Proper place to put point-of-care tests

(Daniel) #1

Hi all, I had question that might have more than one right answer. Is there a proper place to put point-of-care tests like glucose? Vitals might not be the proper place and maybe an LBF is not right for workflow? Any suggestions or input? Thanks!!

( #2

Hi Dan-
I haven’t seen an established ‘proper place’ in a stock OpenEMR to put those things. And in real life, I’ve seen practices put them in several different places for several different reasons.

For one, I believe there’s a large number of tests out there that would qualify as ‘point of treatment’ tests, and a practice takes them for different reasons. That makes them logically more suitable for placement in different locations in the pt record. As far as making one LBF with all possible tests on it, most practices would only ever use a fraction of them, so making an LBF with them all on it… they’d have to select the ones they used and hide the rest.

In the glucose example, some practices would routinely take a fingerstick glucose level every visit, so that would be reasonable to put on a VS sheet. And then, some practices would never do a finger stick, only a ‘24hr glucose tolerance test’ which generates different data.
I think that wide variety is the reason why I’ve seen places arbitrarily add the tests to the Patient Notes, or to a SOAP note along with the Nursing Notes for the visit, or somewhere else that made sense to them.

What might be a hoot is to build a LBF generator where they could input the desired fields and labels and other parameters, and it would create a LBF form for them! In the case of the point of care treatments they could make one with precisely the tests and data they wanted. It would produce a less feature rich form than doing it manually, but who knows, it might be useful?
Just thinking…

  • Harley

(Jerry P) #3

Yep, it’s called a procedure and could easily create the test in procedure configuration or compendium.

( #4

Hi @sjpadgett -
Ah, yes, I remember procedures:
is the wiki article on creating and using them.

As I recall, procedures would work for quick entry of discrete results but if you had several tests to document you’d have to do a multi-click step of searching for each one of the tests you wanted, to open the data entry screen. That instead of simply opening the encounter menu, selecting the test result form name and entering the data. And procedures are pretty complex to set up.

But according to the docs linked above, reports can be run on the tests’ orders and results. So all being said, procedures are a bit heavy handed and overkill for some applications but they would definitely do the job.

(Jerry P) #5

True on all points but i’ve done a lot of work in procedures and @zbig01 added very helpful helps(see what I did there.) so not the same procedure orders wiki refers.
Still, I get the point. However (great but replacement), I would think the ordering provider would not be the same person going a test. So workflow is provider orders and referrer does test and records results once results are had.
Going back to the encounter and creating a record of the procedure after the fact leaves open too many error possibilities such as, umm, which encounter am I supposed to record this procedure/test, what day was this test requested and by whom etc but(there’s the but), I may be ignorant of POC.

( #6

Interesting related post:

modifying the VS form to add a couple fields.
has discussion and link to customization of VS form.

(Jerry P) #7

In general I can see that A1c and glucose(finger sticks) need to be in vitals by default .
Plus if in vitals can track and look at trends.

I can do this for at least v5.0.3 and maybe bring back to v5.0.2. If we agree this is appropriate.

Any others need to go in vitals?

(Luis Angel Uriarte) #8

5 years ago I was asked to place glucose in vitals. Friend, I think it’s necessary.

(Brady Miller) #9

From a clinician standpoint, the place I would look for glucose FS and A1c would be in labs with the rest of the other labs. Probably better to make lab results easier to manually input (if that is the issue) and visualize/flow/chart (if that is the issue).