Labs - Orders and View Results
Slack channel for Lab results hereÂ
PeopleÂ
(To be completed)
Thoughtworks:Â
Ajay Brar - Design
@krishna Teja  - BA & PM
Pilar Rubio - Product & UXÂ
PIH
David DeSimone - BAÂ
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.Â
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"Â
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
PersonsÂ
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.Â
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
Design
Use cases
Orders
| Actor | Use Case | Priority/Notes |
|---|---|---|
| Provider - Physician | View available lab tests orders and panels for a patient, organized by category | |
| Provider - Physician | View the list of the lab tests that are included in each panel | |
| Provider - Physician | Ability to order individual lab tests for a patient | |
| Provider - Physician | Ability to order panels of tests for a patient | |
| Provider - Physician | Ability to specify the urgency of tests and panels ordered for a patient | |
| Provider - Physician | Ability to specify any notes along with a test ordered for a patient | |
| Provider - Physician | Ability to review the labs already ordered for a patient | |
| Provider - Physician | Ability to review the status of labs ordered for a patient | |
| Provider - Physician/Clinician | Ability to view the estimated date for labs results | |
| Provider - Physician/Clinician | Ability to view any potential issues when processing the lab results order | |
| Provider - Clinician | Be alerted when results for a test which I've ordered has results | |
| System Admin | Ensure that only authorized users are allowed to order lab tests | |
| System Admin | Specify labs to be available to be ordered within panels and categories | |
View Lab Results
| Actor | Use Case | Priority/Notes |
|---|---|---|
| Provider - Clinician | Ability to view the lab results test: 'Test' is the subject of the analysis (i.e. Hemoglobin, Hematocrit, etc) grouped together by type in panels (CBC, Liver, Chem) | |
| Provider - Clinician | Ability to view the lab results: 'Result' is the patient absolute result for a specific test. Either number, text or coded (positive/negative etc). Examples: haemoglobin is 7.4 or HIV rapid test is negative. The ability to handle units of lab test rests (e.g. g/dl) | |
| Provider - Clinician | Ability to view trend for the results when available: 'Trend' is the historical trend of lab results for a specific test for a patient (line graph for numerical results) Important: time since the last test that affects the relevance of the trend (depends on the test and the result)Â | |
| Provider - Clinician | Ability to view the reference range: 'Ref range' is what is considered normal (depends on sex and age) + Flag lab results that are outside of a specified normal range as indicated as such | |
| Provider - Clinician | Ability to quickly access context information: Patient data: demographic, previous physical exam, lifestyle, previous disease, etc | |
| Provider - Clinician | Ability to access previous tests and results | |
| Provider - Clinician | Ability to add notes and comment on results | |
| System Admin | Ensure that only authorized users are allowed to view lab results | |
Do we need to capture these use cases?
- Manually enter lab results for existing orders
Workshops & user researchÂ
- Journey Workshop with JJ: Recording:Â https://drive.google.com/file/d/1skAdair_5XWHxgYNfFak6XLqR6xethRA/view?usp=sharing
- Workshop with clinicians:
- Recording:Â https://drive.google.com/file/d/1wC7w5wgSI78kWJadle7QULJWBvh094hl/view?usp=sharing
- Notes from OpenMRS Lab Results - user research - LinkÂ
PIH exampleÂ
For reference, here is what PIH has in place for ordering and entering and viewing results: