effort: 2-4 hours

// Add to PatientSummaryDashboard.tsx
<AllergiesCard allergies={patientData.allergies} />

1.2 Add Care Plan Summary to LHRCopy Anchor Link

• FHIR: CarePlan
• Backend: Already exists (CarePlan model with care_plan_problems)
• Task: Display active care plans in LHR
• Effort: 4-6 hours

1.3 Add Clinical Notes to LHR TimelineCopy Anchor Link

• FHIR: DocumentReference, ClinicalImpression
• Backend: Already exists (ClinicalImpression, ClinicalObservation)
• Task: Include notes in EncounterHistory timeline
• Effort: 4-6 hours

1.4 Add Procedures to LHRCopy Anchor Link

• FHIR: Procedure
• Backend: Already exists (Procedure model)
• Task: Create ProcedureHistory component for LHR
• Effort: 4-6 hours

1.5 Add Referrals to LHRCopy Anchor Link

• FHIR: ServiceRequest
• Backend: Already exists (ServiceRequest model)
• Task: Show referral history and status in LHR
• Effort: 4-6 hours

Phase 1 Total: ~20-28 hours | Coverage after Phase 1: ~80%

Phase 2: Enhancements (Medium Effort)Copy Anchor Link

Components that need frontend improvements.

2.1 Lab Results TrendingCopy Anchor Link

• FHIR: Observation (category: laboratory), DiagnosticReport
• Backend: DiagnosticReport exists
• Tasks:
  • Create LabResultsTrend.tsx component with Recharts
  • Add reference range highlighting
  • Add critical value alerts (visual indicators)
  • Support common lab panels (lipid, metabolic, CBC)
• Effort: 8-12 hours

2.2 Immunizations (Adult Support)Copy Anchor Link

• FHIR: Immunization
• Backend: Immunization model exists
• Tasks:
  • Verify Immunization model supports adults (not just children)
  • Create ImmunizationRecord.tsx component
  • Show immunization history in LHR
  • Add due/overdue indicators
• Effort: 6-8 hours

Phase 2 Total: ~14-20 hours | Coverage after Phase 2: ~85%

Phase 3: New Models (Higher Effort)Copy Anchor Link

Components that need backend models created.

3.1 Family HistoryCopy Anchor Link

• FHIR: FamilyMemberHistory
• Backend: NEW model needed
• Tasks:
  • Create FamilyMemberHistory migration and model
  • Create backend endpoints (CRUD)
  • Create FamilyHistoryManager.tsx component
  • Add to LHR dashboard
• Effort: 12-16 hours

# Migration
class CreateFamilyMemberHistories < ActiveRecord::Migration[7.0]
  def change
    create_table :family_member_histories do |t|
      t.references :patient, null: false, foreign_key: true
      t.references :clinic, foreign_key: true
      t.string :relationship, null: false  # mother, father, sibling, etc.
      t.string :condition_name
      t.string :condition_code  # ICD-10
      t.boolean :deceased, default: false
      t.integer :age_at_onset
      t.integer :age_at_death
      t.text :notes
      t.timestamps
    end
  end
end

3.2 Social History (Structured)Copy Anchor Link

• FHIR: Observation (category: social-history)
• Backend: Extend Patient or create SocialHistory model
• Tasks:
  • Add structured fields to Patient or create new model
  • Create SocialHistoryPanel.tsx component
  • Fields: smoking, alcohol, occupation, exercise, diet, stress
• Effort: 8-12 hours

# Option A: Add to Patient model
add_column :patients, :smoking_status, :string  # never, former, current
add_column :patients, :alcohol_use, :string     # none, occasional, moderate, heavy
add_column :patients, :occupation, :string
add_column :patients, :exercise_frequency, :string  # sedentary, light, moderate, active
add_column :patients, :marital_status, :string

# Option B: Create SocialHistory model (better for history tracking)
class CreateSocialHistories < ActiveRecord::Migration[7.0]
  def change
    create_table :social_histories do |t|
      t.references :patient, null: false, foreign_key: true
      t.string :category  # smoking, alcohol, occupation, etc.
      t.string :status
      t.string :value
      t.date :recorded_date
      t.text :notes
      t.timestamps
    end
  end
end

3.3 GoalsCopy Anchor Link

• FHIR: Goal
• Backend: NEW model needed
• Tasks:
  • Create Goal migration and model
  • Create backend endpoints
  • Create GoalTracker.tsx component
  • Link goals to problems and care plans
• Effort: 10-14 hours

class CreateGoals < ActiveRecord::Migration[7.0]
  def change
    create_table :goals do |t|
      t.references :patient, null: false, foreign_key: true
      t.references :clinic, foreign_key: true
      t.references :patient_problem, foreign_key: true, optional: true
      t.references :care_plan, foreign_key: true, optional: true
      t.string :description, null: false
      t.string :category  # clinical, behavioral, functional
      t.string :status, default: 'in_progress'  # proposed, in_progress, achieved, cancelled
      t.string :priority  # high, medium, low
      t.date :start_date
      t.date :target_date
      t.string :target_value  # e.g., "HbA1c < 7.0"
      t.string :current_value
      t.text :notes
      t.timestamps
    end
  end
end

Phase 3 Total: ~30-42 hours | Coverage after Phase 3: ~95%

Implementation SummaryCopy Anchor Link

Component ChecklistCopy Anchor Link

Phase 1 ChecklistCopy Anchor Link

• 1.1 Allergies card in LHR dashboard
• 1.2 Care Plan summary in LHR
• 1.3 Clinical notes in timeline
• 1.4 Procedure history component
• 1.5 Referral history component

Phase 2 ChecklistCopy Anchor Link

• 2.1 Lab results trending chart
• 2.2 Immunization record (adult support)

Phase 3 ChecklistCopy Anchor Link

• 3.1 FamilyMemberHistory model + UI
• 3.2 Social history structured fields + UI
• 3.3 Goal model + UI
• 3.4 ImagingStudy model + UI

After LHR CompletionCopy Anchor Link

Once LHR is at 95% coverage:

1. Episode of Care - Add program containers
2. Multi-Practitioner Documents - Add EncounterDocument model
3. Role-Based Views - Customize LHR by practitioner type

FHIR Resource Mapping (Complete)Copy Anchor Link

Related DocumentationCopy Anchor Link

• LHR Components Audit - Current gap analysis
• LHR Presentation Strategy - UI design
• Episode of Care Plan - Next phase after LHR