Data Synchronisation Rules

What is considered a change to the Patient's record

Data Synchronisation Client will consider a health record changed if:
  • The clinical record has been opened for that patient since the last time the laptop was synchronised.
  • A clinical item has been recorded using Data Entry Wizard since the last time the laptop was synchronised.
  • A patient's biographic details have been opened in the Patient Biographics since the last time the laptop was synchronised.
Note:

The deletion of clinical items is not supported in the Data Synchronisation Client. The ability to delete these items has therefore been disabled in the offline client.

You can however, delete prescriptions, regular medications, letters, scanned documents, and investigation requests and results in the offline client.

Data Export Rules

The export mechanism will generate an XML file with the entire electronic record of a patient if that patient was deemed to have been changed since the last time it was synchronised.

The patient data that is exported to XML includes:
  • Patient Biographics (excluding patient status changes)
  • Clinical Items
  • Care Plans
  • Prescriptions
  • Documents
  • Progress notes
  • HIC claims
  • Investigation requests
The generated XML will include all the reference table definitions for the exported clinical items in order to allow importing the electronic health record in any other clinic. The reference data exported includes:
  • Used Encounter Places
  • Used Clinical Item Types with the attached measurements and keywords
  • Used Providers
Note: You cannot export investigation results. This includes data relating to the reviewing or other editing of results.You can read results but not receive or review results in the off-line version of Communicare.

Data Import Rules

Electronic Health Records can arrive into Communicare in three ways:
  • Data Synchronisation Client uploading changed health records
  • Manual import of a patient from a different system
  • Updated Health Records coming from another server via Server to Server synchronisation
Regardless of how the electronic health record arrives into Communicare a strict set of rules is always obeyed when importing the health record. In order to describe these rules we use the following conventions:
  • The XML file containing the record we are about to import is called "Source".
  • The Communicare database where the record will be imported into is called "Target".
  • The modified timestamp of a record in Source XML will be called "SMT" and it is stored as a Greenwich Mean Time value.
  • The modified timestamp of a record in Target database will be called "TMT" and it is stored as a Greenwich Mean Time value.
These are the rules followed by the data import:
  • If a Source patient is not found in Target then it will be inserted with the entire Health Record.
  • If a Source patient is found in Target and the SMT is greater than the TMT then it will update Target patient.
  • If a Source patient is found in Target and the SMT is less than or equal to the TMT then it will not update Target patient.
  • If a Source reference record is not found in Target then it will be imported. If the record is from another Server, it will, in most cases be imported with a modified description that will contain the 'site id' of the originating site - 'A description' becomes 'A Description[XXX]' where XXX is the 'site id' of the Source Server.
  • Central data items distributed by Communicare are not updated and they will be matched based on primary key.
Additionally, there are rules which are applied to fields within a record:
  • If a Source field is null it will not be imported into Target (Except for the case where the rule for patient encounter import below takes precedence above this rule).
Special rule applies when importing patient encounter data:
  • The more 'advanced' patient encounter record is retained, while the less 'advanced' patient encounter record is thrown away. For example: If Source encounter has status 'Booked' while the Target encounter has status 'Finished', no change is made to target. However, if Source encounter has status 'Finished' while the Target encounter has status 'Booked', Target will be overwritten with Source.
  • The rank of the encounter status from least advanced to most advanced are as follows: 'Booked', 'Cancelled', 'Waiting', 'Withdrawn', 'Started', 'Paused' and 'Finished'.
  • Encounter statuses of 'Started', 'Paused' and 'Finished' are treated as equally ranked.
  • This rule takes precedence above all else for patient encounter import. Only when the status of the encounter is the same for both Source and Target, that the next rule applies (specified above).

Important Data Import Issues

Table 1. Data import issues and resolutions
Issue Resolution
Use of datasets with enrolment and exit items (e.g. HACC, Drug and Alcohol) Where items depend on a single enrolment and a single exit, make sure that the enrollment and exit items are recorded only once, preferably on the Server database.
Pregnancy starts Make sure that pregnancy starts for a specified pregnancy number are recorded only once.
Reference Tables Changes to reference tables are not imported during Data Synchronisation, hence editing reference tables is disabled.
Patient matching If a patient is added to the Source and the Target, the two records will be matched based on Name, Date of Birth and Sex. If these fail to match then a 'duplicate' patient record will be created. To avoid this situation, make sure this information is complete and accurate as possible. Note: Medicare number is deliberately not used in this matching process.