EMR integration · test results
Getting results into the record
Of the three levels of EMR integration (document delivery, discrete result capture and interface-level exchange), discrete capture is usually the right target: a short, fixed set of values entered as structured observations, so results can be trended and queried instead of sitting in the chart as a PDF.
A diagnostic that lands in the chart as a scanned image satisfies a documentation requirement and answers no population question. It is worth deciding this before the first patient is tested, not after the hundredth.
What are the three levels of EMR integration?
1. Document delivery
The report arrives as a PDF and is filed to the chart. It is visible to a clinician reading that patient’s record and invisible to anything else. Fast to implement, and the level most practices stop at.
2. Discrete result capture
Key values — ankle-brachial index, conductance values, heart rate variability indices, resting energy expenditure, lean mass, cognitive score — are entered as structured observations. Now they can be trended, graphed and queried.
3. Interface-level exchange
Results flow as structured messages into the record without manual entry. Highest effort, and the only level that scales to a whole panel without adding staff time.
Why is discrete result capture usually the right target?
Level one is not enough, because the entire clinical argument for this testing rests on comparison over time, and a PDF cannot be compared with anything by a computer. Level three is the correct destination and is a project with its own timeline. Level two — a short, fixed set of discrete values entered at the point the report is reviewed — captures most of the value for a fraction of the effort.
Choose the fields once and never change them. A trend is only a trend if the same field was populated the same way every time.
Which test results should be entered as discrete fields?
| Field | Why it earns a slot |
|---|---|
| Ankle-brachial index, left and right | The primary vascular screening value; asymmetry matters |
| Toe-brachial index, left and right | Remains valid where the ankle index is falsely elevated |
| Sudomotor conductance, hands and feet | The small-fiber signal; feet are the clinically important side |
| Heart rate variability summary index | The autonomic trend value |
| Orthostatic blood pressure change | Directly actionable, and drives medication decisions |
| Resting energy expenditure | The denominator for any nutrition plan |
| Lean body mass and fat mass | What BMI cannot separate |
| Cognitive screening score | Meaningless without a prior value; invaluable with one |
| Conditions of measurement | Fasting state, caffeine, nicotine, time of day, medication timing |
Practical notes
- Decide who enters the values. If it is the reviewing clinician it will happen inconsistently; if it is the person who performed the study it happens every time.
- Use the record’s own units and never mix them. A field silently switched from one unit to another destroys the trend it was created for.
- Keep the narrative report as well. Discrete values do not carry waveform morphology or the interpreting clinician’s reasoning.
- Confirm the patient’s identifiers before filing. A correct result on the wrong chart is worse than no result.
For patients: the same subject written for the person having the assessment is at understanding your results.
Talk to someone about testing
Tell us what you are trying to find out and we will explain which Measura assessments answer that question, what each one involves, and how the results are reviewed with a clinician.
4477 Woodson Rd, Suite 201, St. Louis, MO 63134. Monday to Friday, 9:00 a.m. to 5:00 p.m. Please do not send symptoms, diagnoses or images through a web form — a website form is not a secure medical channel. Send your name and number and we will call you back.
Common questions
Can results come in as structured data?
It depends on the record system and on what is built; the discrete field approach works everywhere in the meantime. Getting results into the chart.
What is the minimum we should capture discretely?
The nine fields in the table above, including the conditions of measurement. Read more.
Who should enter them?
Whoever performed the study, at the time of the study. What makes a good tester.
Why isn’t a PDF report in the chart enough?
A PDF filed to the chart is visible to a clinician reading that one patient’s record and invisible to anything else. It satisfies a documentation requirement but answers no population question. The whole clinical argument for this testing rests on comparison over time, and a computer cannot compare a PDF with anything. Discrete values can be trended, graphed and queried.
Should we keep the narrative report after entering discrete values?
Yes. Discrete values do not carry waveform morphology or the interpreting clinician’s reasoning, so the narrative report stays in the record alongside them. The discrete fields make the trend possible; the report explains what a given reading meant at the time it was taken.
Why record the conditions of measurement?
Fasting state, caffeine, nicotine, time of day and medication timing all affect these readings. This is the field most often omitted, and it is the one that makes the rest comparable from one visit to the next. Without it, a change in a value cannot be separated from a change in how the patient arrived for the test.
Medically reviewed by Dr. Gurpreet Singh Padda, MD, MBA, MHP, medical director of Measura. Last reviewed .