Add graphical CCS orders and finalization
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@@ -1,5 +1,18 @@
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{
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"orders": [],
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"orders": [
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{ "code": "cbc", "canonicalName": "Complete blood count", "category": "laboratory", "aliases": ["cbc", "blood count", "hemoglobin"], "defaultTurnaroundMinutes": 20, "availableLocations": [], "displayRoute": "Blood", "displayFrequency": "Once", "resultSection": "lab" },
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{ "code": "cmp", "canonicalName": "Comprehensive metabolic panel", "category": "laboratory", "aliases": ["cmp", "chemistry", "bun", "creatinine"], "defaultTurnaroundMinutes": 25, "availableLocations": [], "displayRoute": "Blood", "displayFrequency": "Once", "resultSection": "lab" },
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{ "code": "iron_studies", "canonicalName": "Iron studies and ferritin", "category": "laboratory", "aliases": ["iron", "ferritin", "transferrin saturation"], "defaultTurnaroundMinutes": 30, "availableLocations": [], "displayRoute": "Blood", "displayFrequency": "Once", "resultSection": "lab" },
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{ "code": "h_pylori_breath", "canonicalName": "Helicobacter pylori urea breath test", "category": "diagnostic", "aliases": ["h pylori", "urea breath test", "helicobacter"], "defaultTurnaroundMinutes": 45, "availableLocations": ["office"], "displayRoute": "Breath", "displayFrequency": "Once", "resultSection": "other_test" },
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{ "code": "upper_endoscopy", "canonicalName": "Upper endoscopy with biopsy", "category": "procedure", "aliases": ["egd", "endoscopy", "gastroscopy", "biopsy"], "defaultTurnaroundMinutes": 60, "availableLocations": ["office"], "displayRoute": "Endoscopic", "displayFrequency": "Once", "resultSection": "other_test" },
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{ "code": "omeprazole", "canonicalName": "Omeprazole acid suppression", "category": "medication", "aliases": ["ppi", "proton pump inhibitor", "acid suppression"], "defaultTurnaroundMinutes": 0, "availableLocations": [], "displayRoute": "Oral", "displayFrequency": "Twice daily", "resultSection": "treatment" },
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{ "code": "bismuth_quadruple", "canonicalName": "Optimized bismuth quadruple therapy for 14 days", "category": "medication", "aliases": ["h pylori treatment", "bismuth", "tetracycline", "metronidazole"], "defaultTurnaroundMinutes": 0, "availableLocations": [], "displayRoute": "Oral", "displayFrequency": "14-day course", "resultSection": "treatment" },
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{ "code": "h_pylori_test_of_cure", "canonicalName": "H. pylori test of cure after therapy", "category": "diagnostic", "aliases": ["test of cure", "repeat breath test", "eradication testing"], "defaultTurnaroundMinutes": 0, "availableLocations": [], "displayRoute": "Outpatient", "displayFrequency": "At least 4 weeks after therapy", "resultSection": "other_test" },
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{ "code": "gastro_follow_up", "canonicalName": "Gastroenterology follow-up", "category": "disposition", "aliases": ["gi follow up", "gastroenterology", "follow-up"], "defaultTurnaroundMinutes": 0, "availableLocations": [], "displayRoute": "Outpatient", "displayFrequency": "Follow-up", "resultSection": "treatment" },
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{ "code": "abdominal_ct", "canonicalName": "CT abdomen and pelvis with contrast", "category": "imaging", "aliases": ["ct abdomen", "cat scan"], "defaultTurnaroundMinutes": 60, "availableLocations": [], "displayRoute": "Imaging", "displayFrequency": "Once", "resultSection": "imaging" },
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{ "code": "clarithromycin_triple", "canonicalName": "Empiric clarithromycin triple therapy", "category": "medication", "aliases": ["clarithromycin", "triple therapy", "prevpac"], "defaultTurnaroundMinutes": 0, "availableLocations": [], "displayRoute": "Oral", "displayFrequency": "14-day course", "resultSection": "treatment" },
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{ "code": "ibuprofen", "canonicalName": "Ibuprofen for abdominal pain", "category": "medication", "aliases": ["nsaid", "motrin", "advil"], "defaultTurnaroundMinutes": 0, "availableLocations": [], "displayRoute": "Oral", "displayFrequency": "As needed", "resultSection": "treatment" }
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],
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"cases": [
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{
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"externalId": "ccs-gastro-duodenal-ulcer-office-001",
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@@ -14,7 +27,7 @@
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"graphicalPresentation": {
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"sceneKey": "doctor_office",
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"patientAssetKey": "patient_44_white_male",
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"interviewRevision": 3
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"interviewRevision": 4
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},
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"initialChart": {
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"patientSummary": "44-year-old man attending an office visit",
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@@ -124,7 +137,20 @@
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{ "code": "extremities_spine", "name": "Extremities / Spine", "durationMinutes": 1, "finding": "Extremities have full range of motion without edema, clubbing, cyanosis, or joint swelling. The spine is nontender." },
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{ "code": "neuro_psych", "name": "Neuro / Psych", "durationMinutes": 1, "finding": "He is alert and fully oriented with normal speech, strength, sensation, coordination, gait, mood, and affect." }
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],
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"orderResponses": [],
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"orderResponses": [
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{ "orderCode": "cbc", "turnaroundMinutes": 20, "result": "Hemoglobin is 10.4 g/dL, hematocrit 32%, MCV 74 fL, leukocyte count 7,100/mm3, and platelet count 312,000/mm3.", "resultSection": "lab" },
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{ "orderCode": "cmp", "turnaroundMinutes": 25, "result": "BUN is 27 mg/dL and creatinine 1.0 mg/dL. Electrolytes, glucose, aminotransferases, bilirubin, and albumin are within reference ranges.", "resultSection": "lab" },
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{ "orderCode": "iron_studies", "turnaroundMinutes": 30, "result": "Ferritin is 10 ng/mL, serum iron 31 mcg/dL, and transferrin saturation 9%, supporting iron deficiency.", "resultSection": "lab" },
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{ "orderCode": "h_pylori_breath", "turnaroundMinutes": 45, "result": "Urea breath test is positive for Helicobacter pylori.", "resultSection": "other_test" },
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{ "orderCode": "upper_endoscopy", "turnaroundMinutes": 60, "result": "Upper endoscopy shows an 8 mm clean-based ulcer in the duodenal bulb without active bleeding. Gastric biopsy is positive for H. pylori and shows no dysplasia or malignancy.", "resultSection": "other_test" },
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{ "orderCode": "omeprazole", "turnaroundMinutes": 0, "result": "Proton-pump inhibitor therapy is started.", "resultSection": "treatment" },
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{ "orderCode": "bismuth_quadruple", "turnaroundMinutes": 0, "result": "A 14-day optimized bismuth quadruple regimen is prescribed.", "resultSection": "treatment" },
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{ "orderCode": "h_pylori_test_of_cure", "turnaroundMinutes": 0, "result": "Test-of-cure follow-up is scheduled for at least four weeks after therapy, with PPI held for two weeks before testing.", "resultSection": "treatment" },
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{ "orderCode": "gastro_follow_up", "turnaroundMinutes": 0, "result": "Gastroenterology follow-up is arranged to review healing, anemia, and eradication testing.", "resultSection": "treatment" },
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{ "orderCode": "abdominal_ct", "turnaroundMinutes": 60, "result": "CT of the abdomen and pelvis shows no acute intra-abdominal abnormality.", "resultSection": "imaging" },
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{ "orderCode": "clarithromycin_triple", "turnaroundMinutes": 0, "result": "Empiric clarithromycin-based therapy is prescribed without susceptibility confirmation.", "resultSection": "treatment" },
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{ "orderCode": "ibuprofen", "turnaroundMinutes": 0, "result": "Ibuprofen is prescribed despite suspected peptic ulcer disease and possible gastrointestinal bleeding.", "resultSection": "treatment" }
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],
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"events": [],
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"scoringCriteria": [
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{ "id": "elicit_chief_concern", "title": "Elicit the chief concern", "actionType": "dialogue_choice", "targetCode": "chief_concern", "points": 10, "rationale": "An open-ended opening allows the patient to identify lightheadedness and fatigue in his own words." },
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@@ -140,7 +166,16 @@
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{ "id": "examine_heart", "title": "Examine the cardiovascular system", "actionType": "exam", "targetCode": "heart_cardiovascular", "points": 5, "rationale": "Cardiovascular examination helps assess presyncope and hemodynamic status." },
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{ "id": "examine_abdomen", "title": "Examine the abdomen", "actionType": "exam", "targetCode": "abdomen", "points": 15, "rationale": "Focused abdominal examination identifies epigastric tenderness and screens for peritoneal signs or masses." },
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{ "id": "perform_rectal_exam", "title": "Perform a rectal examination", "actionType": "exam", "targetCode": "rectal", "points": 10, "rationale": "Rectal examination can assess for current gross gastrointestinal bleeding when the history includes black stool." },
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{ "id": "perform_neurologic_exam", "title": "Perform a neurologic examination", "actionType": "exam", "targetCode": "neuro_psych", "points": 5, "rationale": "A focused neurologic examination helps evaluate lightheadedness and exclude focal deficits." }
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{ "id": "perform_neurologic_exam", "title": "Perform a neurologic examination", "actionType": "exam", "targetCode": "neuro_psych", "points": 5, "rationale": "A focused neurologic examination helps evaluate lightheadedness and exclude focal deficits." },
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{ "id": "check_cbc", "title": "Assess anemia with a CBC", "actionType": "order", "targetCode": "cbc", "points": 12, "rationale": "Fatigue, lightheadedness, and intermittent melena warrant assessment for blood-loss anemia." },
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{ "id": "check_iron", "title": "Confirm iron deficiency", "actionType": "order", "targetCode": "iron_studies", "points": 6, "rationale": "Iron studies characterize the microcytic anemia." },
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{ "id": "test_h_pylori", "title": "Test for H. pylori", "actionType": "order", "targetCode": "h_pylori_breath", "points": 12, "rationale": "H. pylori testing identifies a treatable cause of peptic ulcer disease." },
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{ "id": "perform_egd", "title": "Evaluate suspected bleeding with upper endoscopy", "actionType": "order", "targetCode": "upper_endoscopy", "points": 12, "rationale": "Endoscopy confirms the ulcer and evaluates bleeding risk." },
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{ "id": "start_ppi", "title": "Begin proton-pump inhibitor therapy", "actionType": "order", "targetCode": "omeprazole", "points": 8, "rationale": "Acid suppression promotes ulcer healing." },
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{ "id": "eradicate_h_pylori", "title": "Treat H. pylori appropriately", "actionType": "order", "targetCode": "bismuth_quadruple", "points": 15, "afterTargetCode": "h_pylori_breath", "rationale": "Optimized bismuth quadruple therapy is an appropriate empiric eradication regimen." },
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{ "id": "confirm_eradication", "title": "Arrange H. pylori test of cure", "actionType": "order", "targetCode": "h_pylori_test_of_cure", "points": 8, "afterTargetCode": "bismuth_quadruple", "rationale": "Eradication should be confirmed after treatment." },
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{ "id": "avoid_clarithromycin", "title": "Avoid unsupported clarithromycin triple therapy", "actionType": "order", "targetCode": "clarithromycin_triple", "points": -8, "rationale": "Empiric clarithromycin therapy should be avoided without demonstrated susceptibility." },
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{ "id": "avoid_nsaid", "title": "Avoid NSAIDs", "actionType": "order", "targetCode": "ibuprofen", "points": -12, "rationale": "NSAIDs may worsen ulcer injury and gastrointestinal bleeding." }
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],
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"references": [
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{
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