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[Gnumed-devel] Fwd: re: Possible development opportunity

From: J Busser
Subject: [Gnumed-devel] Fwd: re: Possible development opportunity
Date: Mon, 13 Sep 2004 13:05:49 -0700

I don't know if there is a specific messaging code, but to get the 90% inr results (+clinical notes) in, may see if there are specs of how/if the results can be downloaded from the individual path labs. ( e.g. as csv files , simplest). These can be put in the test_result table collaboration.

The two large, private labs created a joint venture company to service their data needs and to optionally serve the needs of other "suppliers" and offer three options:

i)  printed reports (mailed, and faxed when requested on a case by case basis)
- this is what a lot of people still use

ii) web-based portal
- this is what the anticoagulation clinic secretary uses
- permits quick access to results
- requires the data service technician to personally do the install on one's computer
- drawbacks include "pull" technology
   (someone must log-in, you never know when new data is available)
(printing from the portal is less useful than the traditional reports on colored paper)

iii) data download
- they use HL7 and LOINC but are switching their connection protocol (sorry if it's the wrong term) to SSL VPN, approaches to this point have involved loading the results directly into one's data tables and not a file download. I will pursue getting further details.

You could also have a hand entry screen, perhaps a table form resembling the work sheet, and each row linked to patient search for linking with a patient. This work sheet also allows nurse to enter dosage change, clinical notes and next test date entry, after it has been written down on paper as usual after discussing with cardiologist, and the patients' have been rung, as usual. In other words, the nurse still writes it down on paper and the original workflow isn't changed too much.

A hand entry screen will still be important. part of the 10% of results (it could be 15-20% depending on the patient group) could originate from hospital or small private labs, and although some of these can send data through an electronic provider, this data is either coded arbitrarily or not coded at all and just an ASCII dump.

Someone can modify the schema to accept planned actions in general, or just dosage change specifically, and I think the current schema has lab_request table which can be used to store the next test date entry.

see my next email about test results vs therapeutic ranges

A application trigger can be used to scan for lab_requests with id numbers newer than before the worksheet was invoked, and generate mail to be sent the path company ( possibly signed as well) and also publish to a web (?xml files) directory on your web server as further confirmation. Scheduled , sent and confirmed mail can be recorded in a table and viewed as a report.

Local lab companies seem very uninterested in receiving lab requests electronically except hand-entered into their portal which nullifies the advantage of an EMR :-(

Reports can be generated joining the demographic detail, lab_request, lab_result, and a cardiologist recorded recommended dose and recommended next test, and comments, which should probably be double checked by nurse and cardiologist each day.


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