RxConcile

RxConcile is a modern, SMART on FHIR web application designed to assist healthcare providers in the medication reconciliation process. By integrating directly with Electronic Health Record (EHR) systems via FHIR standards, it provides a streamlined interface for identifying therapeutic duplications, managing active prescriptions, and reviewing patient conditions.

🌐 Live Demo

Try out the application connected to a public EHR sandbox: Launch Demo

Note: For the best experience, please select one of the first 2 patients in the sandbox to see the conflict detection in action.

Disclaimer: The live demo connects to the public SMART HealthIT FHIR Sandbox. Service availability depends on their server status and may experience occasional downtime.

🚀 Key Features

• SMART on FHIR Integration: Seamlessly authenticates and retrieves patient data (Demographics, Medications, Conditions) from FHIR-compliant EHRs (tested with Logica/Meld Sandbox).
• Therapeutic Duplication Detection: Leverages the NLM RxNav API to analyze drug classes (ATC, VA, MOA) and automatically flag potential therapeutic duplications (e.g., two different NSAIDs prescribed simultaneously).
• Real-Time Write-Back:
  • Discontinue: Allows providers to stop duplicate or unnecessary medications directly from the dashboard.
  • Prescribe: Interface to prescribe new medications with dosage instructions, writing MedicationRequest resources back to the server.
• Patient Context: Displays key patient demographics (Name, DOB, Sex) and a list of active conditions/diagnoses.
• Modern UI/UX: Built with Shadcn UI and Tailwind CSS for a clean, accessible, and responsive professional healthcare interface.

🛠️ Technology Stack

• Framework: Next.js 14 (App Router)
• Language: TypeScript
• Styling: Tailwind CSS
• Components: Shadcn UI
• FHIR Client: fhirclient (SMART on FHIR JS Client)
• Icons: lucide-react
• External APIs: National Library of Medicine (NLM) RxNav API

📋 Prerequisites

Before running the application, ensure you have the following:

1. Node.js: Version 18.17 or later.
2. SMART on FHIR Sandbox: An account with a FHIR sandbox provider like Logica (Meld) or the Epic on FHIR Sandbox.
3. Client ID: You must register an app in your sandbox to obtain a Client ID.
   • Launch URL: http://localhost:3000/launch
   • Redirect URL: http://localhost:3000
   • Scopes: launch patient/MedicationRequest.read patient/MedicationRequest.write patient/Patient.read patient/Condition.read online_access openid profile

⚙️ Installation & Setup

1. Clone the repository

   git clone https://github.com/Xelem/Rx-Concile.git
   cd Rx-Concile

2. Install dependencies

   npm install

3. Configure Environment Variables Create a .env.local file in the root directory and add your SMART Client ID:

   NEXT_PUBLIC_BASE_URL=http://localhost:3000
   NEXT_PUBLIC_MELD_CLIENT_ID=your_client_id_here

🏃‍♂️ Running the Application

Development Server

Start the Next.js development server:

npm run dev

The application will be available at http://localhost:3000.

Launching with SMART Context

Since this is a SMART on FHIR app, it expects to be launched by an EHR. You cannot simply visit http://localhost:3000 directly without a launch context (unless testing specific standalone components).

1. Go to your FHIR Sandbox (e.g., Logica).
2. Select a Patient from the sandbox interface.
3. Launch the App: Find your registered "RxConcile" app and click Launch.
4. The sandbox will redirect to http://localhost:3000/launch, perform the OAuth2 handshake, and then land on the main dashboard.

📖 Usage Guide

1. Medication Dashboard

Upon login, you will see the Active Medications list.

• Review: See all active prescriptions for the patient.
• Alerts: Red warning boxes appear at the top if therapeutic duplications are detected (e.g., "Multiple active medications found in class: NSAID").

2. Handling Alerts

• Dismiss: Click "Dismiss Warning" to hide an alert for the current session.
• Resolve: Click the Stop button next to a specific medication inside the alert box to discontinue that drug. This sends a request to the FHIR server to update the status to stopped.

3. Prescribing New Medications

1. Click the Add Medication button in the header.
2. Select a medication from the preset list (e.g., "Lisinopril").
3. Enter Dosage Instructions (e.g., "10mg daily").
4. Click Confirm Prescription.
5. The app will write the new order to the EHR and refresh the list.

4. Viewing Conditions

Toggle the view using the View Conditions button to see a list of the patient's active diagnoses and problems.

📂 Project Structure

rx-concile/
├── app/
│   ├── context/        # SmartContext (FHIR client & state)
│   ├── launch/         # SMART Launch handler (/launch)
│   ├── page.tsx        # Main Dashboard
│   └── layout.tsx      # Root layout
├── components/
│   ├── ui/             # Shadcn UI primitives (Button, Dialog, etc.)
│   ├── AlertBox.tsx    # Feedback alerts
│   ├── AlertSection.tsx# Clinical warnings
│   ├── MedicationList.tsx
│   └── ConditionList.tsx
├── lib/
│   ├── rxnav.ts        # Service for NLM RxNav API interactions
│   ├── utils.ts        # Tailwind class merger
│   └── medication-utils.ts # Logic for finding duplicates
└── public/

🔮 Future Roadmap

• Patient-Friendly Summaries: AI-driven "Plain English" explanations of complex medical regimens for patients.
• Restart Logic: Workflows to handle medication restart logic for previously discontinued drugs.

🤝 Contributing

1. Fork the project
2. Create your feature branch (git checkout -b feature/AmazingFeature)
3. Commit your changes (git commit -m 'Add some AmazingFeature')
4. Push to the branch (git push origin feature/AmazingFeature)
5. Open a Pull Request