Chemotherapy Ordering Data Design

[burke (Burke Mamlin)]

@rdahlman3

Dosing reduction is a very important data point for chemotherapy ordering. In chemo ordering in Haiti (which is our main focus), when a doctor orders the chemo medication, they don’t calculate the dosage - the dosage calculation is done by the nurse right before administration. However, the doctor may recommend that whatever the calculated dosage, it should be reduced at administration time by a certain percent. The nurse will then calculate the dosage, and after calculation apply the dosing reduction. The concept of a dosing reduction has been explained as specific to the chemotherapy ordering process, and a vital metric to capture and display to the nurse and doctor and possibly use in future orders and calculations. According to this wiki page, dosing reduction seems like it could be serialized in the dosingInstructions field in DrugOrder.

Regarding dosing reduction, I would probably approach this as a new dosing_type. The design of drug orders includes a dosing_type and dosing_instructions, where the assumption is the content of dosing_instructions should be understandable by any code that understands the dosing_type. In effect, dosing_type is like a media type (aka MIME type) and dosing_instructions is the payload. The intent is to allow for a variety of dosing instructions that go beyond “take this pill once a day”, including tapers, IV fluids, etc. A dosing reduction instruction could be one of these dosing types. Alternatively, you could build in the dosing reduction into the application (although, I’m assuming dose reduction of chemotherapy might be more tricky than a simple algorithm could handle).