IndiviCare HRM Guide

The Hospital Report Manager (HRM) is an OMD solution that enables sending facilities (hospitals or Independent Health Facilities - IHFs) to electronically transmit patient reports to a clinician's EMR for follow-up care. HRM sends Medical Record (MR), Diagnostic Imaging (DI) and Cardio Respiratory Therapy (CRT) reports in a common format to be consumed by the EMR for all recipient providers within the clinic registered with HRM.

In IndiviCare, the HRM component is a value-added service for clinicians who are enrolled and registered with HRM. After the HRM Adoption Process (from OMD), the clinician's IndiviCare EMR is connected to the HRM server to start fetching reports, to which the clinician is a recipient. The received reports are integrated into the patient's record and the clinician's inbox for review and sign-off. 

See the OMD website for more information: https://www.ontariomd.ca/portal/server.pt/community/hospital_report_manager.

Setting Up HRM in IndiviCare

Important

Before using HRM in IndiviCare, you must contact Indivica Support to enable the HRM module in your IndiviCare EMR.

Adding HRM Credentials

In IndiviCare, go to the Admin > Hospital Report Manager (HRM) Preferences screen and specify the following (found in the credentials document that OMD provides to the participating clinics):

Host Name Specify the HRM host address.
Port

Specify the port to use for SFTP.

User Name Specify the username provided by HRM.

SFTP Remote Download Folder

Specify the HRM remote download folder to use (specified in the HRM credentials document provided by OMD)

Decryption Key

Specify the decryption key for the downloaded HRM files.
Auto Polling Slide to right to enable auto-polling.
Auto Polling Interval Specify the interval time in between automated HRM fetches (in minutes). The default time is 30 minutes, if nothing is specified.

 

Warning

Make sure all the HRM Preferences are specified before attempting to download reports from HRM.

Setting Up Categories 

Clinicians can set up categories for automatic filing of HRM documents based on subclass(specific report type) and sending facility. This is a way of organizing the incoming HRM documents for clinicians to easily search and review the reports they are waiting for. For example, you can set up an "Hospital ABC Discharge Reports" category to group all the discharge reports coming from hospital ABC, so that if you are looking for a discharge report for patient, John Smith, you can quickly see the report in the "Hospital ABC Discharge Reports" category from John Smith's chart.

Adding a Category

  1. Click Admin > Hospital Report Manager (HRM) Categories.
  2. Specify a Category Name (this is a one-to-many relationship: one category can be mapped to many sending facility subclass).

Mapping a Subclass and Sending Facility

After the Category is created, you can map a subclass and sending facility to the category. For example, if you map subclass=Consultation and sending facility=5318 (facility code for a local hospital) to Consult category, then all HRM reports coming in with subclass=Consultation and sending facility=5318 will automatically have the Consult categorization when you view the HRM Inbox or the patient's chart.

Keep in mind that you can map many subclass and sending facilities to one category. For example, you can map consultations (subclass=Con^Consultation) from any sending facility to one "Medical Record Consult" category.

Navigate to Admin > Hospital Report Manager (HRM) Class Mappings to view the HRM Class Mappings screen:

Adding a Class Mapping

  1. Click Admin > Hospital Report Manager (HRM) Class Mappings.
  2. Click Add Mapping to open up the Hospital Report Manager Category Definition.
  3. Select a Category Name (categories were created previously).
  4. Specify the Class (Medical Record, Diagnostic Imaging Report, Cardio Respiratory Therapy Report, etc.)
  5. Specify the Sending Facility ID (add a new one, if the desired Sending Facility ID is not in the drop-down list).
  6. Specify the Class-specific fields:
Field Description

Class

 

  • Medical Record Report
  • Consultant Report
  • Lab Report
  • Other Report
Subclass Specify the Subclass for the Medical Record to be mapped to the category.

 

Field Description

Class

 

  • Diagnostic Imaging Report
  • Cardio Respiratory Therapy Report
Accompanying Subclass Specify the Accompanying Subclass.
Accompanying Mnemonic Specify the Accompanying Mnemonic.
Accompanying Description Specify the Accompanying Description.

Configuring HRM Admin Users

EMR users with administrative privileges can enable the HRM Admin property via the Admin > Search/Edit/Delete Provider panel. Setting this property allows you to receive HRM auto-polling alert Messages to view HRM fetch failures as well as other notifications, such as duplicate or change reports detected. (See HRM Alert Messages for details on HRM notifications.)

You don't need HRM Admin enabled to use the HRM module, it is simply an HRM alert mechanism. Any IndiviCare user with administrative privileges can download and view HRM documents sent to them.

Note

The EMR user that initiates a manual ad-hoc HRM fetch will receive alert Messages for that activity, regardless if they are configured as HRM Admin.

Configuring the Confidentiality Statement

The IndiviCare HRM module supports a Medical Practice's confidentiality statement on printed HRM reports. To configure the confidentiality statement, go to the Admin > Hospital Report Manager (HRM) Status screen, and type your statement:

The confidentiality statement is clinic-wide and is printed in the footer of all HRM text reports, as well as all HRM binary reports that can be viewed in the HRM Document screen (embedded links do not have the confidentiality statements added).

Fetching HRM Documents

Setting up the IndiviCare HRM component to retrieve reports from the OMD HRM server is done via the Admin > Hospital Report Manager (HRM) Preferences panel (see Adding HRM Credentials).

There are two methods to retrieve HRM reports:

  • Auto-polling retrieval
  • Manual ad-hoc retrieval

The retrieved HRM reports are automatically parsed and inserted into the EMR database in the auto-polling or manual ad-hoc fetch process. The HRM reports are automatically matched to patients and providers in the EMR. You can view the HRM reports via the HRM Inbox or in the patient's (demographic) Echart. See HRM Inbox for details.

Auto-Polling (Automatic HRM Report Fetch)

Once HRM auto-polling is configured, the IndiviCare HRM component will auto-poll (automatically retrieve) reports from the OMD HRM server, at regular intervals (based on the auto-polling interval configured). This is the typical configuration for clinics receiving HRM reports on an ongoing basis.

The next fetch will occur after the last fetch completion time + auto-poll interval minutes. The default auto-polling interval is 30 minutes, therefore if the auto-polling interval field is empty and auto-polling is enabled, the system will use 30 minutes.

Fetch failure notifications are found in your Message Inbox, if HRM Admin is enabled in your profile.

You can turn off auto-polling in the Admin > Hospital Report Manager (HRM) Preferences panel.

Manual (Ad-Hoc HRM Report Fetch)

You can manually retrieve reports on an ad-hoc basis via the Admin > Hospital Report Manager (HRM) Status panel. Click on the Fetch Next Data from HRM button to initiate a manual download.

EMR users with administrative privileges are able to perform an HRM manual fetch (this includes doctors and nurses). The manual fetch process does not interfere with the auto-polling process (it does not change the timing or the interval for the next auto-poll fetch). However, if you perform a manual fetch while an HRM auto-poll fetch is processing, then the manual fetch will initiate after that auto-poll process is completed.

HRM manual fetch issue notifications (alerts) are sent to the EMR user’s Messenger Inbox (as well as to EMR users with HRM Admin enabled).

HRM Alert Messages

The IndiviCare HRM component uses the IndiviCare Messenger Inbox to alert EMR users of HRM significant concerns, such as:

  • SFTP connection issues (unable to connect to the HRM server due to connectivity or authentication failures)
  • Incorrect HRM directory configuration (therefore, no HRM documents are downloaded)
  • Unable to decrypt the downloaded HRM document
  • Parse errors (errors deciphering the HRM document)
  • Duplicate HRM document detection
  • Changed HRM report detection

These alerts are sent to the user that initiated the HRM manual fetch process. Auto-polling alerts are sent to EMR users with HRM Admin enabled.

 

Suppressing HRM Alert Messages

Once the initial HRM Retrieval Error message is received, the HRM administrator can choose to not receive further notifications for that outage. To suppress future notifications of the same type of outage, go to the Admin > Hospital Report Manager (HRM) Status screen and click on the Prevent further HRM outage message for this outage instance button. The current EMR user is shown on the disabled outage message list:

The disabled outage message list is cleared once a successful SFTP fetch has been performed (or when the IndiviCare server is restarted).

Viewing the Retrieved HRM Reports

After the HRM reports are downloaded into the IndiviCare EMR, you can view the HRM reports from the Inbox > HRM Inbox:

Only HRM reports are visible in the HRM Inbox.

Matching HRM Report to Patient

The HRM report is automatically matched to a patient in the EMR (a demographic record) with exactly all of following information:

  • health card number
  • gender
  • date of birth
  • patient's last name

HRM reports that are matched to patients can also be access through their chart. See E-Chart > HRM Documents.

If there is no patient in the EMR that matches the HRM report's profile, the report will be highlighted in the HRM Inbox. You can manually match or un-match an HRM report to an existing patient via the HRM Document screen. See HRM Document below.

Matching HRM Report to Provider

The HRM report is automatically matched to a provider in the EMR by their CPSO or by their CNO number (matched HRM reports are called “claimed” reports in IndiviCare). Ensure that the provider has their CPSO or CNO number configured, and that the Practitioner Number Type is configured accordingly in their Provider Profile:

The HRM reports, that are matched to a provider in the EMR, are displayed in the provider's HRM Inbox for review (Provider-Claimed view). You can manually match or un-match an HRM report to an existing provider via the HRM Document screen. See HRM Document below.

HRM Inbox

Go to the Inbox > HRM Inbox screen to see the list of HRM reports downloaded to the EMR.

The HRM Inbox is a list of HRM reports with the following displayed columns:

Column
Description

An indicator is shown when a change report has been detected. See Changed Reports below.

Report No.

This is the report number assigned by the source facility.

Health Card Number

The health card number of the patient in the HRM Report.

If the HRM report is matched to a demographic in the EMR, then the health card number of the matched demographic is displayed.

Patient Name

Display the patient name from the demographic record that is matched to this HRM document.

If no patient is matched, the patient name from the HRM report is displayed, and the entire HRM report row is highlighted.

Sex

Display the patient's sex from the patient matched to this HRM document.

If no patient is matched, the sex of the patient from the HRM report is displayed.

Report Date

Display the "message date" from the HRM document (taken from the message unique ID). This is the date the report was created from the source facility.

Received Date This is the timestamp when the HRM report was received (downloaded from HRM) in the EMR.
Category

The category to which the HRM report belongs to based on pre-defined subclass mappings.

An HRM report can have one to many HRM categories assigned to it.

Source Status

This is the "Result Status" from the source facility in the HRM document. For example, "Signed" or "Cancelled", etc.

Delivered To

This is the provider that the HRM document was matched to. For unmatched HRM documents, a "*" is displayed (in IndiviCare, unmatched report to provider are called "Unclaimed" reports). There could be many recipients for a particular HRM document.

The data displayed in this column is dependent on the filter and view you choose.

HRM Document Filters:

  • Provider Filter: 
    • All shows all HRM documents (except duplicates) for all providers. "Delivered To" has a list of providers that this lab is matched to (comma delimited list). 
    • Specific Provider Filter: Only HRM documents routed to the current provider is displayed. Of these documents, the "Delivered To" column should display all the matched providers.
  • Demographic Filter: Displays the HRM documents only for the demographic number specified.
  • Date Range Filter: Displays the HRM documents, based on the Report Date within the specified date range.

You can see specific views, based on the HRM filters:

  • Unclaimed View: Display the unclaimed HRM documents (documents not matched to a provider in the EMR) based on ALL or Provider filter. The "Delivered To" column displays "*", plus any other providers that was matched to this report.
  • Claimed View: Display the claimed HRM documents (documents matched to a provider in the EMR) based on ALL or Provider filter. Of these documents, the "Delivered To" column should display all the matched providers.
  • Duplicate View: Display all the duplicate HRM documents (documents that have been detected to be an exact copy of a previously downloaded document) based on ALL or Provider filter. Of these documents, the "Delivered To" column should display only the routed providers for that duplicate document. See Duplicate Reports below.

NoteIf no patient is matched, the entire HRM report row is highlighted.

E-Chart > HRM Documents

From the E-chart, you can access a patient's HRM documents via E-Chart > HRM Documents area:

HRM reports with an asterisk ("*") are new reports that have not been viewed yet (by the EMR user logged in).

To see the same list, in an expanded view, click on the HRM Documents header to see the HRM Documents List screen for the patient:

  • The red triangle () indicates that the report has been changed. The most recent changed HRM report will be displayed, however, you can access all the changed report versions when you open the HRM report.
  • Green highlighted entries implies that the report is new and has not been viewed by the current logged in EMR user.
  • Report Date is the date that the report was created from the source facility.
  • Date Received is the date that the HRM report was downloaded from the HRM server into this EMR.

HRM Document

The HRM Document contains the content of the report, as well as the associated meta-data for the document at the side and bottom of the document:

Report Content

Texted-based HRM report content is shown in the middle of the HRM Document page. For binary-based HRM report content that cannot be rendered inline, a link is provided to download the file to be opened in a third-party application (i.e., RTF or PDF files).

Report Identification

The report identification section contains the following details:

Report Date This is when the message was created from the HRM. It is the 6th component from the Message Unique ID.
Report Received The date when the HRM report was received into the EMR.
Demographic Info The patient identified in the HRM report.
Linked with Demographic

The demographic record that is linked to the HRM report. Demographic records are automatically linked based on the patient identification in the HRM report. See Matching HRM Report To Patient for details.

If there is no demographic linked to the HRM report, you can manually link the report to an existing demographic record in the EMR. To do this, type the demographic name in the Not currently linked text box.

In addition, you can manually override a demographic record that is already linked to an HRM report. To do this, click Remove from the Linked to Demographic section, and add another demographic name to link the HRM report to.

Assigned Providers

The provider that is assigned to the HRM report is based on the CPSO or the CNO number of the HRM report recipient. See Matching HRM Report to Provider. If there is no provider linked to the HRM report, you can manually link the report to an existing provider in the EMR. In addition, you can add links to other providers in the EMR (or remove them). When you link a provider to an HRM report, that provider will see the HRM report in their HRM Inbox.

Report Class The Report Class identified in the HRM report.
Subclass The report Subclass identified in the HRM report
Category

The  EMR defined category that is matched based on the Report Class and Subclass from the HRM report.

Click Edit, to manually assign a Category to the HRM document. You can override the existing assigned category or assign a new one if there is an unmatched category. For multiple subclass reports, you can assign a category for each subclass provided.

Observation Date The observation date from the HRM report Subclass data.
Accompanying Information   For DI and CRT report class, the Accompanying Subclass, Mnemonic and Description from the HRM report is displayed.
Sign-off Status 

Sign-off status of the HRM report.

HRM reports that are signed-off by a provider are removed from that provider's HRM Inbox.

There is also an option to revoke sign-off of an HRM report. By revoking the sign-off of the HRM document, the document is re-displayed in the provider's HRM Inbox.

Signed-off reports are displayed in the All filter.

Report Comments

Comments can be added for the HRM report. The comment date and provider will be displayed.

Report Source Information

The source information from the HRM report:

Message Unique ID The unique message ID provided by HRM.
Sending Facility ID The ID of the sending facility.
Sending Facility Report No. The report number of the HRM report from the sending facility.
Report Created The date the report was created. This is the same as the Observation Date for DI and CRT class reports, and Event Date for MR class reports.
Result Status The result status of the report from the sending facility.

 

Changed and Duplicate Report Information

The blue box at the top of the HRM Document is where changed or duplicate information is displayed:

  • A counter for the number times a duplicate has been received is displayed. See Duplicate Reports.
  • If a changed report is detected, the list of reports belong to the family of changed reports is displayed. See Changed Reports
  • The current report opened is in the list of changed report without a link.
  • If the reports were received out of sequence with the Message Date, then, the following note is displayed:

Note: The report order may be out of sequence.

Changed Reports

Reports coming from the same Source Facility with the same Report Number are flagged as Changed Reports if their contents are different. All the changed reports are collated together as a Family of Changed Reports, with the latest Message Date (the date the report was created from the source facility) report displayed from the HRM Inbox and HRM Document. You can navigate to the various versions of the changed reports from within the HRM Document, in the top blue header:

The HRM Inbox will have a red triangle to indicate that the report was changed. In addition, a Messenger alert is sent to the HRM admin users, informing them of a detected changed HRM report.

Duplicate Reports

The IndiviCare HRM module detects HRM reports that are an exact duplicate of another HRM report that was previously downloaded. These reports are flagged as Duplicate, and can be viewed in the HRM Inbox > Duplicate view. Duplicate reports are not shown in the Claimed/Unclaimed views.

In addition, a Messenger alert is sent to the HRM admin users, informing them of a detected duplicate HRM report. If there is a high number of duplicate reports, please contact the EMR vendor and the HRM support line.

You can click on Duplicate view from the HRM Inbox to see all the duplicate reports for the specified provider filter. Duplicate reports are not linked to any demographic record (even if the report's patient information matches a demographic record in the EMR). However, duplicate reports are linked to providers in the EMR which match the recipient provider from the HRM report. This is done so that when an EMR provider opens their HRM Inbox and goes to the Duplicate section, they will see all duplicates reports that were sent to them. 

Clearing Duplicate Reports in the Provider's Queue

When a provider goes to their HRM Inbox > Duplicate view, they will see a list of duplicate reports that were sent to them. 

When you open the duplicate report, the contents of the duplicate HRM report is displayed and the top blue information box indicates that it is a duplicate report, with a link to the original report that was previously downloaded.

To clear the duplicate queue from the provider's HRM Inbox > Duplicate view, the provider will need to "Sign-Off" on the duplicate report. After the duplicate report has been signed-off by the provider, it will no longer be shown in the provider's HRM Inbox (it is also good practice to write a comment about the duplicated report). However, you can always search for all duplicate reports by filtering for All providers and selecting the Duplicate view.