EHR Extensions
From MirrorMed
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Creating a form
In order to extend the MirrorMed EHR you must first make a form to collect the data. The forms use the same general syntax as an HTML form. However, in the place of the typical HTML tags, the EHR extensions use specially designed smarty tags. These tags enable the EHR Extension to interface with the Patient and Encounter tracking system. In order to learn about the forms we will use a simple SOAP form as an example. An EHR Extension is a special kind of html form. So if the text below seems like random gibberish then you might want to take a html forms tutorial
{if $back_link}<a href={$back_link}>return to encounter</a>{/if}<nowiki>
<nowiki>{clni_form}
<b>
<h2>SOAP</h2>
<p>Subjective</p>
<p>
{input style="width: 10cm; height: 4cm;" name="a_subjective" value="" type="text"}
</p>
<p>Objective</p>
<p>
{input style="width: 6in; height: 2in;" name="b_objective" value="" type="text"}
</p>
<p>Assessment-Action</p>
<p>
{input style="width: 300px; height: 100px;" name="c_assessment" value="" type="text"}
</p>
<p>Plan</p>
<p>
{input style="width: 80%; height: 10%;" name="d_plan" value="" type="text"}
</p>
<p>Notes:</p>
</b>
<p>
{input style="width: 30mm; height: 10mm;" name="e_notes" type="text"}
</p>
{submit}
</form>
Assuming you understand webforms then things that should stand out are the smarty tags. So the following lines deserve explination.
{clni_form}
{input style="width: 10cm; height: 4cm;" name="a_subjective" value="" type="text"}
{submit}
The first tag, {clni_form} builds the <form> html tag in the appropriate way for MirrorMed. The last tag, {submit} builds the submit html form element. For this discussion, we will leave these as magic elements that need to be present to make your EHR Extension work. The middle tag is the heart of the system. This tag determines how text will be gathered on your system. It also determines how text will be displayed. The first thing to note is the style tag. This is standard CSS style information which will dictate how your html form element will look. If you want to know more about how css works, checkout a css tutorial. The next part of the {input} tag is the most important since it determines the order of the display later.
name="a_subjective"
Note that in the soap example the name values all start with a single letter than an underscore. So the order is..
a_subjective b_objective c_assessment d_plan e_notes
Once a form has been filled out, its data is frozen. When you click on a form that has been filled out, it will display as a grid. While it is possible to create a report (detailed below) that will allow you to see the information on a given EHR datapoint in any format you program, it is simplest to make sure that the grid display will display in the same order as the original form. However the grid display orders the elements alphabetically. By prepending useful data names with a single letter and underscore you can control the order that the grid displays the data.
For the time being only text inputs are supported in EHR extensions.
Associating Forms
So you have created your own form and now you want to begin using it. Generally you want to assign the form either to the patient dashboard or to the patient encounter. To associate the forms go to the menu location Admin->Forms->Add Form. Here you will be able to name, comment and upload your form. Often when you try to upload a form for the first time you will get an error. This can happen because webserver cannot write to the mirrormed/user directory. To fix this type the following command from the mirrormed home directory.
cd /var/www/html/mirrormed/ chown nobody:nobody user/ -R
This assumes that your webserver runs as the user "nobody" but sometimes it might be running as "apache" or something else. Replace both of the nobody with your user.
Once you have successfully uploaded your form you want to add the form to the correct MirrorMed interface. To do this go to Admin->Forms->Connect. This interface is designed to allow you to add forms anywhere in the MirrorMed system, but usually you only want to add them to the patient dashboard or the patient encounter. For instance to associate the form with the patient encounter select the item "Encounter Forms" under the heading "Patient". Doing so will create an interface to add any of the forms you have uploaded to the encounter screen. After this create an encounter, and, when you select forms, your new EHR extension should appear.
Overide the default view
MirrorMed (and not ClearHealth) now support the custom override of the default grid view of form data. If you followed the above instructions carefully then and you entered a patients vitals data and then you go to view the data that you recorded, you would see a grid display of the recorded data. This grid display is pretty useless for printing the data.
The MirrorMed 1.0 tree now has a patch to allow for the override of the default display values. In order to use the patch you must create a report file to override the grid display. First you need to find the file created when you upload your form. Look under mirrormed/user/form. For instance on the default installation there is already a soap form that lives at
/mirrormed/user/form/600001.tpl.html
Your number might be different because they are autonumbered by the system as you upload them. Make sure the file your are working with is really the form that you are seeing on the MirrorMed system.
Now create a special file called
/mirrormed/user/form/600001.display.html
This file is the display override for your form. Lets look at the one for overriding the soap form.
{if $back_link}<a href={$back_link}>return to encounter</a>{/if}
<h2>SOAP for {$patient_last_name}, {$patient_first_name}{if $date_of_treatment} seen on {$date_of_treatment}{/if} </h2>
Last Edit {$last_edit}
<table width=800>
<tr><td>
<div align='right'> {$patient_last_name}, {$patient_first_name}{if $date_of_treatment} seen on {$date_of_treatment}{/if}</div>
<b>Subjective: </b>
<br \>
{$values.subjective.value|nl2br}<br \>
<div align='right'> {$patient_last_name}, {$patient_first_name}{if $date_of_treatment} seen on {$date_of_treatment}{/if}</div>
<b>Objective: </b>
<br \>
{$values.objective.value|nl2br}<br \>
<div align='right'> {$patient_last_name}, {$patient_first_name}{if $date_of_treatment} seen on {$date_of_treatment}{/if}</div>
<b>Asessment/Action: </b>
<br \>
{$values.assessment.value|nl2br}
<br \>
<div align='right'> {$patient_last_name}, {$patient_first_name}{if $date_of_treatment} seen on {$date_of_treatment}{/if}</div>
<b>Plan: </b>
<br \>
{$values.plan.value|nl2br}
<br \>
<div align='right'> {$patient_last_name}, {$patient_first_name}{if $date_of_treatment} seen on {$date_of_treatment}{/if}</div>
<b>Notes: </b>
<br \>
{$values.notes.value|nl2br}
<br \>
<td><tr>
</table>
<br>
<br>
<a href='{$edit_link}'>edit SOAP</a> Last Edit {$last_edit}
Note that we have abandoned the "a_subjective" variable names in favor of names like "subjective" because we are now controlling the layout ourselves.
The display is a simple report with several variables available. Most notably all of the values that were gathered by the form are available as subarrays of the $values array.
$values.subjective.value $values.objective.value $values.assessment.value $values.plan.value $values.notes.value
Since the SOAP Notes form gathers large text areas, it is possible and likely that the user might have used a carriage return while creating the data. But HTML does not respect newlines, as a result we use the Smarty modifier nl2br to translate the new lines to the HTML br tag.
{$values.subjective.value|nl2br}
There are also some static values available to the user...
{$patient_last_name}
{$patient_first_name}
{$date_of_treatment} - the encounter date, if there was an encounter
{$last_edit} - the last time the form was changed.
Lastly there are two special links available in this report. The first is the backlink, which will take the user back to the encounter or to the patient whichever record the form is associated with. The second is the edit link. It should be noted that having this here can be a HIPAA liability. Perhaps you do not want your form editable after the initial entry.
{$edit_link}
{$back_link}
To debug the display system make certain that the variable names from the Form file match up perfectly with the calls to the $values array in the display.
