SRS Chest X-Ray Result-Based Workflow

Part B – Software Requirements Specification (SRS)

1. Functional Requirements

FR-01 – Visit ID Generation

Trigger: Completion of TB Symptoms Screening.

System shall:

1. Validate that TB Symptoms Screening is completed.
2. Generate a unique Visit ID.
3. Associate Visit ID with Beneficiary ID.
4. Store Visit creation date/time.
5. Make Visit ID available for subsequent diagnostic referrals.

FR-02 – Chest X-Ray Referral

When a Chest X-Ray referral is initiated, the system shall:

1. Validate the Beneficiary ID.
2. Identify the applicable Visit ID.
3. Create a unique Chest X-Ray Order ID.
4. Record the current date/time.
5. Set Order Status = Pending.
6. Make the order available to the authorized testing user/device.

1. FR-03 – Order ID Structure

Each Order ID shall maintain at least the following information:

1. FR-04 – Result Capture

The system shall provide:

Manual Result Entry

Search Beneficiary

      ↓

Select Visit

      ↓

Select Pending X-Ray Order

      ↓

Select Result

      ↓

Save Result

Automated Result Flow

Digital X-Ray Device

        ↓

Integration Interface

        ↓

Identify Order

        ↓

Validate Result

        ↓

Save Result

        ↓

Process Business Rules

1. FR-05 – Result Validation

The system shall only accept the following final Chest X-Ray results:

• Normal
• Abnormal but not TB Presumptive
• TB Presumptive
• AI Invalid Result

Any unsupported or invalid result received through integration shall be rejected or flagged for appropriate exception handling.

1. FR-06 – Result Processing Engine

After successful result capture, the application shall execute the applicable business rule.

1. FR-07 – Repeat Test Management

For an AI Invalid Result:

• Current Order ID shall be retained for historical purposes.
• Current Order Status shall become Closed.
• A new Order ID shall be created.
• New Order Status = Pending.
• New Order shall reference the previous Order ID as its Parent Order ID.
• Repeat count/attempt number should be maintained.

Example:

Visit V001

   │

   ├── X-Ray Order XR001 → AI Invalid → Closed

   │                              │

   │                              ▼

   ├── X-Ray Order XR002 → AI Invalid → Closed

   │                              │

   │                              ▼

   └── X-Ray Order XR003 → Normal → Completed

This provides a complete audit trail of repeat attempts.

1. FR-08 – Truenat Referral

For either:

• Abnormal but not TB Presumptive
• TB Presumptive

the system shall automatically initiate a Truenat referral.

The system shall:

1. Complete the Chest X-Ray Order.
2. Create a Truenat Order ID.
3. Link the Truenat Order to the Beneficiary.
4. Link the Truenat Order to the Visit ID.
5. Link the Truenat Order to the Chest X-Ray Order.
6. Set Truenat Order Status = Pending.

1. FR-09 – Test Not Conducted

The system shall provide a "Test Not Conducted" option.

When selected:

• Reason field becomes mandatory.
• User cannot save without reason.
• Order status becomes Closed.
• Closure date/time shall be recorded.
• User ID shall be recorded.

1. FR-10 – EoD Scheduler

The system shall run an EoD process to identify eligible Pending Chest X-Ray Orders.

Processing logic

FOR each Chest X-Ray Order

    IF Order Status = Pending

       AND Order Date < Current Business Date

    THEN

       Change Status → Closed

       Record Closure Date/Time

       Record Closure Reason

    END IF

END FOR

For the current day's EoD, the system shall close applicable orders that have not been completed according to the operational closure rules.

1. FR-11 – Closed Order Management

For a Closed Chest X-Ray Order:

• Result/order history shall remain read-only.
• User shall be able to view the previous Order details.
• User shall have an option to Create New Order where permitted.
• New Order shall have a unique Order ID.
• Previous order shall not be modified to represent the new test.

1. FR-12 – Multiple Orders Under One Visit

The system shall support:

One Beneficiary

       │

       ▼

One Visit ID

       │

       ├── X-Ray Order 001

       ├── X-Ray Order 002

       ├── X-Ray Order 003

       └── Truenat Order(s)

Multiple Chest X-Ray Order IDs may therefore be created against the same Visit ID.

1. FR-13 – Role-Based Access

The application shall provide role-based access for result entry and order management.

Note: Final permissions should be configurable according to program policy.

1. FR-14 – Audit Trail

The system shall maintain an audit trail for:

• Visit ID creation.
• Order ID creation.
• Result entry.
• Result modification, where permitted.
• Result source.
• Repeat test.
• Order closure.
• Closure reason.
• New Order creation.
• User ID.
• Device/integration source.
• Date and time.

1. Non-Functional Requirements

NFR-01 – Offline Capability

The TB Screening Camp application should support the Chest X-Ray workflow in the camp's offline environment where applicable.

NFR-02 – Performance

Beneficiary and Pending Order searches should return results within an acceptable operational response time under the camp's local network conditions.

NFR-03 – Data Integrity

Every result must be linked to the correct:

Beneficiary ID → Visit ID → Order ID

to prevent results from being assigned to the wrong beneficiary.

NFR-04 – Security

Only authenticated and authorized users shall be able to:

• Enter results.
• Mark tests as not conducted.
• Create new orders.
• Close orders manually.

NFR-05 – Auditability

The system shall preserve historical orders and test attempts and shall not delete closed orders as part of normal business operations.

1. Recommended Data Model

BENEFICIARY

     │

     │ 1:N

     ▼

VISIT

     │

     │ 1:N

     ▼

DIAGNOSTIC ORDER

     │

     ├───────────────┐

     │               │

     ▼               ▼

CHEST X-RAY       TRUENAT

ORDER             ORDER

     │

     │ 1:N

     ▼

TEST ATTEMPT

     │

     ▼

RESULT

For repeat AI-invalid testing, the recommended model is:

XR001

AI Invalid

Closed

   │

   │ Parent Order

   ▼

XR002

AI Invalid

Closed

   │

   │ Parent Order

   ▼

XR003

Normal

Completed

This is preferable to overwriting results because it preserves the complete diagnostic history.

1.  End-to-End SRS Workflow and EoD Processing Workflow

1. Final Acceptance Criteria

The functionality shall be accepted when:

• Visit ID is automatically created after TB Symptoms Screening completion.
• New Chest X-Ray referrals automatically generate an Order ID.
• One Visit ID supports multiple Chest X-Ray Order IDs.
• Order IDs have a one-day validity period.
• Order statuses are correctly maintained as Pending / Completed / Closed.
• Manual result entry is available to authorized users.
• Automated results can be received from integrated Digital X-Ray devices.
• Four Chest X-Ray results are supported.
• Normal results complete the order with no further action.
• Abnormal but not TB Presumptive results create a Truenat referral.
• TB Presumptive results create a Truenat referral.
• AI Invalid results are recorded and the current order is closed.
• A new Order ID is created for repeat testing after AI Invalid.
• Repeat Order IDs retain parent/previous order references.
• Test Not Conducted requires a mandatory reason.
• Test-not-conducted orders are closed.
• Pending/unresolved orders are closed according to EoD rules.
• Closed orders remain available in history.
• A new Order ID can be created from a closed order/beneficiary record when required.
• Every result is traceable through Beneficiary ID → Visit ID → Order ID.
• Manual and automated result paths use the same result-processing rules.
• All important transactions are captured in the audit trail.

Key design principle

Beneficiary ID → Visit ID → Test Order ID → Test Result → Next Action

The Visit ID represents the screening encounter, while each Order ID represents a specific Chest X-Ray test order. This allows multiple orders under one visit while preserving a complete history of repeat tests, invalid results, closures, and final outcomes.