Noah will support a method where it is possible for Noah compatible applications to support the following general scenario:
Hearing Care Professional (HCP) A utilizes a Noah compatible application to save diagnostic or hearing instrument data record to Noah, such as a Noah Action.
The Noah action is tagged to represent different types of data (e.g. Audiograms, hearing instrument fittings)
Later, HCP B (e.g. a supervisor) needs to make an appropriate and legitimate addition or change to the summary to this data - usually in the format of a text based comment or report statement. This activity could have the same date of the activity or many days after and the solution will ensure that this is possible.
The Noah compatible application will a have method to collect this comment/report from user B at any time in the future and will be able to save it to Noah so that it may be part of the official patient record while not changing the data that was originally saved by user A.
If the Noah compatible application later reads the data for display, it will have the ability to find the new comments that were referenced to the data and display or otherwise use as is determined by the application.
The solution will:
Minimize the development impact for application developers.
Does not involve a major upgrade to Noah to be implemented or installed by the hearing care business (HCB).
Promotes the public data storage of report summary information. Today, this information cannot be stored in a HIMSA public format; HIMSA measurement standards do not cover the storage of this type of information. For example, the audiogram data standard does not contain a "Report Comments" field. If an application is storing this type of data, it is storing it as private data.
Rationale / What Problem Does This Solve
Starting with Noah 4.9, Noah was implemented to prevent User B from changing User A's action data saved to Noah. This was done as part of a general security update.
Without this solution the only current way to address this use case is for the module/app developer to save a complete new action. This then results in the session list showing two audiogram actions when in fact there was only one diagnostic test performed.
Storing report / summary data in a publicly understood standard would make it possible for other applications to read this data. For example, in the past HIMSA has received requests from Noah compatible business system developers wishing to be able to read the report comments that a HCP enters into the Noah 4 Audiogram module.
HIMSA has defined a new data type called "Report Comments". This new data has one defined public data standard which is Rich Text Format (RTF). RTF is also the standard used for Noah Journal Actions.
This solution will be available on all supported version of Noah 4 without a major upgrade to Noah being necessary. Noah's constant definitions must be updated but this is a small procedure that can easily and safely be incorporated into a Noah compatible installation program or run as a small EXE. See Constant Definitions for more details.
Q: Can more then one comment/report be made? Can they be made over a span of multiple days?
A: Yes, it will be possible to enter multiple comments all at different dates. This is supported by Noah providing applications to be able to make references to other actions attached to the patient record.
Q: Would it be possible to link report comments to more then one Noah action?
A: Yes, this would be possible. A good example of this would be a situation there an Admittance right ear and an Admittance left ear action (store as two actions) are attached a patient session in Noah. In this case it would be more efficient to store the report comments in one separate action in Noah and reference this action to the right and left ear action.
Example 1 - This example covers what is assumed to be the most common scenario. The example covers the case where a Noah user conducts a pure tone and speech testing but another Noah user reviews the test results and writes concluding report comments:
HCP A conducts Air, Bone and Speech testing and save the data to Noah as a Noah Action.
The next day HCP B (the supervisor) reviews test by clicking on the action in the Noah session browser.
The Noah compatible measurement module that created the data opens and displays this data.
User B reviews the test results.
User B types summary report comments information into a GUI provided by the Audiogram module.
The module then saves the report comments but does not do so by adding it (editing) the already saved Audiogram action. A new Noah action is saved to Noah. This new action only represents report comments.
Q: Is it possible to hide the new action discussed above in example 1, the report data?
A: Yes, it is possible for modules to state to Noah that the new action is to be hidden. The Noah session browser will not show this data in the session browser but the data will be present.
Q: Will HIMSA implement this plan in the Noah Audiogram Module?
A: Yes, HIMSA does intend to the follow this same plan in the future.