Sunday, 20 April 2014

Implementation Experience in Indian Hospital - 2

This is one of few surprising and exciting experience from my recent integration assignment when I was implementing an EMR product in an Indian Hospital.
This post is related to integrating EMR with LIS to place the lab orders and receive results back.

It appeared pretty straight forward interface before we came to know about the LIS implementation of Order Number & Grouping.

I didn't have much experience integrating with LIS systems but had worked with LAB order & results processing in my previous implementations of MS Amalga UIS.

Current workflow in hospital was: the Lab orders were placed from Hospital HIS and the Place Order Number was generated with a specific format where each digit had some significance for LIS operators to process the order.
To handle this we had to customize the EMR order placing module to generate the Placer Order Numbers in a specific format.

This is only the first part of story. Second is the Order Grouping.

Requirement was to group the Orders placed for same LAB department in single ordering session. That means group all the orders of a patient for same lab department if all the orders were placed at once by doctor.

This was quite understandable, but the surprise was to use the Order Group Number(ORC-4) as the Placer Order Number(ORC-2) in OML^O33 message for grouped orders.

In this scenario, the O33 message will not contain any Order Group Number in ORC-4 but the same will be sent as Placer Order Number in (ORC-2). From HL7 chapter 4, I could not understand if this is a correct way to handle placer order number & order group number.

LIS does not expect individual placer order numbers for individual order items and while sending the results back LIS sends same Group number in Placer Order Number field (ORC-2).

The new EMR system generates the Placer Order Number for each individual Order Item and handles all the actions (Change/Cancel/Process Result) related to that Order based on Placer Order Number. Order Group Number in the EMR just identifies the grouping.

We were using Mirth as integration engine between EMR & LIS. This particular customization of Order Grouping required a lot of effort and transformations in EMR integration module as well as Mirth.

I am not sure if this is the usual behavior of LIS systems but it was my first experience of such Order Grouping.

Thursday, 17 April 2014

Implementation Experience in Indian Hospital - 1

This is one of few surprising and exciting experience from my recent integration assignment when I was implementing an EMR product in an Indian Hospital.
I will share few of these in different posts. This one is related to ADT & SIU workflow handling.

EMR is implemented in Hospital OPD for clinical workflow i.e. view calendar, chart patient, prescription etc.

The patient registration & scheduling for OPD would still happen in HIS and on each such event, corresponding HL7 message would be pushed to EMR from HIS.
Suppose we received a SIU-S12 for appointment booking in EMR, the same should be reflected in doctor's calendar in EMR. The SIU message had these main segments PID, SCH, RGS, AIL and AIP.
Now, when the patient shows up in OPD staff creates a visit for patient in HIS, the ADT-A01 comes to EMR. The ADT message had these main segments PID, PV1

As, the source of both the events is HIS, there was no way in EMR to link the ADT & SIU so that, whenever doctor selects particular patient on his calendar in EMR the chart for same visit of patient should come up.
To handle this we negotiated (HIS & EMR) to use optional PV1 segment in SIU.
PV1 segment in SIU contains a unique number in PV1-5 which is available at time of scheduling as well as registration in HIS. So in EMR we used this number to link the SIU & ADT of same patient visit.

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