MIS. Research patterns

The last time it was described what basic entities are used to store medical data in the IIED Numede. Today we offer to plunge into the world of templates for research protocols.

The study protocol is a document issued to the patient. What is a pattern? Beautiful pictures and colorful letters are only a facade, and the foundation is a structure stored in a database. By and large, you can choose any format for the description of abstract data, which would preserve the hierarchical structure. We stopped at XML.

Templates are not static data that is entered into a table field once and forgotten. Over time, the pattern structure may change. For example, some measurements are missing, or, on the contrary, they are superfluous, and the doctor does not fill them in, putting dashes or leaving empty spaces. Another case of a change in structure is to extend the functionality of the template system or rethink old ones. Regardless of the reason for the changes, the old version of the template indicates the time until which it is valid, and for the new, in turn, from when it comes into effect. Thus, all the old protocols do not lose or acquire any parts, and remain in the form in which they were given to the patient.

In general, the system uses more than 15 tags, and each has its own set of attributes. Using the basic tags described below, you can create a template for any study protocol.

Template

The root element within which the other tags are located. With the help of two attributes, it indicates the presence and location of the main image in the template:

• image-id - identifier of the image lying in the storage;
• image-position - image location. Options: none, top, left-top-corner, left-bottom-corner, left-top-corner-high. The default is none.

Anatomy

Used to display the essence of anatomy. Attributes:

• id - the number of anatomy in the database;
• font-size, font-bold, font-underline - font settings;
• anatomy-name - allows you to override the name of the anatomy. By default, the name is taken from the database.

Anatomy-comment

Used to display the entity comment. Attributes:

• comment-id - number of the comment in the database;
• use-default is a flag indicating the need to automatically fill in the comment field with a standard template phrase marked as “default”. Options: true and false. The default is false;
• comment-type - indicates the type of comment. Options: comment (comment), conclusions (complaint), complaint (complaint). The default is comment.

Measure

Used to display the entity dimension. Attributes:

• id - number of measurement in the database;
• max-width - the overall width of the element;
• value-width - the width of the drop-down list for enumerated dimensions;
• unit-width - the width of the units for numeric measurements;
• measurement-name - allows you to override the name of the measurement, which by default is taken from the database;
• need-points-to-end — indicates whether points are needed after the value of the enumeration dimension Options: true and false. The default is false;
• empty-name - a flag that allows not to display the name of the measurement. Options: true and false. The default is false;
• show-referent-interval - flag for displaying the reference interval. Options: true and false. The default is true.

Conclusion label

Used at the end of the template. As a result, a green line is added to the full width of the line and the word “Conclusion” displayed below it.

All these tags can be found, for example, in the bladder ultrasound template:

<template><anatomyid="119"font-size="10"font-bold="true"font-underline="false"comment="Мочевой пузырь" /><measurementid="663"comment="Толщина стенки мочевого пузыря" /><measurementid="664"comment="Объем мочевого пузыря на начало исследования" /><measurementid="665"comment="Объем мочевого пузыря после опорожнения(объем остаточной мочи)" /><anatomy-commentcomment-id="94"comment-type="comment" /><conclusion-labelspacing-before="HALF"/><anatomy-commentcomment-id="4"comment-type="conclusion" /></template>

Text

Designed to display plain text. Attributes:

• text-label - the displayed text;
• max-width - the width of the element;
• font-size, font-bold, font-underline - font settings;
• is-color-selection is highlighted in green. Options: true and false. The default is false.

Measurement-group

Used to display an entity group of dimensions. Inside this tag you can put the measurement and text tags . Attributes:

• id - number of the measurement group in the database;
• is-color-selection is highlighted in green. Options: true and false. The default is false;
• multi-interval - used to display reference intervals, when 2 measurements with them are located in one line. Options: true and false. The default is false;
• show-through-slash — show measurements through /. The options are true and false. The default is false.

The tag can be used in two ways. The first way is to specify only the measurement-group tag with the necessary attributes. The system, for its part, will automatically add all measurements that belong to this group of measurements. For example, in the template ultrasound of the liver and gallbladder for the gallbladder states:

<anatomyid="84"font-size="10"font-bold="true"font-underline="false"comment="Желчный пузырь"/><measurement-groupid="7"/><measurementid="429"comment="Толщина стенки"/><measurementid="430"comment="Диаметр общего желчного протока"/><anatomy-commentcomment-id="171"comment-type="comment"comment="Комментарий желчный"/>

The second way is to specify a measurement-group tag with the necessary attributes and internally clarify some attributes of measurement tags or add a tag with text. For example, in the BCA ultrasound pattern, the following code is used to display information for the common carotid artery:




To render the right-to-left inscription, an already familiar text tag and a new line are used , which will be decoded below.

In any rule, you can always find an exception. It also happened with blood pressure. This is exactly the group of measurements that defined the new way of displaying groups: the measurement values ​​are written through a slash, and the reference intervals are located next to each other:

<measurementid="1577"max-width="247"need-points-to-end="false"measurement-name="Тоны сердца" /><measurement-groupid="81"show-through-slash="true"multi-interval="true"><measurementid="1581"unit-width="27"measurement-name="Артериальное давление"comment="Систолическое артериальное давление" /><measurementid="1582"unit-width="27"max-width="190"empty-name="true"comment="Диастолическое артериальное давление" /></measurement-group><measurementid="1621"comment="Частота пульса" />

Line

All elements inside this tag are located in one line. The main difference of the line tag from the measurement-group is that the line visually combines data unrelated to each other. Inside there may be anatomy , measurement and text tags . The tag uses the is-color-selection and multi-interval attributes, the behavior of which corresponds to the similar attributes in the measurement-group .

For example, the following measurements can be found in the brain CT scan pattern:




Well, there are still a few tags, but let's move on to the lyrics, and then to the dry description of the remaining "good."

Each template is tied to a specific price (service). All prices, in turn, are distributed between price groups. The latter are already included in any modalities. For example:

• cervical spine (service) - neck (price group) - magnetic resonance imaging [MRI] (modality);
• cervical spine (service) - neck (price group) - computed tomography [CT] (modality);
• Consultation of a general practitioner (service) - therapy (price group) - consultation and manipulation [CM] (modality);
• kidneys and adrenal glands (service) - abdominal cavity (price group) - ultrasound [ultrasound] (modality).

If we consider the price in more detail, then it is possible to distinguish the following types for it:

• main;
• additional;
• analysis.

Additional services and analyzes are always associated with the main ones and cannot be paid for and performed separately from them. In general, the introduction of additional services within the framework of the basic service not only increases the amount of information obtained during the survey (relevant for research conducted on various equipment), but also makes it easy to introduce into the IIA the concept of primary and repeated visits by a specialist doctor.

Consider a reception to the therapist. If we translate the idea of ​​the primary reception into the language of prices, we get that this reception consists of the prices of consultation of the general practitioner (basic price) and examination of the general practitioner (add. Price). In the meantime, the second reception is only a price consultation. Similarly for other professionals. This approach of dividing the reception into two separate price lists allows the patient to issue a conclusion with only the necessary information.

When generating the study protocol, the current version of the template is taken into account, which is tied to the current main price list. If the patient pays, for example, the service "ultrasound scan of the pancreas" or "consultation of the general practitioner", then there are no questions when it is displayed to the doctor. But what to do if not only the consultation of the general practitioner is paid, but also an examination? How to add a template that is tied to a doctor's examination?

The display of a research protocol for laboratory diagnostics (LD), which uses a different approach from additional price lists, is no less interesting. That is why a separate type of price list was selected for analysis. Each main LD price list (a smear / scraping test, a urine test, etc.) in this case serves to combine several price lists with the “analysis” type belonging to different price groups into a single whole. As a result, only one study protocol is issued for each main price list, regardless of the number of paid analyzes. If, for example, several blood tests were ordered (the main price is a blood test) and a urological smear (the main price is a smear / scraping test), two conclusions will be issued.

We should not forget that some places in different templates can be duplicated, or the template is banally very large and difficult to navigate. For example, a set of measurements for the right and left tonsils are found in examinations by a general practitioner, an endocrinologist, a pulmonologist, and so on.

Thus, it is necessary, firstly, to separate the XML code fragment into a separate template and then add it. in a special place, and, secondly, in attaching to the main template of templates paid additional prices or analyzes. For these tasks, we need the remaining three tags.

Surely the question arose: why use some special tags when you can simply add one template to the end of another, while receiving a kind of locomotive with carriages? Yes, there is such a way. However, the template system must be flexible and be able to insert different templates in the place that we need, while observing a certain order.

Template builder

Used as a link to another template. The id attribute indicates the number of the template to be inserted.

As an example, we give the patterns of the right and left tonsils, which are used in the pattern of examination of specialists.



The part of the specialist's inspection template, where the template with the number 516 is for the right tonsil and 517 is for the left tonsil:

<template-builderid="516"/><anatomy-commentcomment-id="372"comment-type="comment"comment="Комментарий к правой миндалине" /><template-builderid="517"/><anatomy-commentcomment-id="373"comment-type="comment"comment="Комментарий к левой миндалине" />

Price-template-builder

Indicates the insertion of a template, the presence of which depends on the payment. For example, a medical examination, various tests. It contains only one id attribute , where the number of the template is written.

Therapist consultation template:

<template><price-template-builderid="336"/><anatomy-commentcomment-id="370"comment-type="comment"comment="Комментарий для тела" /><conclusion-labelspacing-before="HALF"/><anatomy-commentcomment-id="371"comment-type="conclusion"comment="Заключение для тела" /></template>

Price-group

Used to display the price group in the analysis templates. May contain a price-template-builder tag . Attributes:

• id - number of the price group from the database;
• bgcolor - background color;
• fgcolor - text color.

Consider the blood test protocol for paid prices, lipid status, aspartate aminotransferase (AsAT), alanine aminotransferase (AlAT), total testosterone, estradiol, prolactin, somatotropic hormone (STH).


Template for lipid status (number in the database - 379):

<template><measurementid="36"comment="Триглицериды"/><measurementid="37"comment="Холестерин общий"/><measurementid="38"comment="Холестерин липопротеинов высокой плотности (ЛПВП)"/><measurementid="39"comment="Холестерин липопротеинов низкой плотности (ЛПНП)"/><measurementid="40"comment="Холестерин липопротеинов очень низкой плотности (ЛПО"/><measurementid="41"comment="Индекс атерогенности"/></template>

Template for alanine aminotransferase (AlAT) (number in the database - 381):

<template><measurementid="43"comment="Аланинаминотрансфераза (АлАТ)"/></template>

The system has a couple of attributes that can be found in all tags:

• comment - ignored by the system and acts as a tag for the developer;
• spacing-before - additional distance between lines. Options: NONE, HALF, FULL. The default is NONE;
• is-short - indicates the type of string: normal (false) or short (true). The default is false.

Using the is-short attribute, you can make a study protocol, where the main picture is on the left, and various measurements and groups of measurements are on the right. One of these conclusions is an ultrasound scan of the thyroid gland, a template of which is given below:


Template right share:

<template><anatomyid="24"font-size="10"font-bold="true"font-underline="false"spacing-before="HALF"is-short="true"comment="Правая доля"/><measurement-groupid="2"is-color-selection="true"is-short="true"/></template>

Pattern left lobe:

<template><anatomyid="23"font-size="10"font-bold="true"font-underline="false"spacing-before="HALF"is-short="true"comment="Левая доля"/><measurement-groupid="1"is-color-selection="true"is-short="true"/></template>

We have already mentioned that various metamorphoses occur with a person during the course of life. The remaining tags are intended to describe them, and they will be considered next time.