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docs: add native Japanese translation of ECC documentation (ja-JP)
Translate everything-claude-code repository to Japanese including: - 17 root documentation files - 60 agent documentation files - 80 command documentation files - 99 rule files across 18 language directories (common, angular, arkts, cpp, csharp, dart, fsharp, golang, java, kotlin, perl, php, python, ruby, rust, swift, typescript, web) - 199 skill documentation files Total: 455 files translated to Japanese with: - Consistent terminology glossary applied throughout - YAML field names preserved in English (name, description, etc.) - Code blocks and examples untouched (comments translated) - Markdown structure and relative links preserved - Professional translation maintaining technical accuracy This translation expands ECC accessibility to Japanese-speaking developers and teams. Co-Authored-By: Claude Haiku 4.5 <noreply@anthropic.com>
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docs/ja-JP/skills/healthcare-emr-patterns/SKILL.md
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docs/ja-JP/skills/healthcare-emr-patterns/SKILL.md
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name: healthcare-emr-patterns
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description: 電子医療記録(EMR)パターン、相互運用性、およびHL7/FHIR統合。
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origin: Health1 Super Speciality Hospitals — contributed by Dr. Keyur Patel
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version: "1.0.0"
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---
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# Healthcare EMR Development Patterns
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Patterns for building Electronic Medical Record (EMR) and Electronic Health Record (EHR) systems. Prioritizes patient safety, clinical accuracy, and practitioner efficiency.
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## When to Use
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- Building patient encounter workflows (complaint, exam, diagnosis, prescription)
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- Implementing clinical note-taking (structured + free text + voice-to-text)
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- Designing prescription/medication modules with drug interaction checking
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- Integrating Clinical Decision Support Systems (CDSS)
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- Building lab result displays with reference range highlighting
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- Implementing audit trails for clinical data
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- Designing healthcare-accessible UIs for clinical data entry
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## How It Works
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### Patient Safety First
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Every design decision must be evaluated against: "Could this harm a patient?"
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- Drug interactions MUST alert, not silently pass
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- Abnormal lab values MUST be visually flagged
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- Critical vitals MUST trigger escalation workflows
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- No clinical data modification without audit trail
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### Single-Page Encounter Flow
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Clinical encounters should flow vertically on a single page — no tab switching:
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```
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Patient Header (sticky — always visible)
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├── Demographics, allergies, active medications
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│
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Encounter Flow (vertical scroll)
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├── 1. Chief Complaint (structured templates + free text)
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├── 2. History of Present Illness
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├── 3. Physical Examination (system-wise)
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├── 4. Vitals (auto-trigger clinical scoring)
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├── 5. Diagnosis (ICD-10/SNOMED search)
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├── 6. Medications (drug DB + interaction check)
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├── 7. Investigations (lab/radiology orders)
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├── 8. Plan & Follow-up
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└── 9. Sign / Lock / Print
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```
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### Smart Template System
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```typescript
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interface ClinicalTemplate {
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id: string;
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name: string; // e.g., "Chest Pain"
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chips: string[]; // clickable symptom chips
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requiredFields: string[]; // mandatory data points
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redFlags: string[]; // triggers non-dismissable alert
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icdSuggestions: string[]; // pre-mapped diagnosis codes
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}
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```
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Red flags in any template must trigger a visible, non-dismissable alert — NOT a toast notification.
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### Medication Safety Pattern
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```
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User selects drug
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→ Check current medications for interactions
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→ Check encounter medications for interactions
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→ Check patient allergies
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→ Validate dose against weight/age/renal function
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→ If CRITICAL interaction: BLOCK prescribing entirely
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→ Clinician must document override reason to proceed past a block
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→ If MAJOR interaction: display warning, require acknowledgment
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→ Log all alerts and override reasons in audit trail
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```
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Critical interactions **block prescribing by default**. The clinician must explicitly override with a documented reason stored in the audit trail. The system never silently allows a critical interaction.
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### Locked Encounter Pattern
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Once a clinical encounter is signed:
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- No edits allowed — only an addendum (a separate linked record)
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- Both original and addendum appear in the patient timeline
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- Audit trail captures who signed, when, and any addendum records
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### UI Patterns for Clinical Data
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**Vitals Display:** Current values with normal range highlighting (green/yellow/red), trend arrows vs previous, clinical scoring auto-calculated (NEWS2, qSOFA), escalation guidance inline.
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**Lab Results Display:** Normal range highlighting, previous value comparison, critical values with non-dismissable alert, collection/analysis timestamps, pending orders with expected turnaround.
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**Prescription PDF:** One-click generation with patient demographics, allergies, diagnosis, drug details (generic + brand, dose, route, frequency, duration), clinician signature block.
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### Accessibility for Healthcare
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Healthcare UIs have stricter requirements than typical web apps:
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- 4.5:1 minimum contrast (WCAG AA) — clinicians work in varied lighting
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- Large touch targets (44x44px minimum) — for gloved/rushed interaction
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- Keyboard navigation — for power users entering data rapidly
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- No color-only indicators — always pair color with text/icon (colorblind clinicians)
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- Screen reader labels on all form fields
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- No auto-dismissing toasts for clinical alerts — clinician must actively acknowledge
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### Anti-Patterns
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- Storing clinical data in browser localStorage
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- Silent failures in drug interaction checking
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- Dismissable toasts for critical clinical alerts
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- Tab-based encounter UIs that fragment the clinical workflow
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- Allowing edits to signed/locked encounters
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- Displaying clinical data without audit trail
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- Using `any` type for clinical data structures
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## Examples
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### Example 1: Patient Encounter Flow
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```
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Doctor opens encounter for Patient #4521
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→ Sticky header shows: "Rajesh M, 58M, Allergies: Penicillin, Active Meds: Metformin 500mg"
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→ Chief Complaint: selects "Chest Pain" template
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→ Clicks chips: "substernal", "radiating to left arm", "crushing"
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→ Red flag "crushing substernal chest pain" triggers non-dismissable alert
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→ Examination: CVS system — "S1 S2 normal, no murmur"
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→ Vitals: HR 110, BP 90/60, SpO2 94%
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→ NEWS2 auto-calculates: score 8, risk HIGH, escalation alert shown
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→ Diagnosis: searches "ACS" → selects ICD-10 I21.9
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→ Medications: selects Aspirin 300mg
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→ CDSS checks against Metformin: no interaction
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→ Signs encounter → locked, addendum-only from this point
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```
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### Example 2: Medication Safety Workflow
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```
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Doctor prescribes Warfarin for Patient #4521
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→ CDSS detects: Warfarin + Aspirin = CRITICAL interaction
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→ UI: red non-dismissable modal blocks prescribing
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→ Doctor clicks "Override with reason"
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→ Types: "Benefits outweigh risks — monitored INR protocol"
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→ Override reason + alert stored in audit trail
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→ Prescription proceeds with documented override
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```
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### Example 3: Locked Encounter + Addendum
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```
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Encounter #E-2024-0891 signed by Dr. Shah at 14:30
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→ All fields locked — no edit buttons visible
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→ "Add Addendum" button available
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→ Dr. Shah clicks addendum, adds: "Lab results received — Troponin elevated"
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→ New record E-2024-0891-A1 linked to original
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→ Timeline shows both: original encounter + addendum with timestamps
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```
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