Hey All
The central region has an issue with the Orion Clinical Document Viewer (the left hand column where you click on the test you want to see).
If there are >10,000 entries, the list truncates by date (irrespective of results type). Some ICU long stay patients can generate this many tests in admission, meaning potentially important results can become invisible.
I’m trying to understand whether this a known issue around the country, or if it’s an artefact because our regional uses Orion’s document repository for all lab tests (I believe most other instances of Concerto use Delphic Eclaire to view, sign off and manage lab results)
SO - feedback sought on
whether this is a problem others have encountered
If so, what solutions have been attempted and whether they worked.
Hi Matt
yes we have hit the limit on some patients - and that’s just with documents being visible via the Clinical portal CDV tree - we have to realise than an “eHR is for life” - which means they need to be designed to last the life of a patient
We have had similar challenges with Eclair - at one time we were sending all the POC glucose to the eclair tree and had to remove them after 24 hours so as not to create a similar problem. we now have a version that allows you to have a secondary tree to not have to hide them
Thanks Lara and Lucy
Getting rid of the Point of care stuff is a good idea. I hadn’t actually considered deleting data to clean up the CDV tree, but it makes sense.
Ironically, I’m reminded of a slide from Orion themselves showing just how much growth we can expect in the volume of data per patient over the foreseeable future… what with data from IOT, genomic information and whatnot. I’ve now had a number of patient who exceeded their maximum data capacity within a single ICU admission (starting from 0 before they came in!). In these cases, a histology results from 8 weeks ago may become completely invisible… which is not really safe.
This issue was identified by Francois over 2 years ago to Orion and I would suggest raising it again. There hasn’t been any solutions apart from visible messages to say that not all data might be visible…another way would be to train staff to use the date search function to ensure that they are retrieving the relevant info. for data that is overloaded.
Thanks to all for their responses. Martin - for the central region we made a decision to use the Orion results product - which means that we don’t get users to view or sign off labs in Éclair… for our region this is a real problem… and it may well be something which either pushes us to drive a fix at the Orion end or move to the same processes that appear common in the rest of the country (labs view and sign off in Éclair)… that will be a fun discussion.
I’ve taken it to the team at TAS in the first instance, and we’ll see where we get to. I’m sure they’ll we’ll have a brilliant and slick solution - but maybe don’t hold your breath.
Oh dear. Well I guess it is going to be a journey for u guys. The CDHB made the decision yrs ago for eclair. There was pressure but the clinicians held firm. It is in HealthOne and it’s South Island wide. Seems to work but GP still sign off in their PMS’s of
course
Cheers martin
While I don’t know the specifics for older versions of Clinical Portal (aka Concerto 6.x) I believe that in recent versions there isn’t a hardcoded maximum limit on the overall CDV tree entries.
What there is a configurable limit on each document repository within the CDV tree which can lead to confusion and issues when the number of entries returned by a specific repository exceed the limit on that repository. I’ve had a look around at tickets at our end and I can’t see anything relating to a hardcoded overall limit but just to the per doc rep ones.
For the South Island system we did an exercise in 2019 to identify the maximum results for a single patient for each of the 38 document repositories used in Health Connect South and whether that maximum was likely to grow in the future. Using this data we then modified the Maximum Number of Documents to Display on each repository to a value higher than the max (plus headroom if it was likely to grow). The size we ended up at for the Eclair Document Repository was 10,000 currently (we had a patient with around 6000 results and likely to grow). In a quick test I can set this limit to a very large number and it saves and operates as expected, although I don’t have a patient with >10k results to test with.
This South Island change has meant that the blue “Some documents may not be visible” message at the top of the CDV should no longer display for any patients, however we will need to potentially redo this in the future to keep up with new document repositories and growing patient records.
In terms of results in the CDV tree, within Health Connect South we provide both the ability to launch Eclair itself and also the results in the CDV tree. Usage is approximately 50/50 between the two methods and thus we have over 1 million results opened from the CDV tree entries each month. Because of this heavy usage of results from the CDV, so far the decision has been to retain them in the tree.
Hey Gavin,
Thanks. We appear to have a different way of ingesting results in the ccentral region because we exceed the 10K limit pretty easily. (i.e. in a single admission) The other issue you touch on is that of being more granular with the document limit for each document type. I THOUGHT we had a fix put in place ages ago which ensured that each results type had its own limit, but I recently discovered a patient who had had >10K results since his last histology test, and as such has no “Histology” folder in the CDV tree… this was what prompted my enquiry and concern, but it sounds like I need to go back to double check what the actual settings are.
Cheers
Mat
