Nepal HMIS FHIR Implementation Guide – 🚨 DRAFT VERSION
0.0.1-ballot - ci-build

Nepal HMIS FHIR Implementation Guide – 🚨 DRAFT VERSION - Local Development build (v0.0.1-ballot) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

## Health Journey Opd

This use case describes the process of capturing and exchanging data related to Outpatient Department (OPD) services in health facilities using FHIR.

### Objective

To ensure standardized data capture and reporting for OPD consultations across public health facilities, aligning with EHMIS reporting requirements.

### Actors

- Patient
- Health Worker (e.g., Medical Officer, Health Assistant, ANM)
- OPD Registration Clerk

### Workflow Steps

1. Registration at OPD Desk
   - Capture patient demographic info
   - FHIR Resource: `Patient`
   - Optional linking to previous visit using `Encounter`
2. OPD Encounter Starts
   - FHIR Resource: `Encounter`
   - Type: OPD Visit
   - Status: in-progress → finished
3. Chief Complaints and History Taking
   - FHIR Resource: `Observation` (e.g., symptoms, duration)
   - May also use `Condition` for known diseases
4. Physical Examination
   - Vitals: BP, temperature, pulse, weight
   - FHIR Resource: `Observation`
5. Diagnosis
   - Primary and secondary diagnosis
   - ICD-10/ICPC coding recommended
   - FHIR Resource: `Condition`
6. Treatment/Prescription
   - Medications prescribed (with dosage, frequency, duration)
   - FHIR Resource: `MedicationRequest`
7. Referral or Advice
   - If referred to specialist or hospital
   - FHIR Resource: `ReferralRequest` or `ServiceRequest`
8. OPD Visit Completion
   - `Encounter.status = finished`

### FHIR Resources Used

Resource | Purpose
--- | ---
`Patient` | To capture demographic info
`Encounter` | To record the OPD consultation
`Observation` | Vitals, symptoms, lab values
`Condition` | Diagnoses
`MedicationRequest` | Prescriptions
`ServiceRequest` | Diagnostic or specialist referral

### Example: OPD for a 45-Year-Old Male with Fever

- Patient: Registered with demographics
- Encounter: OPD visit on 2025-08-08
- Observation:
  - Temperature: 101°F
  - Blood pressure: 130/85
- Condition: Acute febrile illness
- MedicationRequest: Paracetamol 500mg TID × 3 days

### Reporting Considerations

- Monthly OPD data can be aggregated using:
  - Condition types
  - Age/sex disaggregation
  - Visit counts
- Can be linked to DHIS2 datasets through mapping