AxiomEHR — Discharge Plan interaction prototype

An interaction-design prototype for two problems raised on the LA County site visit. Built on the Radicle Health Design System, using the same tokens, components and chrome as the existing axiom-ehr-prototype.

Double-click AxiomEHR-Discharge-Plan.html. One file, ~4.9 MB, nothing else needed — no server, no Node, no internet, any browser. Styles, fonts, icons, reference data, React and Babel are all inlined.

index.html is byte-identical; it just keeps the conventional name for the dev server. Either one works on its own, anywhere. Both are generated — edit the sources and re-run python3 tools/build.py.

If the page is blank

Check in this order — in practice it has always been the first one.

1. Are you looking at a dev-server URL? A http://localhost:… tab only works while tools/serve.py is running, and the Claude Browser pane's server is stopped between sessions. A dead port renders as a blank page with no error. Open the file from Finder instead; it needs no server.
2. Give it a second. The splash (product name and a moving bar) appears in well under a tenth of a second. If you see the splash, it is working — Babel is compiling the app behind it.
3. Check the file size. It should be about 4.9 MB. Email and chat clients sometimes clip large attachments; a truncated copy says so on screen.

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The two problems it answers

1 · The application is tethered to a client record

Today AxiomEHR is always inside somebody's chart. You land in one, the chart can change under you, and it is easy to document against the wrong client.

What this prototype does instead:

	Behaviour
Empty by default	Home, Clients, Reports, Billing and Admin carry no client. The client banner is simply absent, and a callout says so.
Deliberate entry	A client enters context only when you open a chart or pick one in the top-bar switcher.
Always visible	While a client is in context a persistent banner sits under the top bar with name, MRN, DOB, pronouns, flags and care team. Off-chart it switches to a dashed "carried in context — you are not in this chart" state.
Switching is intercepted	Changing client shows both charts side by side — who you are leaving, who you are moving to — before anything changes.
Leaving is intercepted	Navigating to a non-client page asks whether to carry the client along or clear the context.
Unsaved work is intercepted	Changing note, changing client, leaving the chart or signing out with unsaved edits names the note and the client it belongs to.
Sessions do not leak	Signing out clears context. Signing back in starts empty, every time — the prior client is never restored.

Every one of these goes through a single guard (src/20-context.jsx). No screen navigates directly; that is what makes the rule impossible to forget.

2 · Discharge assumes every diagnosis is resolved

Enrollment status and clinical status are different facts. A client can complete a residential episode with an alcohol use disorder that is still active. Today the product collapses the two.

Saving the Discharge Plan now stops and asks one question — which diagnoses and problems appear on the discharge summary — and states in the same breath that the answer changes the document and nothing else.

• Every diagnosis and problem-list item on the chart is listed with its status.
• Anything carrying an active status (Active, In Remission, Provisional) is pre-checked. Resolved and Inactive are listed but unchecked.
• Excluded rows fade out, so what will print is legible at a glance.
• Unchecking the primary diagnosis raises a payor warning.
• Saving renders the summary as a paginated PDF-style document in the overlay, with a footnote recording that statuses are as of the chart on that date and were not changed by the discharge.
• After filing, the chart still shows the same statuses. Nothing was resolved.

The note's primary action is Save as Complete or Pend to Manager depending on agency configuration; the prototype bar at the top of the note flips between the two so both paths can be demonstrated.

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Walkthrough (about three minutes)

1. Home. No client banner. The callout explains why.
2. Documentation Due → Discharge Plan (due today) → Open. Dee Carter's chart loads; the banner appears and names him.
3. Prefill demo answers in the prototype bar fills the note.
4. Save as Complete. The diagnosis intercept opens — four of five diagnoses and four of six problems are pre-checked; the resolved cannabis use disorder and the two resolved problems are not.
5. Uncheck F10.20 Alcohol use disorder to see the primary-diagnosis warning, then re-check it.
6. Generate summary → the PDF preview → File to chart.
7. Scroll to the note's Diagnosis section: every status is unchanged.
8. Now try the navigation rules — switch client from the top-bar chip, navigate to Reports, edit a field and change note tabs, or sign out and back in.

To demo the manager-approval variant, flip Agency configuration in the prototype bar before step 4.

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The form

The fields, labels, required markers, control types and section order are taken from the live AxiomEHR Input Clinical Discharge page: Discharge Summary Type · Presenting Condition · Discharge Summary (intake/discharge dates, medication-only, sites) · Last Counseling or CFT · Last Bed Date · Summary of Treatment (services, outcome, cultural needs, strengths, recommendations, reason for discharge, medications at discharge, disposition, goals achieved and not achieved, transition plan, resources offered) · Diagnosis · Persons assisting with transition · Signatures (Patient, Completing Staff, BHT, BHP) · Complete.

Two things are deliberately different from the product:

• The Diagnosis table shows the chart's live diagnoses with their status instead of "No data", and states inline that discharge will not change them.
• The date fields keep the product's Today / 7 / 30 quick-set affordance.

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Data — all of it fictional

Every client, staff member, MRN, address, medication and note in this prototype comes from the shared synthetic EHR reference dataset (fixtures/reference-data/, the ehr-synthetic-data skill). There is no real PHI or PII anywhere in this repository. ICD-10-CM and SNOMED CT codes are public code sets, not client data.

Two tables were added here because the shared seed does not carry them:

File	Contents
client_diagnoses.json	Per-client diagnosis assignments with type, precedence, onset, resolved date and status
client_problems.json	Per-client problem-list entries with category, onset and status

Both are generated deterministically by tools/build-clinical-fixtures.py from a fixed seed, so every teammate sees the same chart. The demo client (CL-100235) has a hand-pinned diagnosis picture — active SUD and PTSD, one episode in remission, one genuinely resolved, one provisional — because the whole point needs a chart where "resolve everything" would be visibly wrong.

If a real business need ever arises to work with actual client data, that is a separate conversation with a validated business case. Do not extend these fixtures with anything that is not clearly fictional.

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Working on it

python3 tools/build-clinical-fixtures.py   # regenerate the two per-client tables
python3 tools/build-refdata.py             # bundle fixtures -> assets/refdata.js
python3 tools/build.py                     # -> index.html + AxiomEHR-Discharge-Plan.html
python3 tools/serve.py                     # dev server on :8791, sends no-store

tools/build.py must be run after any change under src/, styles/, assets/ or vendor/. It inlines everything — CSS, fonts as data: URIs, icons, reference data, React, ReactDOM, Babel and the app source — and writes the same document to both output names. The app source is concatenated in filename order into a <script type="text/plain"> block and transpiled in the page, which is how the prototype runs with no build toolchain.

Both outputs are self-contained on purpose. An earlier version kept a light index.html that loaded siblings, and it failed twice in the field: once as Cannot read properties of undefined when assets/refdata.js didn't load, and once as Babel is not defined when vendor/ was out of reach. Safari refuses file:// subresources by default, so even an intact folder is not enough. There is no such thing as a file that only ever gets opened the intended way — don't reintroduce a partial build.

Nothing heavy is render-blocking, and this is load-bearing. Only tokens.css, app.css and discharge.css sit in the head. The font faces (~1.2 MB of base64), React, Babel, the icons and the reference data all ride in type="text/plain" blocks that the parser merely scans, and the bootstrap evaluates them after yielding. With them in the head or in live <script> tags, first paint was ~890 ms of blank window; now the splash is up at ~70 ms and the app follows in well under a second (Babel's own parse, plus a 256 ms transform of the JSX).

The bootstrap starts on whichever of requestAnimationFrame or a 150 ms timer fires first. rAF alone is not safe: it does not fire in a background or throttled tab, and the page then sits on the splash forever in an unfocused window. Same trap as entry animations owning a resting position — never let a frame callback be the only path to a correct state.

Use tools/serve.py rather than python3 -m http.server: the stdlib server sends no cache headers, so the browser pins index.html and edits appear to do nothing.

Known limitation. Editing the URL hash by hand, or using the browser back button, bypasses the guard — the app's own controls all route through it. The client banner stays truthful either way (it shows the dashed "carried in context — you are not in this chart" state), so nothing is misrepresented, but you won't get an intercept on those two paths.

File	What lives there
src/00-core.jsx	Theme, router, icons, avatar, buttons, checkbox, radio, dropdown, panel, toast
src/10-data.jsx	Projections over window.REFDATA; status vocabulary
src/20-context.jsx	Client context, the navigation guard, the intercept overlay
src/30-chrome.jsx	Top bar, client switcher, persistent banner, left nav, sign-in
src/40-home.jsx	Home, All Clients, non-client stubs
src/50-discharge.jsx	Chart page and the Discharge Plan form
src/60-summary.jsx	Diagnosis selection intercept and the generated summary
src/90-app.jsx	Routes and mount
vendor/	React, ReactDOM and Babel, vendored so nothing loads from a CDN
index.html · AxiomEHR-Discharge-Plan.html	Generated output — identical, self-contained, never hand-edited
styles/discharge.css	Everything new; loads after the shared app.css

House rules carried over from the design system: semantic tokens only, --foreground-tertiary never on copy (it is 3.12:1 — decorative and icons only), cards carry elevation rather than borders.