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

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”, “Good Quality 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/ Area	Label (auto, read-only)	Village name/ Options(any one selected during HH registration)- Tribal-NPVTG Tribal-PVTG Rural Urban Urban Slum Unknown	Source: Beneficiary Registration.
On clicking the individual beneficiary card	Action	-	Opens Collapsible Sections- 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”.

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	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	-Showcase the reported result
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. It displays the image produced by the Digital X-ray device. The viewer is for review only: the image cannot be changed.

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

If CXR is available, then only enable this section.
If CXR is not available, then give a label "CXR not available".

Name of Data Field	Field type	Value/ Options	Validation/ Logic/ Condition
Is the Quality of CXR adequate	radio button	Yes No	Single selection Default "Yes" If selected "No" then enable only "Remarks", "Cancel", "Submit". Such cases should be visible in a separate list titled "Re-Review of CXR". If selected "No" and after submission then automatically move this case to "Pending".
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. Implement AI based auto complete feature- Need knowledge base from clinical domain team. CDSS Knowledge base required. If new interpretations is given by the specialist which is unavailable in the knowledge base, then include it. Should populate/ show with "Clinical interpretation of CXR" knowledge base only.
Clinical Assessment Notes	Multi-line textbox	Free text	To be enabled if “CXR image reviewed” = “Yes” Mandatory if enabled Minimum 10, maximum 1000 characters. Implement AI based auto complete feature- Need knowledge base from clinical domain team. CDSS Knowledge base required. If new interpretations is given by the specialist which is unavailable in the knowledge base, then include it. Should populate/ show with "Clinical Assessment terms" knowledge base only.
Assessment Outcome/ Prognosis	Dropdown	Normal Abnormal - Suggestive of TB Abnormal - Not Suggestive of TB Further evaluation required TB not currently suspected Assessment inconclusive/ additional information required	(Put outcomes as per Nikshay as well to get second opinion apart from AI) 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”, “Good Quality 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 Further evaluation required Referred to Pulmonologist Advice other Investigations	Enabled if “Assessment Outcome” = “Suggestive of TB / high suspicion of TB”, “Further evaluation required”, “Assessment inconclusive / additional information required”, or “Good Quality CXR not available”, "Referred to Pulmonologist" 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”
Advice other investigation details	Textbox	Free text	Enabled and mandatory if “Recommended Next Steps” = “Other investigations”. Character limit 200.
Remarks/ Notes	Textbox	Free text	Optional Character limit 200. Alpha- Numeric
Results of Previous Visits Interpretations		Showcase all results which has values of previous visits- Clinical interpretation of CXR, Clinical Assessment Notes, Recommended next steps. Do not show blank values, only filled values/ information.	read only
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

Dashboard: Clinical Assessment Indicators

All counts follow the Time Period and Village filters. For Clinical Specialist login, counts are limited to the mapped location.

The breakdowns mean:

Sex: male, female, transgender.
Age: children (<15), adults (15-59), elderly (60 and above).

	Indicator	How it’s calculated	Breakdowns
1	Referred for clinical assessment	Count of total beneficiaries listed in the module with bifurcations/ breakdowns	Sex, age, pregnant
2	Assessed by Clinical Specialist (n, %)	Total Assessments completed out of Total referred for clinical assessment	Sex, age, pregnant
3	Pending: Initial	Not yet assessed	Sex, age, pregnant
4	Pending: Re-review	Waiting for re-review	Sex, age, pregnant
6	Clinical Outcome	% of each of the following- Suggestive of TB / high suspicion of TB TB confirmed Further evaluation required TB not currently suspected Assessment inconclusive/ additional information required CXR not available	Sex, age, pregnant
7	CXR image reviewed (%)	Image reviewed out of the total CXR images available	Village, Time
8	CXR image not reviewed, by reason	Options -Image not available / poor quality / other	Village, Time
9	Needing further investigations (n, %)	At least one of the following next steps recommended out of Total referred for clinical assessment- Advice NAAT Repeat Chest X-ray Clinical examination Obtain missing information Arrange further review Other investigations out of Total referred for clinical assessment	Sex, age, pregnant
10	TB diagnosed through clinical assessment	Final outcome = TB confirmed out of Total referred for clinical assessment	Sex, age, pregnant, category, risk group