Incomplete data captured on submissions.

[DJCool1]

On a recent trip to the Dominican Republic, our team was using femr. The buildings are concrete so at times wifi was not the best though we did our best with wifi extenders, etc.

Using a windows laptop running chrome browser I would submit patient encounters but at times it appears that only 1/2 or less of what was submitted would actually be saved. We became aware of this when patients went over to pharmacy but then didn't have any medications saved and most of the note was blank, far less than what I typed (I opened the encounter back up to check what was there). Switching to a MacBook had better wifi and mostly eliminated the problem but it still happened once or twice the next day at least what we picked up on. Is there some server side form validation that confirms that the complete message sent is received? Like perhaps have an invisible variable at the end of a POST be submitted with each entry and if that part isn't received then server side would know the POST was incomplete. Then I guess there would need to be a client side code in the browser jQuery style waiting for server confirmation that submitted form was received properly.

When I started having patients have incomplete data saved, my confidence that documentation was being saved correctly was severely hampered.

[kevinzurek]

Hi @DJCool1, thanks for the feedback! My assumption has been that when dealing with poor WiFi (not uncommon where fEMR is used) the HTTP request would time out rather than letting the server receive a partial partial POST request. I would expect an HTTP status other than 200 as a response from the server in this case. It is also entirely possible that a response other than 200 isn't being properly handled somewhere.

Were you experiencing particular pieces of information not being saved? Prescriptions, problems, vitals, etc... ?

[DJCool1]

I was on the side doing clinic visits so vitals were already in there. When it occurred it looked to me like some of the first sentence of my HPI was in there but not the rest and none of the prescriptions I ordered. We were using wifi extenders which added an extra hop, not sure if that has any bearing. From my end it had looked like it submitted without issue, it was when pharmacy came back asking why a patient was sent to them with no prescriptions that I became aware and then saw HPI was incomplete as well.

[kevinzurek]

We will certainly check the logs from your system when i get access again!

Due to the nature of the environment fEMR is usually used in, i wouldn't be opposed to a more detailed system for tracking any kind of packet loss over the network. I am not sure that it would come in the form of appending a variable to a POST request. It could be a more intelligent parsing of the HTTP response from the server.

[DJCool1]

Sounds even better, sounds like a good plan. Would probably need some change to the client side as well to flag or auto re-submit form data if the server indicates it didn't come through.