PatientOS version 2.0 includes native ePrescribing.  ePrescrbing allows our physicians to electronically send an accurate, error-free and understandable prescription directly to a pharmacy from their office.

What is native ePrescribing?  Most commercial solutions use 3rd party ePrescribing solutions and force the users to flip between their screens and the 3rd partys ePrescribing screens.  They also are forced to use two databases for the patients medications, one is the 3rd party ePrescrbing solutions and the other the vendors read only database with synchronized medications.

Native ePrescribing is where the product integrates directly with the Surescripts network and the prescription order entry screens are native to the application.  This is what PatientOS version 2.0 providers.

ePrescribing Configuration

To use ePrescribing you need to register with PatientOS to be configured.  Surescripts only allows one set of designated servers for all secure communication and only allows one company at a time to be certified to connect and use the network.  We provide that gateway and if you login as an administrator and under the System–>Pharmacy–>ePrescribing menu is where you setup the portal.

Physician Configuration

Each provider needs to be registered for the Surescripts network.   To register a new provider you need a ten digit NPI and optionally a DEA number to be added to the physicians identifiers.  These are added by going to System–>Security–>Users, selecting the user and Edit User Details.  Click on the add identifier button and choose NPI.  After saving this select the provider and click the Provider button.  There the Register for ePrescribing button can be pressed to add the provider to the network.  Note you should make sure the facilitys main telephone number and fax is correct and add a provider specific number for cell, work, etc.

Next post will show how the ePrescribing works with the prescriptions.

Section 1.01 - 1.05

1. Login as reception/demo
2. Patient Search
3. New Patient
4. 07/01/1998
5. 1600 Rockville Pike, Rockville, Maryland
6. Patient Search
7. SMITH
8. Patient Search
9. Other identifier DOB: 07/01/1998 (or SSN if you noted it)
10. Tools–>Administrative–>Merge Patients
11. Lookup Joe smith
12. Lookup Gardner
13. Merge patients
14. Patient search shows age in short format
15. Patient chart banner bar shows age in long format

Patient merge includes a lookup for the patient being merged away and the patient which receives all the visits.

Section ADM.01-.03

1. Login as admin/admin
2. Order Sets
3. Double Click CCHIT Diabetes Order Set
4. Add Order
5. Search Basic Metabolic Panel
6. Search Non-stress test

It turns out iReport has a nice feature that allows you to write a ’scriptlet’ - essentially a single java file which is called at different times during the report execution and can return values to text expressions for display on the report.

So were were example to create in the java file a couple of helper methods and then the following code which is called with each row and collects the vital sign values.

String hval = getDoubleValue("HEIGHT", 0);
 if (hval != null) {
 height = hval;
 }
 String wval = getDoubleValue("WEIGHTMEASURED", 0);
 if (wval != null) {
 weight = wval;
 }

And then we create a standalone method which returns the formatted vital signs

 public String getVitals() {

 StringBuffer sb = new StringBuffer(256);

 sb.append("Height: ");

 sb.append(height);

 sb.append("  Weight: ");

 sb.append(weight);

 return sb.toString();

 }

This is very handy but even more so for the symptoms as there were a mix of record items and controls capturing the symptoms - but all of these are gathered together as a single comma delimeted line.  It would have probably have been near impossible to do that with normal report writer features.

We export our project as a jar file which needs to be in the lib (C:\Program Files\PatientOS\0.99\server\appserver\server\default\lib) directory for runtime and added to the iReport design tool using Tools->Options–>Add Jar

So now our report design, adding a image looks like this.

The last thing we need was the medications.  This is a little trickier as we did not include the meds in query and adding a subreport is a pain in any report designer.  So we will use the scriptlet.  We could setup all the properties need to call the application server ejb service to get orders for this visit.  But even simpler is to add a custom controller.  We’ll save that for another post though.

We also alter the SQL in the report to replace the hardcoded visit id with $P{visit_id} and create a parameter called visit_id.  In version 0.99 user_ref_id, visit_id, patient_id are passed to the program.

Finally we need to incorporate the report into the UI.  For both the thin client and the web client we can add a button (in 0.99) which displays a report with the following properties

Action: System Display PDF Report
Report Output: Your Report

For the report we add a new one which uses the custom controller Report Default Jasper SQL Output.

We browse and select the jasper file.

Thats it.  0.99 has some new jar files to support iReport 3.7 so as long as those were deployed correctly everything should work fine.

PatientOS is an open source EMR, EHR or really enterprise healthcare information system.  It is appropriate to have integration with other great open source products such as iReport.  iReport is enterprise report writer which is the GUI front end to JasperReports.

PatientOS supports a number of ways to integrate with iReport including using its data source capabilities but this article will focus on creating SQL based reports.

The current version of iReport is version 3.7 and can be downloaded from sourceforge here.

Database

After downloading the setup and running you can create your first report by using menu File –> New, selecting a template and then choosing JDBC connection.

On the next screen fill in the connection information which for a database called demopos would look similar to this.

The next step is to create a SQL query for the report.  In this simple example we are going to create a report for a specific form along with some demographics data.

Our query will be the following.

select p.last_name, p.first_name, r1.display as gender, p.birth_dt, pi.idvalue as mrn, r2.ref_key as record_item_key, r3.ref_key as data_type_key,
 fr.value_int, fr.value_string, fr.value_date, fr.value_double, fr.value_ref_id, r4.display as value_ref_display, t.term_name as value_term
from patients p, visits v, refs r1, patient_identifiers pi, forms f, form_records fr, refs r2, refs r3, refs r4, terms t
where v.visit_id = 50000042
  and v.patient_id = p.patient_id
  and p.gender_ref_id = r1.ref_id
  and p.patient_id = pi.patient_id
  and pi.source_ref_id > 0
  and pi.source_ref_id = 50000051
  and v.visit_id = f.visit_id
  and f.form_type_ref_id = 50000104
  and f.form_id = fr.form_id
  and fr.record_item_ref_id = r2.ref_id
  and fr.data_type_ref_id = r3.ref_id
  and fr.value_ref_id= r4.ref_id
  and fr.value_term_id = t.term_id

For your query you would replace the visit id, change the source ref to match the MRN identifier source and form type to match the form you were pulling from.  For now we are hardcoding the visit id but once we have finished testing the report will make that a parameter which will be passed from the application.  You can find the form type ref id on the properties of the form.  The source ref id you can see from this query - select * from refs where reference_group = ‘IdentifierSource’;

Page Layout

Now that we have the report open we want to move fields around to be displayed.  First we will create a page header section by changing the band height of the page section to 40.

Then we drag the patient demographic fields and labels, changing font sizes and other formatting to create a page header.

Instead of having separate first and last name fields we edit the contents of one text field to be

$F{first_name} + ” ” + $F{last_name}

in order to combine the two fields, we also change the font size and bold.

Now can press the Preview button and see the output so far.  So we have some header information but now we need to handle the discrete data from the form.

Content Layout

If we wanted to replicate the layout of the original form we would have used the Jasper XML plugin which generates XML that matches the forms controls.  However for this report we are going to pick out specific field values and display those.  This report is much faster than the XML equivalent - the query runs in around 30 milliseconds.

To be continued…

One the speakers on the electronic medical records panel, Greg Caulton, a Principal at PatientOS Inc. urged trade ministers to leverage the PatientOS Open Source EMR solution. The majority of members from 20 different countries had heard of open source and understood the advantage local companies could have from leveraging an electronic health record free of licensing costs.

PatientOS Inc. principal Greg Caulton spoke of the events success. “ I was thrilled to participate at this event. I spoke one on one at length with representatives spanning the globe, from the Mexican Trade Ministry, to the Consulate General of the Czech Republic. Our message is simple. We want international businesses, large and small to implement our software into their healthcare institutions without the burden of exorbitant licensing fees. We can provide the clinical analysts and software support services to ensure they are successful. By using PatientOS these countries can implement an advanced hospital system at a fraction of the cost of developing or purchasing an equivalent system”.

Luncheon was served at the Trump National Country Club where acclaimed international speaker Camille Sailer and The Apprentice season four winner Randal Pinkett spoke at the event of the local entrepreneurial spirit and support systems New Jersey had to offer international businesses.

At the event Kwangsun Suh, a scientific director at Hackensack university medical center spoke of the complexities in gathering information from disparate electronic records, each serving specialists with unique needs. Each system written with software that is unable to communicate with the other. Greg Caulton spoke of how PatientOS can address this prevalent interoperability problem.

“PatientOS is unique in its capability to support significant differences in the user interface for all specialty clinics and users. Rather than writing code for each solution we provide a common data model and a common set of tools that allows analysts to configure the EMR to meet the needs of the clinicians.”, said Greg. “By putting control into the hands of the people gathering requirements the system is built quicker and with fewer errors. This coupled with a strong software architecture and our implementation of standards has positioned PatientOS to compete with commercial systems on both cost and quality.”

The Center for International Business & Education (CIBE) at Raritan Valley Community College

Founded in 1988, CIBE’s mission is to serve the commercial and academic communities for their international needs on a global and local basis. Learn more about CIBE and the Annual Consul Program for New Jersey at http://www.consulprogramnj.org

PatientOS Inc.

PatientOS Inc. provides development and implementation services for hospitals, clinics and businesses who wish to tailor the Open Source PatientOS EMR to fit their specific workflow and system requirements. For more information about PatientOS, call 888.NBR.1EMR or visit http://www.patientos.com. The open source community can be found at http://www.patientos.org.

The Rapier edition of PatientOS EMR is a commercially supported offering with 24×7 support for physician offices to start using PatientOS.

We have structured this solution to provide a base price of $4999 for the initial setup and configuration of a facility, users, security, forms and interfaces with a billing system.  Our next major release will include claims and financial management.

From there the practice can opt to use the default environment as is or purchase buckets of hours for further configuration for the custom workflow and documentation the physicians prefer.

Features included in the base package, pricing and more information is available at http://www.patientos.com or contact sales@patientos.com.

Here is a video sample of patient portal integration for chronic care.

Try before you buy with our online functional demo environment !

PatientOS is a very flexible and customizable solution which allows analysts and your IT staff to create forms, workflow, orders, device integration and much more using a mature set of PatientOS tools which require no programming.
PatientOS Inc. Partner Offering

PatientOS has a number of parternship levels to provide support and benefits to companies seeking to provide professional services for implementation and support of PatientOS EMR.

http://www.patientos.com/emr/pricing-partner

Please email sales@patientos.com or call for further details

–
http://www.patientos.com
corporate: (888)-NBR-1EMR || fax  857.241.3022

PatientOS Inc. will be demonstrating with a live system which users can log into, the interoperability between two distinct systems using OpenEHR Archetypes. You can see and experience a live, hands on demo at the HIMSS Virtual Conference June 9-10.

The demo will include

1) Provide a live Physician Office environment

2) Provide a live Hospital environment

3) Demonstrate various workflows in both (office visit, hospital closed loop medication management)

4) Demonstrate a patient portal with a consolidated view of the two systems clinical data.

Register for free at http://www.himssvirtual.org

PatientOS Inc provides professional Health Care IT Consulting Services for PatientOS EMR and other commercial products.

Join the PatientOS Community

For any information system it is critical to be able to get the data out as easily as you can get the data in.  PatientOS supports a number of different features for viewing and reporting data.  Version 0.93 wraps these up into a fairly accessible way.

The different types of reports can be divided into reports for viewing (HTML) and reports for printing (PDF).

• HTML reports generated for online viewing within the application using the default system defined XSL
• PDF reports generated from the HTML (above) for printing
• PDF or HTML reports generated using the iReport tool from PatientOS generated XML
• PDF or HTML reports generated using the iReport tool and a native SQL connection
• PDF created using the Adobe forms designer
• XSL custom reports that can generate almost anything (Text e.g. X12, HTML, PDF etc)

HTML reports (System Default)

The report pane control is used to display an HTML representation of a form.  This is down through the generation of XML from the form and then passing it through a stylesheet to generate the HTML.

The XML is generated by a ‘custom controller’ which acts like a plugin .  You can create new plugins to generate different XML.

PDF reports (System Default)

For controls that execute the action ‘System Preview’ it will generate the HTML and convert it directly to PDF.  This is quick and convenient but is missing some header and footer information generally desired.

PDF reports (iReport)

To create a custom PDF report (in version 0.93) for a form that uses XML you can follow these steps.

Part 1 - Get the XML PatientOS will generate

1. Login as the user which has the form you want to add a custom PDF output to.
2. Use the menu Help–> Debug
3. Start a new form and use the menu Tools–>Show XML
4. Copy and save the XML to a file.

Part II - Create the .jasper file in iReport

1. Download and install the compatible version of iReport (currently 3.0)
2. Create an XML data source using the XML generated from Part I
3. Use a report query of /report and drag the fields into your report
4. Complete the layout, test the report and generate the .jasper file

Part III - Create the PatientOS Report

1. Login as admin and add a new report
2. Given the report a name, select the DefaultJasperOutputController controller and upload your new Jasper file.
3. Save the report
4. Open all form types, find the form identified in Part I and on the properties screen set the report to match.
5. Save clear cache and the PDF is generated for the form generated XML.

HTML reports (iReport)

By following the steps above for the PDF report the HTML view of the form will also be generated using this same report.

PDF reports (SQL)

To create a custom PDF report (in version 0.93) using iReport and SQL you can follow these steps.

Part 1 - Create the Report

1. PgAdmin III has a query tool that is best suited to testing and validating the SQL prior to using iReport.
2. Create a datasource in iReport that connects to the database (note you may need the PostgreSQL jar copied to iReport lib)
3. Test the query, layout the fields and generate the .jasper file.

Part II - Create the PatientOS Report

1. Login as admin and add a new report
2. Given the report a name, select the DefaultJasperSQLOutputController controller and upload your new Jasper file.
3. Save the report
4. If the report requires a form to prompt the user for parameters edit the settings and add the form which has the prompt
5. The controls on the prompt form will be used a parameter names (lowercase no space)
6. The form control name and value will be passed as parameters to the report

Part III - Attach Report to Toolbar or Menu

1. Login as user and edit a toolbar or menu
2. Add a button with
   Action System Generate Report
   Report Your report

To be continued…

CCHIT is holding a discussion on open source and we would encourage people to vote for a reasonable discount on certification fees for companies with OSI approved Open Source licenses.

You can vote here:

http://moderator.appspot.com/#15/e=35c32&t=36f61&o=10

Commission Hosts Interoperability and Open Source Roundtables on Certification

In addition to its annual Town Hall at the upcoming  HIMSS09 Annual
Conference in Chicago, the Certification Commission will be  hosting
two technical roundtables, co-located with the conference, for health
IT vendors and developers. The first, “Interoperability 09 and Beyond:
a look  at CCHIT’s roadmap for the future”, will present the
Commission’s  interoperability roadmap and explore the standards and
testing tools with  which developers need to be familiar.

The second, “Open Source  Forum: a dialogue on certification for open
source EHRs”, is designed to  continue the discussion with open source
developers with an interest in  certifying EHRs. This session will
allow an open exchange of the challenges  and opportunities for making
certified open source EHRs available to  providers.

The times and locations of sessions are below. Both Health IT
Technical Roundtables will also be available via free remote access.
Details will be available at cchit.org prior to the date.

CCHIT Town Hall at HIMSS09 Annual Conference
Sunday,  April 5
Room W192b, McCormick Convention Center, Chicago
9:45 - 11:15  AM

Health IT Technical Roundtables at Hyatt McCormick Conference Center
Monday, April 6
Room 10d, Hyatt McCormick Conference  Center, Chicago

Session #1  1:00 – 2:00 PM
Interoperability 09  and Beyond: a look at CCHIT’s roadmap for the future

Session #2  2:00  – 3:00 PM
Open Source Forum: a dialogue on certification for open source  EHRs