PrognoCIS Help: Lab Order

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Introduction: Lab is an abbreviation of Laboratory. Lab orders are created when physicians or clinical staff order Lab tests for a Patient. Users can view the complete list of orders, change the physician who wanted to order the Lab, and order new Lab tests as well from the Lab Order screen.

The current encounter details of the Patient are displayed when the User chooses to add a new Lab order from TOC Lab Order screen. At times, the results of the tests ordered or performed are expected a few days after the encounter with the Patient. Thus, a provision has been made wherein a User is able to edit Lab Order Date; add information regarding the date and time of samples collected or tests conducted as well as the date and time of the food or drink consumed – even after an encounter is closed.

Lab tests can also be ordered from the CPOE Lab Order screen. 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.

Field Description

Add: Click on this button to create a new Lab order. When a 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.

Search: Search the existing list of Lab Orders to choose a Lab Order.

Note: The filters applied on the search popup are retained if the search section name is present on the value of the property save.search.filters.for even if the user navigates to any other screen and then again navigates to the above-mentioned screens and reloads them when the user reopens the Search popup. By default, the property value is set to blank.

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

Location: This field displays the location from where a lab order is initiated. This field along with an Order Location Search

icon are displayed only when the property lab.order.location.show is turned On. By default, the name of the clinic’s location is displayed in the Location field. Users can click on the Order Location Search

icon to invoke the Location search popup and select the location from where the lab order is being initiated. On clicking on a location name on this popup, the selected location is displayed in the Location field and is saved for the lab order on clicking the save button. If the user selects a new location from the Location search popup but navigates to another screen without clicking the save button, then the following is observed depending on the value set in the property prognocis.autosave.rule:

If the property value is set to CONFIRM, then a confirmation popup is displayed informing the user of unsaved changes on the page.
If the property value is set to AUTOSAVE, then the new location selected by the user is saved.
If the property value is set to IGNORE, then the new location selected by the user is not saved.

Only the first 15 characters of the name of the location are displayed in this field. The full name of the location is displayed in the tooltip on hovering the mouse over the location name. The Order Location Search

icon is enabled only for zero duration encounters and remains enabled for lab orders in Entered status and in Approved status. When the user prints/faxes/eSends the lab order and it enters Ordered status, the Order Location Search

icon is disabled. If the encounter is a non-zero duration encounter, then the Order Location Search

icon is disabled, and the default location displayed in the Location field is the encounter appointment location. In this case, the location cannot be changed.

Order Date: It is set by default to Encounter Date. It can be edited by the 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: It shows the selected Patient in the current encounter. In case of CPOE → Lab Order, Add 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.

Patient Info icon : On clicking this icon, Patient Contact popup is invoked which displays the selected Patient’s information such as Name, Age, DOB, Address, Email, etc. The details displayed depend on the Form Template defined in property patient.contactinfo.template.

Comment: This can be used to send special instructions to the laboratory. Click the comment... button 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 and if no comments were entered then 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.

Order Status: This label field is system generated and set as:

E - Entered The Status of an order is displayed as Entered when the User who does not have the rights to Approve an order has created it.
A - Approved The Status of an order changes to Approved on clicking the Save button when a User has the rights to Approve.
O - Ordered (Printed/Faxed/e-Sent) The Status changes from Approved to Ordered (Printed/Faxed/e-Sent) when the User sends the Approved order by either printing it, sending via fax or clicking the eSend button on the top right corder of the screen. If the HylaFAX property prognocis.fax.hylafaxapi is turned On from the Properties Master screen, then the Lab Order is sent via the HylaFAX functionality. In this case, the status of the document can be seen by clicking on the hyperlinked Order Status, which invokes the Status popup.

Note:

Once the Status of the order changes from Approved to Ordered (Printed/Faxed/e-Sent), it can automatically be shared on the PrognoCIS Patient Portal if the Portal is configured. To avail this feature and to auto-share the Lab Orders on the Patient Portal, go to Settings → Configuration → Properties → pp.tab01.options and configure the value LBO. Once this value is configured in the property, all the Lab Orders created from CPOE/TOC Lab Order screens are auto-shared on the Patient Portal on the Lab Orders sub menu under My Health Records. It is important to note that this feature only includes sharing External Lab Orders and not In-House. Deleted Lab Orders from PrognoCIS are not displayed on the Patient Portal.

R - Results Received The Status changes from Ordered (Printed/Faxed/e-Sent) to Results Received once the results for the ordered tests are entered.
C - Complete The Status changes from Results received to Complete once the entered results are approved.
Complete and Reviewed - on The Status changes to Complete and Reviewed once the approved results are Reviewed.

PreAuth Status: This field shows the status of PreAuth. For this field to get displayed, there are three prerequisites. Firstly, the property prognocis.rfa.enabled should be set to Y. Secondly, the property rfa.order.types should have the value LB – Lab selected. Thirdly, Encounter Type used in the Encounter for which the Order is created should have the Requires Authorization checkbox checked in the Enc Types master screen. When a new Lab Order is created, the PreAuth Status label along with the keyword "Created" gets displayed. The RFA Response Status selected on the PreAuth Tracking screen are displayed in front of the PreAuth Status label on the TOC and CPOE Lab screen. Partial statuses are displayed for multiple tests with different RFA Response Statuses. The different statuses that can be displayed here are Created, Approved, Modified, Denied, Appeal, Sandhagen, Sent, Partially Approved, Partially Appealed and Partially Denied. When the conditions for RFA are not met, the PreAuth Status label is not displayed on the Lab Order screen.

List of PreAuth Statuses displayed on Lab Order screen for RFA Response Statuses on PreAuth Tracking screen:

Created - When RFA Response Status is Blank
Sent - When RFA Response Status is RFA Sent
Approved - When RFA Response Status is Approved
Modified - When RFA Response Status is Modified OR when RFA Response Status is Modified Accepted & Appeal OR when RFA Response Status is Rejected Accepted & Appeal
Denied - When RFA Response Status is Appeal
Sandhagen - When RFA Response Status is Sandhagen
Partially Approved - When some RFA Statuses are Approved and Pending OR when some RFA Statuses are Approved and Denied OR when some RFA Statuses are Approved and Modified OR when some RFA Statuses are Approved and Appeal OR when some RFA Statuses are Approved and Sandhagen OR when some RFA Statuses are Approved, Denied, Pending, Modified, Appeal and Sandhagen

Partially Appealed - When some RFA Statuses are Approved, Appeal and Sandhagen OR when some RFA Statuses are Appeal and Sandhagen
Partially Denied - When some RFA Statuses are Denied, Modified, Appeal and Sandhagen

Type: This dropdown field defines the urgency of the Lab test. There are 4 options available under this dropdown:

Routine: If this option is selected, then the selected Lab test is a routine check-up test.
Now: If this option is selected then the Lab test is required to be performed now.
Stat: If this option is selected, then the Lab test is required to be performed immediately.
Scheduled: If this option is selected, then the Lab test is scheduled in advance.

The first options three 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.

Scheduled On: This field displays the date for which the Lab Order is scheduled. By default, this field is shown blank. When the Order Status of the Lab Order changes to 'Ordered(Printed/Faxed)', the Scheduled On label becomes hyperlinked and the field is grayed out. If the Scheduled On date was not selected while ordering a Lab, the Scheduled On field autopopulates Today's Date. Click on the hyperlink to invoke Calendar popup and select another date. The selected date is displayed on the Scheduled On field. Scheduled On date cannot be backdated. The date in this field can be changed only till the Order Status of the Lab Order is 'Ordered(Printed/Faxed)' after which the hyperlink gets removed. By default, the date on which the Lab Order is generated, is set as the Scheduled Date.

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.

Lab: Click on the Vendor Search icon and select one of the vendors from the vendor list. This is not mandatory, as patients may have their own preferred labs or vendors. Hence, by default, Any Lab option is displayed as a Lab vendor. This field also has an autocomplete mechanism wherein on typing an alphabet 5 Vendor suggestions for the same are displayed to the User for selection. A Clear hyperlink is present beside this field for the User to clear their selection. Click on this Vendor Search icon, the Laboratory popup is invoked for Vendor selection. The Vendor Search icon is disabled on Encounter Close for an Order in Entered and Approved status.

Note: For the closed encounter the user having the role assigned as ApprovedLabOrderEdit can edit the Vendor name selected in the Lab dropdown field.

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.

Attach...: Click on the Attach... button to invoke Documents popup. This popup displays the list of documents in a Patient’s Encounter. The popup displays document related information in five columns – Sel, Date, Type, Category, Person and Subject. The document types that can be listed on this popup are as follows: Encounter Attachments, Clinic Forms, Procedure Result, Consult Response, RFA Letters, RFA Response, Referral Documents, Lab Results, Patient Form, Radiology Results, Patient Messages, Letters In, Letters Out, Progress Notes, Legal Documents, Other Documents, Old Progress Notes, Procedure Forms, Billing Attachments, Progress Notes Report, Denied Refill Request, Portal Attachments, Clinical Message, Denied Change Request, Denied Cancel Request, Approved Cancel Request, Machine Interface, Doctor Forms. The Documents popup also displays button. Click the Filters... button, to invoke Apply Filters popup. Apply appropriate filters and click on the ok button to apply the changes and close the popup. After applying filters through this popup, the Filters... button displays a checkmark. Select the document from the Documents popup by checking the Sel checkbox and click on the ok button on the popup. Only five documents can be selected from the Documents popup. When the user tries to select the sixth document, an Alert message, Selected maximum no. of documents gets displayed in a popup with an Ok button. On clicking the Ok button in the Alert Message popup, the popup gets closed. On selection of documents from the popup, icons are displayed beside the Attach... button for the selected Type of documents. Click the icon to invoke the preview of the selected document. Preview popup has detach and close buttons. Click the detach button to remove the document and close the Preview popup. When the User Role ApprovedLabOrderEdit is enabled for a specific Provider, the Attach button is enabled for encounters in Closed Status. The Provider can add an attachment and save the changes.

Note: The icon for the document is no longer displayed on the screen after it has been detached.

The printed / faxed /emailed Order includes the Lab Output Template along with the attachments.

The Attach... button is enabled for only Entered and Approved Order Statuses and disabled for Ordered(Printed) / Ordered(Faxed) / Ordered(Esent).

Orders sent via HL7 do not include the order attachments.

One Test Per Order checkbox is shown conditionally on Lab Vendor screen. If the One Test Per Order check box is checked and order is created with that Vendor, then that Lab order gets split into the number of tests in that order. In this case attachments added for the original order are available for all those orders that have been split.
Tests: Click on the

button to select the applicable tests.
The Test Selection popup has three buttons: Provider Preferred Tests

, All Tests and Order Set

list. Provider Preferred Tests include a list of Provider preferred Lab Tests and All Codes including 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. Order Set 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. This button is shown if the property, lab.orderset.use is set ON. If the property prognocis.clinicwise.orderset is ON, then Order set is at the Clinic Level and templates are shared by all Provider

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 the 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. Based on Patient’s preferred language, the Medlineplus Education material is displayed in that respective language. 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.

Only for Lab Orders, A Copy from Past Lab Orders

icon is present next to the Add Tests icon. On clicking the Copy from Past Lab Orders icon, the Copy Lab Order popup is invoked that consists of all the past Lab orders for the selected patient. Clicking on any of the row, the tests of the selected lab order will get added in the current order. The User can now save and create the new order. The user can also add more other tests from add button after copying the past order tests.

Notes:

The Copy from Past Lab Orders icon is enabled only when the Lab Order status is Approved or Entered.

The Copy from Past Lab Orders icon is disabled once the Lab is in Ordered Status.

For a Lab order, which is copied into the current Lab Order, all the tests present in the earlier Lab Order are copied, if any additional tests need to be added or some tests need to be removed from the current Lab Order this can be done manually.

The Copy from Past Lab Orders is disabled if there are no Lab Orders for the selected patient.

In case, Lab Orders are already present and then the user tries to copy by clicking the Copy from Past Lab Orders icon, an alert popup is displayed to the User that reads: “Copying Lab Order will overwrite existing data (Vendor+ Tests) if any, from the Current Order. Do you want to proceed? Along with Yes or No buttons.

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.multiple ICDis 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.

Assign ICDs: This button enables User to select ICDs from Assessment. The selected ICDs will be assigned to all the Tests.

Note:

This button will be enabled only if the value of property order.asssign.icds.rule is set to "N", otherwise it remains disabled.

The limit for the number of ICDs that can be assigned is defined in the property order.assign.max.icds. This is an admin level property and values are entered in a range of 4 to 25. The default value is set to 25.

Total number of ICD’s will be selected automatically depending on the Rule set in the property order.assign.icds.rule and the value entered in the property order.assign.max.icds.
For Example, if value of the property order.assign.icds.rule is set to "A" and value of the property order.assign.max.icds is set to 10 then, only the first 10 ICD’s from the entire list (Assign ICD popup) will be selected automatically.

Assign ICDs button

is available with aforementioned conditions on Patient Encounter TOC.

The User can set the default ICDs to the Lab Test from the Lab Test Master screen. If the default ICDs are configured from the Settings → Configuration → Lab → Tests Master screen to the required test then on selecting the same lab test while ordering the Lab the configured ICDs are auto populated in the Lab Order screen. These ICDs are displayed once the User saves the entered test. The ICDs are displayed beside the Lab Test under the ICD column section.

The

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

Collection Date/Time: Enter the Lab Sample collected date or select the date from the Calendar for the added Lab Test. The User can also add the Collection Date for the Lab Sample from the Collection button. The Collection button is enabled only when the Lab Test is in the Approved status. Click on the Collection to invoke Collection Details popup. This popup serves the purpose of storing information such as date/time of the last food item or drink consumed by the Patient and the date/time of sample collection. The collection date/time added from this Collection button is auto populated on the main Lab Test screen under the Collection Date/Time column, once the Lab Test is saved.

Sample Specs: Click on the Notes icon:

to enter the Lab test findings or specifications for the ordered Lab Test. On clicking the Notes icon the selected Lab test popup is invoked with the text box. The The User can enter the Lab Sample Specs in this text box manually or can select the frequently used phrases from the Search Phrases icon. Once the Lab Sample Specs are added for the test and User saves the Lab Order then the color of the icon changes to the red

which indicates that the lab samples specs are added to the Test.

Note: The User can also add the Sample specs from the Lab Tests master screen.

PreAuth Status: This column displays PreAuth Statuses of individual tests. When the Encounter Type used is not of the RFA type, this column is displayed empty.

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 sent to the Provider, so that he can Approve it.
If the Nurse has Approve rights then Only a Notification is sent 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.

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.

Note:

A logged in user (Provider, Clinical Staff, Office Staff, Medical Assistant or Biller) can edit certain fields on the Lab Order screen for an Order in Entered or Approved status even after the Encounter is closed if the checkbox for Role ApprovedLabOrderEdit has been checked in Settings → Configuration → User Role master.

Some fields/buttons/icons are enabled for the user to edit while some fields/buttons/icons are disabled in order to avoid impact on Progress Notes or discrepancies on Assessment screen due to addition of CPT/HCPC Codes after Encounter Close.