IS ET&I PRvSCCR

jcahn2 wrote on Sunday, September 01, 2013:

Interoperability Support with Electronic Transfer and Incorporation of Patient Records via Standardized Continuity of Care Records

4.12 (1) on Ubuntu 12.04.2LTS Firefox and/or Chrome

I cannot get this feature (abbreviation in the “Subject” line of this post) to work on any of my 3 installs nor on Sherwin’s nor the oemr.org demo.

Step 3 states, "3. After Uploading click the button Import" but I cannot see any button on the CCR viewing screen or this page in the document interface: http://***/interface/main/main_screen.php?auth=login&site=default

The most progress has been made on the oemr.org demo where there is one import waiting to be parsed, but that fails when attempted. Is this buggy or is it me? This is a critical feature to get my office to use OpenEMR

fsgl wrote on Sunday, September 01, 2013:

Hi Jack,

Just viewed and downloaded the CCR for Ali Ahmad on Sherwin’s Demo, for Betty Boop on the OEMR demo and for one of my patients. I’m using 4.1.2(1) on Windows 7. I presume you are not talking about EMR Direct.

Did you see the note about enabling pop-ups?

Did you try on Firefox?

Do you have trouble downloading other things, such as x12 files, patient statements and the native backups?

jcahn2 wrote on Sunday, September 01, 2013:

The downloading and uploading of CCD’s and CCR’s work fine. I have a very beautiful display of an uploaded CCD and CCR. My frustration is in getting the CCR to queu for parsing directly into the record according to instructions under Patient -> Import -> Upload. However, I am learning a thing or to through trial and error and I will post my experiences back here later.

fsgl wrote on Monday, September 02, 2013:

The Upload must be done in Firefox because it did not work in IE.

After uploading to Documents of an established patient, clicking the XML file brings up the Import button. Import & Approval both successful but no data in Patient Summary screen.

Yes, it is buggy.

fsgl wrote on Monday, September 02, 2013:

Import tried in the regular and OEMR 4.1.2 Demo’s, failing in the final step (the actual import into the patient record) with each attempt.

Tried with Import into Miscellaneous/New Documents. New account was created for Jane Seymour, but again failure of final step. So, buggy x3.

If the good folks at ZH Healthcare wrote the codes for this module, we need their help with the last step.

XML CCR Import deserves a Wiki article. It is not obvious that the XML file has to be clicked to generate the Import button. At a minimum, this should be mentioned in the Import directions.

I can see why it is an important feature for the transition to OpenEMR. But this appears to be a piecemeal approach. Batch transfer would be less time consuming and more efficient. Are you able to do the CCR import as a batch yourself, without professional support?

jcahn2 wrote on Tuesday, September 03, 2013:

I am slow reporting back due to lots of company over LD wk-end and having to dig a drainage ditch because, out of nowhere, a spring (read that “mud hole”) appeared in the center of my gravel driveway. It has been a record setting rainfall this summer in the NC mountains.

Ubuntu 12.04.2 oemr4.1.2 (1) Firefox or Chrome

Upload of *.ccr or *.ccr.xml works well I think. Clicking the entry under “CCR” whatever you have named it always brings up the viewer. When the viewer page is closed, the browser returns to the document page which now proudly displays the “import” button.

At this point, you MUST click import, because if you don’t, you will never get another chance. It will only appear the first time the hypertext file name is selected in the tree view under CCR. You can always discard it later. I suspect it was coded this way intentionally, but I don’t understand why so.

Then you can find a number of listings waiting for approval when you click “Pending Approval” in the left-nav tree.

Select the correct name and you have a list of all the data parsed into individual selection choices each with a thumbs up or down on import.

I am extremely grateful for this module but I do have issues:

I recommend >1 opportunity to select the import button.

Also the yes/no choice for each item should be one click - radio button or toggle on click.

Also need the option to select all items in a group (e.g all immunizations) in one click (an extra radio button for “select all”).

Also my diagnoses did not import (Title or ICD 9 code).

Also my Immunizations only imported the “date”.

Also no allergies.

I don’t think it is all the fault of the exported material form SpringCharts, as the data missing form the import to record is viewable on the CCR viewer (except diagnoses have only codes - no names.)

I volunteer to wiki this stuff when I get it right.

fsgl wrote on Tuesday, September 03, 2013:

I did not realize that Review & Approve meant that each item had to be selected in order for it to be imported. That is why the last step failed.

The module has been changed in the interim. Now it is only Approve instead of Review & Approve, therefore selection of each item is not necessary.

The module must be commended for the fact that an account does not need to be set up for new patients. Once the CCR has been imported via Miscellaneous/New Documents, an account is automatically set up for the patient.

The Demographics loaded but only 1 out of the 3 Issues did so. A little more work is required to make this a smart little module. Thanks, good folks at ZH Healthcare (I presume).

Thanks for offering to write the Wiki article. Please give us plenty of screenshots (very helpful to us non-techies) and also list it under Supplementary and Supplementary Topics.

Sounds like you had a nice time visiting with friends over the weekend.

jcahn2 wrote on Tuesday, September 03, 2013:

There are 2 functions for CCR import that I envision:
Internal: Data migration from old to new emr.
External: Information form referring docs, consultants, HIE’s etc that will now be incorporated into one’s record (whether existing or new).

For the external function it is a marvelous tool (sans the bugs that we have described). A lot of the medical record is generated from 2 sources of “fiber” - 1) coding requirements so that we get paid, 2) “meaningless use” requirements so that we get paid. When it is generated, the CCR is egalitarian about this information and we certainly do not want all the material that we know to be generated from fiber to be automagically entered into the record, so the ability to approve items in the list is important and needs to be done by someone with some clinical guidelines. I don’t want every URI and splinter extraction imported into my record.

Likewise for internal data migration, skipping the approval stage would bypass a golden opportunity to purge the waste material. Having a batch importing tool would be great as long as the approval stage is still required. There would also need to be a mechanism for selecting which records would make it into the batch, as this is also an opportunity to purge the inactive records from a practice.

That being said, the CCD would be the preferred tool for internal data migration as it also contains the progress notes, etc. We need a CCD import tool like the CCR tool we have now. How about that for greed Shameem? The CCD import would only be a partial solution because we would also need to migrate documents from the old emr. Obviously that is a whole new ballgame that depends on which database is used for document storage and how they are indexed - a new challenge for the support vendor.

Disclaimer: excuse the references to the GI tract, not a gastroenterologist.

blankev wrote on Friday, July 04, 2014:

XML CCR Import deserves a Wiki article. It is not obvious that the XML file has to be clicked to generate the Import button. At a minimum, this should be mentioned in the Import directions.

Since fsgl keeps track op everything available for OpenEMR there might be an answer to the above statement.

Did this WIKI ever materialize? It seems like a recurring question and answer problem and indeed, a nice WIKI for the in between group, better non developer of Developer that want to spent some easy time… (My dubious opinion)

fsgl wrote on Friday, July 04, 2014:

Jack’s group decided against deployment of OpenEMR much to his disappointment. Otherwise he would pursue this matter further. Wiki article was never written.

I don’t think that CCD is the way to transfer data into OpenEMR. Its original purpose is to provide a thumbnail sketch of a patient in transit between 2 offices. It’s the synopsis, not the book itself. Bear in mind, we are talking about the Continuous Care Document/Record.

New users are better served with database transfer via .csv files. I’m uncertain how Rod and professionals import the old database, but I doubt that they use CCD/CCR. No practice data, no appointment info, no clinical notes, no billing stuff; in short “transfer lite”. My thinking about this topic has evolved.

It is not possible to write an overarching Wiki article about .csv transfer because the tables of the old EHR may not correspond exactly to that in OpenEMR. If the new user is savvy enough to construct .csv files, he will be able to figure out the correlation between the two sets of tables.

For clueless DIY-ers like myself, it was a combination of reliance on the old system for the accounts receivable data with manual, very laborious, input of patient demographic data.

If the new user is not in either of these two categories, professional support would be the way to go.

jcahn wrote on Friday, July 04, 2014:

I felt there were too many bugs or issues to write instructions on how to use this function to transfer an electronic medical record into OpenEMR. AFAIK the bugs are still present.

@fsgl Au contraire. I think folks who have used an emr for several years, have hard drives full of crap - just like after years of paper records. Using a CCR (or preferrably a CCD) import one patient at a time and the da/nyet option for each important piece of data, provides an excellent opportunity to sanitize the record. I had planned on this import method, sans bugs, for our conversion.

The CCR could be the thumbnail sketch that you describe (for a consultant I supppose), but the CCD should be the complete mobile record that one would carry on the thumb drive, etc.

fsgl wrote on Friday, July 04, 2014:

Hi Jack,

Happy Fourth. Glad to see that you are still engaged.

Total non sequitur: the Sultana & Mr. Lincoln. Loved the Lincoln scholar’s comment about the President’s hagiography, although he used the word “deification”.

Back on track: ZH has been engrossed with Zend and perhaps MU such that your ideal may never come to pass.

jcahn2 wrote on Saturday, July 05, 2014:

The CCD import parsing fix was a part of our RFP. C’est la vie.