Joe,
We have the same issue you are having. As Daniel points out, the last signed OBS function returns results relative to the date/timestamp of the document you are charting under vs the current date/time. For example, if the provider opens up an encounter and starts a document for the patient visit on May 10 at 8:00am; and then lab results become available and are signed off at 8:30am on the same day, the LAST_SIGNED_OBS_DATE will identify the most recent date/time prior to May 10, 8:00am. In other words, you are not going to get the results and date for the lab results that were signed off at 8:30am, because the document that was started at 8:00am uses the document's date/timestamp as its reference point. While this is not necessarily a bug, it does surface a functional limitation in my opinion. The current workarounds include the following:
1) either the provider doesn't start their charting for the visit until all of the supporting lab data has been signed off; while this would work, it is a ridiculous workaround that I've never seen anyone adopt in the real world 🙂
2) sign off on the note without the most recent lab data, and then once the lab results have been signed, go back to the original note and append the lab results. This is better than option 1, but most providers I work with complain about how this looks in their note (i.e. the lab values lose their context when they appear at the end of the note); they also don't want to have to remember to go back to a previous note to append the labs
3) utilize a custom program that can read the most recent lab results directly from your LIS or extract the appropriate OBS terms (read only mode of course) from your database in order to document the results in the note
Using the OBSNOW() function is often not an option for lab results because many practice's rely on a third party or internal lab to deliver the lab results via an HL7 interface.
I have found from experience that providers prefer option 3, but it typically requires some coding experience and/or an investment in a tool that will allow you to pass a query to the database server and have it return results in a delimited string (usually pipe delimited) that you can then parse out and display on the form and/or in the note.
FYI, I have brought this limitation up in the past with the Northstar team when they were defining requirements for the new orders module. It will be interesting to see if and when this gets addressed. If anyone out there would like to see enhanced functionality around capturing and presenting lab data in an office visit note; PLEASE VOTE UP THIS RESPONSE. While there are third parties that provide enhanced functionality around lab data, I feel this is something that should be native to the software. It's hard for me to believe that our workflows are that "unconventional" when I see posts like this.
Posted : May 10, 2018 7:01 am
