The Patient Message Review App is a custom built web application that allows authorized registry users access to the Kentucky Cancer Registry's (KCR) pathology (ePath) and diagnostic radiology (eRad) report database, known as the "Feeds Database".

The application serves two main purposes:

1. Allows the KCR to classify all incoming pathology and diagnostic radiology into one of six assigned categories (See Table 1).

   Review Status	Status Meaning
   New	Has not been review by the KCR Staff
   Needs Review	Contains reference to current cancer, history of cancer or false positive selection by ePath/eRad
   Non-Reportable Skins	Relates to Basal and Squamous cell carcinomas of the skin
   Non-Reportable Cervix	Relates to CIN iii, and other non-invasive cervix diagnoses
   Non-Reportable Other	Non-CNS schwannomas, appendix, carcinoids, and other non-reportable diagnoses which may be of interest for hospital non-reportable list
   No Cancer	Contains no information diagnosisng cancer or false positive selection by ePath/eRad

   ^{(Table 1)}

2. Allows authorized users to search the Feeds Database for their facilities' ePath and eRad reports.

Access to Patient Message Review App (PMRA)

The KCR Web Portal

The PMRA can be accessed through the KCR's secure web portal: https://portal.kcr.uky.edu/ (See Figure 1).

^{(Figure 1)}

First time users to the web portal or to PMRA will be greeted with a Login Window. Providing proper KCR credentials will grant access to PMRA and the other portal web applications. (See Figure 2)

^{(Figure 2)}

By clicking the "Preview Image" or the the link to the Patient Message Review App, the web browser will direct you to PMRA: https://portal.kcr.uky.edu/PatientMessageReviewApp/

The Patient Message Review App

If the user went directly to https://portal.kcr.uky.edu/PatientMessageReviewApp/, the user will be prompted with the Login Window. (See Figure 3)

^{(Figure 3)}

PMRA is comprised of two tab panels:

1. The Search Form: a web form with a wide range of searchable criteria used to query the Feeds Database
2. The Message Stream: A scrollable and paged grid that displays discrete and narrative data about individual reports in auxiliary panels.

Upon providing proper credentials, the browser will display a search form that will allow users to fine tune queries to run over the Feeds Database. Returning users will see the criteria auto-populated from the last successful query made. (See Figure 4)

^{(Figure 4)}

PMRA Search Form Tab

There are numerous discrete data fields that users can search ePath and eRad over using the Search Form Tab.

KCR Status

The KCR Status is a simple classifying field the registry uses to determine if an ePath/eRad has reportable, non-reportable, or no cancer data. Incoming reports that have yet to be reviewed are automatically assigned the "New" KCR Status. PMRA will only query over statuses that have been checked in the KCR Statuses container outlined in blue in Figure 5.

^{(Figure 5)}

Search Fields

The Search Field container outlined in orange holds a variety of searchable fields. (See Figure 6)

^{(Figure 6)}

Narrative Text Search Field

The Narrative Text Drop Down Field is a versatile field that can be used to search over numerous values written in the narrative sections of ePath and eRad. This field is a drop down box that shows multiple ways to search over the text in the Feeds Database. The Narrative Text Field is used in conjunction with the Narrative Text Drop Down Field, text entered into the Narrative Text Field will be searched in the narrative text field. Multiple text strings can be searched over by delimiting them by a comma ",". If the Exact Match box is checked, the commas will be ignored, and the entire string will be searched in whole. Please view each of the three fields in their respective color coding in Figure 7. Please review what each option means in Table 2 below.

^{(Table 2)}

^{(Figure 7)}

Simple Demographic Fields

The SSN, First Name, Last Name, Medical Record Number, and Path Id fields are fairly simple text fields that allow users to search ePath/eRad over those respective values. If the Exact Match box is checked, these fields will be queried as a whole. Partial matches will only be used if the Exact Match box is unchecked. Please see the respective color coded fields in Figure 8.

^{(Figure 8)}

Cancer Data Forward/Cervix Flag Field

The Cancer Data Forward/Cervix Flag Field (displayed as CDF/Cervix Flag in orange in Figure 9) is specialized coded flag that is populated in the same field of an HL7 ePath. Leaving the value at it's default state, "Set, Unset, or CDF", will exclude this field from the query.

^{(Figure 9)}

Message Type Field

The Message Type Field shown in grey allows users to search over only Pathology Reports, Diagnostic Radiology Reports, or both. (See Figure 10)

^{(Figure 10)}

State Search Grid

The State Search Grid highlighted in blue is a multi-select grid that allows users to select the state or region a patient resides in. (See Figure 11)

^{(Figure 11)}

Exact Match Box

The Exact Match box is a checkable box that depending on the filled PMRA search fields will query over the exact value of those filled fields instead of the default (unchecked) partial match.

Search Date Range Field Container

There are four separate date range fields that users can filter their PMRA queries by. Please review Table 3 for the description of each date field. The top date field is the beginning of the date range for that respective date, and the bottom date field is the end of the date range for that respective field. (See Figure 12 below).

^{(Table 3)}

^{(Figure 12)}

Facility Search Grids

There are three possible multi-select facility search grids that allow users to search over specific Hospitals, Clinics, Labs, etc. for ePath and eRad in PMRA. By default, only two are shown. Selecting a Large/Group Facility that is a set of hospitals, labs, clinics, etc, a third grid will be displayed adjacent to it. Only facilities that users have access to will be displayed in these grids.  Please review Table 4 for more detail of the meaning behind each grid. In our example, our user, ned, only has access to the CPDMS Test Facility Database (90201) and sending lab, "TEST". (See Figure 13).

^{(Table 4)}

^{(Figure 13)}

Search Form Tab Buttons

There are two buttons located at the bottom of the Search Form Tab. These buttons are highlighted in green in Figure 14.

Search Button

The Search Button will craft a query from the user filled Search Form Tab from the items listed above. All pathology reports that fall under the crafted query will be displayed in the "Message Stream Tab". The user will be automatically redirected to this tab if the search is successfully completed.

Reset Button

The reset button simply sets all Search Form Tab Fields, Grids, etc. to their default state.

(Figure 14)

Message Stream Tab

The other half of the Patient Message Review App is the Message Stream Tab. This tab displays the results from the Search Tab. Below is a mock up of a query that returns two ePath reports. PMRA will automatically select the first report returned from the query. By default, the results are sorted by the Specimen Date (Observation Date Time).The simple overview of the Message Stream Panel is shown in Figure 15 below.

(Figure 15)

The Message Stream Tab consists of four parts:

1. Message Stream Grid
2. Message Property Grids
3. Narrative Text Tab Panel
4. Index Report Tool Bar

Message Stream Grid

The Message Stream Grid's main purpose is to display many ePath and eRad reports at a glance. The grid loads 500 reports/rows at once. If a query returns more than 500 reports, the paging toolbar highlighted in blue will allow a user to navigate through the rest of the results from the query. At the top of the Message Stream Grid is the grid header highlighted in green brackets "{}" .

Grid Header

The grid header has many features that allow a user to arrange and sort discrete data fields in the ePath and eRad reports.

The purple highlighted section of Figure 16 shows the main utility of a column header. When the mouse hovers over a column header the header highlights in a light blue and a down arrow appears. Clicking the down arrow displays a menu where the user can sort the column. This will sort the entire result list. If the last menu item, "Columns", is selected, a list of all available discrete data items for the ePath and eRad are displayed. Users can check and uncheck these boxes to show or hide, respectively, the columns they wish to see in Message Stream Grid. One last feature that is not shown in Figure 16 for the column header is a drag and drop feature. Users can rearrange columns by clicking and holding a column and placing them in any order in the Message Stream Grid. These small adjustments to the grid should persist upon returning to the Patient Message Review Application.

Lastly, the section highlighted by the red brackets "{}" displays the current page of 500 or less ePath and eRad reports from the Search Tab result. This allows the user to view many reports at once.

^{(Figure 16)}

Message Property Grids

When a row is selected from the the Message Stream Grid, PMRA calls a KCR web service to retrieve additional discrete data as well as the Narrative Text and the Raw HL7 text of the report. The text data will be discussed in the Narrative Text Tab Panel section below.

An expanded form of the Message Property Grids is shown In Figure 17.

^{(Figure 17)}

Narrative Text Tab Panel

Narrative Text Tab Panel is divided into two tabs additionally there is a button to download the selected ePath/eRad report in a PDF format.

1. ePath/eRad Narrative Tab
2. Raw HL7 Message Tab
3. Download PDF Button

Similar to the Message Property Grids described above, the Narrative Text Tab Panel is populated when a row is selected from the Message Stream Grid. The same KCR Web Service asks for the Narrative Text in the ePath/eRad and the original electronic message/envelope it was sent in, an HL7 Message.

ePath/eRad Narrative Tab

By default, the ePath/eRad Narrative Tab is displayed. PMRA does it's best at parsing the original Narrative Text from it's encoded form in the Raw Text. Many layers of encoding are involved in packaging an ePath/eRad report, so the layout/formatting of the narrative text isn't always appealing. An enlarged version of the narrative text is shown in Figure 18.

^{(Figure 18)}

Raw HL7 Message Tab

All ePath/eRad reports are sent using the HL7 2.5.1 messaging standard. This standard uses a pipe-delimited "|" format that has a lengthy set of data items, many of which are not necessary for everyday use. At this moment a Non-PHI HL7 Raw Text message is not available to show on Confluence.

Download PDF Button

The Download PDF Button will generate a PDF formatted ePath or eRad report. A sample report can be seen here: PATLAST_Report.pdf

The Download Index Report Button

Users can download an Excel file containing the results of their PMRA query by clicking the Download Report Button located at the top right of the application, above the Message Info Property Grid. There are multiple arrangements this Excel file can be set, and users can change which format they want by using the drop down box next to the Download Index Report Button. Most users should opt for using the "All Purpose" option. (See Figure 19).

^{(Figure 19)}

A sample of the "All Purpose" Index Report can be downloaded here: AllPurposeTest.xls

Closing Remarks

The Patient Message Review Application is the product of a lot of time, passion, and resources from the CPDMS staff. We wish to make this application as useful for as many users as possible. This means that critiques are always welcome. Please direct any specific inquiries or critiques to cpdms support: cpdmsnetsupport@uky.edu