This type of icon is shown at different places in the app like patient lists, patient dashboard,etc. This was asked specifically by providers as it helps them identify in a quick glance the wherabouts of the patient in the hospital, also whether they have missed admitting the patient,etc.
Recently we have also heard from a client whether something similar can be done for patients who are enrolled into insurance program. They have to book a request with the insurance provider when the patient is admitted. The indicator would help in identifying if they missed out any patient enrolling into insurance program.
Thinking of more usecases for this, i can think of high risk as one another usecase where this could be useful.
I am wondering if there are more usecases like this that could improve patient care or adoption of the system?
Thinking of a generic solution, i can think of this as a tag on a patient.
Bahmni shows a particular UI behaviour (icon, colour) based on the tag of the patient.
There could be predefined tags that Bahmni comes with and users can define new tags as well.
For new tags, users can choose from a set of icon/colours
Patient can get tagged by an action in the system like admit patient, abnormal lab tests,etc. or they could be manually marked by the providers.
For tag definitions, and marking patients with tags a separate app in Bahmni can be provided.
This is very similar to a problem we once tackled for an emergency department. There is indeed a never-ending set of properties that could be represented by an icon; however, it has to be done in moderation. Once you get past about three icons or three different colours, it becomes much more of a source of confusion than a source of efficiency or alerting.
Our previous system outlined patient cards with three colours: in the ED case, blue meant orders were pending, green meant the patient was admitted, yellow meant the patient had not yet been seen (these didn’t overlap much, but that was the priority order if two flags were true); also, a red card face meant “panic” (very abnormal) lab results were posted. The card also had a numeric icon showing that lab results were ready. That was about the limit of what people could easily remember and appreciate with a quick glance when scanning several patient cards.
In the newer Epic system, all of those properties have been replaced by about eight icons that surround the patient’s name all around the card. They are very hard to understand and pretty much nobody uses that view anymore.
So: a few tags and especially a few (<=3) colors can be very helpful, and they could certainly be configurable; be very strict about not letting it be overdone.
One more thing I wanted to point out. While we are talking about tagging a patient as High Risk, we should make sure that for some high risk patients (HIV+), privacy needs to be maintained as it becomes a socially sensitive issue. So, if not in the MVP, we should also target making these tags aware of the provider context. For eg: If Patient A is HIV+, it should appear as high risk to only few authorised providers (ART Physician, ART Counsellor etc.) who have access to this sensitive information.
@akhilmalhotra, valid point.
sharing a comment on behalf of the client
“Diagnosis information disclosure is sensitive issue. Not just for HIV but it is true for any other diagnosis. Sharing something like tuberculosis, sickle cell, cancers attracts some comments/views and leads to some form of exclusion. but a common, non-specific-diagnosis tag indicating one of the multiple high risk criteria would only mean that the patient has got something abnormal. Providing access only to clinical staff would help make it intense on the sensitivity issue. On the other hand the benefits of this would be that the clinical staff at various levels would be able to identify such patients and facilitate their care.
The other need (insurance program) for this type of tagging was with administrative purposes, not impacting any of the care protocols.”
A few items that are often considered for “heads-up” patient tags:
Infection precautions (not usually HIV, which has no special precautions – but definitely TB, resistant staph, C difficele, MERS, etc., which require special care in approaching and touching the patient)
Patient on a care plan – once those exist, it’s important to know which patients have active care plans
Very abnormal labs, usually from a small list of “important” tests (if not IPD, need to decide how long until they expire)
Urgent things to do (pending orders, tests, visits to schedule, insurance follow-up, etc.)
A few minutes ago I came away from a meeting where our chief surgeon asked for just this feature. Our use case is in the maternity context where prior labour difficulties, specific lab tests or specific observations lead to the view that greater care should be taken with further examinations and delivery. I understand and support the information overload and confidentiality points. Initially I would settle for a single at risk patient attribute that could be manually set (by a clinician and visible to only clinicians) and in the longer term a mapping between named observations/tests and the auto setting of the attribute.
