Image results MU2 Certification

OpenEMR Development
1

jeyasithar wrote on Tuesday, October 22, 2013:

Hi Brady,

I am analyzing the image results module of MU2 certification. As per my understanding, we can use the document section under patient summary to pass this requirement. Is my understanding correct? Or we need to integrate any 3rd party application to view the image results as well?

Thanks,
Jey
Computech

2

mdsupport wrote on Wednesday, October 23, 2013:

Few questions based on the test doc -

  1. Currently a document can be associated with an issue which is a huge limitation e.g. with lab reports that span across several issues. This probably is not a deal breaker from MU2 perspective but if you do decide to address it, please, please use issue<=>document type of structure and not store multiple issues in a single field.
  2. Currently there is no display at issue level indicating related images/information exist.
  3. Current document structure will have to be extended for an indicator to tell if the document/image contains interpretation.
  4. Not sure if the description of IN 170.314(a)(12) – 1.01: requires ability to store and indicate links to external images or application where those images can be accessed. If yes, currently there is no provision to store links to external documents.
3

jeyasithar wrote on Wednesday, October 23, 2013:

Thanks for your sharing your views. So please confirm the following,

  1. We should have to integrate a 3rd party application to view the images (radiology).
  • We can use notes field under documents section for narrative interpretations about the images.
  • We should add additional field to capture external link of image (optional field) under document upload section.
  • On clicking 3rd party link added here will navigate the user to the 3rd party application to either view/download the image.

Guys, Kindly let me know if anybody working on this.

Thanks,
Jey
Computech

4

mdsupport wrote on Wednesday, October 23, 2013:

Perhaps Visolve or other testers need to interpret the 3rd party requirement because it is such an open-ended objective. Also consider the platform limitations - this is web only client so your ability to ‘integrate’ depends on the 3rd party supporting that ability. Hopefully certification is based on minimum threshold of ability to view images which is partially present. Please review the documents viewer code to see if the viewer passes the required tests.

Not sure how you are planning to treat notes as interpretation - does it mean if notes is not null => interpretation exists? Those implicit flags are never a robust solution. It may be easier to add a boolean or even a description telling where interpretation can be found.

5

visolveemr wrote on Thursday, October 24, 2013:

Hi Jey,

Image results could be achieved in two ways

  1. EHR can store the image in their DB itself and link the images & narrative interpretations to the placed radiology order.

  2. EHR can integrate to the third party application in which linking to images should not require any additional sign in or look up for patient. The link should take the physician to corresponding patient’s image directly.

So the following features are required

Indicate:

Indication of arrived results for radiology tests ordered. It could be link or any other indication

Access:
Click on the link should take the user either to the document section which has images and narrative interpretations stored or to the third party

Please do see my replies inline for your statements

1.We should have to integrate a 3rd party application to view the images (radiology). – Yes

2.We can use notes field under documents section for narrative interpretations about the images. – It would be better to have the narrative interpretations where ever the images are stored. But We doubt the accuracy of interpretation if manually entered.

  1. We should add additional field to capture external link of image (optional field) under document upload section. --* There should be a link against placed radiology order and not in documents section.*

4.On clicking 3rd party link added here will navigate the user to the 3rd party application to either view/download the image --* Yes*

Thanks,
ViSolve
MU Consulting Team

6

mdsupport wrote on Thursday, October 24, 2013:

How about current capability where
. Proc order is placed with imaging center
. Lab responds with hl7 that contain images and other readings
. Hl7 processed with images in documents and narration in the order results table
. Ordering User gets message with link to the results. Results have link to images.

If this is ok then after rod’s patch we should be ready.

7

sunsetsystems wrote on Thursday, October 24, 2013:

Yes, the recent procedure ordering/results update handles images embedded in HL7 results. It’s working well for PDFs from path labs, though raw images from radiology for example might be too big for this to be practical.

Rod
http://www.sunsetsystems.com/

8

visolveemr wrote on Friday, October 25, 2013:

I agree with first three steps you mentioned. Shall we change the last step to provide link against the order placed rather than in messages

Ordering User gets message with link to the results. Results have link to images.

Thanks,
ViSolve
MU Consulting Team

9

jeyasithar wrote on Friday, October 25, 2013:

Thanks guys.

So to summarize,

  • With Rod’s procedure order module, we can build the image result handling functionality.

i.e Place image order from procedure order section to radiology lab
2. Radiology lab PACS will send the DICOM results
3. Interface engine will parse the DICOM result and store the patient metadata in the DB, which will get reflected in the Procedure Results section
4. Configure the interface engine to store the image from the DICOM result in a ‘documents’ directory (which is specific to user)

  1. Even we can use the CouchDB documents management module contributed by ZH Healthcare and this way the documents management (including backup) will be done at ease.

Rod, Can i go ahead and pull your code for testing. Please let me know.

Thanks
Jey
Computech

10

sunsetsystems wrote on Friday, October 25, 2013:

Hi Jey, the commit for support of documents embedded in electronic results is already in the current master branch, so you can just pull that. If you’re interested in the commit itself, that’s here:

But again, that’s about embedding the images directly in the HL7. If it’s just a link being passed, some code enhancement is probably needed to do something intelligent with that.

Rod
http://www.sunsetsystems.com/

11

mdsupport wrote on Friday, October 25, 2013:

It may be better to get clear idea / even step by step testing requirements from Visolve before Jey spends time on modifications.

Regarding message links, currently message notifications do contain link to the order which coincidentally also display results since it is geared for lab results. This or some other display page will need development related to embedded DICOM browser instead of current lab test >> test results type of table layout.

If certification testing permits, we can supplement SFTP/background processing since Rod’s process lets you upload a file manually. We have further modifications which will let you manually upload a order related document while in order viewing mode.

Regardless of process, point made earlier about ‘issues’ still needs to be addressed. Rod uses a general purpose ‘from’ <=> ‘to’ table for linking various entities. This could be a great way to leverage that functionality.

Challenge here is prioritizing MU2 Certification vs usability. Since MU2 is a must have in near future, it may be good to set that as first target, get this item to ‘green’ and then let community add features that do not jeopardize certification readiness.

12

visolveemr wrote on Monday, October 28, 2013:

Here are the step by step testing procedure to be performed for image results [taken from ONC test procedures]

  • Create a patient record and populate with narrative interpretations and associated images (or links to associated images) for two or more radio-graphics or other diagnostic tests.

  • Tester will evaluate the availability of patient’s images and associative narrative interpretations indication.

  • Tester accesses the patient images and narrative interpretations and validates for accuracy.

  • Tester also validates that the images and interpretations are accessed without requiring additional patient look up or selection.

Please do let us know for further clarifications.

Thanks,
ViSolve MU Consulting team,
services@visolve.com

13

jeyasithar wrote on Monday, October 28, 2013:

OK. I will pull the master branch now. I will explore the code and keep you posted with the steps being taken by me.

14

sunsetsystems wrote on Monday, October 28, 2013:

Sounds good, thanks Jey!

Rod
http://www.sunsetsystems.com/

15

bradymiller wrote on Sunday, February 09, 2014:

Hi Jey,
Just checking in if this is still being actively worked on.
thanks,
-brady
OpenEMR