Labs - Orders and View Results

Slack channel for Lab results here 

People 

(To be completed)

Thoughtworks: 

Ajay Brar - Design

@krishna Teja  - BA & PM

@Pilar Rubio  - Product & UX 

PIH

@David DeSimone - BA 

Background and assumptions

EMR is connected to many systems (pharmacy, lab test, microbiology etc) and serves as a consolidated view for providers. For the purpose of this project (Lab results) we're not considering how the data is input into the system and how this data is then verified. We assume that this data can be manually input or imported from another system. How the data is input is not the purpose of this project. 

Providers are the main users of this information. Providers are clinicians, nurses, social workers or community health workers. (confirm)

The way in which test results are received is as follows: providers order tests on a patient and after a certain period of time, results are received. It is important for providers to always know what's going on with the orders and to have visibility of the status of the orders and any potential issues.

The way in which providers use this information may be different depending on their level of understanding/expertise. While some users will do a more in-depth and sophisticated analysis, for others it might be something way more basic.

The main elements of the test information are:

• Test (subject of the test i.e. Hemoglobin, Hematocrit, etc) can be grouped together by type in panels. Grouping is important as there's a high level of standardisation in which this information is presented and users are used to review the information in that way (CBC, Liver, Chem)

• Result: patient absolute result for that test. Either number, text or coded (positive/negative etc). Examples: hemoglobin is 7.4 or HIV rapid test is negative. The ability to handle units of lab test rests (e.g. g/dl)

• Ref range: what is considered normal (depends on sex and age)

Results have to be interpreted in context. "Clinicians want to understand the context of a lab result, the more we can do to make it easy to get the data to create context, the better. Most EMRS, force lots of clicking back and forth throughout the chart to do this which is very annoying and (likely) leads to clinicians failing to get all the data" 

Context information may include:

• Trend based on previous tests (one of the most important things)

• Time since the last test that affects the relevance of the previous point

• Patient data: demographic, previous physical exam, lifestyle, previous disease, etc

• Circumstances of the patient when the test was performed

• Medications (what medications were active or have been discontinued)

• Reasons behind ordering the test in the first place

• Notes that were written

• The trend of temperature, etc

Relevant terms and concepts

Persons 

Every individual who is referred to in a patient record in OpenMRS is stored in the system as a Person. These include Patients, any patient relative or caretaker, Providers, and Users.

Patients

Anyone who receives care in OpenMRS must be a Patient. Every Patient must have at least one Identifier. 

Providers

A Provider is a person who provides care or services to patients. A provider may be a clinician like a doctor or a nurse, a social worker, or a lab tech. Generally speaking, any healthcare worker that a patient can have an encounter with is a provider. Providers may have full records in OpenMRS as persons, or they may just be a simple name and ID number.

Relationships

A Relationship is a bidirectional link between two Persons in OpenMRS. The metadata that describes a particular kind of relationship is a Relationship Type. It defines the names of each direction of the relationship. Typical Relationship Types are Parent/Child and Doctor/Patient.

Orders

An Order is an action that a provider requests be taken regarding a patient. For example, a provider could order a Complete Blood Count laboratory panel for a patient. An Order only records an intention, not whether or not the action is carried out. The results of an Order are typically recorded later as Observations.

Observations

An Observation is one single piece of information that is recorded about a person at a moment in time. Every observation has a Concept as its question and depending on the data type of the concept, it has a value that is a number, date, text, Concept, etc. Examples of observations include Serum Creatinine of 0.9mg/dL or Review of cardiopulmonary system is normal.

Also check https://guide.openmrs.org/en/Getting%20Started/openmrs-information-model.html

UX notes

Filters/sort info by:

• Chronologically by order date

• Ability to search/filter by lab test/lab group

• Ability to filter by date period

Flag results which are abnormal or new

Provide a way to view normal ranges for each lab test

Should be able to use short synonyms or full names in the viewer

Alerts for:

• Abnormal results

• Manually enter lab results for existing orders

Inspo: Bloomberg terminal for doctors

More notes 

Journey Map 

Design

• Sketch File 

• Video walkthrough (12 Aug 2020): Vimeo, YouTube

Use cases

Orders

View Lab Results

Do we need to capture these use cases?

• Manually enter lab results for existing orders
  
  
  

Workshops & user research 

1. Journey Workshop with JJ: Recording: https://drive.google.com/file/d/1skAdair_5XWHxgYNfFak6XLqR6xethRA/view?usp=sharing

2. Workshop with clinicians:

   1. Recording: https://drive.google.com/file/d/1wC7w5wgSI78kWJadle7QULJWBvh094hl/view?usp=sharing

   2. Notes from OpenMRS Lab Results - user research - Link 

PIH example 

For reference, here is what PIH has in place for ordering and entering and viewing results:

Open