This guide is intended to provide detailed information for laboratories wanting to implement direct transfer of results to their customers. It may also be of interest to Clinical users wishing to gain an 'in-depth' understanding of the systems involved.
Clinical can be used to import and manage Radiology and Pathology (investigations) results. Clinical can also automate the running of third-party communications packages (often supplied by the Lab) which have been configured to dial-in and transfer the investigation results from the Lab to the client's computer. This means that it is quite possible to configure the system in such a way that a single click or keystroke will dial-in, log-on, transfer, decrypt and import results for multiple laboratories.
Following is a list of the fundamental steps required to achieve this, including pre-requisites and setup detail.
There are two basic processes:
o Transferring the batch files from the Lab's computer to the customer's computer.
o Importing the actual result files into Clinical's holding file.
Clinical itself is not responsible for any communications or file transfer of results. Rather, it is the sole responsibility of the laboratory to provide the necessary software required to transfer the files to the customer's computer. The solution you provide here may involve an Internet connection (possibly encrypted e-mail), a pre-scripted communications program (such as PCAnywhere® or Telix®) or you may provide a custom-written software package developed in-house.
Result batch files must be decrypted by the provider's download program and stored in a folder that has been setup in Clinical. The default folder on the server computer is C:\Program Files\Health Communication Network\Messages\In
You have three options:
o Provide a 'shortcut' (icon) on the user's desktop, which runs the download program.
o Set up a scheduler to automatically transfer the results at regular intervals. As this is most frequently a part of the download program it should be setup by the provider during installation. The provider will be able to confirm this facility is available and how to configure it for the Surgery's requirements.
o Allow Clinical to run your program when a user clicks the 'Import Investigations' menu in Clinical. This method is infrequently used today and is included for legacy support. See below.
This can be setup in two ways:
o MedicalDirector Clinical has the facility to execute or run a user defined 'command' for all entries in the Clinical specialists database which have been marked as either Pathology or Radiology providers. Make sure that there is an address book entry for the provider (File > Address Book) with the 'Category' field set to either 'Pathology' or 'Radiology'. Then set the path or command line you would like to run when the user clicks the 'Import Investigations' item on the 'Tools' menu (Tools > Options > Investigations > Set Download Programs).
o Originally the running of external programs (when performing investigations imports) were handled using specifically named batch files. MD1.xx uses this method only and Clinical (for backward compatibility) will detect and run these batch files if they exist.
There are two batch files that MedicalDirector Clinical looks for:
o SNP.BAT
o PATHOL.BAT
When the user clicks Import Investigations on the Tools menu, if either of these two files are found in the Clinical home directory, they are run. Because batch files are run in a DOS window, you may need to set up a PIF (Program Information File) for each batch file so that the DOS window closes automatically after execution.
If you do decide to use this method, then be aware that SNP.BAT is reserved for use by Sullivan & Nicolaides Pathology. It is therefore preferable that you use PATHOL.BAT to launch your program.
There are two Industry Standard formats used for transferring this type of information.
o PIT - The Pathology Information Transfer specification was developed by MedicalDirector Clinical, Sullivan & Nicolaides and Queensland Medical Laboratory for the downloading of Pathology information. Although initially designed for pathology, this format can be used for other report types. This is a simple format without the features available in HL7.
o HL7 is the Australian Standard result transfer format. Further information about AS 4700.2 - Implementation of Health Level Seven (HL7) is available from Standards Australia.
Result files MUST conform to either of the above two industry standard formats. Clinical does have an option to log errors ('pathol.log') found during import of results for troubleshooting purposes.
For more information about troubleshooting your investigations download/import system, contact Clinical Customer Service.
To import Investigations Results in Clinical, select Correspondence > Download, or press F4.
This causes Clinical to run any of the external programs that have been setup within MedicalDirector Clinical (described above), and then import any result files (PIT or HL7 format) into Clinical's own Holding file (Holding.dbf) before prompting the user to view or check the imported results. This facilitates the total process of dialling in, transferring, decrypting, importing and optionally viewing the lab results with a single action.
Selecting Investigations > Check Holding File (or pressing F5) will import results that have already been downloaded, and then prompt the user to check/view the results.
Clinical looks for files (in the specified paths) with a three character file extension matching any of Clinical's list of registered file extensions. While not absolutely necessary, it is recommended that your result files use the 8.3 DOS naming convention (8 characters followed by a dot followed by a further 3 characters) so as to maintain compatibility with legacy systems. The three character file extension should be appropriate for the type of file and/or name of the laboratory that is PIT, HL7, SNP (Sullivan, & Nicolaides Pathology) and so forth. Please do not use common file types such as TXT (text file), DOC (Document) or file types which may have special meaning to your operating system such as DLL (Dynamic Link Library), CPL (Control Panel), EXE (Executable) and so forth.
As mentioned above, Clinical only looks for files with a file extension corresponding to a list of registered file types. By default this list automatically includes common extensions such as PIT, HL7 and some of the larger or more common labs. This list is maintained by a user who can add and delete file extensions as required. Refer to Investigations Options for details on how to add custom files types.
You can specify a different search path for each provider. This is the path Clinical looks for result files when importing investigations. The configuration of Investigations Downloads is handled by the Manage Communications utility.
Following is a step-by-step review for how Investigations Results are processed using Clinical:
1. The practitioner prints out a Pathology or Radiology request form from Clinical. This is done using the appropriate patient's record and can be either a plain paper format or on pre-printed paper supplied by the lab.
2. Patient presents at the lab for the test(s).
3. The lab processes the result into a PIT or HL7 format file, encrypts the file (if required) and makes it available for download from the labs (or 3rd parties) computer systems. Security and permissions would obviously be set to restrict download to just the clinic or practitioner who initiated the request, or any copy to practitioners/specialists designated by the requesting practitioner. This is the responsibility of the provider.
Results may be downloaded and/or imported:
o Staff at the surgery will initiate the download program from a desktop icon. This will download the result batch files, decrypt the files and store them in the designated folder.
o Where automatic downloads have been setup the provider will download the result batch files, decrypt the files and store them in the designated folder, at regular intervals.
o The MedicalDirector Clinical user clicks the 'Check Holding File' option in MedicalDirector Clinical. Clinical will move any files in the designated folders with the designated file extensions to the Processing folder on the local machine. Individual result information is then extracted and imported into the Holding file. The files are then deleted.
o The MedicalDirector Clinical user clicks the 'Download' option on MD3 item on the TOOLS menu. Clinical first looks through it's database for Investigations Providers which have command line options specified and executes those commands. Results from these providers are downloaded, decrypted and stored.
o Then MedicalDirector Clinical checks for and runs any of the specific communications software for labs which have a special arrangement with Clinical. This includes 'Medcoms', 'Macquarie Healthnet', 'Optus Messenger' and 'Clinipath'. This is controlled by options which can be enabled/disabled as required. Results from these providers are downloaded, decrypted and stored.
o MedicalDirector Clinical checks for and runs 'SNP.BAT' and then 'PATHOL.BAT' (if these files exist).
o The default folder on the server is checked for any files with file extensions in Medical Director's own list of registered file types. Any files that match this criteria are moved to the Processing folder on the local machine. The content of each file is tested for result data and if they are determined to be PIT or HL7 format the results are imported into the MedicalDirector Clinical holding file (Clinical Server). The files are then deleted from the Holding File.
o The user is then prompted to check the imported investigations. A list of the practitioners who have results waiting in the holding file is presented. Selecting a name then presents a list of all results waiting for that practitioner. Practitioners should select their own name from this list to view their own results. The All option should not normally be used as this will block other practitioners from viewing their results.
o The practitioner selects an entry (usually the first in the list). The Result's demographics are automatically matched against the demographics in MedicalDirector Clinical's Database.
• If an exact match is found the result will be displayed immediately.
• Where one or more possible matches is found, a list of patients is displayed for the practitioner to select from. The practitioner may also select a patient from the Clinical database.
• Where no matching patient is found, the practitioner will be asked to select from the main database. The same conditions apply as in the preceding paragraph.
o MedicalDirector Clinical then checks the patient's record for a Matching Result. If there is no matching result the result is displayed. If a matching result is found both the new and matching results are displayed for the practitioner to elect whether the old one will be replaced. Matching results are based on request date and patient name, only. A matching result may be for cumulative tests – like a weekly INR, or for a completely different test. It is the responsibility of the practitioner to decide if both are to be retained.
o At this point the actual result is displayed, the practitioner enters a comment against the result, or clicks the appropriate action button. The next result in the list is presented.
o When the last result in the list has been checked a message that there are no more results is displayed. The View Result window is closed to show the Holding file, with all results intact. When the Holding file is closed all checked results are transferred to the relevant patient's record.
o Files matching the import criteria are removed after import even if they are not PIT or HL7 format. For this reason it is best to use a separate pathology folder for receiving your result files and not to use common system file types for your result files.
o The computer which is performing the transfer of results from the lab (that is fitted with modem and running the communications software), does NOT have to be the Clinical server. It can be any MedicalDirector Clinical workstation which is sharing a common database. This is because the result files are imported into the holding file which resides on the Clinical server not the holding file on the local drive. The download folder must have sharing and security settings that allow all users full control of the files.
o If you have provided a scheduled dialler or desktop icon which transfers result files externally to Clinical, then the user would select the 'Check Investigations' item from the Tools menu instead of 'Import Investigations'. The difference here is that Clinical does not run any command line options or checks for communications software. It will import result files and prompt to check results. In this case it may be appropriate to initially transfer the result files to a shared directory (on Clinical Server). In this way any MedicalDirector Clinical user on the network could actually import and check results based on the search path set on each workstation.
o The Holding file is a managed resource. It is the practitioner's responsibility to regularly check off results as they come in. Properly managed, the Holding file should only ever hold recent results and should never be allowed to grow too large that is 100's of results.
o The Processing folder should not be used to store downloaded results, or for other purposes. This folder will be emptied after each processing.