Open Standards for WordPress in Healthcare

Disclaimer: Code review of the WordPress code base
or other security measures should be done to ensure
security of sensitive and privacy-related applications,
like healthcare applications.

The Open Standards for WordPress in Healthcare aims to standardize application development in healthcare using WordPress content management system as application development platform. These standards go beyond the use of the content management system as a tool for creating informational or brochure-type websites or blogging, and extends to mission critical operation applications.

The standards focus on WordPress application development where there are multiple users with varying access level permissions to different types of content. Use of these open standards can be extended beyond the field of nursing – to other fields of healthcare service.

Scope

The Open Standards for WordPress in Healthcare focuses on four (4) main aspects of application development – data management, data presentation, security and user access levels. The standards will guide healthcare professionals on how they will define, store and manipulate data in the database; how these stored data can be presented using codes or plugins; preventing user access to the dashboard and admin bar for security; and how to provide user access privileges using the default settings.

Title: Open Standards for WordPress in Healthcare
Version: v1.0
Published: March 14, 2018
Revised: March 11, 2018
Initial Draft: February 18, 2018
Standard 1. Data should be defined as custom post type, and stored in the posts table of the WordPress database.

 

Most, if not all, healthcare web applications are database-driven applications. Database design usually dictates that data entries of different types should be stored in different tables to give structure and improve query performance. As an example, there should be one table for the list of patients and custom fields, a separate table for clinic or hospital visits, and another table for doctors or care providers and associated attributes.

WordPress was initially designed and developed as a blogging platform. Thus, every data entry revolves around posts. The integration of custom post types in WordPress core gave flexibility to support not just posts and pages, but other entities as well, such as patients, hospital or clinic visits, care providers, and the likes. To maintain compatibility, these data entries are stored and defined in the same table – the posts table.

If the data concerned is a news update, a blog post, or an entry of that nature, it can be defined as a post type of “Post” . However, medical information that is not considered a news update or blog post should not be defined as a post type of “Post” and categorized using taxonomies. These entries should be registered as custom post types.

 

Standard 2. Data entry fields other than those that can be found in the posts table, should be treated as meta or custom fields and stored either (a) in the postmeta table of the WordPress database as meta fields, or (b) in a separate custom table for each custom post type as custom fields.

 

Instead of creating additional table columns in the posts table, WordPress utilizes the postmeta table to extend data fields using metadata or custom fields, such as age, sex, date of admission, reason for admission, physician, and the likes. These metadata point to a particular post entry which is defined by the custom post type – patient, visit, or doctor for example.

There are methods and plugins that would allow the inclusion of custom fields as separate columns in a custom table, instead of the postmeta table. Though the accepted WordPress development ecosystem favors the use of the postmeta table to extend attributes and store entry fields through metadata, storing custom fields in a separate table for each custom post type may improve query performance and speed, and ease in creating reports using the stored data. One drawback with this data structure though is that the system being developed may work with plugins compatible with custom post types (as long as data is still defined as a custom post type), but not integrate well with plugins that map custom fields as metadata in the postmeta table.

 

Standard 3. Data entry and modification by users should be done in the front-end. Only administrators should have access to the back-end, including the dashboard and admin bar.

 

As a platform initially created for blogging, the WordPress dashboard was designed for interaction between contributors/authors and editors/publishers. The administrative back-end revolves around content creation, editing and publishing. For security reasons and to have a smooth user experience that extends outside the realm of blogging, all data entry and modification by users should be done in the front-end. There are plugins available to achieve this functionality. Advanced developers can also use custom codes to lock these back-end features for administrator access only.

The developer has the option to manually code the form layout in the front-end, or use plugins to create submission forms or edit fields. The decision of whether to use manual code or plugins to lock regular users from accessing the dashboard, admin bar, and other back-end features depends on project management and security measures instituted.

 

Standard 4. When displaying custom fields, the developer can (a) use the WordPress template development process by creating a “single-post_type.php” file inside a child theme folder for each custom post type, (b) use plugins to display custom fields through a templating system, or (c) use the content area as a template canvas to display custom fields.

 

When creating WordPress post templates, the developer needs to have good knowledge in PHP, HTML and CSS to properly display metadata or custom fields. Configuring single post type templates can be done by creating a “single-post_type.php” file inside a child theme folder for each custom post type. The reason for creating a child theme and placing the changes inside the child theme folder is to prevent updates to the parent theme from modifying or deleting changes made, like post and page templates. The WordPress Codex contains valuable resources in WordPress development, including child theme development (https://codex.wordpress.org/Child_Themes).

There are plugins available that would allow designing of post templates without creating a child theme and manually coding a “single-post_type.php” file for each custom post type. These plugins, however, use their own templating system to render the post templates in displaying custom fields. So when these plugins are deactivated, the system will revert back to the default post template.

For technology-inclined healthcare professionals who are just starting to delve into WordPress development, the content editor can be a good area to display custom fields using shortcodes specific to particular custom fields plugins. The WordPress content editor is a What-You-See-Is-What-You-Get (WYSIWYG) editor and can be used as a template canvas where custom fields can be displayed using shortcodes.

 

Standard 5. Users, roles or user groups, access levels and capabilities should be based on default WordPress settings.

 

For security reasons and to adhere to default WordPress settings and installation, users, roles or user groups, access levels and capabilities should be based on default WordPress settings.

User attributes can be extended using custom fields. Roles can be created and extended, with capabilities added or removed. These roles need to be in the default settings and not dependent on third-party plugins using different database structure. It may be possible though for plugins to have their own set of roles or groups, but these have to be synchronized with the default WordPress roles to adhere to this standard.

 

References

Brazell, A. (2011). WordPress Bible (2nd ed.). Indianapolis, IN: Wiley Publishing Inc.

Lefebvre, Y. (2012). WordPress Plugin Development Cookbook. Birmingham, UK: Packt Publishing.

Messenlehner, B., & Coleman, J. (2014). Building Web Apps with WordPressWordPress as an Application Framework. Sebastopol, CA: O’Reilly Media Inc.

McGonigle, D., & Mastrian, K. G. (2017). Nursing Informatics and the Foundation of Knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.

McLean, A. (2015). Open-source software. Canadian Journal of Nursing Informatics, 10(3).

Onishi, A. (2014). Pro WordPress Theme Development. New York, NY: Apress.

Ratnayake, R. N. (2017). WordPress Web Application Development (3rd ed.). Birmingham, UK: Packt Publishing.

Williams, B., Damstra, D., & Stern, H. (2015). Professional WordPress: Design and Development (3rd ed.). Indianapolis, IN: John Wiley & Sons, Inc.