I have created several workflows for this type of project, to include Medfusion's encounter forms and Visual Signature Capture's integration with SuiteRomeo. I also collaborated with Dr.Thompson to create the background code for PatientLink's more recent integration workflow.
There are several factors that must be considered when creating the workflow to include: Importing values signed before the update was started, importing values after the update was started, and importing values for that rare moment of at the exact same time the update was started (yes, they all use different coding pathways). For those values before the update was started, you need to decide if you want to use a 'time frame limitation' for the age of the DEP value or if you simply are going to accept data from any date. Then you need to consider how to handle duplicate data (free text comments are a complete mess due to the lack of structure so how do you handle those?). Lastly, creating a crosswalk between portal values in 'plain speak' and obsvalues in you forms which are appropriately more in line with proper medical terminology. And don't forget the table based family history and structure because you will need a SNOMED-CT crosswalk for that workflow too.
Does the portal (input system) permit population of previous data so the patient is not forced to re-enter all of it again? If yes, then what to do with that data and how to 'date' it (keep it as previous or re-establish it as new)?
You will also want to consider how data is used in the EMR as it relates to audits and tort law. As Joe alluded to, it 'might' make sense to accept a direct population of data from the portal, but be certain to understand the ramifications if those values are brought in to the udpate as 'obsnow' (obsnow stamps the value with the user's credentials - a potential issue on many layers). I typically recommend DEP obs for everything and avoid direct population to alleviate potential concerns.
If your portal system presents the last values to the patient, don't forget to create workflows that reverse the process and updates any DEP value that might have been updated in the office visit, otherwise, bad information will continue to repopulate.
I would go into more detail, but hopefully you can see that there are numerous workflows and design considerations which make it difficult to express in a post. If you are at C-Live, look me up and I will be happy to discuss further so that you can begin to formulate a plan.
Hope this helps.
Posted : May 16, 2017 5:05 am
