Kenya Patient Summary FHIR Implementation Guide
0.1.0 - ci-build KE

Kenya Patient Summary FHIR Implementation Guide, published by Digital Health Agency of Kenya. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/IntelliSOFT-Consulting/Kenya-Patient-Summary-FHIR-IG/ and changes regularly. See the Directory of published versions

Decision Support Logic

Decision support logic (also called decision tables or decision-support tables, or DTs) are structured representations of clinical rules that can be embedded in a digital system to guide health workers in delivering evidence-based care.

This section presents key decision tables derived from Kenya's clinical guidelines and the WHO Digital Adaptation Kit methodology. Each table maps input conditions to recommended actions and links to the corresponding business process.

DT.01 – Determine Whether a Client is New or Returning

Trigger: Health worker begins the registration process (KPS.A).

Input Condition Condition Values Action Annotations
Client has existing record in system (by ID, name, or biometric) Yes Retrieve and display existing client record for verification Prompt health worker to confirm record belongs to the correct client before updating
Client has existing record in system No Create a new client record and issue a Unique Patient Identifier (UPI) Check client registry before creating; de-duplicate where possible
Multiple matching records found Yes Display all matches and prompt health worker to select the correct one Flag suspected duplicates for administrative review

DT.02 – Triage and Danger Sign Detection

Trigger: Health worker records vital signs during clinical consultation (KPS.B).

Input Condition Condition Values Action Annotations
Systolic blood pressure (mmHg) ≥ 160 Flag as danger sign – escalate to clinician immediately Severe hypertension threshold per Kenya MOH ANC guidelines
Oxygen saturation (SpO2 %) < 92% Flag as danger sign – initiate oxygen therapy assessment Applicable in all care settings
Body temperature (°C) ≥ 38.5 Flag as fever – initiate fever management protocol Prompt evaluation for malaria, sepsis in endemic regions
Respiratory rate (breaths/min) ≥ 30 (adult) Flag as danger sign – evaluate for respiratory distress Different thresholds apply for paediatric patients
MUAC (cm) – children 6–59 months < 11.5 Flag severe acute malnutrition – initiate SAM protocol Per Kenya National IMAM Guidelines
All vitals within normal range Yes Proceed with standard clinical consultation workflow

DT.03 – Allergy Alert at Point of Prescribing

Trigger: Clinician initiates a prescription or treatment order (KPS.D).

Input Condition Condition Values Action Annotations
Prescribed drug matches a recorded allergy in the patient summary Yes – same substance or same drug class Block prescription and display allergy alert to clinician Clinician must document clinical override with justification if overriding
Prescribed drug is in the same class as a recorded allergen Yes – cross-reactive class Display warning (non-blocking) and request clinician confirmation E.g., penicillin allergy → flag cephalosporins
No allergy record found for the patient Unknown / Not recorded Prompt health worker to capture allergy status before prescribing Allergy status must be marked as "unknown" or "no known allergy" if not assessed
No drug–allergy conflict No conflict found Allow prescription to proceed

DT.04 – Immunization Eligibility Check

Trigger: Clinician reviews immunization history during clinical visit (KPS.E).

Input Condition Condition Values Action Annotations
Pregnant woman with no prior TT vaccination record True Recommend TT1 dose – administer at current visit Per Kenya KEPI – Tetanus Toxoid-containing Vaccine (TTCV) schedule
Pregnant woman with TT1 recorded; interval since TT1 ≥ 4 weeks True Recommend TT2 dose – administer and record Minimum 4-week interval between TT1 and TT2
Child under 1 year: BCG not recorded True Recommend BCG – administer at birth contact or next visit Per Kenya KEPI infant immunization schedule
Vaccine contraindicated (e.g., severe allergic reaction to prior dose) True Do not administer; document contraindication in immunization record Alert clinician to review alternative options
Vaccine already administered and schedule complete for age group True No action needed – confirm schedule is complete in record

DT.05 – Referral Decision

Trigger: Clinician evaluates whether a referral is needed (KPS.B, KPS.G).

Input Condition Condition Values Action Annotations
Danger sign detected AND facility cannot manage condition True Initiate emergency referral – stabilize patient and arrange transport Bypass standard referral steps; use emergency referral pathway (KPS.G Step 2)
Required diagnostic test or procedure not available at current facility True Initiate planned referral with complete clinical summary Share patient summary to receiving facility via HIE or referral form
Specialist consultation required True Arrange specialist referral and share patient summary with receiving clinician Document referral reason, receiving facility, and expected follow-up date
Condition manageable at current facility True Continue management at current facility; no referral needed

DT.06 – Gestational Age Estimation

Trigger: Clinician records last menstrual period (LMP) date during antenatal care consultation (KPS.B).

Input Condition Condition Values Action Annotations
LMP date is known and reliable True Calculate gestational age (GA) from LMP using Naegele's rule; display estimated due date (EDD) GA = (Current date – LMP) in weeks; EDD = LMP + 280 days
LMP date is unknown or uncertain True Flag for ultrasound confirmation; record GA as estimated range if clinically assessed Recommend first-trimester ultrasound (before 24 weeks) for accurate dating
Gestational age < 12 weeks (first trimester) True Schedule next ANC visit and first-trimester screening Per Kenya MOH ANC schedule
Gestational age ≥ 28 weeks with no ultrasound on record True Recommend urgent ultrasound if not yet performed Late presentation increases risk; flag for clinician follow-up