Breast Surgery Module

The Breast Surgery module is designed to manage the data and workflow of a breast surgery practice.   A set of screenshots and an overview of the module can be reviewed via this downloadable PowerPoint presentation.


As with most HRA modules, the patient enters a large amount of structured data up front, using a Tablet PC in the Waiting Room.  Data collected includes risk factors, family history, social history and medical history.

Risk models are run on this data, including BRCAPRO, Claus, Tyrer Cuzick, Myriad, Gail, MMRPRO, CCRAT and others.  The patient entered data and the risk calculations can be reviewed by the clinician and staff on the desktop application or on a prinout.

HRA then asks Providers and their staff to review the patient entered data and then to enter discrete pieces of more clinical information (structured data) which can be used for Clinical Decision Support, research and quality initiatives.  In return, HRA decreases Provider and staff workload by producing documents needed for patient care.

Visit Related Documents

For all patients, 3 documents are created, and displayed as word documents.  The Provider can edit these documents, adding specific verbiage as needed.

Editing paragraphs:

The general idea of these three documents are the same – they give an overview of the data in HRA.  The main area to customize these documents (besides logo/letterhead/signature) are the paragraphs.  In the Patient Care Summary, you can see these under the “Outcome of the visit” section and in the Surgical Clinic Impression Note you can see these under “Impressions” and in the Surgical Clinic PCP Letter they are just in the main body of the letter.

These paragraphs come from 4 different pieces of information entered by the clinician in HRA

1) Impressions – whatever impression(s) were selected on the impressions tab
2) Procedures – whatever procedure was scheduled for the patient during that visit
3) Breast Rx – whatever value was selected from the Breast Rx dropdown on the impressions tab (For breast cancer patients)
4) Axillary Rx – whatever value was selected from the Axillary Rx dropdown on the impressions tab (For breast cancer patients)

This excel file has 4 tabs corresponding to these 4 items.  MasterParagraphsForHRA

On each tab you will have a row for each value in the dropdown.  So for example looking at the impression column on the impression tab, those are the values the clinician can select as the impression(s).  Then you see a column for patientImpression.  That is what is used on the patient document directly under the “outcome of visit” and is just a patient friendly way of describing the impression.  And there are columns for paragraph and patient paragraph (the former used on the note and pcp letter and latter used on the patient document)  The impressions tab has additional columns related to what procedure is created based on an impression.  So for example if the impression is “Abnormal mammogram: Core biopsy inconclusive”, HRA will automatically generate a “Needle localized breast biopsy” (of course the clinician can override this, but it’s a shortcut)  So if you want to review that while reviewing the paragraphs, those columns are there.  The other tabs are similar in that each row has the value in the dropdown and corresponding paragraphs for the letters.

You can modify the text in the paragraph and patientParagraph columns on all four tabs.  If there is anything else you want to change on the spreadsheet, let’s discuss or just make the change, but indicate it in another color.

If multiple Providers each want different paragraphs, that’s possible.  Just create an extra two columns and label them as Provoder1Paragraph, Provider1PatientParagraph, etc.

Visit/Problem/Procedure Related Documents

This Excel shows which documents print for each situation:

Each surgery in HRA is a row and each surgery-related document is a column.  I have created columns for the 8 documents Dr. Hughes has and have indicated with an “X” which letters print for each surgery.  I have also attached samples of those 8 documents.

Documents you might want to use:

Patient information sheets

Wire Loc. Biopsy Info Sheet

IV Sedation Info

Info About Your Surgery 2

Core Biopsy Info Sheet

Consent Form

Patient Consent Form


PreOp Orders Hughes IV Sedation

PreOp Orders Hughes General

Upload to EHR

It is ideal if the H&P and the letters to referring MDs gets into the EHR.

Most EHRs can upload documents.  You will need to work with your IT department to see if your EHR has this function.  If so, the document upload process can be automated.

If not, your staff can open a blank patient note in your EHR and paste in the H&P generated by HRA.

In the perfect world, structured data would be uploaded into the EHR.  Unfortunately, most EHRs lack places to put most of the structured data that is collected in HRA.  For example, most EHRs do not have a field for size of a palpable breast lump, or character of nipple discharge.  Where there are corresponding EHR fields, EHR can upload structured data via HL7 if your EHR permits it.  It is likely that if your EHR can accept the CCD, we will be able to upload the H&P automatically as text plus structured data.  We are happy to work with you on this.

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