Re: [Gnumed-devel] How to display your results

[Jim Busser]

Richard's ideas about function and display have been, and remain, quite 
helpful. It is good for the project to have people who think differently and 
who argue ideas, in some cases ideas that are compatible and in other cases 
ideas that are less so.

Richard's arguments about display are well taken. I would have us avoid to 
confuse storage, with display. It shall always be a good idea to structure 
storage sanely. The observations about display do not, I do not think, have 
their basis in the model of storage. I imagine it is more to do with the 
constraints of coding up the GUI elements.

With respect to whatever model of storage Richard has used, I am not sure 
whether in the case of the print-to-dislay (page dump containing a PSA in the 
middle of a blank page) he built into his software the provision for tagging or 
coding the result. It would come as no surprise that despite as good of a 
design as Richard no doubt managed,  a key problem remains doctors' lack of 
time to fix (if it depends on the doctor to tag) what the lab should have 
better done in the first place.

Here is a twist. The doctor has ordered tests. The lab supplies results 
information (see below, appended HL7 from which I removed the MSH and PID 
segments…)

1) NTE comments about the conduct of the test
        hours fasting = 14 <--- likely from the technician
        No Thyroid Meds / ? Hypothyroid <--- likely from the pathologist
        Added FT4 Td June 6/05 <--- decided by the pathologist? ordering Dr?

2) OBX comments (5 rows) from the pathologist, providing expert opinion about 
the thyroid portion of the results

@ Richard:

- how do you arrange for the pathologist's report to be "accessible" to the 
doctors who work in your EMR? In other words, do you somehow "relate" these 
comments to any of your patient's medical problems, or do these comments exist 
hierarchically (and only inside) the test results area?

How do you solve the problem where, at the same time, you wish results to be

        - in their respective little boxes, but also
        - not in little boxes (if this is what it takes, for "brush strokes as 
opposed to pixels")

**************************************************

To my view, one of the actual problems with traditional lab test results 
storage (paper and EMR) is that pathologist comments can get trapped in the 
section of the chart that is "results" and fail to get connected to the 
clinical formulation, and the possible need for action items and re-evaluation 
of the care plan.

One way of handling this would be shocking… we are so accustomed to looking for 
microbiology results and pathologists' comments in and among "granular data" 
that it feels weird to consider that you might actually want the pathologists' 
comments to be parsed *not* into a little box but redirected instead so that 
you would pipe

        parent MSH, PID, ORC, OBR
        plus the OBX comments

into a

        document of semantic type 'consultation'

and where the pathologist was (say) a clinical hematopathologist you might 
actually refer this patient to see this hematologist, and you could establish a 
chain of communication that later includes your referral letter to the 
hematologist and the hematologist's letter in return.


ORC|RE||05994047-GCM-0|||||||||90909^MDCARE^BOB
OBR|1||05994047-GCM-0|GCM^General 
Information||20050601083001|20050601083001|||||||20050601125101||90909^MDCARE^BOB||||||20050603101318||GENERAL|F|||90909^MDCARE^BOB
NTE|||Hours fasting =14 / No Thyroid Meds / ? Hypothyroid\.br\Added FT4 Td June 
6/05
ORC|RE||05994047-LIP-0|||||||||90909^MDCARE^BOB
OBR|2||05994047-LIP-0|LIP^Lipids|R|20050601083001|20050601083001|||||||20050601125101||90909^MDCARE^BOB||||||20050603101318||CHEM|F||^^^^^R|90909^MDCARE^BOB
OBX|1|NM|14647-2^Cholesterol|1|4.10|mmol/L|< 5.2|N|||F|||20050601165401
OBX|2|NM|14646-4^HDL Cholesterol|1|1.19|mmol/L|> 0.9|N|||F|||20050601165401
OBX|3|NM|22748-8^LDL Cholesterol|1|2.26|mmol/L|< 3.4|N|||F|||20050601165401
OBX|4|NM|9322-9^Chol/HDL (Risk Ratio)|1|3.4||<4.7|N|||F|||20050601165401
OBX|5|NM|14927-8^Triglycerides|1|1.44|mmol/L|< 2.26|N|||F|||20050601165401
ORC|RE||05994047-TSR-0|||||||||90909^MDCARE^BOB
OBR|3||05994047-TSR-0|TSR^TSH|R|20050601083001|20050601083001|||||||20050601125101||90909^MDCARE^BOB||||||20050603101319||CHEM|F||^^^^^R|90909^MDCARE^BOB
OBX|1|NM|3016-3^TSH|1|9.12|mU/L|0.10 - 5.00|H|||F|||20050602111101
ORC|RE||05994047-FTR-0|||||||||90909^MDCARE^BOB
OBR|4||05994047-FTR-0|FTR^Free 
T4|R|20050601083001|20050601083001|||||||20050601125101||90909^MDCARE^BOB||||||20050608095641||CHEM|F||^^^^^R|90909^MDCARE^BOB
OBX|1|NM|14920-3^Free T4|1|14.1|pmol/L|11.0 - 23.0|N|||F|||20050606144501
ORC|RE||05994047-PATHC-0|||||||||90909^MDCARE^BOB
OBR|5||05994047-PATHC-0|PATHC^Pathologist 
Comments|R|20050601083001|20050601083001|||||||20050601125101||90909^MDCARE^BOB||||||20050608095636|||F||^^^^^R|90909^MDCARE^BOB
OBX|1|TX|X10011^Pathologist Comments|1|Results could indicate subclinical 
hypothyroism||||||F|||20050608095201
OBX|2|TX|X10011^Pathologist Comments|2|OR non-thyroidal 
illness.||||||F|||20050608095201
OBX|3|TX|X10011^Pathologist Comments|4|Probable subclinical hypothyroidism. 
Serum held for||||||F|||20050608095201
OBX|4|TX|X10011^Pathologist Comments|5|FT4.If confirmed treatment is 
recommended if the||||||F|||20050608095201
OBX|5|TX|X10011^Pathologist Comments|6|anti TPO is elevated ( GPAC 
'04).||||||F|||20050608095201


-- Jim