An Enterprise Approach for Pathology Reporting Utilizing PDF Functionality for the Electronic Medical Record

Abstract

Background: Shortcomings of plain text renderings of pathology reports in the electronic medical records (EMRs) are widely known. As the pathology reports grow in complexity, Portable Document Format (PDF) renderings of pathology reports are seen as a flexible solution. Since 3/2014, our group has successfully implemented architecture for PDF functionality for pathology report integration into the EMR. Design: We outlined our architectural framework. Within our architectural framework, pathology reports are first generated as MS Word documents. They are then exported into both HL7 and PDF formats in the EMR. The clinicians may then choose to view either format. The HL7 interface message contains the file location path of the PDF, and the PDF reports are stored on the hospital servers for display retrieval within the EMR. As the HL7 feed is maintained, data can still be extracted into the institutional data warehouse (IDW). The retained HL7 rendering of the report allows copy/pasting of the pathology report into clinical documents. A reconciliation report is generated to match the transmissions sent with those received. Results: The number of PDF reports sent across the interface from 3/2014 to 5/2015 total 191,868. The monthly reports sent range from 11,449 to 14,422 per month, with a median & average of 12,419 and 12,791, respectively. Conclusions: PDF renderings of pathology reports have been successfully integrated into the EMR system. PDF reports bypass errors that may occur when HL7 strips the formatting from MS Word documents, such as blood counts or gene mutation lists. Use of visual analytics is also possible with PDF reports. Most commercially available EMRs have the capability of displaying PDF documents. We hope that our experience can serve as a framework for PDF functionality in EMRs.