[CEP-X] Add support for customizable ordersets and trigger mechanisms

docs/care/CEP/Draft/0006-customizable-ordersets.md

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+# CEP-6: Customizable Ordersets and Trigger Mechanisms
+
+
+## Requirements/Motive 
+We propose to introduce support for customizable clinical ordersets within the CARE system to enhance decision-making and standardize care processes. This feature should include a mechanism to trigger ordersets based on specific clinical criteria or diagnoses.
+
+### Feature Details
+- **Triggerable Ordersets**: Ordersets should be automatically triggerable based on predefined conditions such as patient diagnosis or lab results.
+- **Customization**: Allow customization of ordersets to cater to the specific protocols of various healthcare facilities or departments.
+
+### Example Orderset: Management of Acute Asthma in Adults
+- **Medications**: High-dose inhaled corticosteroids, Oral steroids, Rescue inhaler (Albuterol)
+- **Diagnostics**: Peak flow measurement, Blood gases
+- **Observations**: Monitor respiratory rate, oxygen saturation
+- **Instructions**: Patient education on inhaler technique, Asthma action plan review
+
+## Implementation
+
+### Rulesets
+
+Rulesets will define the conditions under which an orderset should be triggered. These rulesets can be based on any patient related model and fileds. 
+
+```python
+class Ruleset(models.Model):
+    name = models.CharField(max_length=255)
+    model = models.CharField(max_length=255)
+    description = models.TextField()
+    conditions = models.JSONField()
+```
+
+#### Rulesets Conditions
+
+A single ruleset can have multiple conditions, and each condition can have multiple fields to check against.
+
+```python
+conditions = {
+    "operator": "AND",
+    "conditions": [
+        {
+            "operator": "OR",
+            "conditions": [
+                {
+                    "field": "diagnosis",
+                    "operator": "contains",
+                    "value": "asthma"
+                },
+                {
+                    "field": "diagnosis",
+                    "operator": "contains",
+                    "value": "allergy"
+                }
+            ]
+        },
+        {
+            "field": "age",
+            "operator": "gte",
+            "value": 18
+        }
+    ]
+}
+```
+
+
+### Ordersets
+
+Ordersets will be triggered based on the rulesets defined above. Ordersets will have a many-to-many relationship with rulesets.
+
+```python
+class Orderset(models.Model):
+    name = models.CharField(max_length=255)
+    description = models.TextField()
+    rulesets = models.ManyToManyField(Ruleset)
+    actions = models.JSONField()
+```
+
+#### Orderset Actions
+
+Ordersets will have a list of actions that will be suggested when the orderset is triggered.
+
+```python
+actions = [
+    {
+        "model": "Prescription",
+        "values": {
+            "medicine": "Albuterol",
+            "dosage": "2 puffs",
+            "frequency": "PRN"
+        }
+    },
+    {
+        "model": "Procedure",
+        "values": {
+            "name": "Peak Flow Measurement",
+            "instructions": "Measure peak flow every 4 hours"
+        }
+    }
+]
+```
+
+#### Orderset Suggestions
+
+Orderset Suggestions will be a list of actions that will be suggested when the orderset is triggered.
+
+```python
+class OrdersetSuggestions(models.Model):
+    orderset = models.ForeignKey(Orderset, on_delete=models.CASCADE)
+    model = models.CharField(max_length=255)
+    model_id = models.IntegerField()
+    executed = models.BooleanField(default=False)
+    created_date = models.DateTimeField(auto_now_add=True)
+    expires_date = models.DateTimeField() # default: created_at + 24 hours
+```
+
+
+### Orderset Trigger Mechanism
+
+Ordersets can be triggered by signals, or by a manual trigger from the user interface. 
+
+
+##### Helper functions to check conditions
+
+```python
+def check_conditions(conditions, instance):
+    ...
+
+def suggest_orderset(orderset, instance):
+    # skip if orderset is already suggested
+    ...
+```
+
+#### Signal Trigger
+
+```python
+
+@receiver(post_save, sender=Patient)
+def trigger_ordersets(sender, instance, created, **kwargs):
+    rulesets = Ruleset.objects.filter(
+        model="Patient",
+    )
+    for ruleset in rulesets:
+        if check_conditions(ruleset.conditions, instance):
+            ordersets = ruleset.orderset_set.all()
+            for orderset in ordersets:
+                suggest_orderset(orderset, instance)
+```
+
+### Manual Trigger
+
+Users can request to trigger an orderset manually from the frontend. This will start a background task to check the conditions on the requested object.
+
+Users can then list the OrdersetSuggestions and execute them as needed.
+
+
+## Annexture
+
+Here's a list of actions, that may be triggered as part of an orderset:
+
+1. **Medications**
+   - Prescription drugs
+   - Over-the-counter medications
+   - Intravenous solutions
+   - Pre-medication protocols
+
+2. **Observations**
+   - Vital signs monitoring (blood pressure, temperature, heart rate, respiratory rate)
+   - Pain assessment
+   - Fluid intake and output
+   - Nutritional status and dietary requirements
+
+3. **Lab Tests**
+   - Blood tests (CBC, blood glucose, lipid profile)
+   - Urine tests (urinalysis)
+   - Microbiological cultures (bacterial, fungal)
+   - Genetic testing or biomarkers
+
+4. **Imaging**
+   - X-ray
+   - MRI
+   - CT scan
+   - Ultrasound
+
+5. **Procedures**
+   - Surgical interventions
+   - Non-surgical treatments (e.g., catheter insertion, lumbar puncture)
+   - Rehabilitation exercises
+   - Wound care
+
+6. **Consultations**
+   - Referrals to specialists (cardiologists, endocrinologists)
+   - Mental health evaluations
+   - Physiotherapy
+   - Dietary consultation
+
+7. **Patient Education**
+   - Disease-specific information
+   - Medication instructions
+   - Lifestyle and dietary recommendations
+   - Follow-up care and self-monitoring techniques
+
+8. **Care Coordination**
+   - Follow-up appointments
+   - Transfer orders within or between facilities
+   - Home care or community health services
+
+9. **Dietary Orders**
+   - Specific diets (low salt, diabetic, allergy-specific)
+   - Fluid restrictions or supplements
+   - Parenteral nutrition
+
+10. **Safety and Precautions**
+    - Allergy checks
+    - Fall risk assessments and interventions
+    - Isolation precautions for infectious diseases
+
+11. **Discharge Planning**
+    - Medication reconciliation
+    - Summary of hospital stay and treatment
+    - Instructions for home care or rehabilitation
+