everything-claude-code/skills/healthcare-emr-patterns/SKILL.md

name, description, origin, version, observe, feedback, rollback

name	description	origin	version	observe	feedback	rollback
healthcare-emr-patterns	EMR/EHR development patterns for healthcare applications. Clinical safety, encounter workflows, prescription generation, clinical decision support integration, and accessibility-first UI for medical data entry.	Health1 Super Speciality Hospitals — contributed by Dr. Keyur Patel	1.0.0	PostToolUse	manual	git revert

Healthcare EMR Development Patterns

Patterns for building Electronic Medical Record (EMR) and Electronic Health Record (EHR) systems. Prioritizes patient safety, clinical accuracy, and practitioner efficiency.

When to Activate

• Building patient encounter workflows (complaint → exam → diagnosis → prescription)
• Implementing clinical note-taking (structured + free text + voice-to-text)
• Designing prescription/medication modules with drug interaction checking
• Integrating Clinical Decision Support Systems (CDSS)
• Building lab result displays with reference range highlighting
• Implementing audit trails for clinical data
• Designing healthcare-accessible UIs for clinical data entry

Core Principles

1. Patient Safety First

Every design decision must be evaluated against: "Could this harm a patient?"

• Drug interactions MUST alert, not silently pass
• Abnormal lab values MUST be visually flagged
• Critical vitals MUST trigger escalation workflows
• No clinical data modification without audit trail

2. Single-Page Encounter Flow

Clinical encounters should flow vertically on a single page — no tab switching during patient interaction:

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

3. Smart Template System

Build templates for common presentations:

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
}

Red flags in any template must trigger a visible, non-dismissable alert — NOT a toast notification.

4. Medication Safety Pattern

User selects drug
  → Check current medications for interactions
  → Check encounter medications for interactions
  → Check patient allergies
  → Validate dose against weight/age/renal function
  → Display alerts (critical = block, major = require override reason)
  → Log override reason if clinician proceeds

Critical interactions should block prescribing by default. The clinician must explicitly override with a documented reason.

5. Locked Encounter Pattern

Once a clinical encounter is signed:

• No edits allowed — only addendum
• Addendum is a new record linked to the original
• Both original and addendum appear in the patient timeline
• Audit trail captures who signed, when, and any addenda

UI Patterns for Clinical Data

Vitals Display

• Current values with normal range highlighting (green/yellow/red)
• Trend arrows comparing to previous measurement
• Clinical scoring auto-calculated (NEWS2, qSOFA, MEWS)
• Scoring result displayed inline with escalation guidance

Lab Results Display

• Normal range highlighting with institution-specific ranges
• Previous value comparison (trend)
• Critical values flagged with non-dismissable alert
• Timestamp of collection and analysis
• Pending orders shown with expected turnaround

Prescription PDF

• One-click generation
• Patient demographics, allergies, diagnosis
• Drug name (generic + brand), dose, route, frequency, duration
• Clinician signature block
• QR code linking to digital record (optional)

Accessibility for Healthcare

Healthcare UIs have stricter accessibility requirements than typical web apps:

• 4.5:1 minimum contrast (WCAG AA) — clinicians work in varied lighting
• Large touch targets (44x44px minimum) — for gloved/rushed interaction
• Keyboard navigation — for power users entering data rapidly
• No color-only indicators — always pair color with text/icon (colorblind clinicians)
• Screen reader labels on all form fields — for voice-assisted data entry
• No auto-dismissing toasts for clinical alerts — clinician must actively acknowledge

Anti-Patterns

• ❌ Storing clinical data in browser localStorage
• ❌ Silent failures in drug interaction checking
• ❌ Dismissable toasts for critical clinical alerts
• ❌ Tab-based encounter UIs that fragment the clinical workflow
• ❌ Allowing edits to signed/locked encounters
• ❌ Displaying clinical data without audit trail
• ❌ Using any type for clinical data structures