PrognoCIS Help: Lab Order

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CPOE stands for Computerized Physician Order Entry. Proper implementation of CPOE is crucial to reducing medical errors. CPOE feature is an integral part of PROGNOCIS, allowing user to place lab orders, radiology orders, and prescription. It also lets user store Lab and radiology results when they are received.

Lab is an abbreviation of Laboratory. The Lab Order can be placed for a patient on a selected laboratory.

Add New: Click on the button to make a new Order.
When user adds an order, the current patient and encounter details are selected for the new order and information like Patient Name, Provider Name, List of ICD Codes, is automatically displayed.

eSend: PrognoCIS supports eLAB (bidirectional interface) for Lab Corp and QUEST. For QUEST lab, the Lab Order is processed by Quest and if the order requires an ABN (Advance Beneficiary Notice) to be sent and confirmation to be taken then system prompts the User with an alert, “This lab has an ABN generated, please get it signed by the Patient and get it printed by clicking on ABN” → ABN button is enabled and the User clicks on ABN button to take a print and takes Patient's consent for further processing of the Lab order → If patient agrees then User clicks on the eLab button again and the Lab Order is processed.

Order No: In case of a New Lab Order, the Order No is generated as per property, lab.orderno.prefix and lab.orderno.length, on save of the Order.

Order Date: is set by default to Current Date. It can be edited by user. When the Order is Send / Print / Fax for the First time, the Order Date is changed to Current Date and if Results (expected By) Date is less than Current Date it is set to Current Date.

Patient: Is the selected Patient in the current encounter. In case of CPOE >Lab Order, Add new Button will invoke a Patient search. The selected Patient's latest Encounter Id and the associated Attending Provider and Primary Provider will be set in the Order. Ordering Provider by default will be the Attending Provider.

Comment: This can be used to send special instructions to the laboratory. Click Comment to open a multi-line edit control dialog box where these details can be entered. After the lab order is sent, the entered comments can only be seen but not edited. After the lab order is sent, if no comments were entered, the button is disabled so that the user knows for sure that there are no associated comments.If comments are present, the button is displayed with a check sign.

Label Printer: For all 'Ordered' labs the Label Printer icon is enabled and Users can print on labels.

Status: This is set by the system as:

E - Entered on clicking Save by a user who has been assigned entry rights only.
A - Approved on clicking Save by a user who has been assigned approval rights.
O - Ordered on clicking Send.
R - Results Received on entry of the received results.
C - Complete on approval of entered results.
Complete and Reviewed on reviewing the completed Lab Order Results.

Urgency: Options available are Routine, Now, Stat and Scheduled. The first 3 indicate the urgency in ascending order. The last option is provided so that a Provider can schedule an order well in advance, for example, asking a patient to do a blood sugar test after 3 months.

Results By: Select the date by which the Laboratory is expected to return the results for the first 3 Urgency types. In case the Urgency is Scheduled, the label changes from Results By to Scheduled On.

Provider: Is the Ordering Provider. If a new Order has been created by a logged in Provider, this will be set to the Login Provider. If a new Order has been created by a logged in Nurse, this will be set to the encounter Attending Provider. Note that the ordering Provider can be different from the attending Provider. Provider name is followed by a search button. This way user can change the Ordering Provider. This button is disabled once the status becomes ordered.

Recurring Lab Order: If the user had clicked on an existing Lab Order whose status is 'Approved', a button: Recurrence appears. Click on this to repeat this Lab Order multiple times. Note the subtle features:

In a New Lab Order no Recurrence button is displayed.
Existing Lab Order which has not been repeated, Recurrence button is displayed.
Existing Base (Original) Lab Order which has been repeated. A message is shown "Recurs X times"
Existing Non Base Lab Order which has been repeated. A message is shown "Base Lab Order on ". A trash can is also shown to delete this specific instance of repeated Lab Order.
In case of recurring Lab Orders, the delete Button is used to delete all instances of recurring Lab Order for a base Lab Order.

Laboratory: Select one of the vendors from the vendor list. This is not mandatory, as patients may have their own preferred Laboratory in which case the default is Any Lab. The default Lab selected is the same as that used in the Last Ordered Lab for same Patient. If a Lab is being ordered for a Patient for the first time, the default Lab is set to Any Lab.

Address: The Lab Address is displayed in a single line, following the selected Lab.

Required Data: In case of an ordered test some additional information like patient's height, weight, or blood pressure maybe required that could influence the results, this additional information is called as Required data. On save of the Lab Order, the system knows the list of Ordered Tests. For the selected Vendor (other than Any Lab), the Vendor Test Master has a provision of defining the List of Vital / Physical / HPI / ROS /Specialty / Social History Tests whose values need to be reported to the Lab while ordering the Test. The system now makes a union of these tests (two order tests may require the same Vital test like Weight) and presents the list along with the values entered for them in this encounter.

Tests: Click on the "+" button to select the applicable tests.
The Test Selection pop-up has two buttons: Preferred Codes and All Codes Preferred Codes include a list of Provider preferred Lab Tests and All Codes includes the complete list of Lab Tests. The fields displayed for selection include the Test name, the Grouping Category and flag to indicate Panel / Test. The user can sort the Tests by any one of these fields. By default the list appears sorted by Test name.

Note: The list does not display Lab Test of type HL7 Results All the selected tests appear below in the table. Also, note that the tests displayed in the list are the ones applicable to the sex of the Patient, AND supported by the selected Vendor. Hence it would be prudent for thxe User to always first select the Vendor and then the tests.

Tip:

At times a single Lab Order may consist of tests with different temperature types and certain Laboratories prefer to receive them as individual orders. The system automatically splits and creates the individual orders from a single order and the User has to just eSend them individually. The individual Lab Order created after splitting of the single Lab Order has the naming convention such that the Lab Order number remains the same ending with suffices such as ‘A', ‘B', and ‘C'. User has to open each Lab Order individually and click on eSend button to send the Lab Order electronically to the Laboratories. The Tests Search popup when viewed for ‘Any Lab' Lab is different than the Tests search when viewed for any other value of Lab. The Lab test saved displays the Lab test name; its LOINC code; and the temperature type.
Provision to provide patient specific education material to the patients on the basis of Lab Order (LOINC code added).
A Patient Education icon: has been provided on click, the icon invokes Patient Education popup; the material displayed is sourced from Medline Plus; the User has the option to either take print of the material and give patient print copies or send the same as email to patients.

Adhoc Tests: The Provider might need to Order a Test which he does not find in the list. The system has provision to handle such a possibility. The system provides a test category by the name Adhoc tests (under Settings → Configuration → Tests → Lab → Category). This special record cannot be deleted. The user may however change the name. User may further define one or more tests under this category (Settings → Configuration → Tests → Lab → Tests ). If one or more of such tests were selected in the test selection, the user will get a provision to edit the test name. He can enter the test description of his choice and send the Lab Order. This edited name is tracked for Lab result also. However note that it does not modify the Test Master. For the next order if the same Adhoc test is selected, user will need to edit the name again as per new requirement.

Impact on Lab Matrix: Since the Test name can be any text entered by user in each Lab Order, comparing the results on Test ID does not make sense. Hence these tests will NOT be considered by default for Review → Lab Matrix.

Note: Please note that test imported from HL7 have a category as HL7ADHOC which will appear in the Lab Matrix.

Impact on Order Set : Adhoc Tests are not considered in Order Set.

Add from Order Set Button: This button is displayed only when the login person is a Provider. It displays the list of all existing order sets. User may select any one of the templates. All the tests in the selected Order Set are added to the current Lab Order along with the ICD codes, if they are present.

ICD: A list box appears on each line of the selected test. The default selection is None. Besides this option it contains all the ICD (ICD9 and ICD10) codes selected under Assessment for the current encounter. The user may select appropriate code to serve as a basis for justification if required later. A proper selection can also help the Provider make a good statistical analysis of the tests which were ordered for various problems.
If the property lab.order.tests.assign.multipleICD is set to Y then the List Box is substituted with a multi select popup as on Assessment CPT tab.
If property lab.order.icdmust is set to Y then it is mandatory for users to assign an ICD to every Order Test.
User Can also add ICDs (ICD9 and ICD10) dynamically to the list box by clicking only button.

These ICDs if assigned to any test will get added to the Assessment if the property assessment.addicd.fromlab is set to Y. This button is enabled only if the property lab.order.addIcd is set to Y.

The 'H' button allows user to select ICDs from Past Medical History.

The 'Assign ICDs' button allows user to select ICDs from Assessment. The selected ICDs will be assigned to all the Tests.

The

icon allows user to select ICDs from Assessment. The selected ICDs will be assigned to individual test.

Save: The button SAVE saves the Lab Order. Note that User is able to create a Lab Order without having to type in any characters. The system validates if the selected tests are supported by the selected Lab. If they are not supported an error is displayed.

If the Login Person is a Provider, or has Approve rights then the status of Order is set to Approved.
If a Nurse creates an Order without Approve rights then an Alert is send to the Provider, so that he can Approve it.
If the Nurse has Approve rights then Only a Notification is send to Provider informing him about the Order.

Send: An order for the test can be sent to the laboratory either by Fax, E-mail, Print and Mail. An order can be sent only after its Status is changed to Approved. Once the Order is sent, its Status changes to Ordered and it cannot be edited.

eSend: This button allows creation of HL7Lab Order message and sending it electronically to the Lab Vendor.

Order Set Button: This button is displayed only when the login person is a Provider. The current Lab Order can be saved as a template by the Provider. This button displays the list of all existing Order Sets. User may decide to overwrite an existing Order Set or create a new one. Select one of the Order Set. All the tests in the current Lab Order along with their details like ICD, are saved in the selected Order Set overwriting any exisintg information. The Provider can thus make Order Set of often ordered tests for various common ailments. This button and the

button are shown if the property, Order Sheet > lab.orderset.use, is set to Y.
If the property Prognocis Parameters > prognocis.clinicwise.orderset=Y then Order set is at the Clinic Level and templates are shared by all Provider).

Statistics: Click to get a list of tests ordered by the same Provider, in the last 180 days, using one or more of the ICD Codes assigned to the current patient. The pop-up window shows the tests and the frequency in descending order.

Provider Involved:

Primary Provider: The primary Provider of the Patient, defined in his Registration.
Attending Provider: The Provider whose appointment was taken / Who created the encounter. Normally this must be same as Primary Provider, unless he is not available.
Lab Ordering Provider: The person who actually Created and Approved the Lab Order. Normally this must be same as Attending Provider.

A Lab Order is for the current selected Patient.

Access Control: The User can come to this screen by many routes, in each case the Orders Accessible will be different.

1. Encounter > Lab Order.
  The Orders which can be selected are the ones belonging to:
  Selected Patient and
  Selected Encounter and
  Ignore External Lab
  (No constraints on Status)

2. CPOE - Lab Order (Log in person is a Provider)
  The Orders which can be selected are the ones
  whose Status = Entered / Approved / Ordered and
  Ignore External Lab and
  Login Person = Attending Provider/ Lab Ordering Provider/ Primary Provider
  (at the time of Ordering)

3. CPOE - Lab Order (Log in person is a Nurse and there is a Selected Provider in Tool Bar)
  The Orders which can be selected are the ones
  whose Status = Entered / Approved / Ordered and
  Ignore External Lab and
  Selected Provider = Attending Provider/ Lab Ordering Provider/ Primary Provider
  (at the time of Ordering)
  The drop down list of Provider in the Tool Bar, will be those to whom the Log in Nurse has been assigned.

4. CPOE - Lab Order (Log in person is a Nurse and All Providers Selected in Tool Bar)
  The Orders which can be selected are the ones
  whose Status = Entered / Approved / Ordered and
  Ignore External Lab and
  Any Provider to whom she is assigned = Attending Provider/ Lab Ordering Provider/
  Primary Provider (at the time of Ordering)

5. CPOE - Lab Order (Log in person is other than a Provider or Nurse)
  Ideally they would not have access rights to this option. If they are given rights then
  The Orders which can be selected are the ones
  whose Status = Entered / Approved / Ordered and
  Ignore External Lab

6. Messages
  If the Provider has received an Alert / Notification for a Lab Order, he clicks on the Messages, and it brings him to this screen with ONLY ONE Lab Order, namely the one referred to in the messages.

See Also:
	Provider’s Preferred Tests \| Vendor Lab / Rad Tests