QHR Product Ideas

HRM is becoming an important data source, but its implementation in Accuro is flawed and needs to be improved significantly.

Virtual Chart (VC)

HRM reports have type, sub-class and procedure codes. In the virtual chart these elements correspond to Type, Sub-Type, with procedure buried somewhere under Note. The problem is that the classification or taxonomy is being displayed from too high a level. Type is almost always "MEDICAL RECORDS" or "DIAGNOSTIC IMAGING" (that's 1 bit of information) and Sub-Type covers broad swathes such as "MR", "CT", "MISC". Whereas the interesting, salient, significant information conveyed by the Procedure Code is buried and lost in "note".

It would be like operating a vet clinic where you had to refer to every animal as a MAMMAL/Canine or MAMMAL/Feline, with the occasional AVES/Budgie. Not very helpful when all you really want to do is call Mister White Paws in to have his anal glands squeezed. 

Queries

What's worse is Query building. HRM reports are instances of Labs. Why? - obviously it was expedient to implement HRM using the lab infrastructure since HRM reports arrive something like a lab, and sometimes contain Lab information. But most of the HRM reports we deal with are more like Clinical Notes, containing text that we would like to search, and with the important Procedure Code that is inaccessible to the Query builder.

HRM ought to be either: i) a category in the builder itself, or ii) be an element in the "EMR" category. We should be able to select information elements such as "Type", "Sub class", "Procedure", "Report Body" with the usual "equals", "contains" etc options. 

Right now we have to search as if the HRM were a lab. We have options for Lab Type (=HRM Sub Class), Lab Test (=HRM Type) and Observation Date( =HRM review date!). "Collection date" seems to be the review date also. It might have been more helpful if one represented the date of HRM report. One might think that (Lab) Value and its test "text containing" might correspond to something useful....but alas, our hopes are dashed.

What's even worser (sic) is that the columns in the output results contain nothing useful. The Procedure Code and report body would be useful outputs. 

Changing Mappings

One might think that the configuration UI for HRM mappings would be the answer to these problems. But unfortunately all it lets us do is change the verbiage in the HRM type and sub-class descriptions. As if anyone is likely to fiddle with this. Instead we would like to map HRM Sub-class to VC Type, and HRM Procedure to VC SubType. There, that would fix the VC. Ah well...

Conclusion

It seems to me that HRM in Accuro is deficient in a number of ways, perhaps impeded by its implementation using the Lab infrastructure. It needs a proper remapping in the VC so important information becomes visible, and a treatment in the Query builder that reflects the classification and text nature of text-based HRM reports. Without the latter we can't USE reports in automated and semi-automated clinical processes; they are good for eye-balling only.