mdsupport wrote on Monday, September 30, 2013:
Rod,
We are beginning to see situations where other practices are directing common labs to CC us on the results.
So we are looking for ideas to store these historical/external order results using current structures. While the HL7 results can obviously fill report & results tables, we would hate to create dummy orders and encounters.
Just throwing it out as this trickle that can quickly become a flood.
Thx.
sunsetsystems wrote on Monday, September 30, 2013:
Not sure exactly what you’re looking for, but the results HL7 is already archived in sites/sitename/procedure_results/. If you want them in current tables then I think we can work out acceptability of a 0 encounter ID, but something to fill in for the order will be needed.
mdsupport wrote on Monday, September 30, 2013:
Consider two different scenarios:
Both can be treated like a manual upload process in current logic.
Currently when you upload a file, the receive process extracts openEMR order number and uses it to link results with the patient + encounter. The issue here is processing a valid HL7 file for an order by another physician and processed by a lab not set up in openEMR. For this file, receive process cannot (in fact should not) be use the order number in the file. We can change ask some confirmations and digest the file by creating an proc_order record for manually specified patient with encounter nbr as 0.
The reason for the question is although the first issue was dealt with, resulting order and its associated results will not be truly usable. This data will be ‘invisible’ to rest of the package which relies on forms table. So for starters something as simple as patient asking for a printed copy of the file they gave us, openEMR will not show it patient report where the access is patient >> encounters >> forms…
This will become a major issue as we will be sending hl7 data along with referrals and expect to receive the same.
sunsetsystems wrote on Tuesday, October 01, 2013:
Yes, of course in that situation the missing order will need to be created on-the-fly as results are processed. This is something that I’ve always considered would be done when the need arose.
cmswest wrote on Sunday, October 06, 2013:
May I suggest another scenario?
If one can’t send hl7 lab orders but only receive hl7 results then missing orders have to be created on the fly because there is no knowledge of the order id. Currently a practice using openEMR has to send paper lab slips to the local hospital lab which handles 99.9% of their lab work. However, the outbound hl7 result comes through the HIE.
Do you have any plans to address this before the end of the year? I have access to interface reimbursement from my REC as an enticement.
mdsupport wrote on Sunday, October 06, 2013:
Someone has to create a order as a proof there was need. Someone has to confirm specimen was collected and sent physically. So it does not make sense to create orders. That is legal risk.
We already do results only interfaces. Wish we got any incentives for that!
sunsetsystems wrote on Sunday, October 06, 2013:
Stephen, yes that’s the method I was suggesting. The “on-the-fly” order would just be an artifact of the results-only interface and would not indicate, legally or otherwise, that it represents the actual order (which presumably is on paper somewhere). I would be happy to assist - just email me.
mdsupport wrote on Sunday, October 06, 2013:
Rod, Stephen -
It takes 4 clicks (in Stephen’s case 3 clicks) / 15 seconds for clinician to create a blank order - no tests. Lab order sheets are filled as in the past - only change is pulling up report of orders not sent and printing them. The printed order sheets are stapled to lab test sheets. This allows us to catch exceptions when lab transmission does not match one (and only one) order with pt name+dob+source(lab)+collection date combination. Import process adds individual tests as needed so that a completed order has all codes from the lab. Now front office has ability to track lab orders and answer calls from patients.
Cost (15 seconds) vs benefits are compelling for us. We understand there may be other situations. So if automatic order creation is added as a standard feature, please make it optional.
sunsetsystems wrote on Sunday, October 06, 2013:
MD Support: Yes of course a results-only interface would be optional. But you started this thread with a desire to receive CC’d results, so we want to accommodate that also. Let me know if you have thoughts as to the rules for accepting vs. rejecting incoming results with no matching orders.
Thanks.
mdsupport wrote on Sunday, October 06, 2013:
When the patient presents any data, it has to be accepted with a note that source is patient…
When data comes from other sources, it becomes complicated. With CC’d results, distinction has to be between solicited vs. unsolicited receipts. So we are still trying to figure out a staging area and appropriate steps to get ok from patient and / or requesting physician. Catch here is HL7 is not a friendly format for users to read.