Hugo Halloway · Notes · Demo Health Record (demonstration)

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

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COPD follow-up note

Unsigned draft

Type: Clinic visit
Date: 2026-11-10 12:00
Author: Dr. Imogen Vale
Status: Unsigned draft
Drafted by: Clinician-typed

Edit note Signing is never blocked.

COPD follow-up. S: Stable dyspnea on exertion, no exacerbations since spring. O: SpO2 94% on room air. Scattered wheeze. A/P: 1. COPD: continue inhaled maintenance therapy; pulmonary rehab referral. 2. Tobacco use: counselled; nicotine patch offered.

The note does not mention this.

Visit diagnoses (as entered by the clinician)

Chronic obstructive pulmonary disease, unspecified

Exact Dx Before you sign

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

1 to look at before you sign · 2 checked

Needs a look Kidney function over time

Two kidney results 180 days apart are in the G4 range (filtering rate 25.6 on 2026-05-14 and 23.4 on 2026-11-10); the note doesn't mention kidney function.

Where in the note? Show the results

The note does not mention this.

Show all (2)

1 more, grouped by what was measured. At most three are shown above at once.

Lung function and oxygen Needs your clinical judgement

Needs your clinical judgement Lung function after bronchodilator Draft · pending review

The note says COPD. FEV1/FVC 0.58 on 2026-09-11 10:00; FEV1 % predicted 62 % on 2026-09-11 10:00: the record shows these values; this needs your clinical judgement (gold2026_copd_airflow@1.0 uses them as one part of a wider clinical picture, category “FEV1/FVC below 0.7 with FEV1 50 to below 80% predicted (grade 2)”).

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

Show in the note Show the results

Published definition and source

Global Strategy for Prevention, Diagnosis and Management of COPD: 2026 Report — Pocket Guide
gold2026_copd_airflow@1.0

In patients with COPD (FEV1/FVC < 0.7): GOLD 1: Mild FEV1 ≥ 80% predicted; GOLD 2: Moderate 50% ≤ FEV1 < 80% predicted; GOLD 3: Severe 30% ≤ FEV1 < 50% predicted; GOLD 4: Very Severe FEV1 < 30% predicted

Global Initiative for Chronic Obstructive Lung Disease (GOLD) · edition 2026 (pocket guide v1.1, 20 Nov 2025) · Figure 2.10 (PDF page 20); key points (PDF page 11) · opened 2026-11-14 · source

Threshold for this category (gold2026_copd_airflow@1.0): FEV1/FVC < 0.7 and FEV1 % predicted ≥ 50 % and FEV1 % predicted < 80 %.

Draft definition: pending clinical and coding review.

Details

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
gold2026_copd_airflow@1.0 draft, pending review · source

Record

Check RUN-00007 · kidney-engine 2.0 · replay 42508c0c3a9b…. Data for this sidebar (JSON).

Library check LRUN-00007 · library_default_set@1.0 · library-engine 1.0 · replay 7e6a5c327d65….

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