My Ideas, Suggestions, and Contributions for Bahmni (India Specific)

Software Bahmni
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My Ideas, Suggestions, and Contributions for Bahmni (India Specific)

It’s been almost 1.5 years since I reached out to this community. Over this time, I’ve made an extensive list of ideas, observations, and suggestions based on real-world usage in a hospital setting.

:pushpin: Full Notes & Implementation Reference: :backhand_index_pointing_right: Bahmni Implementation - Dr. Sivaram

:magnifying_glass_tilted_left: General Feedback

Please prioritize improving the doctor-facing UI and workflow instead of adding newer features. The core premise and clinical work flow need to be more intuitive and efficient. Compared to commercial alternatives, Bahmni still falls behind in easing the day-to-day workload of doctors and staff.

:light_bulb: Suggestions (in no specific order)

  1. Integrate Appointment Module with Doctor Portal
  • Allow doctors to set review dates after prescribing medication.
  • This should auto-register into the Appointment module, reducing reception workload.
  1. Implement BAHMNI NEXT Medication Page
  • Reference
  • It’s vastly superior to the current drug entry method. I urge developers to focus here.
  1. Standardize Document Formats
  • Please don’t put them as hospital-specific/implementation specific. NABH-accredited hospitals already use 90% similar forms only.
  • Develop a standard template set, customizable only in minor areas.
  1. Workflow Support for Insurance-Centric Hospitals
  • Many hospitals now handle insured patients; soon it will be universal.
  • Required documents to support this include:
    • Discharge Summary (NABH format)
    • Fitness Certificate
    • Medical Certificate
    • Referral Letter
    • Patient Satisfaction Feedback
    • General Consent Form
    • Informed Consent Forms (Anesthesia, Surgery, HIV Testing, ICU, Blood transfusion, Chemotherapy, etc.)
    • Nutritional Screening/Assessment
    • Pre/Post-Operative Checklists
    • T.P.R Chart, Intake/Output Chart, Drug Chart
    • Nurse’s Report, Death Summary, Death Certificate
  • Billing Requirements:
    • Hospital Bill
    • Pharmacy Bill
    • Lab Bill
    • Procedure Bill
    • Consolidated Bill
    • All with proper bill numbers and formats required by insurance providers.
  • All the above documents should pull the correct data from Bahmni backend. Most of the reference can be found here : https://nabh.co/sdm_downloads/
  1. ICD Code Integration in the above documents
  2. Brand + Generic Name in Prescription
  • Common feature in modern HMS.
  1. Simplified Consultation UI
  • One-page or two-tab layout instead of the current 5+ tabs.
  1. Registration Page Improvements
  • Recent patient list(atleast last 30 or user configurable) with actions for the receptionist like selecting multiple doctors/departments for consultation , Marking them who referred , or adding specific notes to convey to doctors. Even giving internal use scoring/rating for patient.
  1. Internal Patient Referrals
  • Allow referring to another department + auto-populate in Appointment page.
  1. Vitals Entry
  • Use modern UI elements (sliders/icons) for quick and error-free entry.
  1. Staff Entry Page
  • A dedicated space for staff to enter patient history or other filler info before the doctor sees them.
  1. Mobile UI Compatibility
  2. Migration / Upgrade Support
  • Make it easier to migrate customizations from older Bahmni versions.
  1. Free Quantity in Purchase Bills
  • Needs core support in Odoo from Bahmni team.
  • This is essential for any functioning pharmacy and not just a customization.
  1. Odoo Module Enhancements
  • Support for billing in strips, bottles, tablets, with correct calculations based on input.

Will try to add more to this list and also add my contributions in coming days.

I think every year , the dev team has to look into other commercial offerings and decide the road map. At the end of the day , its who gives comfortable experience. IMHO , no doctor is well tuned or knows ins and outs to run a self hosted bahmni. they are bound to rely on implementors , that literally makes this a commercial software only. If thats the case , developers HAVE to do a reality check with other software from time to time. I have demoed software which have integrated so well , that staffs or EMR/Casualty can call for ambulance from the software itself. There is also an option to automatically put a notification to house keeping to clean the room once a patient is discharged. Not to mention the automatic emails/sms/whatsapp integration , QR code generations etc etc.

Bahmni can have a commercial wing and support these extensive features at nominal pricing, the adoption rate will be through the roof. Currently most hospital setup are at mercy or either single developer or local software vendor , who locks database and what not. BUT , they give the comfort of usage , make doctors life easy, they have formatted documents , ready to bill (gst) features with all the latest bells and whistles like QRcode payment etc.

Think of it Wordpress and WPASTRA , WooCommerce, Yoast SEO ,etc. Wordpress is opensource , but these commerical offering elevate the WP experience , making it leader and relevant till date.

TLDR ; Dear Developers , improve the UI and overall workflow for doctors and staff , i dont need snomed , abdm integration , latest features.. just make the basics work. And more importantly the base bahmni should have most common things covered , not leave it to implementers or doctor specific.

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CONTRIBUTION

Chief Complaints :

The current list of chief complaints is very minimal Created this list which should encompass 70-80% use case.

Chief Complaints Version 4.txt (6.4 KB)

This list is just an small alternative to snomed for a purpose which need this little data alone.

Some suggested for other integration , but that means the server has to query it and provide which is time consuming and also internet dependent.

If this list is not upto standard , what i would suggest is let bahmni query from standards like snomed , let it store locally. I am 100% sure either departments or doctors will only use same complaints , medical terms repeatedly and very rarely they will use something different. till such time , the locally stored , referenced data can be populated in those entry fields . It will be fast and quick , less strain on the sever.

Document formats:

Medical Certificate | Fitness Certificate

MEDICAL_CERTIFICATE_OF_FITNESS_Format.pdf (131.7 KB) MEDICAL_CERTIFICATE_OF_FITNESS_Format 2.pdf (272.9 KB)

[Will try to compile as single one later]

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WISH LIST

  1. Social Media integration for various purpose like emailing , sms .. bills , collecting reviews.
  2. Portal for insurance staffs , who can only view certain parts of the bahmni , odoo. They can check the ICD-10 codings , whether everything is billed for patient , ability to send them to respective insurance agents , upload to such online portals. Have a log of who did what with these documents for future reference.
  3. Pre-Formatted summaries for easy data entry.
  4. Exhaustive Drug Database(India Specific) needs to be created. This will be a one time work. We can pool some funds to create or buy drug database with brand names and dose forms , route and incorporate. This will have a long term effect on bahmni. Currently its left to hospitals to create this. This is an enormous workload each time it gets implemented. We can call upon implementors to share such database with community , developers can filter , cross verify , remove duplicate , format and store it in master drug database.
  5. Store Repeated used datas. This is what many commercial softwares are doing. They store repeatedly used datas , be in single word or paragraphs , making it easier to enter such datas. This is pretty similar to Pre-Formatted summary feature.
  6. A better Patient dashboard. Declutter and only display important things , either relevant to current visit or their chronic illness, It
  7. Referral Module. In current era of integrated system of different clinics , hospitals , etc , it becomes crucial on tracking who referred for what. This module can help notify the person who referred the patient about crucial information , and even open a one time portal to show the patients details (mostly for doctors).
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Did you have the version of CC which was mapped to CIEL?

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I have no idea.. Implementers might know those details.

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This thread has the mapped concepts: Slack

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Went through the discussion on slack again(sorry it was long time).

Diagnosis surely needs proper entry of data to correlate with correct ICD-10 codes.

What i am reiterating here and there too is the Chief Complaints part. Currently the bahmni cheif complaints are bahmni-java-utils/coded_complaints.csv at 6083d8347978e75ca0fe7a030d7d38943bea4329 · Bahmni/bahmni-java-utils · GitHub kindly correct if i am wrong. I recall a csv file shared with me long before for base bahmni chief complaints , i am unable to find . The above one closely resembles. But then it includes complaints as well diagnosis.

Chief complaints list needs improvement. The diagnosis one can refer CEIL other other standards and store them locally initially. Only refer the CEIL later when the need arise. In a single specialty setup or consultation , doctors will keep using same complaints or same diagnosis 80% of the time. This is were speed is crucial. Currently under diagnosis , the list is pretty vast , i agree. But every time i search for hypertension , it lists me everything starting from H , then HY , then HYP etc.. All i am saying is when i press “H” Let bahmni populate the most used one first.

For this i think bahmni should constantly rearrange the database of such data(diagnosis) based on frequency.

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Chief Complaints Work Flow.drawio
Chief Complaints Work Flow.drawio701×751 22.3 KB

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:page_facing_up: Relevant Documents

  1. Discharge Summary
  2. Fitness Certificate
  3. Medical Certificate
  4. Referral Letter
  5. Patient Satisfaction Feedback Form
  6. General Consent Form
  7. Informed Consent Form – Anaesthesia Administration
  8. Informed Consent Form – Blood and Blood Product Transfusion
  9. Informed Consent Form – Chemotherapy
  10. Informed Consent Form – General Surgery
  11. Informed Consent Form – HIV Testing
  12. Informed Consent Form – Intensive Care
  13. Nutritional Screening Form
  14. Nutritional Assessment Form
  15. Post Anaesthesia Recovery Score
  16. Pre-Operative Checklist
  17. Post-Operative Checklist
  18. T.P.R Chart
  19. Intake / Output Chart
  20. Drug Chart
  21. Nurses Report
  22. Death Summary
  23. Death Certificate

:money_bag: Relevant Bills (with proper bill numbers)

  1. Hospital Bill
  2. Pharmacy Bill
  3. Lab Bill
  4. Consolidated Bill
  5. Procedure Bill
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