医疗 EMR 开发模式¶

Patient Header (sticky — always visible)
├── Demographics, allergies, active medications
│
Encounter Flow (vertical scroll)
├── 1. Chief Complaint (structured templates + free text)
├── 2. History of Present Illness
├── 3. Physical Examination (system-wise)
├── 4. Vitals (auto-trigger clinical scoring)
├── 5. Diagnosis (ICD-10/SNOMED search)
├── 6. Medications (drug DB + interaction check)
├── 7. Investigations (lab/radiology orders)
├── 8. Plan & Follow-up
└── 9. Sign / Lock / Print

interface ClinicalTemplate {
  id: string;
  name: string;             // e.g., "Chest Pain"
  chips: string[];          // clickable symptom chips
  requiredFields: string[]; // mandatory data points
  redFlags: string[];       // triggers non-dismissable alert
  icdSuggestions: string[]; // pre-mapped diagnosis codes
}

User selects drug
  → Check current medications for interactions
  → Check encounter medications for interactions
  → Check patient allergies
  → Validate dose against weight/age/renal function
  → If CRITICAL interaction: BLOCK prescribing entirely
  → Clinician must document override reason to proceed past a block
  → If MAJOR interaction: display warning, require acknowledgment
  → Log all alerts and override reasons in audit trail

Doctor opens encounter for Patient #4521
  → Sticky header shows: "Rajesh M, 58M, Allergies: Penicillin, Active Meds: Metformin 500mg"
  → Chief Complaint: selects "Chest Pain" template
    → Clicks chips: "substernal", "radiating to left arm", "crushing"
    → Red flag "crushing substernal chest pain" triggers non-dismissable alert
  → Examination: CVS system — "S1 S2 normal, no murmur"
  → Vitals: HR 110, BP 90/60, SpO2 94%
    → NEWS2 auto-calculates: score 8, risk HIGH, escalation alert shown
  → Diagnosis: searches "ACS" → selects ICD-10 I21.9
  → Medications: selects Aspirin 300mg
    → CDSS checks against Metformin: no interaction
  → Signs encounter → locked, addendum-only from this point

Doctor prescribes Warfarin for Patient #4521
  → CDSS detects: Warfarin + Aspirin = CRITICAL interaction
  → UI: red non-dismissable modal blocks prescribing
  → Doctor clicks "Override with reason"
  → Types: "Benefits outweigh risks — monitored INR protocol"
  → Override reason + alert stored in audit trail
  → Prescription proceeds with documented override

Encounter #E-2024-0891 signed by Dr. Shah at 14:30
  → All fields locked — no edit buttons visible
  → "Add Addendum" button available
  → Dr. Shah clicks addendum, adds: "Lab results received — Troponin elevated"
  → New record E-2024-0891-A1 linked to original
  → Timeline shows both: original encounter + addendum with timestamps