Hello Community,
Summary
We would like to propose a schema change to the orders table by adding an intent column. This column would align with the FHIR ServiceRequest.intent (and MedicationRequest.intent) attribute, allowing to distinguish between a formal order, a proposal, a plan, and other stages of the clinical decision-making process.
Background
Currently, the OpenMRS orders table primarily assumes that every entry is a “directive” to be carried out (effectively intent = order). However, as we move toward deeper FHIR integration and to support more complex clinical workflows—such as resident-to-consultant sign-offs, future orders like planned procedures —the lack of an “intent” field becomes a limitation.
The Proposal
Add a new column intent to the orders table:
-
Column Name:
intent -
Type:
VARCHAR(50) -
Value: Enum (same as RequestIntent Valueset.)
-
Default Value:
order(to ensure backward compatibility for all existing orders).
Why is this needed?
-
Support for “Proposed” Orders: Currently, there is no clean way in our systems for a junior clinician to “propose” an order that requires a signature before it becomes “active.” Another scenario is a physician provides a proposal to conduct a procedure and it goes through planning and then the order becomes active.
-
FHIR Mapping: To be fully FHIR-compliant, the
ServiceRequestandMedicationRequestresources require an intent. Currently, every order by default translates to intent as order. -
Complex Workflows: It allows for “Plan” orders (e.g., part of a standard protocol) vs. “Original” orders.
Examples & Use Cases
-
The Proposal (intent:
proposal): A physician proposes a procedure to be performed, but it cannot be an order yet. The proposal goes through review / planning to become an order to be acted upon. -
The Plan (intent:
plan): A TB treatment regimen generates a set of “Plan” orders. These aren’t executed yet but exist as a roadmap for the patient’s care. -
The Directive (intent:
order): The current standard workflow where a clinician authorises a medication or test to be performed. -
The Filler (intent:
filler-order): Used in lab integrations where a Lab Information System (LIS) needs to create internal sub-orders to fulfill a clinician’s request.
I look forward to hearing the community’s thoughts on this addition to the OpenMRS Core.
@dkayiwa @ibacher @mseaton @burke @angshuonline @binduak @soorya @sumazmrs @akhilmalhotra @abhinab
