Clinical Schema

Purpose: Patient care, clinical documentation, AI-assisted care, and FHIR-aligned clinical resources Tenant Scoped: Yes (all tables) RLS Enabled: Yes

Overview

The clinical schema contains all patient care data aligned with FHIR R4 resources. It supports:

Longitudinal Health Record (LHR) as a computed view
Episode of Care for treatment programs
Multi-practitioner encounters
Care Plans with versioning
AI-Assisted Care (transcription, suggestions)

Entities

Patients

Entity: Patient

Purpose: Individual receiving healthcare services (FHIR: Patient)

Attributes:

Attribute	Type	Required	Description
id	UUID	Yes	Primary identifier
tenant_id	UUID	Yes	Owning tenant
mrn	String	No	Medical Record Number (facility-specific)
abha_id	String	No	ABHA identifier (India)
first_name	String	Yes	First name
last_name	String	No	Last name
display_name	String	No	Preferred display name
gender	Enum	No	male, female, other, unknown
birth_date	Date	No	Date of birth
deceased	Boolean	No	Deceased status
deceased_date	Date	No	Date of death
marital_status	Enum	No	single, married, divorced, widowed
photo_url	String	No	Patient photo
email	String	No	Email address
phone	String	No	Primary phone
address	JSONB	No	Address information
emergency_contact	JSONB	No	Emergency contact details
communication_preferences	JSONB	No	Language, contact preferences
is_active	Boolean	Yes	Active patient

Emergency Contact Structure:

{
  "name": "Jane Doe",
  "relationship": "spouse",
  "phone": "+919876543210",
  "email": "jane@example.com"
}

Relationships:

Belongs to: Tenant
Has many: PatientFacilities, EpisodesOfCare, Encounters, Conditions, Observations
Has many: MedicationRequests, CarePlans, Goals, Appointments

FHIR Mapping: Patient resource

Entity: PatientFacility

Purpose: Links patients to facilities they receive care at

Attributes:

Attribute	Type	Required	Description
id	UUID	Yes	Primary identifier
tenant_id	UUID	Yes	Owning tenant
patient_id	UUID	Yes	Patient reference
facility_id	UUID	Yes	Facility reference
facility_mrn	String	No	Facility-specific MRN
registration_date	Date	No	First registration
is_primary	Boolean	No	Primary facility
is_active	Boolean	Yes	Active registration

Relationships:

Belongs to: Tenant, Patient, Facility

Episodes of Care

Entity: EpisodeOfCare

Purpose: Treatment program container spanning multiple encounters (FHIR: EpisodeOfCare)

Attributes:

Attribute	Type	Required	Description
id	UUID	Yes	Primary identifier
tenant_id	UUID	Yes	Owning tenant
patient_id	UUID	Yes	Patient reference
facility_id	UUID	Yes	Managing facility
managing_practitioner_id	UUID	No	Primary practitioner
status	Enum	Yes	planned, waitlist, active, onhold, finished, cancelled
type	Enum	No	Episode type (rehabilitation, chronic_care, mental_health, etc.)
diagnosis_codes	JSONB	No	Primary diagnoses for this episode
period_start	Date	No	Episode start date
period_end	Date	No	Episode end date
description	Text	No	Episode description

Status Lifecycle:

planned --> waitlist --> active <--> onhold --> finished
                                          \--> cancelled

Type Values:

rehabilitation - Post-surgical or injury recovery
chronic_care - Chronic disease management
mental_health - Mental health treatment program
maternity - Pregnancy and postnatal care
oncology - Cancer treatment program
preventive - Preventive care program
acute - Acute care episode

Relationships:

Belongs to: Tenant, Patient, Facility, Practitioner
Has many: Encounters, TreatmentGoals, ProgressNotes
Referenced by: CarePlans

FHIR Mapping: EpisodeOfCare resource

Entity: TreatmentGoal

Purpose: Goals specific to an episode of care

Attributes:

Attribute	Type	Required	Description
id	UUID	Yes	Primary identifier
tenant_id	UUID	Yes	Owning tenant
episode_of_care_id	UUID	Yes	Parent episode
description	Text	Yes	Goal description
target_date	Date	No	Target completion date
status	Enum	Yes	proposed, planned, accepted, active, achieved, cancelled
priority	Enum	No	high, medium, low
outcome	Text	No	Outcome description

Relationships:

Belongs to: Tenant, EpisodeOfCare

Entity: ProgressNote

Purpose: Progress notes within an episode

Attributes:

Attribute	Type	Required	Description
id	UUID	Yes	Primary identifier
tenant_id	UUID	Yes	Owning tenant
episode_of_care_id	UUID	Yes	Parent episode
encounter_id	UUID	No	Related encounter
author_id	UUID	Yes	Note author (practitioner)
note_date	Timestamp	Yes	Note date/time
content	Text	Yes	Note content
note_type	Enum	No	progress, assessment, plan, summary

Relationships:

Belongs to: Tenant, EpisodeOfCare, Encounter, Practitioner

Encounters

Entity: Encounter

Purpose: Clinical visit or interaction (FHIR: Encounter)

Attributes:

Attribute	Type	Required	Description
id	UUID	Yes	Primary identifier
tenant_id	UUID	Yes	Owning tenant
patient_id	UUID	Yes	Patient reference
facility_id	UUID	Yes	Facility where encounter occurs
episode_of_care_id	UUID	No	Parent episode (optional)
status	Enum	Yes	planned, arrived, triaged, in-progress, onleave, finished, cancelled
class	Enum	Yes	ambulatory, inpatient, emergency, virtual, home
type	Enum	No	consultation, follow_up, procedure, therapy, etc.
priority	Enum	No	routine, urgent, emergency
period_start	Timestamp	No	Start time
period_end	Timestamp	No	End time
reason_codes	JSONB	No	Reason for visit
diagnosis_codes	JSONB	No	Encounter diagnoses
hospitalization	JSONB	No	Admission details (inpatient)
service_type_id	UUID	No	Healthcare service reference

Class Values:

ambulatory - OPD, clinic visit
inpatient - Hospital admission
emergency - Emergency department
virtual - Telemedicine consultation
home - Home visit

Hospitalization Structure (for inpatient):

{
  "admit_source": "emergency",
  "re_admission": false,
  "diet_preference": "vegetarian",
  "special_arrangement": ["wheelchair"],
  "discharge_disposition": "home"
}

Relationships:

Belongs to: Tenant, Patient, Facility, EpisodeOfCare, HealthcareService
Has many: EncounterParticipants, Observations, MedicationRequests, ServiceRequests
Has many: TranscriptionSessions, AiSuggestions

FHIR Mapping: Encounter resource

Entity: EncounterParticipant

Purpose: Practitioners involved in an encounter (multi-practitioner support)

Attributes:

Attribute	Type	Required	Description
id	UUID	Yes	Primary identifier
tenant_id	UUID	Yes	Owning tenant
encounter_id	UUID	Yes	Encounter reference
practitioner_id	UUID	Yes	Practitioner reference
role	Enum	Yes	primary, consultant, assistant, observer
period_start	Timestamp	No	Participation start
period_end	Timestamp	No	Participation end

Role Values:

primary - Primary/attending practitioner
consultant - Consulting specialist
assistant - Assisting practitioner
observer - Observer (training, etc.)

Relationships:

Belongs to: Tenant, Encounter, Practitioner

FHIR Mapping: Encounter.participant

Clinical Data

Entity: Condition

Purpose: Diagnoses and problems (FHIR: Condition)

Attributes:

Attribute	Type	Required	Description
id	UUID	Yes	Primary identifier
tenant_id	UUID	Yes	Owning tenant
patient_id	UUID	Yes	Patient reference
encounter_id	UUID	No	Diagnosing encounter
recorder_id	UUID	No	Recording practitioner
clinical_status	Enum	Yes	active, recurrence, relapse, inactive, remission, resolved
verification_status	Enum	No	unconfirmed, provisional, differential, confirmed
category	Enum	No	problem_list_item, encounter_diagnosis
severity	Enum	No	mild, moderate, severe
code	JSONB	Yes	Diagnosis code (ICD, SNOMED)
body_site	JSONB	No	Affected body site
onset_date	Date	No	When condition started
abatement_date	Date	No	When condition ended
recorded_date	Date	No	When recorded
note	Text	No	Additional notes

Code Structure:

{
  "system": "icd-10",
  "code": "E11.9",
  "display": "Type 2 diabetes mellitus without complications"
}

Relationships:

Belongs to: Tenant, Patient, Encounter, Practitioner
References: reference.icd_codes, reference.snomed_concepts

FHIR Mapping: Condition resource

Entity: Observation

Purpose: Vitals, measurements, and clinical findings (FHIR: Observation)

Attributes:

Attribute	Type	Required	Description
id	UUID	Yes	Primary identifier
tenant_id	UUID	Yes	Owning tenant
patient_id	UUID	Yes	Patient reference
encounter_id	UUID	No	Related encounter
performer_id	UUID	No	Performing practitioner
status	Enum	Yes	registered, preliminary, final, amended, cancelled
category	Enum	Yes	vital_signs, laboratory, imaging, social_history, exam
code	JSONB	Yes	Observation type (LOINC, SNOMED)
value	JSONB	Yes	Observation value
interpretation	Enum	No	normal, abnormal, critical_low, critical_high
effective_date	Timestamp	Yes	When observed
issued	Timestamp	No	When result issued
note	Text	No	Additional notes
reference_range	JSONB	No	Normal range
body_site	JSONB	No	Body site
method	String	No	Observation method

Value Structure (varies by type):

// Quantity
{ "type": "quantity", "value": 120, "unit": "mmHg" }

// String
{ "type": "string", "value": "Normal breath sounds" }

// CodeableConcept
{ "type": "code", "system": "snomed", "code": "17621005", "display": "Normal" }

// Boolean
{ "type": "boolean", "value": true }

Common Vital Signs:

Blood Pressure (systolic/diastolic)
Heart Rate
Temperature
Respiratory Rate
Oxygen Saturation
Height, Weight, BMI

Relationships:

Belongs to: Tenant, Patient, Encounter, Practitioner
References: reference.lab_tests, reference.snomed_concepts

FHIR Mapping: Observation resource

Entity: AllergyIntolerance

Purpose: Patient allergies and intolerances (FHIR: AllergyIntolerance)

Attributes:

Attribute	Type	Required	Description
id	UUID	Yes	Primary identifier
tenant_id	UUID	Yes	Owning tenant
patient_id	UUID	Yes	Patient reference
encounter_id	UUID	No	Recording encounter
recorder_id	UUID	No	Recording practitioner
clinical_status	Enum	Yes	active, inactive, resolved
verification_status	Enum	No	unconfirmed, confirmed, refuted
type	Enum	No	allergy, intolerance
category	Enum	No	food, medication, environment, biologic
criticality	Enum	No	low, high, unable_to_assess
code	JSONB	Yes	Substance/allergen
onset_date	Date	No	When allergy started
recorded_date	Date	No	When recorded
reactions	JSONB	No	Reaction details
note	Text	No	Additional notes

Reactions Structure:

[
  {
    "substance": "Penicillin",
    "manifestation": ["Hives", "Difficulty breathing"],
    "severity": "severe",
    "onset": "immediate"
  }
]

Relationships:

Belongs to: Tenant, Patient, Encounter, Practitioner

FHIR Mapping: AllergyIntolerance resource

Medications

Entity: MedicationRequest

Purpose: Prescriptions and medication orders (FHIR: MedicationRequest)

Attributes:

Attribute	Type	Required	Description
id	UUID	Yes	Primary identifier
tenant_id	UUID	Yes	Owning tenant
patient_id	UUID	Yes	Patient reference
encounter_id	UUID	No	Prescribing encounter
requester_id	UUID	Yes	Prescribing practitioner
status	Enum	Yes	active, on-hold, cancelled, completed, stopped, draft
intent	Enum	Yes	proposal, plan, order, original-order, reflex-order
priority	Enum	No	routine, urgent, asap, stat
medication	JSONB	Yes	Medication details
dosage_instruction	JSONB	Yes	Dosage instructions
dispense_request	JSONB	No	Dispensing details
substitution_allowed	Boolean	No	Generic substitution allowed
reason_code	JSONB	No	Reason for medication
authored_on	Timestamp	Yes	When prescribed
validity_period_start	Date	No	Prescription start
validity_period_end	Date	No	Prescription end
note	Text	No	Additional instructions

Medication Structure:

{
  "drug_id": "uuid",
  "name": "Metformin 500mg",
  "generic_name": "Metformin Hydrochloride",
  "form": "tablet",
  "strength": "500mg"
}

Dosage Instruction Structure:

{
  "sequence": 1,
  "text": "Take 1 tablet twice daily with meals",
  "timing": {
    "frequency": 2,
    "period": 1,
    "period_unit": "day"
  },
  "route": "oral",
  "dose_quantity": {
    "value": 1,
    "unit": "tablet"
  },
  "as_needed": false,
  "duration": {
    "value": 30,
    "unit": "day"
  }
}

Relationships:

Belongs to: Tenant, Patient, Encounter, Practitioner
References: reference.drugs

FHIR Mapping: MedicationRequest resource

Care Planning

Entity: CarePlan

Purpose: Treatment and care planning (FHIR: CarePlan)

Attributes:

Attribute	Type	Required	Description
id	UUID	Yes	Primary identifier
tenant_id	UUID	Yes	Owning tenant
patient_id	UUID	Yes	Patient reference
encounter_id	UUID	No	Creating encounter
episode_of_care_id	UUID	No	Related episode
author_id	UUID	No	Plan author
status	Enum	Yes	draft, active, on-hold, revoked, completed
intent	Enum	Yes	proposal, plan, order
category	Enum	No	assess-plan, orders, overall-plan
title	String	No	Plan title
description	Text	No	Plan description
period_start	Date	No	Plan start date
period_end	Date	No	Plan end date
activities	JSONB	No	Planned activities
addresses	JSONB	No	Conditions addressed
version	Integer	Yes	Version number (default: 1)
replaces_id	UUID	No	Previous version reference
created_at	Timestamp	Yes	Creation timestamp

Activities Structure:

[
  {
    "detail": {
      "kind": "ServiceRequest",
      "code": "Physical therapy",
      "status": "scheduled",
      "scheduled": "2024-02-01",
      "performer_id": "uuid"
    }
  },
  {
    "detail": {
      "kind": "MedicationRequest",
      "code": "Pain management",
      "status": "in-progress"
    }
  }
]

Versioning Pattern:

New versions created via replaces_id chain
Old versions remain immutable
Only one version can be active at a time

Relationships:

Belongs to: Tenant, Patient, Encounter, EpisodeOfCare, Practitioner
Has many: Goals
Self-referential: replaces_id for version chain

FHIR Mapping: CarePlan resource

Entity: Goal

Purpose: Patient health goals (FHIR: Goal)

Attributes:

Attribute	Type	Required	Description
id	UUID	Yes	Primary identifier
tenant_id	UUID	Yes	Owning tenant
patient_id	UUID	Yes	Patient reference
care_plan_id	UUID	No	Related care plan
expressed_by_id	UUID	No	Who expressed goal
lifecycle_status	Enum	Yes	proposed, planned, accepted, active, on-hold, completed, cancelled
achievement_status	Enum	No	in-progress, improving, worsening, no-change, achieved, not-achieved
priority	Enum	No	high, medium, low
category	Enum	No	dietary, safety, behavioral, physiotherapy
description	Text	Yes	Goal description
start_date	Date	No	Target start
target	JSONB	No	Target measures
status_date	Date	No	Last status update
status_reason	Text	No	Reason for current status
note	Text	No	Additional notes

Target Structure:

{
  "measure": "HbA1c",
  "detail": {
    "type": "quantity",
    "value": 6.5,
    "comparator": "<=",
    "unit": "%"
  },
  "due_date": "2024-06-01"
}

Relationships:

Belongs to: Tenant, Patient, CarePlan, Practitioner

FHIR Mapping: Goal resource

Orders and Results

Entity: ServiceRequest

Purpose: Lab orders, imaging orders, referrals (FHIR: ServiceRequest)

Attributes:

Attribute	Type	Required	Description
id	UUID	Yes	Primary identifier
tenant_id	UUID	Yes	Owning tenant
patient_id	UUID	Yes	Patient reference
encounter_id	UUID	No	Ordering encounter
requester_id	UUID	Yes	Ordering practitioner
status	Enum	Yes	draft, active, on-hold, revoked, completed
intent	Enum	Yes	proposal, plan, order, original-order
priority	Enum	No	routine, urgent, asap, stat
category	Enum	Yes	laboratory, imaging, procedure, referral, consultation
code	JSONB	Yes	Service/test code
order_detail	JSONB	No	Additional order details
quantity	Integer	No	Number of repetitions
occurrence	JSONB	No	When service should occur
authored_on	Timestamp	Yes	When ordered
reason_code	JSONB	No	Reason for order
supporting_info	JSONB	No	Additional clinical context
specimen	JSONB	No	Specimen requirements
note	Text	No	Additional instructions

Relationships:

Belongs to: Tenant, Patient, Encounter, Practitioner
Has many: DiagnosticReports
References: reference.lab_tests, reference.procedures

FHIR Mapping: ServiceRequest resource

Entity: DiagnosticReport

Purpose: Lab results, imaging results (FHIR: DiagnosticReport)

Attributes:

Attribute	Type	Required	Description
id	UUID	Yes	Primary identifier
tenant_id	UUID	Yes	Owning tenant
patient_id	UUID	Yes	Patient reference
encounter_id	UUID	No	Related encounter
service_request_id	UUID	No	Original order
performer_id	UUID	No	Performing lab/center
status	Enum	Yes	registered, partial, preliminary, final, amended, cancelled
category	Enum	Yes	laboratory, radiology, pathology, cardiology
code	JSONB	Yes	Report type
effective_date	Timestamp	No	Clinically relevant time
issued	Timestamp	No	When report issued
results	JSONB	No	Observation references
conclusion	Text	No	Clinical conclusion
conclusion_code	JSONB	No	Coded conclusions
presented_form	JSONB	No	Attached reports/images
note	Text	No	Additional comments

Results Structure (links to Observations):

[
  { "observation_id": "uuid", "name": "Hemoglobin", "value": "14.5 g/dL" },
  { "observation_id": "uuid", "name": "WBC Count", "value": "7500 /uL" }
]

Relationships:

Belongs to: Tenant, Patient, Encounter, ServiceRequest
Has many: Observations

FHIR Mapping: DiagnosticReport resource

Appointments

Entity: Appointment

Purpose: Scheduled clinical appointments (FHIR: Appointment)

Attributes:

Attribute	Type	Required	Description
id	UUID	Yes	Primary identifier
tenant_id	UUID	Yes	Owning tenant
patient_id	UUID	Yes	Patient reference
facility_id	UUID	Yes	Facility reference
practitioner_id	UUID	No	Practitioner reference
service_id	UUID	No	Healthcare service
status	Enum	Yes	proposed, pending, booked, arrived, fulfilled, cancelled, noshow
service_type	Enum	No	consultation, follow_up, procedure, therapy
appointment_type	Enum	No	routine, walk_in, checkup, emergency
reason_code	JSONB	No	Reason for appointment
priority	Integer	No	Priority (1-10)
start	Timestamp	Yes	Start time
end	Timestamp	No	End time
slot_id	UUID	No	Booked slot reference
created	Timestamp	Yes	When booked
cancellation_reason	Text	No	If cancelled
patient_instruction	Text	No	Instructions for patient
note	Text	No	Additional notes

Relationships:

Belongs to: Tenant, Patient, Facility, Practitioner, HealthcareService
Has one: Encounter (created on arrival)

FHIR Mapping: Appointment resource

AI-Assisted Care

Entity: TranscriptionSession

Purpose: AI Scribe transcription sessions linked to encounters

Attributes:

Attribute	Type	Required	Description
id	UUID	Yes	Primary identifier
tenant_id	UUID	Yes	Owning tenant
encounter_id	UUID	Yes	Related encounter
practitioner_id	UUID	Yes	Conducting practitioner
status	Enum	Yes	recording, processing, completed, failed
started_at	Timestamp	Yes	Session start
ended_at	Timestamp	No	Session end
duration_seconds	Integer	No	Total duration
audio_url	String	No	Audio recording URL
language	String	No	Transcription language
ai_provider	Enum	No	openai, anthropic, google
ai_model	String	No	Model used
raw_transcript	Text	No	Raw transcription
processed_transcript	JSONB	No	Structured transcript
confidence_score	Decimal	No	Overall confidence (0.0-1.0)
error_message	Text	No	If failed

Processed Transcript Structure:

{
  "segments": [
    {
      "speaker": "practitioner",
      "start_time": 0,
      "end_time": 5.5,
      "text": "How are you feeling today?",
      "confidence": 0.95
    },
    {
      "speaker": "patient",
      "start_time": 6.0,
      "end_time": 12.0,
      "text": "I've been having headaches for the past week.",
      "confidence": 0.92
    }
  ],
  "summary": "Patient presents with one-week history of headaches..."
}

Relationships:

Belongs to: Tenant, Encounter, Practitioner
Has many: AiSuggestions

Entity: AiSuggestion

Purpose: AI-generated clinical suggestions (CDS)

Attributes:

Attribute	Type	Required	Description
id	UUID	Yes	Primary identifier
tenant_id	UUID	Yes	Owning tenant
encounter_id	UUID	Yes	Related encounter
transcription_session_id	UUID	No	Source transcription
suggestion_type	Enum	Yes	diagnosis, medication, order, observation, care_plan, goal
category	Enum	No	clinical, documentation, administrative
content	JSONB	Yes	Suggestion content
confidence_score	Decimal	No	AI confidence (0.0-1.0)
status	Enum	Yes	pending, accepted, rejected, modified
reviewed_by_id	UUID	No	Reviewing practitioner
reviewed_at	Timestamp	No	Review timestamp
modification_note	Text	No	If modified, what changed
source_reference	JSONB	No	Source evidence
created_resource_id	UUID	No	If accepted, created resource ID
created_resource_type	String	No	Type of created resource

Content Structure (varies by type):

// Diagnosis suggestion
{
  "type": "diagnosis",
  "icd_code": "G43.909",
  "display": "Migraine, unspecified, not intractable",
  "confidence": 0.85,
  "evidence": ["Patient reports recurring headaches", "Photophobia mentioned"]
}

// Medication suggestion
{
  "type": "medication",
  "drug_name": "Sumatriptan",
  "dosage": "50mg",
  "frequency": "as needed",
  "confidence": 0.78,
  "rationale": "First-line treatment for acute migraine"
}

Status Flow:

pending --> accepted --> (creates resource)
       \--> rejected
       \--> modified --> (creates modified resource)

Relationships:

Belongs to: Tenant, Encounter, TranscriptionSession, Practitioner
Creates: Conditions, MedicationRequests, ServiceRequests, Observations, CarePlans, Goals

Schema Diagram

+---------------+
|   patients    |
+---------------+
       |
       +---------------------------------------------+
       |                    |                        |
       | 1:N                | 1:N                    | 1:N
       v                    v                        v
+---------------+    +---------------+        +---------------+
| patient_      |    | episodes_of_  |        | appointments  |
| facilities    |    | care          |        +---------------+
+---------------+    +---------------+
                            |
                            | 1:N
                            v
                     +---------------+       +---------------+
                     |  encounters   |------>| encounter_    |
                     +---------------+       | participants  |
                            |                +---------------+
                            |
       +--------------------+--------------------+
       |          |         |         |          |
       v          v         v         v          v
+----------+ +----------+ +------+ +--------+ +-------------+
|conditions| |observa-  | |medica| |service_| |transcription|
|          | |tions     | |tion_ | |requests| |_sessions    |
+----------+ +----------+ |reqs  | +--------+ +-------------+
                          +------+      |            |
                                        v            v
                                 +----------+  +----------+
                                 |diagnostic|  |ai_       |
                                 |_reports  |  |suggestions|
                                 +----------+  +----------+

+---------------+       +---------------+
|  care_plans   |------>|    goals      |
+---------------+       +---------------+
       |
       | (replaces_id)
       v
+---------------+
|  care_plans   | (previous version)
+---------------+

FHIR Resource Mapping

Internal Entity	FHIR Resource	Notes
Patient	Patient	Core patient identity
EpisodeOfCare	EpisodeOfCare	Treatment program container
Encounter	Encounter	Clinical visit/interaction
EncounterParticipant	Encounter.participant	Multi-practitioner support
Condition	Condition	Diagnoses and problems
Observation	Observation	Vitals, labs, findings
AllergyIntolerance	AllergyIntolerance	Allergies and intolerances
MedicationRequest	MedicationRequest	Prescriptions
CarePlan	CarePlan	Treatment planning
Goal	Goal	Patient goals
ServiceRequest	ServiceRequest	Lab/imaging orders
DiagnosticReport	DiagnosticReport	Results
Appointment	Appointment	Scheduled visits
TranscriptionSession	N/A	AI Scribe (platform-specific)
AiSuggestion	N/A	CDS suggestions (platform-specific)

RLS Policies

-- All clinical tables: tenant isolation
CREATE POLICY tenant_isolation ON clinical.patients
    USING (tenant_id = current_setting('app.current_tenant_id')::uuid);

CREATE POLICY tenant_isolation ON clinical.encounters
    USING (tenant_id = current_setting('app.current_tenant_id')::uuid);

-- Similar policies for all tenant-scoped tables

LHR (Longitudinal Health Record) Implementation

The LHR is NOT stored as a table. It is a computed view aggregated on demand from:

Patient demographics
Conditions (problem list)
Medications (active prescriptions)
Observations (vitals history)
Allergies
Care Plans
Encounters (grouped by Episode)
Goals

LHR Computation Pattern:

LHR = aggregate(
  patient.demographics,
  conditions.where(clinical_status: active),
  medication_requests.where(status: active),
  observations.recent(90.days),
  allergy_intolerances.all,
  care_plans.where(status: active),
  encounters.grouped_by(episode_of_care),
  goals.where(lifecycle_status: active)
)

Reference: Clinical Data Hierarchy

Clinical Schema

OverviewCopy Anchor Link

EntitiesCopy Anchor Link

PatientsCopy Anchor Link

Entity: PatientCopy Anchor Link

Entity: PatientFacilityCopy Anchor Link

Episodes of CareCopy Anchor Link

Entity: EpisodeOfCareCopy Anchor Link

Entity: TreatmentGoalCopy Anchor Link

Entity: ProgressNoteCopy Anchor Link

EncountersCopy Anchor Link

Entity: EncounterCopy Anchor Link

Entity: EncounterParticipantCopy Anchor Link

Clinical DataCopy Anchor Link

Entity: ConditionCopy Anchor Link

Entity: ObservationCopy Anchor Link

Entity: AllergyIntoleranceCopy Anchor Link

MedicationsCopy Anchor Link

Entity: MedicationRequestCopy Anchor Link

Care PlanningCopy Anchor Link

Entity: CarePlanCopy Anchor Link

Entity: GoalCopy Anchor Link

Orders and ResultsCopy Anchor Link

Entity: ServiceRequestCopy Anchor Link

Entity: DiagnosticReportCopy Anchor Link

AppointmentsCopy Anchor Link

Entity: AppointmentCopy Anchor Link

AI-Assisted CareCopy Anchor Link

Entity: TranscriptionSessionCopy Anchor Link

Entity: AiSuggestionCopy Anchor Link

Schema DiagramCopy Anchor Link

FHIR Resource MappingCopy Anchor Link

RLS PoliciesCopy Anchor Link

LHR (Longitudinal Health Record) ImplementationCopy Anchor Link

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Overview

Entities

Patients

Entity: Patient

Entity: PatientFacility

Episodes of Care

Entity: EpisodeOfCare

Entity: TreatmentGoal

Entity: ProgressNote

Encounters

Entity: Encounter

Entity: EncounterParticipant

Clinical Data

Entity: Condition

Entity: Observation

Entity: AllergyIntolerance

Medications

Entity: MedicationRequest

Care Planning

Entity: CarePlan

Entity: Goal

Orders and Results

Entity: ServiceRequest

Entity: DiagnosticReport

Appointments

Entity: Appointment

AI-Assisted Care

Entity: TranscriptionSession

Entity: AiSuggestion

Schema Diagram

FHIR Resource Mapping

RLS Policies

LHR (Longitudinal Health Record) Implementation