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.
The Lab Results will be received either by E-mail, Fax, or Postal Mail.
The system also allows the user to enter the results.The encounter review tag, ENC_REVIEW__LAB$ allows User to view Lab results in text format.
A search pop up displays the list of In House Orders Or Lab Orders with Status as Ordered / Results Received / Complete ie. Results Approved but not reviewed. On selecting one of the Lab Orders the details are retrieved and displayed.
Order No: The Order No is generated as per property, lab.orderno.prefix and lab.orderno.length, on save of the Order from the menu option: Lab Order.
Order Date: It is the date when the order was generated and saved. 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
:
Click on icon to display the selected patient's contact details; the details displayed depend on the Form Template defined in property patient.contactinfo.template
Lab: Displays the name of the Lab vendor where the lab order was sent to and recieved from; if the Lab Results were imported from a HL7 message, the Lab Vendor's name is suffixed with HL7.
on the invoked HL7 message popup. The current
HL7 import version has been upgraded to 2.5.1Address: The button displays the address details of the Lab vendor other than the Inhouse Lab vendor
DOB: Displays the Date of Birth of the patient along with the gender details.
Status: Displays the current status of Lab results i.e Complete.
Results Date: This date is automatically set by the system to current date. User can override this date and select another date from Calendar.
Doctor: It is the name of the Ordering Doctor ; for Lab Orders generated from PrognoCIS, the ordering doctor's name is displayed. If the Order was directly imported from a HL7 message or attached using the menu option: Message > Attach Center then the Lab is considered as external (to PrognoCIS)and the name is displayed as External Doctor.
Comment: Displays the specific comment that was added during the order generation. The comment can only be viewed and not edited. The inclusion a comment within the lab order is confirmed if the button is displayed with a check sign and the button remains disabled if no comments are associated with the lab order.
Review Results: This option if selected indicates that the result has been reviewed;
review: Displays the specific comment that was added during the order generation.
HM: displays the specific comment that was added during the order generation.
Matrix: Displays the Patient's Lab Result Matrix.
Included in Encounter: Displays the specific comment that was added during the order generation.
add: Displays the specific comment that was added during the order generation.
To provide for the requirements of both a property,
Lab Parameters > lab.matrix.specific.order, can be set to Y(recommended) to view matrix of Tests in current Order. Set the above mentioned property to N to view a matrix of all Patient-Tests.
Action: If there is an action selected it is displayed prominently in red color.
RESULTS TAB
Tests: The list of lab ordered tests is shown, grouped by the Category. If one of the test is a Panel it is shown in Bold, followed by all the individual tests (indented) constituting the Panel. It is also likely that two Panels were ordered, and that there were some tests common. These tests will be shown under each panel, and as such might seem to be duplicated.
Min / Max: The minimum or maximum range for a particular test. These default values are taken from the Tests Master. If these values are different from the laboratory’s standard values, they can be edited.
Result:The actual value of the result received from the lab. Depending on the result type specified in the Tests Master, the value can be either an Integer or Text.
Abnormal: If the Result Type is Numeric and the result entered is outside the Range specified, the Abnormal flag gets checked. However when the ordering doctor reviews lab results, he or she can change the status of this flag, depending on the relevance to the particular patient or encounter.
Type, Location, Notes: These three columns will be displayed only if the results are imported from HL7.
Note:
- There is provision to import and incorporate a valid Hepatitis A B C panel and a reflex test.
- There is provision to import and incorporate a valid Parent-Child message for a microbiology/susceptibility culture reporting.
- The Detail Column displays Order Test Details button which on click invokes Order Detail popup that displays order level test details whereas the Result Test Details icon found at the test level invokes the Result Details popup.
- The Normalcy Flag column displays various normalcy codes that interpret received results such as Normal (N); HH (Upper Panic Limit) etc.
- The Status Column displays individual result test status.
- Provision to provide patient specific education material to the patients on the basis of Lab Result (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.
Hint:
REMARKS TAB
Enter notes on the lab results here using this multi-line edit control.
ATTACH TAB
The Attached file is displayed by default. If nothing is attached, it will
be Blank.
Attach: The lab results may be received
as a document file. The file could either be in the form of a Word document,
Text file or a Graphic file. The lab results could also be paper documents.
Result can also be as a Fax Paper output, OR Fax softcopy image file. In
this case, scan the paper documents and paste the scanned images in one
Word document.
In all the above cases, Upload the relevant file. Once a file is attached,
the Attach button toggles to Detach. The user can click on button to
detach the file. A detached file can be attached to any other Lab Order if
required using the Message > Attach Center menu option.
Multiple Attachments: At times Lab/Radiology results are awaited 3-4 weeks after the patient has undergone a test, thus it is possible that results may arrive at different times for the same Lab/Radiology Order and may require to be attached to the same order of patient.
Considering such scenarios, PrognoCIS now also supports multiple ( maximum 5 ) attachments of Lab/Radiology results.
• User can click on the attach button and attach attachments for the selected Lab/Radiology Order multiple times (maximum 5).
• Individual deletion of attachments is possible.
• The property, prognocis.attach.labrad.maxdays keeps a check on the maximum No. of days that the Order (Lab/Radiology) should be kept open for User to attach results. Maximum value for the property is of 90 days.
• The visibility of such Lab/Radiology Orders in Search depends upon the condition that if an Order already has a maximum of 5 attachments and the ordered date with respect to the current date is less than 90 days then the Order will not be visible in any of the Order searches.
Save: Results can be Approved only ifa) Remarks Tab has some entry
b) Attach Tab has an attachment
c) Each of the Ordered Test has a Result entered Or Abnormal Checked.
In case of Panel, it is sufficient that one of its constituent Test has a result entered Or Abnormal Checked. This is because, it is likely that the Clinic has defined a Panel to consist of 10 tests, while the lab had defined it to consist of only 8 tests. If the Lab send results for more tests than what are defined in the Panel they cannot be entered, however they can be added to remarks.
If there are tests repeated (say same test in two panels selected) and results are entered for first one, it automatically gets copied to the later one.
Lab Order Results are saved. If the Login Person is a Doctor, or has Approve rights, the status is set to Complete.
If a Nurse without Approve rights enters results, status is set to Results Received and an Alert is send to the Doctor, so that he can Approve it. If the Nurse has Approve rights status is set to Complete, and Only a Notification is send to Doctor to inform him.
Action: Depending upon the results the Doctor may want his assistant / nurse to take some Action. A clik on this button opens a pop up allowing the user to define the necessary action, notes, response expected and mail it to the concern people.
Status: At every step, the progress of the lab order is monitored by the system. The Status is set automatically to R, indicating Result Received, once the results are entered and saved. It is updated to C, indicating Complete, once the doctor approves the results. When a Lab Result is subsequently reviewed, it is frozen and cannot be edited. Till then it can be edited by a person with Approve rights.
The User can come to this screen by many routes, in each case the Orders Accessible will be different.
Access Control: The User can come to this screen by many routes, in each case the Results Accessible will be different.
1. Encounter > Lab Result.
The Orders which can be selected are the ones belonging to
Selected Patient and
Selected Encounter
Status = Results Received / Complete
2. CPOE - Lab Result (Log in person is a Doctor)
The Orders which can be selected are the ones
whose Status = Ordered / Results Received / Complete and
Order Results is Not Reviewed and
Ignore External Lab and
Login Person = Attending Doc / Lab Ordering Doc / Primary Doc
(at the time of Ordering)
Note: the results can be edited only by Lab Ordering Doc.
3. CPOE - Lab Result (Log in person is a Nurse)
The Orders which can be selected are the ones
whose Status = Ordered / Results Received / Complete and
Order Results is Not Reviewed and
Ignore External Lab and
Selected Doctor = Attending Doc / Lab Ordering Doc / Primary Doc
(at the time of Ordering)
4. CPOE - Lab Result (Log in person is other than a Doctor 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 = Ordered / Results Received / Complete and
Ignore External Lab and
Order Results is Not Reviewed
5. Message
If the Doctor has received an Alert / Notification for a Lab Order Result,
he clicks on the message, and it bring him to this screen with ONLY ONE
Lab Order, namely the one referred to in the message.
Encounter TOC, Lab Result option:
A number is displayed in round brackets ( ) which indicates the count of such previously Ordered Lab Orders whose results need to be reviewed.
It is likely that a when Patient walks in, a simple Lab Test is done in House. The results are available immediately. Another Lab Test is Ordered whose results are available after 4 days. A third Lab Test Ordered pertains to culture, which takes 15 days. So even if the Patient comes back for an encounter after 10 days, the results of the Last Order will not be available. But they will be available when he comes back after 20 days. The system keeps track of results reviewed and will always ensure that the Doctor does not miss out on any Lab results.
User is expected to click on review Button, to enter One single, comprehensive review note for all applicable Last Labs for that Patient Encounter.
Hint:
The screen displays the list of Lab
Orders whose status is Results Received as well as Complete (which means
Received results have been Authorized by designated authority). Only Lab
Results with Status as Completed are marked as reviewed.