Patient History Sync in Patient Encounter

User Story

As a physician, I want the patient's medical history (allergies, surgeries, medications, comorbidities) to automatically appear in the encounter form so that I have full clinical context during consultation.

As a physician, I want changes I make to the patient's history during an encounter to sync back to the patient record so that the master record stays up to date.

Entry Point

• Automatic: Triggered when creating a new Patient Encounter (loads history from Patient)
• Automatic: Triggered when submitting a Patient Encounter (syncs history back to Patient)
• Manual: "Load Patient History" button in Patient Encounter form

How It Works

Patient history sync is bidirectional:

1. Load (Patient → Encounter): When a new encounter is created, the system copies the patient's current medical history into the encounter form. This gives the physician a working copy to review and modify.

2. Save back (Encounter → Patient): When the encounter is submitted, any changes the physician made to the history fields are written back to the Patient master record.

This ensures the Patient record always reflects the latest clinical information from the most recent encounter.

Steps — Loading History into Encounter

1. Create new Patient Encounter

   • User action: Select a Patient on a new Patient Encounter form
   • Trigger: load_history_from_patient() (patient_encounter.py line 341–424)

2. System copies history fields

   • Copies these fields from Patient → Encounter:

   Patient Field	Encounter Field	Type
   allergies	allergies	Small Text
   surgical_history	surgical_history	Small Text
   medication	medication	Small Text
   patient_madical_history	patient_madical_history	Table (diagnosis links)
   family_medical_history	family_medical_history	Table (diagnosis links)

   • Clears existing child table rows before loading to avoid duplicates (line 369–372)
   • Copies diagnosis entries from patient's comorbidities (line 375–380)
   • Calls _deduplicate_child_tables() to remove any remaining duplicates (line 420)
   • Wrapped in try/except — errors are logged but don't block encounter creation (line 422–424)

3. Physician reviews and modifies

   • The history fields are now editable in the encounter form
   • Physician can add new allergies, update medication, add comorbidities, etc.

Steps — Syncing History Back to Patient

1. Submit the Patient Encounter

   • Trigger: update_patient_history() (patient_encounter.py line 426–518)

2. System writes back to Patient

   • Updates these fields from Encounter → Patient:

   Encounter Field	Patient Field	Sync Method
   allergies	allergies	Direct overwrite
   surgical_history	surgical_history	Direct overwrite
   medication	medication	Direct overwrite
   patient_madical_history	patient_madical_history	Clear + repopulate
   family_medical_history	family_medical_history	Clear + repopulate

   • For child tables (comorbidities, family history): clears all existing rows, then copies from encounter (line 449–458, 500–509)
   • Saves Patient with ignore_permissions=True (line 512)
   • Shows success message (line 514)

3. Medical Record created

   • After encounter submission, create_medical_record() hook fires
   • Creates a Patient Medical Record entry linking to this encounter
   • Used by the Patient History page for timeline display

Patient History Settings

The Patient History Settings DocType controls which documents appear in the Patient History page.

Configuration Fields

• standard_doctypes: Pre-configured healthcare DocTypes (Patient Encounter, Lab Test, Clinical Procedure, etc.)
• custom_doctypes: User-added DocTypes to include in history
• Each entry specifies:
  • document_type: The DocType to track
  • date_fieldname: Which date field to use for ordering (must be Date or Datetime type)
  • selected_fields: JSON array of field names to display in the history summary

Medical Record Creation

• Hook: create_medical_record(doc) (patient_history_settings.py line 75–100)
• Fires as after_insert for healthcare documents
• Creates Patient Medical Record with: patient, subject (rendered from selected_fields), communication_date, reference_doctype, reference_name

Patient History Page API

• get_feed(name, document_types, date_range, start, page_length) (patient_history.py line 12–25)
  • Returns Patient Medical Records for the patient
  • Optional filters: document types array, date range
  • Paginated (default: 20 per page)
  • Sorted by communication_date DESC

Fields Synced

Field Name	Type	Description	Note
allergies	Small Text	Free-text allergy list	Direct text overwrite
surgical_history	Small Text	Free-text surgery history	Direct text overwrite
medication	Small Text	Free-text current medications	Direct text overwrite
patient_madical_history	Table	Codified comorbidities (diagnosis links)	Spelled with typo in field name
family_medical_history	Table	Codified family conditions (diagnosis links)	Clear + repopulate on sync

Note: The field name patient_madical_history contains a typo ("madical" instead of "medical"). This is in the original codebase and is used consistently across Patient and Patient Encounter DocTypes.

Error States

• Patient not set on encounter → history load skipped
• Load fails → error logged, encounter creation continues (non-blocking)
• Encounter amend → history loaded from patient again (fresh copy)
• Multiple encounters submitted same day → last submitted encounter's history overwrites Patient record

Permissions

• Physician: Can view and edit history fields in encounters
• Healthcare Administrator: Can configure Patient History Settings
• Patient (Portal): Can view their own history through Patient History page

Related Code

• Backend: healthcare/healthcare/doctype/patient_encounter/patient_encounter.py
  • load_history_from_patient() — lines 341–424
  • update_patient_history() — lines 426–518
  • load_patient_history() — lines 520–540 (manual reload whitelist method)
• History Settings: healthcare/healthcare/doctype/patient_history_settings/patient_history_settings.py
  • create_medical_record() — lines 75–100
  • update_medical_record() — lines 103–117
• History Page: healthcare/healthcare/page/patient_history/patient_history.py
  • get_feed() — lines 12–25
  • get_patient_history_doctypes() — lines 60–70