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Charting

Building out a charting experience requires composing multiple FHIR resources into an experience that meets the requirements of practitioners. There are three primary interactions that developers should consider when building out a custom charting experience:

  • Summarizing patient history and status
  • Capturing clinical notes
  • Placing orders for medications, labs, imaging, etc.

Patient History​

Here is a sample of what a charting experience might look like - to be clear, charting can look however you want it to. A sample charting application built off of Medplum React components and be found on medplum-chart-demo github.

Chart sample

When summarizing patient history, gathering demographic data from the Patient resource is a basic first step. You can also query all resources related to a given patient from the Patient $everything endpoint.

Depending on your use case, $everything may be verbose to summarize in a chart, so queries for specific resources like active CarePlans, MedicationRequests, Conditions may be more appropriate. Search is useful to construct the specific queries that will give the context needed for a chart.

React components are available to aid in building a quick charting experience. PatientTimeline, Timeline, Search control, ResourceAvatar, FhirPathDisplay and Tabs are potential components that can speed development of the summarized history.

Key Resources​

ResourceDescription
ObservationA structured representation of point-in-time clinical measurements.
ConditionA record of a long-term diagnosis for a patient.
RiskAssessmentA specialized form of an Observation used to model propensity for an adverse outcome.
AllergyIntoleranceUsed for a specific type of risk: adverse reaction to a drug or substance.
ImmunizationA summary statement of vaccination records.
MedicationA representation of an instance of a given drug. The Medication lifecycle also includes the below resources.
MedicationRequestAn order or prescription.
MedicationAdministrationA lifecycle resource representing when the Patient ingests the drug.
MedicationStatementA summary statement of the drug.

Key Code Systems​

Code SystemDescription
LOINCUsed in Observation and RiskAssessment resources for compliance, billing, and reporting.
ICD-10Used in Condition resources for interoperability and billing.
RXNORMUsed in AllergyIntolerance resources to track drug intolerances and MedicationRequest resources to track requested drugs.
SNOMEDUsed in AllergyIntolerance resources to track substance intolerances.
CVXUsed in Immunization resources to track vaccine types.

Encounter & Charting​

Capturing Notes​

A wide variety of notes experiences are possible, and customizability is one of the key reasons to use a headless system. From a technical perspective, after a practitioner/patient interaction is complete, a set of appropriate FHIR resources should be created.

Some implementations have a simple text box and allow the practitioner to enter text free form, then construct Encounter and/or ClinicalImpression resources.

Some implementations have a library of Questionnaires that practitioners fill out and use Bots to drive workflow and create resources in a specific way.

Key Resources​

ResourceDescription
EncounterPrimary tracking resource for a visit (either in-person or virtual).
ClinicalImpressionMedplum-advised resource for recording unstructured notes.
ConditionA record of a long-term diagnosis for a Patient. The outcome of an Encounter can be a Condition with a type of 'encounter diagnosis'. For more details see the Representing Diagnoses docs.
ObservationA structured representation of point-in-time clinical measurements.
RiskAssessmentA specialized form of an Observation that is used to model propensity for an adverse outcome.

Key Code Systems​

Code SystemDescription
CPTUsed to annotate Encounter resources for billing.
ICD-10Used to annotate Encounter resources for billing.

Placing Orders​

Placing orders requires constructing the right resources, which can be created directly or via Questionnaires and Bots. Refer to our section on Labs and Imaging or Prescriptions for more details.

Reference​