TBMJA PRD - Clinical Specialist
Overview
ACTOR: Clinical Specialist | ENTRY POINT: Clinical Specialist login > Home > Clinical Assessment and Diagnosis card | QUEUE: Beneficiaries listed in Clinical Assessment & Diagnosis (Referral section) for the user's (Clinical Specialist) mapped location.
The Clinical Specialist is a new user role in the TBMJA application. It provides clinical assessment for beneficiaries whose screening and diagnostic results do not give a clear outcome: abnormal digital chest X-ray (CXR) with a negative or not-conducted NAAT (Truenat), and symptomatic or high-risk beneficiaries who could not undergo chest X-ray (CXR). The Clinical Specialist reviews the beneficiary's existing record, records the clinical interpretation and outcome, and recommends next steps.
The role may be held by an authorized Medical Officer (MO) and above, chest physician, radiologist or other designated specialist.
Diagnostic data vs clinical decision. Test results (Digital Chest X-ray, NAAT, Liquid Culture) are read-only for the Clinical Specialist. The Clinical Specialist enters only clinical observations, outcomes and recommendations. These are stored as a separate Clinical Assessment record and never overwrite a test result.
Core objectives of this role:
- Make the Clinical Assessment & Diagnosis line list available to an authorized Clinical Specialist.
- Enable review of the CXR image and result, symptoms, NAAT results, clinical history and other relevant information.
- Record the clinical interpretation, probable diagnosis, assessment outcome and next steps, including additional investigations or referral.
- Route beneficiaries diagnosed with TB to Confirmed TB Cases.
- The role works in the same application, with the same login, offline and online modes, etc.
Role Based Access and User Configuration
If a User is assigned with a role "Clinical Specialist", then should be able to access following Modules and Privileges:
- Clinical Assessment line listing (Privileges: View access)
- Beneficiary Clinical Summary of listed beneficiaries (Privileges: View access)
- Chest X-ray (CXR) image viewer of listed beneficiaries (Privileges: View access)
- Clinical Assessment form (Privileges: View, Add, Edit until submit)
- The Clinical Specialist cannot access: Household, Non-Household and Registration sections; Anthropometry, General Examination, TB Screening, General OPD and Referral data-entry forms; Counselling, Contact Tracing and TPT modules; Admin panel.
End-to-end Workflow
Only "TB diagnosed/confirmed" and "TB not Suspected" end the record. Every other outcome sends Actions to field roles, and the beneficiary comes back to the Clinical Specialist for re-review.
Listing Rules: Clinical Assessment & Diagnosis
Beneficiaries are listed automatically. There is no manual referral to this list. Both the categories should be line listed in this module.
- Individuals with TB symptoms (Symptomatic) or no TB symptoms (Asymptomatic) with an abnormal Chest X-Ray (CXR) and a negative Truenat result, or in whom Truenat could not be conducted.
- Individuals with TB symptoms (Symptomatic), previous history of TB with current symptoms, TB among close household contacts, smoking, COPD, HIV or other clinical risk factors who could not undergo Chest X-Ray (CXR) due to specific reasons, including pregnancy, paediatric age or other clinical or operational constraints with a negative Truenat result, or in whom Truenat could not be conducted.
For Clinical Specialist login, Home shows the Clinical Assessment card and the Dashboard tab only. Clicking the card opens the Clinical Assessment line listing.
Flow: Home > Clinical Assessment card > Line listing (tab: Pending and Completed) > Beneficiary card > Beneficiary Clinical Summary > Start Assessment.
Home card
Name of Data Field | Field type | Value/ Options | Validation/ Logic/ Condition |
Clinical Assessment | Card (button) | Title + count badge | Visible only for Clinical Specialist role. Badge shows total count of beneficiaries i.e Clinical Assessment = No. of Pending + No. of Completed. On click open line listing. Give a sorting filter- Date listed (oldest first); Date listed (newest first); Name (A-Z). Default should be oldest date first. Here give two tabs- Pending and Completed. If clicked on “Pending” open the line listing of cases which have not yet been reviewed by the Clinical Specialist or even if reviewed by this role has not been assigned an outcome. If clicked on “Completed” open the line listing of cases which have been reviewed by the Clinical Specialist and an outcome has been assigned and closed. |
Pending | Tab | Title + count badge | In the clinical assessment card, give two tabs. First tab should indicate “Pending” where all the cases are line listed which have not yet been reviewed by the Clinical Specialist or even if reviewed by this role has not been assigned an outcome. Give a sorting filter- Date listed (oldest first); Date listed (newest first); Name (A-Z). Default should be oldest date first. In the “Pending” tab, give a further bifurcation of “Type” = “Initial” and “Re-review”. In “Initial” show the line listing of all the new cases which are yet to be assessed by a clinical specialist. In “Re-review” show the line listing of all the cases with an “Assessment Outcome” = “Further evaluation required”, “Assessment inconclusive/ additional information required”, “CXR not available” as an outcome has not been assigned yet and needs further review. |
Completed | Tab | Title + count badge | In the clinical assessment card, give two tabs. Second tab should indicate “Completed” where all the cases are line listed which have been reviewed by the Clinical Specialist and an outcome has been assigned and closed. Give a sorting filter- Date listed (oldest first); Date listed (newest first); Name (A-Z). Default should be newest date first. |
Beneficiary card
Following details should be visible on the beneficiaries card to the user. Also put Result status on the card for “TB Symptoms”, “CXR”, “NAAT” with icons (as being followed already)
Name of Data Field | Field type | Value/ Options | Validation/ Logic/ Condition |
Full Name | Label (auto, read-only) | First Name + Last Name | Source: Beneficiary Registration. |
Age / Gender | Label (auto, read-only) | Age in years / Gender | Source: Beneficiary Registration. |
Beneficiary ID (AMRIT ID) | Label (auto, read-only) | Existing AMRIT ID | Source: Beneficiary Registration. Not editable. |
Nikshay ID | Label (auto, read-only) | Existing Nikshay ID | Shown only if available. |
HoF / Father / Husband name | Label (auto, read-only) | Name | Source: Beneficiary Registration. |
Phone number | Label (auto, read-only) | 10-digit number | Hidden if backend default 9999999999 is stored. Source: Beneficiary Registration |
Address | Label (auto, read-only) | Village name | Source: Beneficiary Registration. |
On clicking the individual beneficiary card | Action | - | Opens Collapsible Sections- A. Clinical Summary B. |
Opens on clicking a beneficiary card in the line listing. All fields on this screen are read-only and auto-populated from existing modules. The Clinical Specialist cannot edit any of them.
Following Sections are collapsible-
- Clinical Summary
- Diagnostics and CXR image viewer
- Clinical Assessment Form
- Re-review form- enabled if “Assessment Outcome” = “Further evaluation required”, “Assessment inconclusive/ additional information required”, “CXR not available”.
A. Clinical Summary
Name of Data Field | Field type | Value/ Options | Validation/ Logic/ Condition |
Date | Label (auto, read-only) | Date/ Month/ Year | Auto populated when the case moves into the “Clinical Assessment and Diagnosis” module. |
Beneficiary Name | Label (auto, read-only) | First Name + Last Name | Source: Beneficiary Registration. |
Weight (Kgs) / Height (cms) / BMI | Label (auto, read-only) | Numeric | Auto populated |
Temperature (Degree Fahrenheit) | Label (auto, read-only) | Numeric + label (hypothermia / Normal / Fever) | Auto populated |
Pulse Rate Random Blood Sugar | Label (auto, read-only) | Numeric with unit | Auto populated |
Systolic BP / Diastolic BP | Label (auto, read-only) | Numeric with unit | Auto populated |
Random Blood Sugar | Label (auto, read-only) | Numeric with unit | Auto populated |
Clinical Symptoms | Label (auto, read-only) | Symptoms of- Pallor / Icterus / Cyanosis / Clubbing / Lymphadenopathy / Oedema | Shown only if recorded as “Present”. No need to show Symptoms which were recorded as “Absent” |
Chief Complaint / Medication | Label (auto, read-only) | Shown only if recorded. Hide if not recorded. Showcase chief complaint >> Medication advised >> Frequency >> Duration >> Remarks (if any) Showcase in a structured manner. | |
TB Symptoms | Label list (auto, read-only) | Showcase reported symptoms here including other symptoms if reported. Auto populated | Showcase all the symptoms which were reported as “Yes” during TB screening/ Symptom screening including “History of TB”, “Are you currently taking Anti-TB drugs”, “Anyone in Family Currently Suffering from TB”. Do not show symptoms which were reported as “No” during TB screening Show “Asymptomatic” if all Symptoms are reported as “No”. |
Key Population / Risk Factors | Label list (auto, read-only) | Options selected during TB Screening | Showcase all the reported risk factors here. |
HIV Status | Label (auto, read-only) | Positive / Reactive / Negative / Unknown | - |
Field Notes | Label (read-only) | Text, author, role, date | Notes added by Nurse, Counselling Officer or Lab Technician on the Clinical Assessment & Diagnosis card. Hidden if none. |
B. Diagnostics
Name of Data Field | Field type | Value/ Options | Validation/ Logic/ Condition |
CXR Result | Label (auto, read-only) | Should be auto populated from Digital Chest X-ray (CXR) results. | Source: Referral > Digital Chest X-ray (CXR). Auto-populated by device sync or manual entry. If CXR results are available, then showcase the result and date. If CXR is not conducted then show the field “Reason for not conducting CXR” If not conducted due to Pregnancy, then showcase "Not referred: Pregnant". |
CXR Image | Image | Should be fetched from the central server. Refer to B.1 for further instructions. | |
Reason for not conducting CXR | Label (auto, read-only) | Source: Referral > Digital Chest X-ray (CXR) Enable only if “CXR Result” is not available Showcase the reason logged. | |
NAAT MTB test result | Label (auto, read-only) | MTB Not Detected; MTB Detected | Source: Referral > NAAT If MTB detected, then enable “NAAT Rif test Result” If MTB not detected, then do not enable “NAAT Rif test Result” |
NAAT Rif test result | Label (auto, read-only) | Rif Resistance Detected; Rif Resistance Not Detected | Showcase the reason logged. Should not be visible if |
Reasons for not conducting the NAAT test / Other | Label (auto, read-only) | Section 5.4 options | Showcase the reason logged. Do not show if NAAT results are available. |
Cy-TB results | Label (auto, read-only) | Positive Negative | This field should be shown only if results are available. Hide if not relevant to the individual beneficiary or no results available. |
Liquid Culture result | Label (auto, read-only) | Growth detected No Growth detected | This field should be shown only if results are available. Hide if not relevant to the individual beneficiary or no results available. |
B.1 Chest X-ray (CXR) Image Viewer
Opens full screen on clicking the CXR Image thumbnail in the Beneficiary Clinical Summary (section E). It displays the image produced by the Digital X-ray device. The viewer is for review only: the image cannot be changed, annotated, downloaded or shared. Viewer controls: Proposed - Requires Stakeholder Validation.
Name of Data Field | Field type | Value/ Options | Validation/ Logic/ Condition |
Context bar | Label (auto, read-only) | Beneficiary Name, Age / Gender, AMRIT ID, CXR Date, Digital Chest X-Ray Test Result | Always visible at top so the image cannot be attributed to the wrong beneficiary. |
CXR Image | Image (read-only) | Image file from X-ray device | Source: Central Server after sync. |
Zoom | Gesture / buttons | Pinch zoom; + / - buttons | Range 1x to 8x. |
Pan | Gesture | Drag | Enabled when zoom > 1x. |
Brightness / Contrast | Slider | -50 to +50 | Display-only adjustment. Not saved to the image. |
Invert | Toggle | On / Off | Display-only. |
Reset | Button | - | Restores default zoom, position, brightness, contrast and invert. |
Image selector | Swipe / thumbnails | All CXR images for the current TB Screening episode, labelled with date | Shown only if more than one image exists (for example, repeat CXR after a Specialist recommendation). |
Close | Button | - | Returns to Beneficiary Clinical Summary. On close, "CXR image reviewed" in the Clinical Assessment form is pre-set to Yes (user can change). |
Image open log | System (not shown) | User ID, beneficiary, date and time | Logged on every open (10.12 audit). |
Loading state | Spinner + text | "Loading image..." | If not loaded within 30 seconds show "Image could not be loaded. Retry" with Retry button. |
Image not available | Label | "Image pending sync. Last sync: [date, time]" | Shown when the result exists but the image has not reached the server the user reads from. |
C. Clinical Assessment Form
Opens on clicking Start Assessment, Continue Draft or Review New Evidence in the Beneficiary Clinical Summary. All text fields allow Speech to Text input.
Section 1: Header
Name of Data Field | Field type | Value/ Options | Validation/ Logic/ Condition |
Assessment Date | Calendar / Date picker | Date | Mandatory. Default: Today's date. Not greater than Today's date. Not before the latest of TB Screening date, CXR date and NAAT test date. Not editable once submitted. |
Clinical Specialist Name | Label (auto, read-only) | Logged-in user's full name | Source: user profile. |
Specialist Type | Label (auto, read-only) | · Medical Officer (MO) · Chest Physician · Radiologist · Other | Source: user configuration on login |
Section 2: Review of diagnostic evidence
Name of Data Field | Field type | Value/ Options | Validation/ Logic/ Condition |
CXR image reviewed | Radio button | · Yes · No | Pre-set to Yes if the image viewer was opened during this session; user can change. Mandatory |
Reason CXR image not reviewed | Dropdown | · Image not available · Image quality inadequate · Other | To be enabled if “CXR image reviewed” = “No” Mandatory if enabled Single selection |
Other reason | Textbox | Free text | Enabled and mandatory if “Reason CXR image not reviewed” = Other. Character limit 200. |
Clinical interpretation of CXR | Multi-line textbox | Free text | Enabled and mandatory if CXR image reviewed = Yes. Character limit 500. Records the specialist's interpretation; does not change Digital Chest X-Ray (CXR) Test Result. |
Clinical Assessment Notes | Multi-line textbox | Free text | To be enabled if “CXR image reviewed” = “Yes” Mandatory if enabled Minimum 10, maximum 1000 characters. |
Prognosis | Textbox | Free text | To be enabled if “CXR image reviewed” = “No” Mandatory if enabled Character limit 200. |
Assessment Outcome | Dropdown | · Suggestive of TB / high suspicion of TB · TB confirmed · Further evaluation required · TB not currently suspected · Assessment inconclusive/ additional information required · CXR not available | Mandatory. Single selection. Enabled in either case of “CXR image reviewed” = “No” or “Yes” If “Assessment Outcome” = “TB Confirmed” then move the card to the Confirmed Case line listing for counselling, contact tracing etc. If “Assessment Outcome” = “Suggestive of TB / high suspicion of TB”, “TB confirmed” , “TB not currently suspected” then the case moves to Tab “Completed” as an outcome has been assigned. If “Assessment Outcome” = “Further evaluation required”, “Assessment inconclusive/ additional information required”, “CXR not available” then the case moves to Tab “Pending” as an outcome has not been assigned yet. |
Recommended Next Steps | Checkbox (multi-select) | · Advice NAAT · Repeat Chest X-ray · Clinical examination · Obtain missing information · Arrange further review · Other investigations | Enabled if “Assessment Outcome” = “Suggestive of TB / high suspicion of TB”, “Further evaluation required”, “Assessment inconclusive / additional information required”, or “CXR not available” Mandatory if enabled. If “Recommended Next Steps” = “Advice NAAT” then re-list the beneficiary in the NAAT card of the referral section. If “Recommended Next Steps” = “Repeat Chest X-ray” then re-list the beneficiary in the Digital Chest X-Ray card of the referral section. If “Recommended Next Steps” = “Clinical examination” enable the field “Clinical examination details” If “Recommended Next Steps” = “Other investigations” enable the field “Other investigation details” |
Clinical examination details | Textbox | Free text | Enabled if “Recommended Next Steps” = “Clinical examination”. Optional. Character limit 200. |
Other investigation details | Textbox | Free text | Enabled and mandatory if “Recommended Next Steps” = “Other investigations”. Character limit 200. |
Remarks | Textbox | Free text | Optional Character limit 200. Alpha- Numeric |
Cancel | Button | Yes / No | Popup "Are you Sure?" with Yes / No. If Yes: returns to Beneficiary Clinical Summary without saving changes since the last draft. No: form stays open. |
Submit | Button |
D. Re-review Form
This form is enabled if “Assessment Outcome” = “Further evaluation required”, “Assessment inconclusive/ additional information required”, “CXR not available”.
Name of Data Field | Field type | Value/ Options | Validation/ Logic/ Condition |
Date of Re-review | Calendar / Date picker | Date | Mandatory. Default: Today's date. Not greater than Today's date. Cannot be before the first time filling of the form. No back dates allowed. Not editable once submitted. |
Previous assessment | Label (auto, read-only) | Full previous assessment record | Shown at top in Re-review mode. |
New evidence | Label list (auto, read-only) | Results and Action Taken entries saved after the previous Assessment Date | Highlighted. |
Assessment Outcome | Dropdown | · TB confirmed · TB not currently suspected · Death · Migrated · Refused further evaluation · Not reachable · Other | Mandatory. Single selection. |
Other | Textbox | Enabled if “Assessment Outcome” = “Other” Character limit 300. Mandatory if enabled | |
Closure Remarks | Multi-line textbox | Free text | Optional. Character limit 300. |
Cancel | Button | Yes / No | Popup "Are you Sure?" with Yes / No. If Yes: returns to Beneficiary Clinical Summary without saving changes since the last draft. No: form stays open. |
Submit | Button |
10.14 Dashboard: Clinical Assessment Indicators
The existing card "Clinical Assessment & Diagnosis Cases Summary" (section 9) continues with its demographic breakdown (Male, Female, Pregnant Women, Children (< 15 years), Senior Citizens (60 years), Transgender) and diagnosis classes (Diagnosed with TB, Not Diagnosed with TB, Diagnosis Pending, Referred for Further Evaluation, Drug-Resistant TB Diagnosed), populated from Case Status as per 10.11. The monitoring indicators from Concept Note section 5 are added as secondary KPIs. All counts follow the Time Period and Village filters. For Clinical Specialist login, counts are limited to the mapped location. Same table format as section 9.
Dashboard Card: Primary KPIs | Secondary KPIs | Logic / Condition/ Formula |
Clinical Assessment & Diagnosis Cases Summary | 1. Eligible and referred for clinical assessment, by Referral Category (Category 1 - Symptomatic, Category 1 - Asymptomatic, Category 2) | Count of Clinical Assessment records created (T1) in selected Village and Period. |
2. Assessed by Clinical Specialist: count and percentage | Count of records with at least one submitted assessment. Percentage = (Assessed / Referred) * 100. | |
3. Requiring further investigations, and investigations completed | Requiring = records with at least one Action. Completed = records where all Actions are Completed. | |
4. Additional TB cases diagnosed, and treatment initiated | Diagnosed = Case Status Closed - TB Diagnosed, split by Basis of Diagnosis. Treatment initiated = of these, records with Treatment Start Date in Confirmed TB Cases. | |
5. Referred individuals with documented final outcome: count and percentage | Count of records with any Closed status. Percentage = (Closed / Referred) * 100. |
10.15 Acceptance Criteria - Clinical Specialist
- Given a non-pregnant beneficiary is Symptomatic, Digital Chest X-Ray Test Result = TB Presumptive and NAAT MTB test result = MTB Not Detected, When the NAAT result is saved or synced, Then the beneficiary appears in the Clinical Assessment and Diagnosis line listing.
- Given a non-pregnant beneficiary is Asymptomatic, Digital Chest X-Ray Test Result = TB Presumptive and Is NAAT test conducted = No with reason "Cartridge unavailable", When saved, Then the beneficiary is listed in the Clinical Assessment and Diagnosis line listing as Asymptomatic and Referral Reason shows "Truenat not conducted: Cartridge unavailable".
- Given a beneficiary with Are you Pregnant = Yes, "Beneficiary is Asymptomatic" = No and NAAT MTB test result = MTB Not Detected, When saved, Then the beneficiary is listed in the Clinical Assessment and Diagnosis line listing and CXR section shows "Not referred: Pregnant".
- Given any NAAT MTB test result = MTB Detected, When listing rules run, Then the beneficiary is not listed in Clinical Assessment.
- Given a Clinical Specialist is mapped to Block A only, When the line listing or search is used, Then beneficiaries from Block B are not to be shown.
- Given the Beneficiary Clinical Summary is open, When the Clinical Specialist tries to edit any test, screening or registration field, Then no field is editable.
- Given a pregnant beneficiary, When Recommended Next Steps loads, Then "Chest X-ray" is not shown.
AC-CS-18: Given Assessment Outcome = TB diagnosed/confirmed with Basis = Clinically Diagnosed TB, When Submit is confirmed, Then a Confirmed TB Cases record is created with classification "Clinically Diagnosed TB", the notification alert in section 7.3 is shown, the Counselling Diagnosis label shows the Clinical Assessment source, and Case Status = Closed - TB Diagnosed.
AC-CS-19: Given Assessment Outcome = Further evaluation required with Recommended Next Steps = Additional NAAT, When Submit is confirmed, Then Case Status = Further Evaluation Pending, and the beneficiary appears in Referral > NAAT with Referral Reason = "Specialist recommendation" and a new test order ID, while the earlier NAAT result stays visible as history.
AC-CS-20: Given a record with two Actions, When a Lab Technician records one as Completed, Then Case Status stays Further Evaluation Pending; When the second is recorded as Not done with a reason, Then Case Status = Awaiting Re-review and the beneficiary appears in the Clinical Specialist's Pending Assessment tab with a Re-review flag.
AC-CS-21: Given an open record in any status, When a NAAT MTB Detected result is saved, Then Case Status = Closed - TB Diagnosed with the result linked, any open draft is discarded with notice, and the beneficiary appears in Confirmed TB Cases.
AC-CS-22: Given Assessment Outcome = TB not currently suspected and Follow-up / Referral Advice = No further action, When Submit is confirmed, Then Case Status = Closed - TB Not Suspected and the Dashboard counts the beneficiary under "Not Diagnosed with TB".
AC-CS-23: Given Beneficiary Status is set to Death, When saved, Then any open Clinical Assessment record moves to Closed - Other with Closure Reason = Death.
Dashboard, sync and audit
AC-CS-24: Given the Dashboard is filtered to Village V and This Month, When loaded, Then the Clinical Assessment & Diagnosis Cases Summary card shows the five diagnosis classes and the five secondary KPIs for Village V and this month only.
AC-CS-25: Given a Clinical Specialist submits an assessment offline, When the device syncs and another version for the same record already exists, Then the earlier-submitted version is kept, the later one is stored as a rejected version, and its author sees the conflict message.
AC-CS-26: Given any Case Status change, When it occurs, Then a status log entry is written with from status, to status, event, user ID, role, device ID and timestamp.
Actions, navigation and display
AC-CS-27: Given an assessment with Recommended Next Steps = Additional NAAT and Repeat sample collection, When Submit is confirmed, Then exactly one new NAAT attempt is created in Referral > NAAT with Referral Reason = "Specialist recommendation" and Sputum Sample submitted at defaulted to Facility for Next Step, and both Actions show Action Status = Pending.
AC-CS-28: Given a re-listed NAAT attempt, When the Lab Technician saves NAAT MTB test result = MTB Not Detected for that attempt, Then the linked Actions change to Completed automatically, and if no other Action is open, Case Status = Awaiting Re-review.
AC-CS-29: Given a re-listed NAAT attempt, When the Lab Technician saves Is NAAT test conducted = No with reason "Patient refused", Then the linked Actions change to Not done with that reason copied.
AC-CS-30: Given the Clinical Specialist has filled Section 4 fields for one outcome, When a different Assessment Outcome is selected and the user confirms the popup, Then the Section 4 fields that no longer apply are cleared and the newly applicable fields are shown.
AC-CS-31: Given the Clinical Assessment form has unsaved changes, When the user taps Back, Then the popup "You have unsaved changes. Save as draft?" appears with Save Draft, Discard and Stay.
AC-CS-32: Given a Non-Household beneficiary, When CS-03 opens, Then section H Household members is hidden and the "No HH" flag is shown in the header.
AC-CS-33: Given three records are Pending Assessment and one is Awaiting Re-review in the mapped location, When the Clinical Specialist opens Home, Then the Clinical Assessment card badge shows 4.
AC-CS-34: Given the Clinical Specialist's device is offline, When CS-02 opens, Then the banner "You are offline. Showing records synced at [time]." is shown and only records already synced to the device are listed.
AC-CS-35: Given a record has Case Status = Further Evaluation Pending, When a Nurse opens All Beneficiaries, Then that beneficiary's card shows the chip "Clinical Assessment: Further Evaluation Pending".