Elise Elmstead · Notes · Demo Health Record (demonstration)

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Demo Health Record Riverbend Community Hospital (fictional) synthetic data · demonstration

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Clinic visit note

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Type: Clinic visit
Date: 2026-04-04 10:15
Author: Dr. Imogen Vale
Status: Signed 2026-04-04 10:27

Follow-up visit. S: Doing well. Taking medications as prescribed. O: BP 137/72, HR 80. Weight 56.8 kg. A/P: 1. Hypothyroidism: stable; continue current plan. 2. Osteopenia: stable; continue current plan. 3. Osteoarthritis: stable; continue current plan. Labs drawn today: basic metabolic panel and blood count. Return in 3 to 4 months.

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Clinician-typed This draft, as declared by the source system

1 to look at before you sign · 2 checked

Agrees Kidney function over time

Kidney results 220 days apart are 60 or above (filtering rate 72.7 on 2026-04-04 and 77.9 on 2026-11-10) and the note doesn't mention kidney function.

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Needs a look Bone density T-score Draft · pending review

The note says Osteopenia; T-score -2.7 on 2026-10-11 09:00 meets the published definition's criteria for the category “T-score -2.5 or lower band” (who1994_osteoporosis@1.0), not the category written.

Published bodies disagree on these thresholds; another definition may give a different answer.

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Published definition and source

Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: report of a WHO Study Group (WHO Technical Report Series 843)
who1994_osteoporosis@1.0

Normal. A value for BMD or BMC within 1 SD of the young adult reference mean. Low bone mass (osteopenia). ... more than 1 SD below the young adult mean but less than 2.5 SD below this value. Osteoporosis. ... 2.5 SD or more below the young adult mean.

World Health Organization · edition 1994 · Section 2.1 Definitions, printed pages 5-6 (PDF pages 11-12) · opened 2026-11-14 · source

Threshold for this category (who1994_osteoporosis@1.0): T-score ≤ -2.5 SD.

Draft definition: pending clinical and coding review.

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Thresholds

Kidney function over time: Threshold: filtering rate below 60 on two results at least 90 days apart, none of 60 or more between them.

Rules and published sources

ckd_epi_2009@1.0 Levey et al., Ann Intern Med 2009;150:604-12 (2009 eGFR equation, drift check) · source
ckd_epi_2021@1.0 Inker et al., N Engl J Med 2021;385:1737-49 (2021 race-free eGFR equation) · source
kdigo_aki_2012@1.1 KDIGO 2012 guideline, Kidney Int Suppl 2012;2:1-138 (Rec 2.1.1-2.1.2, Table 2) · source
kdigo_ckd_2024@1.1 KDIGO 2024 guideline, Kidney Int 2024;105(4S):S117-S314 (G/A categories, >3 months) · source
kidney_compare@1.1 Two-sided comparison (this tool); ICD-10-CM guideline I.A.19; ACDIS/AHIMA compliant query practice, 2026 update · source
kidney_exclusions@1.0 KDIGO 2024 guideline, limitations of creatinine-based eGFR (muscle mass, pregnancy, kidney replacement); local list · source
lab_units@1.1 KDIGO 2012 and 2024 guidelines, unit conversion (creatinine 1 mg/dL = 88.4 umol/L; ACR 1 mg/mmol = 8.84 mg/g) · source
who1994_osteoporosis@1.0 draft, pending review · source

Record

Check RUN-00004 · kidney-engine 2.0 · replay 091c426b3502…. Data for this sidebar (JSON).

Library check LRUN-00004 · library_default_set@1.0 · library-engine 1.0 · replay c5f6663f69e1….

Decision support only: you decide and you write the note. Exact Dx 1.0.0 · data as of Fri Nov 13, 2026 04:55 PM