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We are testing populating the flowsheet with interfaced Radiology results.
We've selected an obsterm to use for each modality. For example, all types of Xrays populate an obsterm called "xray, type". Then all MRIs show on one horizontal line in the flowsheet. No problem.
The issue comes in where 2 or more Xrays are received for the same date/time. This is populated in OBR-7 of the hl7 messages. The 2 results still populate the flowsheet but Centricity only shows the last one it processed on the flowsheet itself. What it DOES do is display a green circle to indicate there are multiple obs recorded for that date/time. But even if you drill down by hour/minute in the flowheet, you still only see the one value. That is because all the results have the same date/time. You can click on the value in the flowsheet and there is a small drop down displayed at the bottom which allows you to view/select date/times that new obsterms were recorded for that for the selected date/time on the flowsheet. Upon selecting a different value, you can then see the selected observation value in the details below. But that is not an ideal solution.
We discovered the techs at the hospital will select multiple exams and start them at the same time. This leads to the same date/time in OBR-7. Changing this is not an option.
The clinical staff says they need the date of the observation to be the actual Date of Service, so using OBR-22 (report signed date/time) or other field doesn't appear to be an option either.
While the issue isn't going to impact all patients with radiology results, it will for those that have multiple test performed for the modality and the same date/time.
Does anyone have any suggestions/recommendations? thanks in advance.
Posted : July 16, 2014 5:29 am
Centricity isn't really built to handle multiple OBS entries at the exact same time, so you're stuck with a workaround or modifying your workflow. A few ideas:
1) Have a second obsterm like "xray 2, type" and populate it when your first obsterm already has a value with the same datetime.
2) Scrape your database nightly (or after imports) for duplicate times on imported data and adjust one of the times by a few seconds/minutes/hours.
3) Scrape the database but instead of adjusting the times, move the data to a second obsterm as per option 1.
4) If a datetime already exists for an incoming OBS value, append the existing value instead of creating a duplicate.
Data-wise the best way to handle this would be to put the data into multiple obsterms to prevent overlap. I think most practices will use a different obsterm for each test, then at the form level they have to check each obsterm for contents. The real problem here is that CPS doesn't provide any abstraction at the flowsheet level, ie you can't group obsheads together in a flowsheet for easy viewing. I think this is a common problem when dealing with lab results. Hopefully one day CPS will figure out the need and give us more powerful flowsheets. For now I'd encourage you to keep your data as intact as possible and just deal with it at the UI level. You can build a custom History View with a table as a stand-in for a fancy flowsheet.
Justin
Posted : July 23, 2014 2:25 am
Topic starter
Thanks Justin! Good ideas.
Posted : July 23, 2014 4:37 am
I have been following this thread, as I am interested in a good way to solve this problem.
Justin, what do you mean by
... You can build a custom History View with a table as a stand-in for a fancy flowsheet...
Are you speaking of a custom History Template or a custom view in the database ?
Can you describe more fully what you mean here ?
thanks,
Beverly
Posted : July 23, 2014 4:41 am
I'm speaking of the "Histories" screen in the Chart module, selectable from the left navigation pane. You can add your own views from the Administration module under Charts->Chart->History Views. If you copy and paste a blank table from MS Word you can get a table into a view. Use MEL code to load whatever you like.
Justin
Posted : July 23, 2014 5:41 am
Excellent. Thank you 🙂
Posted : July 24, 2014 3:09 am
