PrognoCIS Help: Tests

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Introduction: Medical screening includes history, examination and medical decision-making required to determine the need for appropriate care and treatment of the patient. The descriptions for the levels of Evaluation & Management services recognize components viz.

SH	Social History	An understanding of past and current activities that includes significant information like Marital Status, Occupational History, Hobbies, Addictions, Activities, etc.
VI	Vital Indicators	These include the Weight, Blood Pressure, Pulse Rate, Respiratory Rate and Body Temperature of the patient.
HP	History of Present Illness	A description of the patient’s present illness from the first sign and/or symptom to the present.
RS	Review of Systems	An examination of body systems seeking to identify signs and/or symptoms that the patient may be experiencing or has experienced.
PH	Physical Exam	Detailed Examination of the patient's body parts.
SC	Specialty	Standard Examinations and questions related to the Doctor's Specialty.
SF	Surgery Forms	Questions related to Surgery/Procedure Forms.
LB	Lab Tests	Various laboratory tests viz. ABO and Rh, RBC Count, WBC count etc.
RL	Radiology Tests	Various radiology tests viz. X-Ray, MRI etc.
Image	Attach Image	User can select an image file and click on the *zoom* button to view the image file details to be attached. PNG, JPEG, GIF, and BMP are the type of image files that can be attached. The maximum size for attaching the image file is 4 MB.
JT	Justify	Questions for the Justification of Lab, Radiology, Consult, Procedure and Prescription (Rx) orders.

All these are Group Types in the application. The Interface to define the details is same for all the above-mentioned types.

The printed form for any of these tests will have one thing in common. There is a broad Class/Category and specific tests below it. Consider Labs, the Classes/Category can be Panels, Hematology, Cultures and a number of tests under each. Likewise, Review of Systems can have Classes like Major Body organs Heart, Eyes, and a number of specific parts/tests to be observed. On the other hand, Vital Indicators are too few and may not need any Class, but a single Class/Category can still be defined for them.

Field Descriptions:

Code: This Test Code is auto-generated on adding a new Test. Users are allowed to edit the Test Code at any time. This Code is mandatory and must be unique. If the Test is System-level, then the word System is displayed beside the code and users cannot make any changes to the test.

Name: Enter the name of the test.

Test Type dropdown: This dropdown is applicable to only Lab/Radiology Tests. The main types are:

Both Order / Result - Where the Order Test/Result Test is same (retained for backward compatibility).
Panel - This Test consists of Orderable Tests i.e tests with type as Both or HL7 Order.
HL7 Order Test - These are Tests which are specified in the OBR segment in HL7 Lab Order/Result. Each of these tests contains one or more tests of the type HL7 Order Result.
HL7 Order Result - These are Tests which are specified in OBX segment in HL7 Lab Result.

System: The first option under each of these is to define the Group/Category/Class of tests. The Label for this field is displayed in the menu depends on the values in the property applicable.system.label.VT (or other types) as explained under Test Execution. Click on the

to invoke the Search Category popup. A group Master screen is invoked to define the applicable test Group/Category/Class records.

Unit: Define a unit of measure for the test.

Sex: Select the sex of the patients for which this test is applicable. The available options are Both, Male and Female. By default, Both is selected in this dropdown.

Seq. No.: While displaying all tests within a Class, they will normally appear sorted by Name. However the user might prefer to see ‘Pulse’ before ‘BP’. To facilitate this, enter a sequence number. The actual sort order within a Class will be Sequence No., Name wise. With this mechanism it is not necessary to define the Sequence No. for all entries, nor is it necessary to have the Sequence No. unique. It can be changed any number of times, without any side effects.

Non Reporting: This option when selected marks the test as Non-Reporting and the test is not available on any of the Output templates. The other tests where the this checkbox is not checked are available on the Output Templates. On the Test level, it is available on Social Hist, Vital, HPI, ROS, Physical, Specialty, Justify, and Clinic Forms.

LOINC Code: Enter the LOINC code for the test.

LOINC Code for Answer: Enter the LOINC code for the specific Answers list. This field is available only for Social History tests.

Assign Codes button: This button is displayed in enabled mode for all the Test Types except the HL7 Result Test Type in case of Lab/Radiology Tests. The User can assign the CPTs/HCPCs and ICD codes to the selected Test from this button. On clicking this button, the Assign Codes popup is invoked which displays Add CPTs/HCPCs and Add ICDs button. Once the codes are added to the selected test and User clicks on the Ok button, a checkmark appears on the Assign Codes button indicating that the codes are added to the selected test.

Add CPTs/HCPCs button: The availability of this button is governed by the property addcpt.applicable.test.types. To assign CPTs/HCPCs code, click on the Add CPTs/HCPCs button. The CPTs/HCPCs popup is invoked wherein the User can select the code for the selected Test. The number of CPTs/HCPCs code to be selected is governed by the property order.assign.max.icds.

Add ICDs button: The availability of this button is governed by the property addicd.applicable.test.types. Click on this button to assign default ICDs to the selected Test. The number of ICDs code to be selected is governed by the property order.assign.max.icds.

Note: When the User adds the ICDs for a specific Lab Test and selects the same Lab Test for any Lab Order, then the configured ICDs gets associated with respective Lab Test on the Lab Order screen. The associated ICDs are assigned to the respective Lab Test, once the User clicks on the Save button and saves the Lab Order from the Lab Order screen. This functionality works only when the property lab.order.icdmust is turned OFF and the property order.assign.icds.rule value is set as N-No ICDs are assigned to tests automatically.

Result Type: To facilitate formatting tests and accepting results in a proper way, it is also important to define the type of result expected. Following are the available result types:

Boolean	*Yes/No radio buttons. For e.g. Response to, Is eye site Normal? It can also be set to No / Yes* (Default - No).
Numeric Range	Pulse within 0 – 200.
Fraction	Decimal values can be entered. e.g. Temperature 94.6F
Set of Values	Yellow / White / Reddish for Color of eyes/ nails. These are user defined set of values. The very first value is assumed to be the normal reading. This ensures proper validation. During test execution if the reading is any other than the first specified value, the system considers this as abnormal.
Multi Select	The definition part of allowed values is identical to that under Set of Values. However, in Test Execution when this test is used it will allow the user to make multiple selections.
Text	Users can enter a narrative text upto 512 characters with no validation. Practically, a user is expected to use this for smaller text of upto 30 characters, so that it is easily readable.
Notes	Users can enter a narrative text upto 5000 characters in the text field. A *Notes* icon is displayed next to the text field which invokes an *Other Notes* popup where users can read/edit the complete notes. If a user tries to enter more than 5000 characters in the *Other Notes* popup, then a validation message: *You have reached the maximum length of characters permitted here* is displayed. If the user clicks on the Ok button on the *Other Notes* popup in this case, then an alert message popup: *Notes Length Exceeds 5000 characters. It will be Truncated* is displayed. Clicking on the OK button on the alert message popup closes the popup, removes the extra characters from the notes and saves the notes.
Pick List	Works like Multi Select, except that while entering results, user can also edit the selected result values.
Date	To accept the date. Eg. LMP. User is provided with a Calendar Icon to pop up a calendar and select a date at the time of execution.
When	User is provided with a Calendar Icon to pop up a calendar and select a date, or enter any Text like Jan 2000.
Clock Time	Saves EMR Time
Formula	Formula can be defined using a combination of the following: Test Code of a test of Numeric / Fraction Result Types. Formulae Parameters and Keywords: Predefined in the program, such as *BMI* and *BSA. Numbers: Whole Numbers or Fractions. These can be combined using mathematical operators: addition (+), subtraction (-), multiplication () and division (/). The usage of Brackets ( ) is also supported. For example, the formula **(ORGWT - THISWT) 100 / ORGWT* can be used to get the percentage weight loss. Any formula entered is re-computed on every save. For Formula result type, the params/keywords are listed below. The character limit is 1024 characters. MAX(): Displays Maximum value from list of comma separated test code whose result type is Numeric or Fraction. For example: MAX(SC1,SC2,SC3) MIN(): Displays Minimum value from list of comma separated test code whose result type is Numeric or Fraction. For example: MIN(SC1,SC2,SC3) AVE(): Calculates average from List of comma separated Test Codes whose result type is Numeric or Fraction. For example: AVE(SC1,SC2,SC3) PERCENTILE_: Following supported Keywords to be entered after _ without any space (such as PERCENTILE_BMI): BMI: Calculates BMI percentile for patients ages 2 to 20 considering the Height and Weight in the current encounter. It then considers the patient's age and the values of BMI at standard percentiles applicable to age. The computed BMI is mapped to the percentiles, and the matching extrapolated percentile is returned. HEIGHT: Calculate HEIGHT percentile for patients ages 2 to 20 depending on the values entered in Height and Age. WEIGHT: Calculate WEIGHT percentile for patients ages 0 to 20 depending on the values entered in Weight and Age. HEADSZ: Calculate HEAD CIRCUMFERENCE for patients ages 0 to 36 months depending on the values entered in Height and Weight. BMI: Calculates BMI based on values entered in Height and Weight tests which are part of MU settings. Normal range defined is 17 to 29.9. A BMI value other than normal range will be marked as abnormal automatically by system and displayed in red color on output. BSA: Calculate BSA for patients based on values entered in Height and Weight tests which are part of MU settings. LASTENC_VAL(): LASTENC_VAL(TESTCODE) - will display the last Encounter's value where LASTENC_VAL is defined. PREVENC_VAL(): PREVENC_VAL(TESTCODE) - will display the previous Encounter's value where PREVENC_VAL is defined. SYS_SCORE: Calculates the total score for all tests with result type as Score within the same system. TEMP_SCORE: Calculates the total score for all tests with result type as Score within the same template. AUDIOCV_: Audiometric frequency in decibels can be calculated for patients whose age is between 20 to 60. If age is less than 20, then program will consider values for age 20 and similarly if age is greater than 60, then values for age 60 will be considered. No value will be displayed for patients with unknown gender. Following supported Keywords to be entered after _ without any space (such as AUDIOCV_1000): 1000: Displays the value for patient by taking into consideration of patient's age, gender and frequency at 1000Hz as defined in standard chart 2000: Displays the value for patient by taking into consideration of patient's age, gender and frequency at 2000Hz as defined in standard chart 3000: Displays the value for patient by taking into consideration of patient's age, gender and frequency at 3000Hz as defined in standard chart 4000: Displays the value for patient by taking into consideration of patient's age, gender and frequency at 4000Hz as defined in standard chart 6000: Displays the value for patient by taking into consideration of patient's age, gender and frequency at 6000Hz as defined in standard chart ANESTHESIA_DURN: Two tests should be created as Anesthesia Start Time and Anesthesia End Time with Result Type as Fraction, and their test codes should be defined in the properties: anesthesia.starttime.testcode and anesthesia.endtime.testcode. Define one more test as Anesthesia Duration with Result Type as Formula and Value as ANESTHESIA_DURN and add test code in the property: anesthesia.duration.testcode. Time for Start Anesthesia and End Anesthesia should be in Military Time format, for example: 0100, 1000, 1600, 2300, etc. Anesthesia duration will be calculated in minutes. COCKCROFT_GAULT: Calculates the Creatinine Clearance on the basis of Serum Creatinine value, height, weight, age and gender of the Patient. IDEAL_BODY_WEIGHT_KG: Calculation for Ideal Body Weight in KG is done using this formula. Estimate ideal body weight in (kg): Males: IBW = 50 kg + 2.3 kg for each inch over 5 feet. Females: IBW = 45.5 kg + 2.3 kg for each inch over 5 feet. IDEAL_BODY_WEIGHT_LBS: Ideal body weight in Kgs converted to Pounds. WORK_DAYS: This formula will consider Clinic work days only which are set under Settings → Configuration → Location → Code 'CL'. For example: TestCode1 + (TestCode2) (WORK_DAYS) where TestCode 1 resulttype should be Date/Date Calc and TestCode2 resulttype should be Numeric. DOCWORK_DAYS: This formula will consider work days defined under Provider workpattern. For Example: TestCode1 + (TestCode2) (DOCWORK_DAYS) where TestCode 1 resulttype should be Date/Date Calc and TestCode2 resulttype should be Numeric. WEEK_DAY_: Following supported Keywords to be entered after _ without any space (such as WEEK_DAY_MON**): MON TUE WED THU FRI SAT SUN
Date Calc	User can specify a Test (of Date type) and any formula which reduces to a number. The program computes the new date considering the computed positive or negative offset. E.g. LMP + 40 * 7 to get the Estimated Delivery Date. For Date Calc result type, following are the valid keywords: DOB: When this keyword is used, the system picks up the patient's date or birth and generates the result. TODAY: When this keyword is used, the system picks up the current EMR date and generates the result. ENCDATE: When this keyword is used, the system picks up the EMR date and time and generates the result. If the encounter is a backdated encounter, then the system picks up the encounter date from the database table at the backend and generates the result. Mathematical operators: addition (+), subtraction (-), multiplication (*) and division (/) can be used with the above-mentioned keywords to generate the desired result. The usage of brackets ( ) is also supported.
Tag	User can use any String with Tags (Patient or Encounter Tags).
Master Search	User can enter any one of these Text Values, ICD, ICD:UserCategory, ICD:PREF, CPT, CPT:UserCategory, CPT:PREF, HCPC, HCPC:UserCategory, HCPC:PREF, DRUGS, DRUGS:IH, DRUGS:PREF, DRUGS:DEAXY, SUPPLIES, SUPPLIES:IH, SUPPLIES:PREF, DRUGNAME, DRUGNAME:PREF, MEDICS:ALL, MEDICS:DR, MEDICS:RD, MEDICS:RN, MEDICS:ST, MEDICS:BL, LABTEST, LABTEST:PREF, RADTEST, RADTEST:PREF, CONSULT, GROUPS:TypeCode. At the time of Test Execution i.e. Vital/HPI/ROS... entry, a Search button appears after this Test. A click on the button invokes appropriate search, so that user can select the name of ICD/CPT/Drug as required. The selected Name becomes part of the test result. User can select up to 5 records from search. Existing selection will be overwritten. Multiple selections will be Comma separated. Also, in the value set filters, the search for Medics can be refine by Designation and Specialty. It means, you can define filters by Designation and Specialty separated with a caret ^. For example: MEDICS:DR^DSG:Physician^SPL:Abdominal Surgery This example searches results with Medics type = DR, Designation = Physician, and Specialty = Abdominal Surgery Note: The keywords should be in upper case only. Multiple Specialty and Designation is not allowed. IMO search popup is displayed with the ICD9 and ICD10 codes when the text value is ICD.
Score	A test score is a piece of information, usually a number, that conveys the performance of an examinee on a test. It can be a type of test, assessment, or evaluation which yields an estimate of the position of the tested individual in a predefined test. If this Result Type is used, then a dropdown appears on the template where only one option can be selected from the given options to score the tests which help to calculate total score for system or template for evaluation purpose. Both *Value* and *Score* should be configured in the test code. This works in conjunction with formula SYS_SCORE, TEMP_SCORE, SYS_SCORE(XX), and TEMP_SCORE(XX) in the *Formula* Result Type. (XX) refers to the *Score* value defined in brackets.
Scale	Users can drag the pointer and place at any value from 0 to 10 on the scale. Fraction is not supported on scale. This Result Type is not applicable for: Defining Lab tests, Radiology tests Designing Doctor Form/Patient Form Defining grid
Quantity	Users can define a range of allowed values upto 3 decimal digits in a *Normal* and *Valid* Range. If User enters a value less than three decimal digits, then on save, the missing decimal digits are appended with zero(s). For example, if 1.12 is entered, then on save, the value is displayed as 1.120. *Normal* Range value set serves as subset of *Valid* Range value set. Appropriate validation messages are displayed when a value with more than 3 decimal digits is entered or if the *Valid* Range values do not include *Normal* Range values.
Image	Users can attach and view image files from the *Attach* and *Zoom* buttons. Allowed image file types are PNG, JPEG, GIF, and BMP, and the maximum size for attaching the image file is 4MB.
Custom Result Type	Users can define either *OVARY* or *DENTAL* in the Value Set of this Result Type as required. According to the defined value, an *OVARY* button or *DENTAL* button appears on the template. On clicking the *OVARY* button, a popup is invoked where the user can view/edit three component fields: *Ovary 1, Ovary 2* and *Ovary 3. On entering some data in this field and clicking the Ok button on this popup, the entered data is concatenated and displayed as a caret ^ separated Data Components string as Data1^Data2^Data3* where *Data1, Data2* and *Data3* is the data entered in the *Ovary 1, Ovary 2* and *Ovary 3* fields respectively. This entered data is displayed on the Progress Notes of the patient in the form of a Report Sentence string using the tag [ENC_SPL_STR__LINE]. The Report Sentence is displayed as *Data entered for Ovary is Data1 Data2 Data3. On clicking the DENTAL* button, a popup is invoked which displays two fields: *Teeth Upper* and *Teeth Lower, each having checkboxes for numbers from 1 to 16. Upon checking the required checkboxes, a caret ^ separated Data Components string is generated and displayed on the template as: U1^U2^...L3^L4... (depending on the numbers for which checkboxes are checked) followed by a \| separator and a Report Sentence string: The Patient has under gone root canal for Upper Teeth Nos:X. The Patient has under gone root canal for Lower Teeth Nos:Y.* where X and Y are the comma separated numbers whose checkboxes were checked in the *Teeth Upper* and *Teeth Lower* fields respectively. This Report Sentence can be displayed on the Progress Notes of the patient using the tag [ENC_SPL_STR__LINE]. Note: The data OR sentence cannot use ^ and \| characters, and the data components string cannot exceed 255 characters.

Supported Result Types can be set using the property, test.resulttypes.

Depending on the type of result selected, the requisite fields to define the valid Numeric Range OR valid Set of Values will be either shown or hidden.

Note that with this structure, the Test Definition is very generic. It could mean a physical test like Taking Temperature, or it could even mean asking a simple question like “Number of Cigarettes smoked per day?”.

If the result type is set of values or multiselect, the list can be shuffled using the Move Up and Move Down buttons.

CPT/HCPC: Click Name [+] button to invoke the CPT/HCPC popup to choose codes (CPT/HCPC/SNOMED) to be assigned.
It is mandatory to specify at least one of the three names given for the disease. The user name will be used to specify this CPT/HCPC code in PrognoCIS. Since the names are imported from the External CPT/HCPC database the user is allowed to change the name according to User's nomenclature.

SNOMED: Click on the button to select a SNOMED code from the Search popup.

SNOMED Search popup:

Associate either an ICD or CPT/HCPC code to search for respective SNOMED code.

ICD: Select ICD option to search for ICD associated SNOMED code.

CPT/HCPC: Select CPT/HCPC option to search for either CPT associated or HCPC associated SNOMED code.

Code Description: Select this option to either enter a SNOMED code or the description of code directly in the 'Search' field to search for results.

SNOMED code: Select this option to enter a SNOMED code directly in the 'Search' field to search for results.

Search texbox: Enter either code description or the SNOMED code according to the option selected as the criteria for search.

Search button: Click 'Search' button to display the filtered list based on the option selected.

Selected: The field displays the codes that are selected from the list.

Clear: On click, clears the selection from the ‘Selected’ field.

Group Number: For Tests having the Question Settings in property applicable.test.fields.VT/HP/RS/PH/SC/SH, this field will appear. This is a mode where a set of questions belonging to a Group Number are asked. Depending on the response to each question it is possible to zoom to another set of Questions.

Sub Grp: (Number) can be specified for each option of Boolean Result Type OR Set of Values Result Type. This is the Group Number Question set which will be popped up if the specific answer is chosen by the user while entering the HPI / ROS during the encounter. This can also be specified for Result type Numeric or Fraction. This is the Group Number Question set which will be popped up if the result lies outside the normal range.

Report Sentence: The user can define the format of the sentence in which this test result should be presented when used in the progress notes. This sentence can use one or more of the following tags:

<TEST> This tag gets replaced with the test name.
<ISARE> If the result contains multiple selections, ARE is used otherwise IS is used.
<RESULT> Prints the test result entered.
<REMARK> Prints the test remarks entered.
<BOOLRESULT> This is applicable to tests with result type Boolean only. Depending upon the result, one of the two texts entered using the Special Text, button get printed.
<UNIT> It is a test unit.
<GENDER> The word He or She is used depending on the sex of the Patient selected.
<HISHER> The word His or Her is used depending on the sex of the Patient selected.
<TICK> If the test result type is Boolean and the non default option is selected, a tick mark is printed on a new line.
<NL> New line
<PLURAL> Appends a ‘s’, if "comma" or "and" are found in the Result Text.
<SUBTEST> This tag can be used if there are subtests applicable. On entering data, if the user zooms to other tests from the current one, all the subtests sentences are concatenated and they replace this tag in the main test sentence. This makes it a powerful tool to build composite sentences using the nested tests.
<CONTRA> Prints concatenated String of Results not selected from Multiselect.
<PT xxxx> These are any of the Patient Tags used in Progress Notes. Please note that this Tag begins and ends in Square Brackets [ and ], unlike all other tags.
All patient tags from progress notes can be used here. Please note that patient tags are with square brackets.
Two Tags <MBULRESULT> and <MNOSRESULT> for Tests with Result Type as Multi-select. The M indicates Multi-select. The BUL indicates Bullets and NOS for serial numbers.
The tag, <LBSOZ> prints the weight values in pounds and ounces.
The tag, <ICDCODENAMESNL> prints the ICD Codes and Names from selection in a new line whereas the tag <ICD10CODENAMESNL> prints the ICD10 Codes and Names from selection in a new line. The data is printed on the Progress Notes in bulletin format.

For Example: Test Name is Pain and options are Dull, Sharp, Tearing, Intermittent, Radiating.
Consider options selected: Sharp, Intermittent, and Radiating

Test Sentence was <NAME> is < RESULT >

Output: Pain is Sharp, Intermittent, and Radiating.

Test Sentence was <NAME> is < MBULRESULT >

Output: Pain is

Sharp

Intermittent

Radiating

Test Sentence was <NAME> is < MNOLRESULT >

Output: Pain is

Sharp

Tearing

Dull

Note: Proper serial numbers are assigned to options.
If these tags are used for Tests whose result Type is NOT Multi-select, they will be processed as normal <RESULT> tag.
There is an additional construct using a conditional statement which needs special emphasis. A test sentence can be specified as IF(=xyz^sentence1^sentence2).
This essentially means if the result satisfies the specified condition use sentence1, otherwise use sentence2.
The first character after IF( is the operator used for evaluation).
The permitted operators are:
= Equal to
> Greater than
< Less than
The string following the operator (xyz) is the one used for comparing with the current test result using the specified operator. Please note that this is a string comparison.
Sentence1 will be used for printing in the report if the first condition is evaluated to be TRUE.
Sentence2 will be used for printing in the report if the first condition is evaluated to be FALSE.
Sentence1 and sentence2 can be defined using any of the above-defined tags.

The additional information required only for Lab Tests are mentioned below.

Panel Check Box: Many standard tests can be combined to f
orm a Panel of tests. If this is checked, the fields for Result types will be hidden and a Table list appears. The test required under this panel can be defined here. Note that one test can appear under more than one Panel.

Add: Applicable to only Lab/Rad Tests.

Hide: Applicable to only Lab/Rad Tests.

CPT Code: All Lab and Radiology Tests have an associated CPT Code. Select one by clicking the adjoining button. CPT Codes can also be selected for Specialty Tests depending on property test.specialty.cpt=Y.

Abnormal Phrases Button: Clicking this button, a popup opens up in which Phrases for Abnormality can be added and/or deleted.

If a test is used in any test execution, it should ideally not be modified as it can result in a change in the progress notes for an earlier closed encounter. A property, tests.used.messagetype, if set to E does not allow the user to edit the test once it has been used in any encounter. If the property was set to W the program allows the modification but warns the user accordingly.

Name in Pat/Doc Forms: If the User uses the selected test in Patient or Doctor Form, the label for those test can be set from this field.

Sample Specs in Lab Order: Enter the Lab Sample specification in this field. The entered samples specs for the Lab gets automatically assign to the Lab Order when the same Lab Test is ordered on the Lab Order screen.

(Inventory Items assigned) Assign Items: This button is enabled only when the property assign.items.to.LB is turned ON, by default the property is turned ON. Click on this button to invoke Inventory Items popup, on this popup with the help of the Add icon, the User can add the items as required. After adding the items the popup displays the name, quantity and unit of the assign items.

Action Buttons:

save: Click to save the details. This button is initially displayed in disabled mode, on adding the information for the Test, the save button is enabled.

delete: Click to delete the respective test.

reset: Click to reset the values of the test to the previously saved values.

replace: Click to replace the test with another test selected from the Tests search popup.

importXls: Click to import the tests from the attached xls into PrognoCIS.

Note: This button is available only through Admin login.