=== data on file === patient: John Mwangi (#1) · tests: 15 · panel: PNL-FBC analyzers: CHEM-1 #1 · IMMUNO-1 #3 · URIN-1 #4 === order A: CPOE → phlebotomy → accession → results → verify → release → charge === doctor raises the order (panel + GLU-R) ok order no assigned 1 panel expands to 7 + GLU-R = 8 lines 8 panel charge rides on FBC-HB 293 FBC-HB carries the panel price 1800.00 other constituents unbilled 6 GLU-R carries its own charge 18 GLU-R standard price 400.00 order starts as ordered ordered OK lab-orders.stickers (nurse) 19864 bytes nurse draws the samples ok second collect with nothing left refused one tube per specimen requirement 2 EDTA tube serves the haematology panel 7 specimens barcoded and collected 2 items moved to collected 8 order status now collected collected accession: tubes received at the bench ok order status now in_lab in_lab specimens stamped received 2 draw event on each tube 2 receipt recorded for every line 8 re-accession refused refused centrifuge Fluoride oxalate plasm ok centrifuge Whole blood EDTA ok items now in progress 8 critical result recorded AND flashed refused critical flag stored critical_high value stored 21 reference range applied 13.0 - 17.0 verify refused before the call refused critical call logged ok call recorded with recipient Dr. Achieng — Ward 4 in-app alert to the ordering clinician 1 second call refused refused critical verify now allowed ok line verified and signed 11 acknowledgement closes the loop ok acknowledged by the clinician 1 result FBC-WBC ok verify FBC-WBC ok result FBC-PLT ok verify FBC-PLT ok result FBC-HCT ok verify FBC-HCT ok result FBC-MCV ok verify FBC-MCV ok result FBC-MCH ok verify FBC-MCH ok differential as text ok differential verified ok glucose recorded ok glucose normal against 3.9 - 7.8 normal delta check reads first_result first_result glucose verified ok every line verified 8 order workflow complete verified completed_at stamped 1 amend a signed line refused refused release to chart and print queue ok released_at stamped 1 second release refused refused billing carries the work to the account ok order stamped is_charged 1 draft invoice raised draft invoice typed laboratory laboratory two billable lines 2 panel + glucose = Kshs 2,200 2200.00 source traced to the order items 2 no GL posting on a draft 0 re-charge refused — nothing left refused === order B: analyzer bridge — transmit, pull, verify === order B raised (K+ / Na+) 2 nurse collects — one serum tube ok one shared tube 1 bench accession ok transmit worklist to CHEM-1 ok outbound ORM on the wire 1 IMMUNO-1 not bidirectional — refused refused URIN-1 in maintenance — refused refused pull the result batch from CHEM-1 ok machine values applied 2 flags left for the scientist to judge 2 inbound ORU archived 1 re-pull with no open work refused refused verify RFT-NA ok verify RFT-K ok order B verified verified === order C: radiology loop === images filed against the study ok report opened as pending pending two images stored 2 files really on the disk 2 dictate the chest report ok report now reported reported study completed on the worklist completed verify the chest report ok report verified and signed 11 line verified verified dictate the ultrasound — critical ok verify blocked until the call invalid: critical_called_to critical call recorded, report verified ok call on the record Dr. Kamau — Casualty report verified verified critical alert raised 1 amend without a reason refused invalid: amendment_reason amendment re-reports and re-signs ok report status amended amended amendment stamped 11 order C fully verified verified === order D: rejection and cancellation === nurse draws two tubes ok EDTA and capillary drawn separately 2 cancel after the draw refused refused reject the haemolysed EDTA tube refused its lines rejected with reason 1 cancel with work in flight refused refused reject the capillary tube refused order closed as rejected rejected cancel a rejected order refused refused charge a rejected order refused refused === quality control === control run in limits ok z computed 0.4, accepted 0.400 in control, no deviation accepted is_deviation false 0 control beyond 3 SD rejected refused z 3.2 on the record 3.200 Westgard 1_3s flagged 1_3s deviation raised 1 resolve the deviation ok corrective action on file 1 second resolve refused refused === catalogue === new test created ok active on creation 1 duplicate code refused invalid: code test updated ok price revised to 650 650.00 test retired ok no longer orderable 0 panel created ok two constituents attached 2 panel withdrawn ok panel inactive 0 === renders === OK lab-orders.index (lab) 42696 bytes OK lab-orders.index filtered 36234 bytes OK lab-orders.create (doctor) 32934 bytes OK lab-orders.show A (lab) 109708 bytes OK lab-orders.show B (doctor) 57644 bytes OK lab-orders.show C (billing) 37580 bytes OK lab-orders.stickers (nurse) 19315 bytes OK lab-orders.print A (doctor) 29898 bytes OK lab-orders.patient-copy A 12012 bytes OK emr patients.clinical (doctor) 181550 bytes OK radiology.index (radiologist) 32185 bytes OK radiology.index filtered 29621 bytes OK radiology.show C 71055 bytes OK radiology.print chest 16532 bytes OK lab-qc.index (lab) 328994 bytes OK lab-qc.index + Levey-Jennings 299411 bytes OK analyzers.index (lab) 92622 bytes OK analyzers.messages CHEM-1 33902 bytes OK lab-catalogue.index (consultant) 318481 bytes OK lab-catalogue.search+edit 101719 bytes === gate matrix (route middleware `can:` is the enforcement surface) === doctor lab-orders.view yes 1 doctor lab-orders.create yes 1 doctor lab-orders.cancel yes 1 doctor lab.verify-results yes 1 doctor radiology.report yes 1 doctor invoices.create yes 1 doctor lab.enter-results no 0 doctor lab.collect-sample no 0 doctor lab.receive-sample no 0 doctor lab.qc-manage no 0 doctor lab.analyzers-manage no 0 doctor lab-catalogue.manage no 0 doctor radiology.verify no 0 nurse lab-orders.view yes 1 nurse lab-orders.create yes 1 nurse lab.collect-sample yes 1 nurse radiology.view yes 1 nurse lab-orders.cancel no 0 nurse lab.enter-results no 0 nurse lab.verify-results no 0 nurse lab.receive-sample no 0 nurse lab.reject-sample no 0 nurse radiology.report no 0 nurse invoices.create no 0 lab_technician lab-orders.view yes 1 lab_technician lab-orders.create yes 1 lab_technician lab-orders.cancel yes 1 lab_technician lab.collect-sample yes 1 lab_technician lab.receive-sample yes 1 lab_technician lab.reject-sample yes 1 lab_technician lab.enter-results yes 1 lab_technician lab.verify-results yes 1 lab_technician lab-catalogue.manage yes 1 lab_technician lab.qc-manage yes 1 lab_technician lab.analyzers-manage yes 1 lab_technician radiology.view no 0 lab_technician radiology.report no 0 lab_technician invoices.create no 0 radiologist lab-orders.view yes 1 radiologist lab-orders.create yes 1 radiologist lab-orders.cancel yes 1 radiologist lab.collect-sample yes 1 radiologist lab.receive-sample yes 1 radiologist lab.reject-sample yes 1 radiologist radiology.view yes 1 radiologist radiology.report yes 1 radiologist radiology.verify yes 1 radiologist radiology.upload-images yes 1 radiologist lab-catalogue.manage yes 1 radiologist lab.enter-results no 0 radiologist lab.verify-results no 0 radiologist invoices.create no 0 billing_officer invoices.create yes 1 billing_officer lab-orders.view yes 1 billing_officer lab-orders.create no 0 billing_officer lab.enter-results no 0 billing_officer radiology.view no 0 receptionist lab-orders.view no 0 receptionist lab-orders.create no 0 receptionist radiology.view no 0 receptionist lab.enter-results no 0 receptionist lab.qc-manage no 0 medical_coder lab-orders.view yes 1 medical_coder radiology.view yes 1 medical_coder lab-orders.create no 0 medical_coder lab.enter-results no 0 medical_coder invoices.create no 0 >>> renders clean and all write paths OK