Patient header

The patient header, displaying all known patient information, remains visible at the top of the screen throughout the entire prescribing process. See the figure below for what the patient header looks like in Touchdose:

Various patient inputs can be included in the patient header, with certain inputs being mandatory while others are optional. Please refer to Patient inputs for detailed rules regarding these inputs.

The following is a list of potential patient inputs that can be featured. The order presented here mirrors their sequence in the patient header.

Patient name

When the patient's name is successfully extracted from the EHR, it will be displayed in the following format: SURNAME, First name.

Patient age display

The specificity level of the patient's age is determined by their age range according to the following rules:

• 18 years or older: Age is shown in years only, for example, 25 years.
• 1 year up to but not including 18 years: Age is presented in years and months, for example, 5 years 3 months.
• 1 month up to but not including 1 year: Age is displayed in months and weeks, for instance, 3 months 3 weeks.
• 1 week up to but not including 1 month: Age is indicated in weeks and days, such as 3 weeks 4 days.
• Under 1 week: Age is expressed in days, e.g., 4 days.

If a value equals 0, it will not be displayed. For example, 3 weeks and 0 days will be presented as 3 weeks.

Clicking on the age will trigger a pop-up displaying the patient's age and date of birth. See the figure below to see what information is presented when clicking on the patient's age:

Birth sex display

The patient's sex at birth will be displayed and can only be "Male" or "Female".

Body weight display

Selecting the patient's weight will prompt a pop-up that includes:

• The patient's weight in kg.
• The source of the observation, which will be “EHR” or “User entered”.
• Days since the observation was entered into the EHR.
• Weight percentile and the method used for determining the percentile when the patient is a child.
• The patient's weight category and the criteria followed to classify the patient's weight category. Note that height needs to be known for the system to provide this information. Refer to Obesity status for additional details on how weight categories are determined.

See the figure below to see what information is presented when clicking on the patient's weight:

Body height display

If the clinician clicks on the patient’s body height then a pop up will display:

• The patient's body height in cm.
• The source of the observation, like From EHR or User entered.
• Days since the observation was entered when the value is retrieved from an EHR.
• Height percentile and the method used for determining the percentile when the patient is a child.

See the figure below to see what information is presented when clicking on the patient's height:

BSA display

When the clinician clicks on the patient's BSA, a pop-up will appear, showcasing the patient's BSA in square metres (m²) along with the method employed for the calculation.

BMI display

Upon the clinician's click on the BMI, a pop-up will showcase the following details:

• The BMI value.
• BMI percentile and the methodology utilised for determining the percentile for paediatric patients.
• The patient's weight category and the criteria adhered to for classifying the patient's weight category. For additional insights into how weight categories are determined, please refer to Obesity status.
• The position of the patient's BMI or BMI percentile on a line chart depicting the distribution.

See the figure below to see what information is presented when clicking on the patient's BMI:

If the system cannot determine the patient's obesity status, but the user manually indicates that the patient is not obese, the BMI will be shown as "Normal" without any specific value or percentile. To calculate the BMI, the user must enter the patient's height.

IBW display

In the event that the clinician clicks on the IBW, the pop-up will reveal the IBW presented in kg along with the calculation method employed to ascertain the patient's Ideal Body Weight.

AdjBW display

In the event that the clinician clicks on the AdjBW, the pop-up will reveal the AdjBW presented in kg along with the calculation method employed to ascertain the patient's adjusted body weight.

Obese for dosing purposes flag

If the patient is classified as obese, a flag will be displayed in the patient header, below the patient inputs, indicating "Obese for dosing purposes". If the clinician clicks on this flag, the following information will be presented:

• The patient's BMI if the patient is an adult or the patient's BMI percentile if the patient is a child.
• The methodology used to calculate the child's BMI percentile.
• The criteria followed for classifying the patient's weight category, specifically as obese in this instance.
• The position of the patient's BMI or BMI percentile on a chart illustrating the distribution.
• A note explaining that the patient will be dosed according to the relevant alternative body weight scalar, such as IBW or AdjBW, when the formulary recommends it as applicable.

See the figure below to see what information is presented when clicking on the obese for dosing purposes flag:

Not obese for dosing purposes flag

If the user manually indicates that the patient is not obese when the system requires the obesity status but cannot determine it due to missing height data, this flag will be added to the patient header. However, if the system determines that the patient is not obese based on the available patient data, the flag will not appear in the header. By clicking on the flag, the user can view additional information and reset their decision regarding the patient's obesity status.

Patient information not considered by Touchdose

This is only relevant to children as creatinine is not yet supported in adults.

Creatinine

Selecting the patient's creatinine will prompt a pop-up that includes:

• The patient's creatinine in umol/L.
• The source of the observation, which for creatinine will always be “EHR”.
• Days since the observation was entered into the EHR.
• Creatinine reference range which is according to Caliper and is dependent on the patient's age and sex.
• The creatinine classification based on whether it is outside the reference range or within.

See the figure below to see what information is presented when clicking on the patient's creatinine:

If creatinine is outside the reference range, a red arrow will appear next to the parameter name. If it falls within the reference range, a green dot will be displayed.

eGFR

Selecting the patient's eGFR will prompt a pop-up that includes:

• The patient's eGFR in mL/minute/1.73m².
• The calculation method for eGFR which for children is Modified Bedside Schwartz.
• The classification of kidney disease based on eGFR according to KDIGO.
• A note explaining the limitations of using Modified Bedside Schwartz as a method to determine kidney disease.

See the figure below to see what information is presented when clicking on the patient's eGFR:

Renal caution flag

If the patient may have renal dysfunction as determined by the patient's creatinine or eGFR a renal caution flag will be displayed in the patient header. See Caution renal function flag for more information about when this flag is generated. If the clinician clicks on this flag a message will be displayed explaining that the patient may have renal dysfunction and that Touchdose cannot take that into consideration when providing dosing recommendations so the user needs to proceed with caution.

Rounding

Body weight, body height, BSA, BMI, IBW and AdjBW are all rounded to 3 significant figures. If the decimal place is rounded to 0, it will not be shown. Importantly, this is solely for display purposes, as Touchdose does not round the patient’s weight for dose calculations.

Parameters not shown in the patient header

The clinician should consistently check the patient header to identify which parameters are recognised by the system. If any parameter is not mentioned in the patient header, it means that Touchdose considers it unknown and will not utilise it for dose recommendations or formulary filtering. In cases where Touchdose necessitates an unknown parameter, the clinician will be prompted to input the missing value.

Adding a missing weight or height

If weight or height are missing then you can optionally enter them by clicking on the plus button as seen in the figure below:

If creatinine is present but no height is provided, eGFR cannot be calculated. However, by clicking the plus button next to eGFR, you can enter a height, enabling the calculation.

Changing weight or height

If weight or height are present but you would like to change them then click on the edit button as seen in the figure below: