Viewing test results and other measurements

Test results, as is the case with all measurements, are fully integrated into the clinical structure of the GNUmed medical record. Each result is associated with an encounter as well as an episode of illness. GNUmed then uses this contextual information to display test results in two conceptually different ways, quite similar to progress notes.

The test results grid

This module displays all test results of the active patient in a chronological grid layout as is familiar from spreadsheets. The most recent data appears on the left, the rows denote test types. Hovering over a particular result shows a tooltip with all known details.

There is one column for each day for which test results are available. Thus each cell will usually hold a single value - the result for that test on that day. If, however, there is more than one result for a given test on a certain day the cell will list all the values prefixed with hour and minute. The most recent value is shown at the top. The details in the tooltip also correspond to that most recent result.

Certain cues in the value display hint at more complex information to be available:

• results followed by a writing hand symbol
  • this result lacks a review/signing by either the current user or the responsible clinician
• results marked with "++", "--", "(+/-)" or another abnormality indicator
  • such results fall outside their reference range or are abnormal technically
• results printed in red and bold
  • these results have been marked by a GNUmed clinician as clinically relevant
• results followed by an ellipsis ("...")
  • the supplied or entered alphanumeric value cannot be completely displayed, and/or
  • additional textual information relating to the actual value is available, in the form of either
    • a Comment or
    • a Note
• when results had been modified…
  • an indication of "revision" will be footnoted in the result's tooltip

Groups of test results can be selected and then acted upon (review, deletion, etc). A few widgets at the bottom assist easy selection of often-used combinations for marking the tests as whether technically abnormal, and as whether clinically significant (important). Selections which contain multi-value cells will raise a disambiguation dialog before proceeding to act on the results.

Clinician action on results

Single-cell "selection" may be non-obvious. When you click a cell, its borders are bolded (which then means this cell is "active" but not yet "selected") however the Action button rejects this as not properly selected... either the cell needs to be part of a multi-cell selection or it needs to be double-clicked.

Just SHIFT-click the cell ...

Double-clicking will open the cell value (test result) editor. Upon exiting the editor (even if a Save was done) the cell is not considered "selected".

You can identify whether cells are considered "selected" by whether or not they are shaded (IOW their background color is changed).

When the Select button at bottom would not correspond to the cells that would be of interest (say, the abnormals) then the current trick to make a multi-cell continuous selection is to click inside a cell, and hold down the shift key, and use an arrow-key to extend the selection, including the original cell.

It seems presently unsupported to be able to make a discontinuous selection. Sorry.

Sure, SHIFT-CLICK should do it, no ? Generally, applying any selection mechanism (clicking row or column headers, using arrow keys, dragging the selection with the mouse) should allow extending the current selection even discontinously provided SHIFT is held down. The key to hold down may be platform specific.

If the cell holds multiple values, GNUmed will let you choose which one to edit. (??) or else it wouldn't be possible to act on only a few select results when there are several for a day given that such are displayed in one cell and selection is granular at the cell level

The widget for updating a measurement, affords immediate review (or re-review) by whoever updates the result. The old review will be considered no longer valid. Affirmation, by the person modifying the result, that a old review remains appropriate will allow the result to be considered fully-handled without a need for further flagging. If a new review changes the old review, this will be made evident to any assigned-as-responsible (for the result) clinician. If no new review is recorded, the result is treated as equivalent to unreviewed, and will result in its inclusion in provider inboxes. Filenotes (archives): 1, 2, 3

(This section needs more added. Some of this may be elsewhere in this wiki and needing to be linked or consolidated.)

Contextual use of test results

Above and beyond the overview of test results offered by the grid view they are displayed in various places contextually. The EMR journal lists test results under their corresponding encounters. The EMR tree shows test results in their relation to episodes and encounters.

Future functionality ideas

Filters in mind to be successively added to the core viewer when time permits:

• unsigned (no matter their age)
• all forward from to
  • dateFrom could default to a configurable value (e.g. 3 months), or from being touched more recently than the most recent encounter that involved the patient (in praxis or phone but not chart review etc)
• optionally show only abnormals

Next: Workflow Management