healthcare-emr-patterns

SKILL.md

Healthcare EMR Development Patterns

Patterns for building Electronic Medical Record (EMR) and Electronic Health Record (EHR) systems. Prioritizes patient safety, clinical accuracy, and practitioner efficiency.

When to Use

Building patient encounter workflows (complaint, exam, diagnosis, prescription)

Implementing clinical note-taking (structured + free text + voice-to-text)

Designing prescription/medication modules with drug interaction checking

Integrating Clinical Decision Support Systems (CDSS)

Building lab result displays with reference range highlighting

Implementing audit trails for clinical data

Designing healthcare-accessible UIs for clinical data entry

How It Works

Patient Safety First

Every design decision must be evaluated against: "Could this harm a patient?"

Drug interactions MUST alert, not silently pass

Abnormal lab values MUST be visually flagged

Critical vitals MUST trigger escalation workflows

No clinical data modification without audit trail

Single-Page Encounter Flow

Clinical encounters should flow vertically on a single page — no tab switching:

Patient Header (sticky — always visible)
├── Demographics, allergies, active medications
│
Encounter Flow (vertical scroll)
├── 1. Chief Complaint (structured templates + free text)
├── 2. History of Present Illness
├── 3. Physical Examination (system-wise)
├── 4. Vitals (auto-trigger clinical scoring)
├── 5. Diagnosis (ICD-10/SNOMED search)
├── 6. Medications (drug DB + interaction check)
├── 7. Investigations (lab/radiology orders)
├── 8. Plan & Follow-up
└── 9. Sign / Lock / Print

Smart Template System

interface ClinicalTemplate {
  id: string;
  name: string;             // e.g., "Chest Pain"
  chips: string[];          // clickable symptom chips
  requiredFields: string[]; // mandatory data points
  redFlags: string[];       // triggers non-dismissable alert
  icdSuggestions: string[]; // pre-mapped diagnosis codes
}

Red flags in any template must trigger a visible, non-dismissable alert — NOT a toast notification.

Medication Safety Pattern

User selects drug
  → Check current medications for interactions
  → Check encounter medications for interactions
  → Check patient allergies
  → Validate dose against weight/age/renal function
  → If CRITICAL interaction: BLOCK prescribing entirely
  → Clinician must document override reason to proceed past a block
  → If MAJOR interaction: display warning, require acknowledgment
  → Log all alerts and override reasons in audit trail

Critical interactions block prescribing by default. The clinician must explicitly override with a documented reason stored in the audit trail. The system never silently allows a critical interaction.

Locked Encounter Pattern

Once a clinical encounter is signed:

No edits allowed — only an addendum (a separate linked record)

Both original and addendum appear in the patient timeline

Audit trail captures who signed, when, and any addendum records

UI Patterns for Clinical Data

Vitals Display: Current values with normal range highlighting (green/yellow/red), trend arrows vs previous, clinical scoring auto-calculated (NEWS2, qSOFA), escalation guidance inline.

Lab Results Display: Normal range highlighting, previous value comparison, critical values with non-dismissable alert, collection/analysis timestamps, pending orders with expected turnaround.

Prescription PDF: One-click generation with patient demographics, allergies, diagnosis, drug details (generic + brand, dose, route, frequency, duration), clinician signature block.

Accessibility for Healthcare

Healthcare UIs have stricter requirements than typical web apps:

4.5:1 minimum contrast (WCAG AA) — clinicians work in varied lighting

Large touch targets (44x44px minimum) — for gloved/rushed interaction

Keyboard navigation — for power users entering data rapidly

No color-only indicators — always pair color with text/icon (colorblind clinicians)

Screen reader labels on all form fields

No auto-dismissing toasts for clinical alerts — clinician must actively acknowledge

Anti-Patterns

Storing clinical data in browser localStorage

Silent failures in drug interaction checking

Dismissable toasts for critical clinical alerts

Tab-based encounter UIs that fragment the clinical workflow

Allowing edits to signed/locked encounters

Displaying clinical data without audit trail

Using any type for clinical data structures

Examples

Example 1: Patient Encounter Flow

Doctor opens encounter for Patient #4521
  → Sticky header shows: "Rajesh M, 58M, Allergies: Penicillin, Active Meds: Metformin 500mg"
  → Chief Complaint: selects "Chest Pain" template
    → Clicks chips: "substernal", "radiating to left arm", "crushing"
    → Red flag "crushing substernal chest pain" triggers non-dismissable alert
  → Examination: CVS system — "S1 S2 normal, no murmur"
  → Vitals: HR 110, BP 90/60, SpO2 94%
    → NEWS2 auto-calculates: score 8, risk HIGH, escalation alert shown
  → Diagnosis: searches "ACS" → selects ICD-10 I21.9
  → Medications: selects Aspirin 300mg
    → CDSS checks against Metformin: no interaction
  → Signs encounter → locked, addendum-only from this point

Example 2: Medication Safety Workflow

Doctor prescribes Warfarin for Patient #4521
  → CDSS detects: Warfarin + Aspirin = CRITICAL interaction
  → UI: red non-dismissable modal blocks prescribing
  → Doctor clicks "Override with reason"
  → Types: "Benefits outweigh risks — monitored INR protocol"
  → Override reason + alert stored in audit trail
  → Prescription proceeds with documented override

Example 3: Locked Encounter + Addendum

Encounter #E-2024-0891 signed by Dr. Shah at 14:30
  → All fields locked — no edit buttons visible
  → "Add Addendum" button available
  → Dr. Shah clicks addendum, adds: "Lab results received — Troponin elevated"
  → New record E-2024-0891-A1 linked to original
  → Timeline shows both: original encounter + addendum with timestamps