PFT Data Integration in the Electronic Medical Record

Transcription

1 PFT Data Integration in the Electronic Medical Record Matthew J. O Brien MS, RRT, RPFT, FAARC University of Wisconsin Hospital Madison Wisconsin Focus Spring 2018, Memphis TN

2 Conflict of Interest I have no conflicts of interest related to this presentation. I have provided presentations for: MGC Diagnostics Methapharm ERT Carefusion Our lab uses a mix of PFT systems/products including: MGC Diagnostics, Jaeger, Vyaire, ndd, nspire, Ecomedics, Ganshorn, Hans Rudolph, Circasia.

3 Electronic Medical Records

4 Objectives Terminology related to EMR interfaces What is an HL7 message? Outline options for data integration The process and team members Steps to take for a successful EMR interface Timelines Project pitfalls and how to get it back on track

5 Overview of HL7 and EMR EMR is the system HL7 is a set of standards Language for messages between various systems Labs Imaging (PACS) Dictation EMRs Lab PACS EMR Radiology PFT PFT Billing Dictation

6 Options for data integration Scanning the PDF report. Importing the PDF report. Integration of the MD interpretation within the PFT report. One-way or unidirectional interface. Bi-directional interface. Including discrete data parameters Including PDF report

7 Terminology related to interfaces HL7 interface Middleware Unidirectional or bidirectional interface Incoming / outgoing message Tabular data or results review PDF link OBX and OBR segments

8 HL7 Stands for Health Level 7 (standard) Allows various applications to communicate Structured content between systems EMR to PFT, EMR to Lab, EMR to Pharmacy Outbound messages Interface engines Translator for devices to communicate using the HL7 standard. Middleware

9 What an HL7 Message Looks Like

10 The HL7 Message Structure Segments separated by characters and field separators MSH: message header PID: Patient ID Name, med record Pipe characters separate fields OBR and OBX lines Separate detail of observation PFT numbers

11 Scanning in the PDF The most basic option Print, scan and place for interpretation. Advantages Low cost Faster now because of software and hardware changes. Reliable Disadvantages Location in EMR maybe limited (media or outside docs tab) No tabular data in the results or lab area of the EMR. Labor task Resolution of some images might suffer.

12 Scanning Low or high tech Various software options Indexing automation software Documents require: First name Last name DOB Med record number Bar code

13 Scanning workflow Scanning requires attention to detail and preparation. Staple removal Post-it positioning Black and white verses color Scanning resolution Batch numbers Quality control (did the document post?) Document disposal

14 Location of Scanned Reports Often PDF images of Pulmonary Reports are stored on a server and accessed via a link. The link takes you to the PDF or PACS image server.

15 HL7 Interface & PDF only export to EMR PFT order E M R PDF MD places order for PFT Patient registers or checks in Incoming order triggers from EMR to PFT system PFT staff imports patient data PFT staff tests patient PDF exported to EMR from PFT system Advantages Minimal programing required Disadvantages No tabular data in the results or lab area of the EMR.

16 HL7, PDF export and MD interp to EMR PFT order E M R PDF MD places order for PFT Patient registers or checks in Incoming order triggers from EMR to PFT system PFT staff imports patient data PFT staff tests patient MD provides interpretation in PFT software PDF exported to EMR from PFT system MD Interp Advantages Minimal programing required Disadvantages MD needs to be trained on PFT software to enter interpretation

17 MD Interpretation directly in EMR PFT order E M R PFT output MD views PFT data MD places PFT interpretation directly in EMR Voice dictation or Smart phrases MD Interp

18 Sending the PFT parameters and PDF Most vendors have a set key stroke for this PFT System EMR

19 Prep Work---Pre Interface Is your current PFT system / equipment up-to-date? Hardware Software Operating system? (XP, Win7, Win10) System CPU Are you considering switching vendors? What kind of interface do you think you need? Have you met with IT to see if they are available? Do you have an IS analyst with experience? Is the hospital HL7 person available? Have you budgeted for the capitol expense?

20 The Team Members PFT Lab Manager or senior staff Hospital IS Interface analyst Sever team Security team HL7 coder EMR specific teams HOD Ambulatory Vendor Sales person Project manager Interface specialist

21 The Process 1. Determine what type of interface is needed / desired 2. Get the project approved by hospital IT 3. Budget (more than enough $ and get approved) 4. Complete specifications document and send to vendor. 5. Obtain quote and agree on realistic timelines 6. Purchase interface and or licenses 7. Install software on test PFT system Create reports and test Incoming / outgoing messages Test PDF posting 8. Install software on production server 9. Install software on main PFT systems and turn on the interface

22 Project management for an Interface

23 Time lines for an EMR Interface? 5 months? 1 week 2 weeks 3-6 months 1 month Planing, budgeting and approval Agree on specifications, timeline and price. Purchase interface. Obtain security access for vendor. Install software Build reports. Test incoming messages / patient data Test reports, verify document an or tabular posting of data Find errors Test every report Move from test environment to production environment

24 Simple Tabular data in the EMR

25 Tabular data in an EMR over time

26 PDF data in the EMR

27 Trending Spiro in the PDF report

28 Example of off-line data entered

29 Problems with the data display Tabular data No data Labels for pre and post BD Time stamps Decimals Data all in one column Location

30 Documentation and Troubleshooting Documentation by IT analyst. PFT Lab Interface Interface analyst: Kathy Jones Pulmonary lab should have a master document showing workflow and interface mapping. Post the number of who to call when the interface needs troubleshooting. Call: IT help desk at to report a problem. If data does not post, look for discrepancies in patient demographics or the parameters you are sending. Call Patty if the PDF posts but no tabular data.

31 Why is implementation of an EMR interface sometimes so difficult? The PFT lab might be a low priority for the IT department. Your first interface was only outbound and now it is bi-directional. Your designated IT person changes like the weather. There is a hold up in completion of the specifications document sent from the vendor. The manager of the department is overwhelmed by the process and decides to put implementation on hold 5 years!!! The vendor or IT department is over committed and can only allocate a one hour conference call per week.

32 What causes the data/pdf to not post? Changes to the report parameters Once reports parameters are defined, it is best not to change these. Settings within the vendor software were turned off by mistake. The interface server is down or was rebooted. The PDF or PACS server is down. There was a software upgrade that changed some settings. Make it part of your workflow to verify PFT data posted correctly every test

33 Overview of HL7 and EMR EMR is the system HL7 is a set of standards Language for messages between various systems Labs Imaging (PACS) Dictation EMRs Lab PACS EMR Radiology PFT PFT Billing Dictation

34 PFT EMR Data Integration Summary Define what type of interface works best for you. Realize the EMR becomes your database if the PFT tabular data is integrated. There is some new terminology related to interfaces. Allocate enough time to develop PFT reports and test the interface. Work as a team. Assure your data posts correctly so clinical assessments can be made.

35 PFT Equipment has come a long way Ok, one more, and then I will print a report to my dot matrix printer for your chart? I wonder how the clean these things?

36 Thank you! Matthew O Brien MS RRT RPFT FAARC University of Wisconsin Hospital and Clinics Pulmonary Diagnostic Lab mobrien@uwhealth.org