Integrating EMRs & eForms

Questions on Ocean eForms have the ability to automatically populate certain fields in the patient's chart in the EMR. To set an item in an eForm to update the corresponding field in the patient's chart, follow the steps below.

Keywords allow you to insert a piece of data from the patient object (usually from the EMR) into a caption, to prepopulate a field, or as part of a note. To see a list of available keywords, simply type @ and the menu will appear in the editor. A full list of options is also included in the chart below.

To indicate a keyword, just add "@" to the beginning. For example, "Dear @ptPreferredOrFirstName" will appear as "Dear Jacob".

You can also access keyword values in a script with the ScriptUtil.getKeyword() function, like "ScriptUtil.getKeyword('@ptName')". This is particularly useful for tablet rules, since a rule can access most of the patients information via this function. For example, you can show a COPD assessment questionnaire if the patient has COPD in their problem list or past medical history like this:

ScriptUtil.getKeyword('@ptHas.copd') == 'Y'

Keywords can be very useful in conjunction with EMR Fields to allow patient to update their profile automatically. For example, by setting the default text of a text field to "@ptPreferredName" and setting the EMRField mapping on the same item to "preferredName", the initial value will be the patient's preferred name in the EMR and any changes will be applied to the preferred name field in the EMR.

Some keywords accept suffixes, which should be added after a trailing period. For example, "@ptHnExpiryDate.yyyysmmsdd" will show the date as "2015/06/21".

Using keywords (please see "Using Keywords to Automatically Insert Content" for more information about keywords), you can pull the following lab values from Accuro into your Ocean form:

The table below describes which dropdown option in this eForm Editor's "Populate answer for EMR Field" field correspond to which demographics fields in PS Suite.

Ocean allows PS Suite users to customize their eForms to pre-populate custom forms with answers completed using Ocean. This powerful functionality allows you to use your existing custom forms to record the patient's answers, in addition to the usual progress note added to the chart.

Configuring the eForm for Custom Form Prepopulation

Configuring the Custom Form Field Mapping

In some cases, you may not have an ideal one-to-one mapping between an eForm question item and a custom form value. In these cases, eForm formula items may provide the flexibility you need. For any custom form item that you'd like to populate, you can create corresponding invisible formula item. The formula can make use of any other eForm value, or even calculate new values.

To map a formula item to a custom form item:

• For example:

  • Suppose you have a question on your eForm, "Are you having any pain?", with the item reference: 'pain'. You also have two checkboxes on a PS Suite custom form to record the answer to this question, one called 'PainYes' for a 'Yes' answer and one called 'PainNo' for a 'No' answer.
  • Since the 'pain' question in your Ocean eForm can only have one item reference, you cannot have it directly populate both of the checkbox values on the PS Suite custom form.

  • However, you can create two new formula items on the eForm to map these values:

    Item Reference	Formula
    PainYes	pain.r == 'Y' Copy Formula
    PainNo	pain.r == 'N' Copy Formula

  • 
  • Now, if the patient answers 'Yes' to the question on your Ocean eForm, the 'PainYes' formula will evaluate to 'true' and the 'PainNo' formula will evaluate to 'false'.
  • Then, when Ocean populates the PS Suite custom form field, the 'PainYes' checkbox will be set to the value of 'true', which will mark the checkbox checked. The 'PainNo' checkbox will be set to the value of 'false', which will leave it unchecked.

To map a formula item to an encounter assistant item:

Using a similar technique, you can also map eForm answers to Encounter Assistant (EA) fields. Encounter Assistant's are actually just a special type of custom form, so you can use the same "pssCF" formula as above to point to the Encounter Assistant.

Mapping the answers to Encounter Assistant items is slightly more difficult. First, you need to find out the ID of the Encounter Assistant item of interest by opening the Encounter Assistant in the custom form editor (as opposed to the usual custom form editor).

• Find the ID of the Encounter Assistant item

  • To open the Encounter Assistant in the custom form editor, press and hold Alt (Option) when you click to open the Encounter Assistant in the Edit Custom Forms dialog. You can then see the Encounter Assistant items as they are rendered within the Custom Form.
  • Warning: Do not make any changes in the custom form editor. Any changes you make to the Encounter Assistant in the custom form editor may be overwritten when you make subsequent changes in the Encounter Assistant editor.
  • Click on the box for the Encounter Assistant item to view its ID. It should start with a "#". Your corresponding eForm item ref should be the same, except with "NUM_" replacing the "#".
  • For Example: In an Encounter Assistant with ID "#item1614254" maps to "NUM_item1614254" in the eForm XML.
  • Warning: Make sure you click on the actual checkbox or the cycle box to see the ID, not the label of the Encounter Assistant item. The label ID is different.

A special custom form has been built to trigger a PS Suite message (i.e. yellow sticky note) based on a patient's response in an Ocean eForm (or based on completion of a form). This custom form is called "Ocean - Send Message" and is available in the CognisantMD Resource Library. Follow the steps below to trigger a message, based on an Ocean eForm.

Note: To set this up, you will need to be familiar with a few of the more advanced aspects of the Ocean-PS Suite integration.

1. Download the "Ocean - Send Message" custom form and open up your Ocean eForm.

   • Download the "Ocean - Send Message" custom form from the Ocean Library and install it in PS Suite, like you would with any other PSS custom form
   • Back in the Ocean Portal, select the form that you would like to use to trigger the PSS message and open it in the eForm editor. You will be adding several formula items to the bottom of this form.

2. Create a new formula item in your Ocean eForm.

   • To add the first item, select "Add Item" and change the item type to Formula.
   • 
   • In the Note Formatting tab, set "Create a Note for this Item" to "never".
   • 

3. Link your Ocean eForm to the "Ocean - Send Message" custom form.

   • Under the Scripting and More tab, add the item reference "pssCF", set "Show this field if" to "false" and enter 'Ocean - Send Message' in the formula field.
   • 
   • Note: The text in the formula field MUST be surrounded by single quotes (' ').

4. Define the target user for your PS Suite message.

   • Repeat step 2 to add a second formula item to set the user that will receive the message.
   • Instead of using the item reference "pssCF", this time use "msgTarget" and enter the PSS user initials into the "Formula" box. In the example to the right, the PSS user initials are CMD (remember to use the single quotes in the "Formula" box).
   • 

5. Define the message body for your PS Suite message.

   • Again, repeat step 2 to add a third formula item to configure the body of the message.
   • This time use the item reference "msgBody" and type your message into the "Formula" box. In the example below, the message shown to the user will be 'Pt. completed the test form'.
   • 

6. Define when the PS Suite message shows up.

   • Repeat step 2 to create a fourth formula item to set the message timing.
   • This time, use the item reference "dueAfterXDays" and type a number in the "Formula" box. In the example to the right, 0 days have been entered, which means that the message will display as soon as the chart is opened.
   • 

7. Define the title for your PS Suite message (optional).

   • You can also repeat step 2 to add an optional 5th formula item in order to give your message a title.
   • This time, use the item reference of "msgTitle". In the example below, the message title is 'Test form alert'.
   • 
   • Once you have completed these steps, you should see the PSS message whenever a patient completes the associated Ocean eForm.

Note: The "send message" action is triggered when the patient chart is opened. If a patient is sent a form to complete at home using Patient Messaging, there may be a significant delay between the completion of the form and the patient chart being opened (and thus, the PS Suite message being triggered). Clinics may consider implementing a message management workflow that ensures that Ocean alerts are enabled and patient charts are always opened as soon as an alert is received.

Using keywords (please see "Using Keywords to Automatically Insert Content" for more information about keywords), you can pull the following lab values from PSS into your Ocean form:

The smoking status is drawn from the "RISKS" field in PS Suite, as text. The content of "RISKS" is available in the keyword "@ptCpp.soc" (if you are curious: "soc" stands for social history).

If you would like to display the smoking status, you can use the "@ptCpp.soc"" keyword in one of the following formulas:

To check if someone is a current smoker:

ScriptUtil.getKeyword("@ptCpp.soc").indexOf("current smoker") >= 0

To check if someone is an ex-smoker:

ScriptUtil.getKeyword("@ptCpp.soc").indexOf("ex-smoker") >= 0

To check if someone has never smoked:

ScriptUtil.getKeyword("@ptCpp.soc").indexOf("never smoked") >= 0

Updating the cumulative patient profile (CPP) is problematic for three reasons:

1. Patients often provide incorrect information (e.g. spell a drug name wrong, wrong dosage, inaccurate condition diagnosis, etc.).
2. CPP fields often contain information already, meaning that decisions need to be made about merging updates (e.g. how does a system automatically merge "chf:father" and "F:chf age dx80").
3. The CPP fields are often treated somewhat canonically by staff, so updates must be reviewed carefully.

As a result, we mostly protect the CPP from patient updates. We recommend colour formatting of answers that indicate a CPP update should be considered (e.g. highlight if a patient's mother had breast cancer, so that a clinician can easily spot necessary CPP updates and apply them if appropriate).

That being said, there are some things that you can do in Ocean using the PS Suite CPP:

• All demographic fields update automatically (e.g. address, phone, email, etc.). You can do this either with the standard demographic review screen or with special "EMRFields" that indicate a custom field should update a demographic field.
• You can display CPP fields in forms. As an example, try the Medication Reconciliation eForm.
• You can drive tablet rules off of problem lists.

  For example, here's one to drive the Canadian Lung Health Test for non-diagnosed 40+ year olds COPD once a year:

  !ScriptUtil.getKeyword('@ptHas.copd').equals('Y') && pt.getAge() > 40 && daysSinceLastCompleted >= 365

  Copy Rule
• You can also automatically update smoking status and drinks per week by tagging eForm items with the corresponding new EMRFields in the eForm editor, For example, if you have a question like "Do you smoke currently?", set the EMRField to "smoker" and it will update the risk factor automatically.
• You can have the Ocean eForm trigger the automatic insertion of a PS Suite custom form or an EA. The PS Suite custom form can then update the CPP and even send messages. See this article for more information.