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CEP-8: PDF Generation in Care

Proposal Preface

Care is currently using django-hardcopy to generate discharge reports, which utilizes Chromium Headless for rendering Django templates in Chrome and converting them to PDF. However, this method is not very efficient and could be improved by using a native Python package that can directly convert HTML to PDF without the need for browser rendering. This would result in lower resource consumption and increased efficiency.

Currently, this function is responsible for generating PDFs, and the following is the Django template used for generating reports using Tailwind CSS and Django templates.

Drawbacks of Current Approach​

  • Dependency on Chromium Headless: Adds significant overhead and resource consumption.
  • Increased Docker Image Size: Including Chromium Headless impacts deployment and scalability.
  • Slower and Less Efficient Rendering: Generating PDFs through browser emulation is slower and less efficient compared to native PDF generation.
  • Higher Memory Usage: Requires higher memory usage during PDF generation, potentially affecting performance and responsiveness.
  • Lack of Recent Maintenance: The absence of recent maintenance and updates for django-hardcopy, last seen in July 2018, has raised concerns regarding possible security vulnerabilities.

Proposed Solution

Initial Solution Approach​

Initially, I considered utilizing a Python library like WeasyPrint or xhtml2pdf. Both libraries offer Django-friendly code. Here are the respective documentation links for further reference:

After conducting further research and receiving feedback, I came across a recent article by Zerodha that discussed PDF generation. This is where I discovered Typst.

Final Solution (Using Typst)​

Initially, PDFs were generated from HTML using Puppeteer, which involved spawning headless instances of Chrome. According to the Zerodha article, their earlier tech stack, similar to ours, relied on headless Chrome for PDF rendering, which proved inefficient at scale. However, they transitioned to Typst, noting its efficiency and scalability benefits. This sparked my interest, leading to extensive research validating Typst's effectiveness and credibility through various references.

We can also refer to the official documentation, to get detailed information related to the tool.

I engaged with the Typst community and moderators on Discord, where I received predominantly positive feedback and had productive interactions. The notable advantage I found with Typst is its freshness compared to competitors like LaTeX. While it may have fewer available resources for reference, my experience within the Typst community has been positive. The community is extremely helpful and responsive, making any potential lack of resources a minor concern.

By adopting Typst for our PDF generation needs, we can significantly improve the efficiency and scalability of our discharge report generation process, ensuring lower resource consumption and enhanced performance.

Implementation Plan​

  • Step 1: Update Docker Files to Add Typst Dependencies

  • Step 2: Update Helper Functions for Typst and Create a Wrapper for Typst to Compile Templates

  • Step 3: Create a Static Template for Our Report

  • Step 4: Integrate Typst with Django Templates in Our Project

  • Step 5: Create Tests

  • Step 6: Remove All Previous Dependencies and Remove Chromium and django-hardcopy

  • Step 7: Update production files for the changes

Step 1: Update Docker Files to Add Typst Dependencies​

Since we don't have an apt installation for Typst, we can download it from the official releases according to the build we are working on. Updated Dockerfile : dev.Dockerfile

Step 2: Update Helper Functions and Create Typst Wrapper​

First of all we have to create a wrapper function to allow our typ binary to compile our template. The updated function - compile_typ

After creating a wrapper we can update our helper functions. Updated helper function - generate_discharge_summary_pdf

Step 3: Create Static Template for Reports​

Static Report Template progress could be seen here - Report Template.

Now this document just contains different components that I've used in the template.

Step 4: Integrate Typst with Django Templates in Our Project​

Updated the previous template using HTML/CSS with Typst. Template can be at patient_discharge_summary_pdf_template.typ

Step 5: Create Tests​

Generating PNG of the pdf using typst and comparing using Pillow library. It involves have sample png images of the pdf in care/facility/tests/sample_reports folder which are to be compared with the newly generated pdf pngs , if identical the test cases passes, else throws error.

To Update the sample PNG files, we can update the test_compile_typ function by adding the below code to test function below line 59.

subprocess.run(
    ["typst", "compile", "-", sample_file_path, "--format", "png"],
    input=content.encode("utf-8"),
    capture_output=True,
    check=True,
    cwd="/",
)

To investigate any errors, we can remove the finally block from our test_compile_typ. It'll generate the test_output{n}.png files in care/facility/tests/sample_reports folder, from where you can use image diff checker to investigate the differences.

if in future we decide to add more data to the test function and the number of pages increases, then one should also update the number_of_pngs_generated number to the number of pages of pdf generated.

Step 6: Remove All Previous Dependencies and Remove Chromium and django-hardcopy​

Updated all the functions utilising the older dependencies with the newer versions and removed django-hardcopy from pipfile and chromium from docker file.

Step 7: Update production files for the changes​

Updated prod.Dockerfile to remove older dependencies and added newer dependencies.

Updates in the template are listed below

Patient Detail section​

  • Remove Date of Birth field

Admission Details Section​

  • Removed Decision After Consultation field
  • Removed Examination details and Clinical conditions field
  • Removed From field
  • Added Duration of Admission field , which shows the time span the patient was admitted (discharge date - encounter date)
  • Added Admitted to field , which shows the bed and it's type
  • Added Diagnosis at admission field which shows List the ICD-11 in the following order - confirmed,provisional, unconfirmed, differential
  • Added Reported Allergies field, which shows the list of allergies
  • Added Symptoms at admission field ,which show list of all active symptoms at the time of admission

Health Insurance Details​

  • kept the table as the last item below discharge details

Treatment Summary Section​

  • Combined Prescriptions medication details into a single table with updated format
  • Removed Treatment Plan
  • Removed General Instructions
  • Removed Special Instructions
  • Removed Prescription notes it is not relevant for discharge summary

Discharge Summary Section​

  • updated Discharge Notes to Discharge Advice
  • Added Discharge Prescription table

Others​

  • Removed Symptoms and Diagnosis (ICD-11) tables and Health Status at admission section
  • Removed Daily Round section
  • Created three new templatetags , one to format prescription, one to format_to_sentence_case and one to handle empty data
  • Added conditions to update fields name according to admission status

Results​

  • Typst is 8-15 times faster in generating PDFs
  • Container size decreased by 30%
  • Typst is 10-15% more memory efficient
  • We eliminate the overhead associated with browser-based rendering, resulting in a more efficient and scalable process.