Update r/t clinical lessons learned from the pilot: Provide a CDS notification when "ECC Positive" is present as a colpo result

[ssebast2]

Dr. Updike mentioned that he would want his physicians to know that they need to look at the guidelines if this result is positive and there is no additional histologic results documented. What we don't know if what if ECC Positive and a histologic result from a colpo or excision procedure is present. Would it be appropriate to just provide the care recommendation r/t the histology result from the colpo or excision procedure?

[ssebast2]

IF colposcopy test recorded on the smart form
AND the result = "ECC Positive"
AND other results from the same dateTime are NOT FOUND
THEN DISPLAY "You have entered 'ECC Positive'. Please enter the specific result in the ECC form to receive a clinical recommendation."

[mickohanlon23]

@ssebast2 @gmmeadows @mrnosal When only the ECC Positive button is clicked in the pap tracker Smart Form, I believe we decided that we will proceed as our CDS currently would, which is return the error saying that a lab test is found with an unrecognized result (paraphrasing). Does that sound correct? If so, I will close this thread, since there would be no other need to make a custom mapping for this.

[ssebast2]

Dr. Guido and Updike asked for this to be implemented:

IF colposcopy test recorded on the smart form
AND the result = "ECC Positive"
AND other results from the same dateTime are NOT FOUND
THEN DISPLAY "You have entered 'ECC Positive'. Please enter the specific result in the ECC form to receive a clinical recommendation."

[mickohanlon23]

I thought that was what they originally had requested, but later we decided that our default error text was acceptable?

The language above ("you have entered 'ECC Positive'", "ECC Form") seems very specific to the UPMC workflow, and something that should be addressed in their training, rather than something that should be a part of our logic.

I also do not see anything about this in our Jira Backlog.

[ssebast2]

Hmm. Ginny transferred the items from Github to JIRA. I'm not sure if it was overlooked or deemed no longer applicable.

I guess it depends what our error message says. If it says "A lab test was identified without a corresponding result. Please enter a result so a CDS recommendation can be provided." That may be confusing to the clinician, because in their minds, they entered the result (ECC Positive). The ECC test is not missing a result, it is just not specific enough for us to provide a recommendation...

[mickohanlon23]

The CDS would output the following ErrorDiagnosticReportWithNoConclusonCodes:

A laboratory test was found without a result. Please review patient record to resolve.

[ssebast2]

Ginny concurs with me that we would prefer the ECC Positive message be displayed as suggested by the UPMC doctors.

[mickohanlon23]

What was the text suggested by the UPMC doctors? There are two different statements listed in the Go-Live spreadsheet, which is the last place where I remember tracking this issue.

Dr. Guido has already indicated this is not critical for go-live, so I do not think we should prioritize this over anything in our current sprint.

[ssebast2]

That is fine with me r/t prioritization.

The final logic statement is

IF colposcopy test recorded on the smart form
AND the result = "ECC Positive"
AND other results from the same dateTime are NOT FOUND
THEN DISPLAY "You have entered 'ECC Positive'. Please enter the specific result in the ECC form to receive a clinical recommendation."

[mickohanlon23]

What if a patient at UMMC happens to have an ECC positive result? Will the clinician understand what this recommendation means? How about Alliance Chicago? I am fine including a recommendation for this, but I think we should really avoid trying to make it specific to the UPMC workflow if at all possible, since updating a recommendation text statement involves modifying it in the logic that anyone using the CDS will access. Again, our app is not just making recommendations based upon inputs from the pap tracker. We convert the pap tracker results to a FHIR resource that represents that result, and then add that to the patient record to calculate a new result.

Could we say something like: "A colposcopy result of ECC positive was found. Please review the patient record and enter a more specific result to receive a clinical recommendation."

This addresses:

1. An ECC+ result could have already existed in the patient record and wasn't necessarily "entered".
2. Using less specific language about where to enter the results, since this will differ across sites.

[ssebast2]

How about "An ECC result of "positive" was found. Please review the patient record and enter a more specific ECC result to receive a clinical recommendation."

We shouldn't say a colpo result of ECC positive b/c ECC positive is an ECC result.

[mickohanlon23]

I said colpo result because ECC Positive falls under the "Colposcopy" section of the pap tracker. But what you wrote sounds good to me. Can you add a Jira ticket to our backlog for this? @ssebast2

[ssebast2]

Done: https://jira.mitre.org/browse/CCSMCDS-49