Clinical Features Support

LHR (Computed)
├── Demographics
│   └── clinical.patients
│
├── Problem List
│   └── clinical.conditions
│       (clinical_status: active, category: problem_list_item)
│
├── Active Medications
│   └── clinical.medication_requests
│       (status: active)
│
├── Allergies
│   └── clinical.allergy_intolerances
│       (clinical_status: active)
│
├── Vitals History
│   └── clinical.observations
│       (category: vital_signs, last 90 days)
│
├── Lab Results
│   └── clinical.observations + clinical.diagnostic_reports
│       (category: laboratory)
│
├── Immunizations
│   └── clinical.observations
│       (category: immunization) or dedicated table
│
├── Care Plans
│   └── clinical.care_plans
│       (status: active)
│
├── Goals
│   └── clinical.goals
│       (lifecycle_status: active)
│
└── Encounter History
    └── clinical.encounters
        (grouped by clinical.episodes_of_care)

SELECT patient.*,
       (SELECT json_agg(c) FROM conditions c
        WHERE c.patient_id = patient.id
        AND c.clinical_status = 'active') as problem_list,

       (SELECT json_agg(m) FROM medication_requests m
        WHERE m.patient_id = patient.id
        AND m.status = 'active') as active_medications,

       (SELECT json_agg(a) FROM allergy_intolerances a
        WHERE a.patient_id = patient.id
        AND a.clinical_status = 'active') as allergies,

       (SELECT json_agg(o) FROM observations o
        WHERE o.patient_id = patient.id
        AND o.category = 'vital_signs'
        ORDER BY o.effective_date DESC
        LIMIT 10) as recent_vitals,

       (SELECT json_agg(e) FROM encounters e
        WHERE e.patient_id = patient.id
        ORDER BY e.period_start DESC) as encounter_history

FROM patients patient
WHERE patient.id = :patient_id

Episode of Care
├── Managing Practitioner
├── Diagnosis (primary condition)
├── Treatment Goals
│   ├── Goal 1 (e.g., "HbA1c < 7%")
│   ├── Goal 2 (e.g., "Weight loss 5kg")
│   └── Goal 3 (e.g., "Blood pressure controlled")
├── Progress Notes
│   ├── Note 1 (Week 1 assessment)
│   ├── Note 2 (Week 4 progress)
│   └── Note 3 (Week 8 review)
└── Encounters (sessions)
    ├── Encounter 1 (Initial consultation)
    ├── Encounter 2 (Follow-up)
    ├── Encounter 3 (Therapy session)
    └── ...

planned
    ↓
waitlist (optional)
    ↓
active ←→ onhold
    ↓
finished or cancelled

Patient
├── Primary Care Provider (PCP)
│   └── identity.practitioner_roles (is_primary: true)
│
├── Care Team
│   └── clinical.care_plans (activities with performers)
│
└── Episode-Specific Team
    └── clinical.episodes_of_care (managing_practitioner_id)
        └── clinical.encounters (participants)

Service Request (category: referral)
├── requester_id: Referring practitioner
├── performer_id: Target practitioner (if known)
├── code: Referral type/specialty
├── reason_code: Clinical reason
└── status: draft → active → completed

Patient
└── patient_facilities (junction table)
    ├── Facility A (is_primary: true)
    ├── Facility B
    └── Facility C

Encounter
└── Transcription Session
    ├── Raw audio (stored externally)
    ├── Raw transcript
    ├── Processed transcript (speaker-separated)
    └── AI Suggestions (generated from transcript)

recording → processing → completed
                     ↘ failed

{
  "segments": [
    {
      "speaker": "practitioner",
      "start_time": 0.0,
      "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 have been experiencing headaches.",
      "confidence": 0.92
    }
  ],
  "summary": "Patient presents with chief complaint of headaches...",
  "entities": {
    "symptoms": ["headache"],
    "duration": "not specified",
    "severity": "not specified"
  }
}

AI generates suggestion (pending)
         ↓
Practitioner reviews
         ↓
    ┌────┴────┐
    ↓         ↓
accepted   rejected
    ↓
modified (optional)
    ↓
Clinical resource created

AiSuggestion
├── status: accepted
├── reviewed_by_id: practitioner
├── reviewed_at: timestamp
├── created_resource_type: "Condition"
└── created_resource_id: uuid → links to clinical.conditions

LLM Call Log
├── Provider: openai/anthropic/google
├── Model: gpt-4/claude-3/gemini
├── Call Type: transcription/suggestion/summary
├── Input Tokens / Output Tokens
├── Latency
├── Confidence Score
├── Status: success/error
└── Moderation Flags (safety checks)

Facility AI Settings
├── ai_provider: openai/anthropic/google
├── ai_model: specific model
├── is_enabled: true/false
├── suggestions_enabled: true/false
├── confidence_threshold: 0.75
├── language: en/hi/ar
└── medical_terminology_enabled: true/false