Add New: Click the button on the toolbar to generate a new Radiology 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.Order No: This is a non-editable display only field. Order No is auto-generated by the system on saving the Order, as per settings in the properties: rad.orderno.prefix and rad.orderno.length.
Order Date: This is set by default to Encounter date. The user can select any Date between the first day of last year and the last day of the next year from the calendar icon beside it. If the Order Date is changed to a date which is not today's date, it does not change to the current date when the status is changed to Ordered. This field along with the calendar icon beside it are disabled on Encounter Close for an Order in Entered or Approved status i.e., this field is not editable after Encounter is closed. In such a case, the date previously entered in this field shows grey font.
Patient Name: This field gets auto populated with the name of the patient in the current encounter on adding a new Radiology Order. This is a non-editable, display-only field which cannot be changed.
Patient Info: On clicking this icon, Patient Contact pop-up 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 This icon remains enabled after Encounter Close for an Order in Entered or Approved status.
Comment: This can be used to send special instructions to the Radiology. Click Comment to open a multi line edit control dialog box where these details can be entered. The user can either add comments manually in the text box or select comments from the search icon. Multiple comments can be selected from the search. The comments selected from the search are displayed in the text box in the order of their selection. If the comments selected from the search exceeds the character limit, an alert message, Phrases exceeds allowed limit will be Truncated is displayed. If the user clicks on the OK button of the comments... popup and the number of characters exceed 1024, another validation message, Comments: Length Exceeds Allowed Size (1024). Do you want to Truncate? is displayed. On clicking the OK button in the validation message, the characters above 1024 are truncated and the popup gets closed automatically. After the Radiology order is sent the entered comments can only be seen but not edited. After the Radiology order is sent, and no comments are entered, the button is disabled so that the user knows for sure that there are no associated comments. This button remains enabled on Encounter Close for an Order in Entered or Approved status to view the earlier added comments or add new comments.
Label Print: Click on the icon to print labels as per requirement. The system invokes the Label Printing popup.Order Status: This is set by the system 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 e-Send 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 Radiology Order is sent via the HylaFAX functionality. In this case, the status of the order can be seen by clicking on the hyperlinked Order Status, which invokes the Status popup.
- 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.
Note: Once the Status of the order changes from Approved to Ordered (Printed/Faxed/e-Sent), it can automatically be shraed on the
PrognoCIS Patient Portal if the Portal is configured. To avail this feature and to auto-share the Radiology Orders on the Patient Portal, go to Settings → Configuration → Properties →
pp.tab01.options and
configure the value RLO. Once this value is configured in the property, all the Radiology Orders created from CPOE/TOC Radiology Order screens
are auto-shared on the Patient Portal on the Radiology Orders sub menu under My Health Records.
It is important to note that,
This feature only includes sharing External Radiology Orders and not In-House.
Deleted Radiology Orders from PrognoCIS are not displayed on the Patient Portal.
List of PreAuth Statuses displayed on Radiology Order screen for RFA Response Statuses on PreAuth Tracking screen:
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. The default value in this dropdown for a newly added Order is Routine. If Schedule is the selected value from the dropdown, then the Result Date field gets changed to Scheduled On field.
Scheduled On: This field displays the date for which the Radiology Order is scheduled. By default, this field is shown blank. When the Order Status of the Radiology 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 Radiology, 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 Radiology Order is 'Ordered(Printed/Faxed)' after which the hyperlink gets removed. By default, the date on which the Radiology Order is generated, is set as the Scheduled Date.
Results (Required) By: Select the date by which the Radiology 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. If the Results By (expected By) Date is less than Current Date, it is set to Current Date. After Encounter Close for an Order in Entered or Approved status, a. Results By field and Calendar icon remain disabled, b. If Urgency field has Schedule option selected, the Scheduled On field and its corresponding Calendar icon remains enabled.
Ordering Provider: This is a display only field which populates by default based on the logged in provider/staff who creates the order and can be changed using the Medics Search icon provided next to it. If a new Order has been created by a logged in Provider, this will be set to the Logged in Provider. If a new Order has been created by a logged in Clinical Staff, Office Staff, Medical Assistant or Biller this field will be set to the encounter Attending Provider. Note that the Ordering Provider can be different from the Attending Provider and can be changed using the Medics Search icon provided next to this field.
Medics Search: Clicking on this icon invokes Medics popup. By selecting a Medic from the popup, the Ordering Provider can be changed. This icon is disabled after Encounter Close for an Order in Entered or Approved status. So the Ordering Provider cannot be changed after the encounter is closed even if the Order is in Entered or Approved status.
Patient Name, DOB and Gender: The patient's name is displayed on one line, with the DOB and Gender displayed below it, below the Ordering Provider field. When accessing the order from CPOE → Radiology, the patient's name is hyperlinked and clicking it navigates the system to the Face Sheet in the patient’s Encounter.
Recurring Radiology Order: If the user clicks on an existing Radiology Order, whose status is Approved, a recurrence… button appears. Click on this button and set the preferred recurrence period to repeat this Order multiple times. The User cannot change the recurrence pattern of a Radiology Order after the Encounter is closed. Hence the recurrence… button is disabled for a closed Encounter in Approved status. Since it is not even applicable for Entered status Order, it is not shown.
Note: The subtle features,
- For a new Radiology Order, the Recurrence button is not displayed.
- For an existing Radiology Order which has not been repeated, the Recurrence button is displayed.
- For an existing Base (Original) Radiology Order which has been repeated, A message is shown Recurs X times
- For an existing Non Base Radiology Order which has been repeated. A message is shown Base Radiology Order on. A trash can is also shown to delete this specific instance of repeated Radiology Order .
- In case of recurring Radiology Orders, the delete Button is used to delete all instances of recurring Radiology Order for a base Radiology Order.
Radiology: 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
radiology labs or vendors. Hence, by default, Any Rad option is displayed as a Radiology 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 Radiology 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 ApprovedRadOrderEdit can edit the Vendor name selected
in the Radiology dropdown field. Required Data: In case of an ordered test, some additional information like patient's height, weight, or blood pressure may be required that could influence the results.This additional information is called Required data. On save of the Radiology 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 Vendor 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. This button is enabled only when tests associated in Settings → Configuration → Vendor Tests master screen have been selected for a Radiology Order otherwise it is disabled. For open or closed Encounter, the Reqd Data button is not available when the Order is in Entered Status whereas this button is available and enabled when the Order is in Approved Status. The button gets disabled when Status is changed to Ordered (Printed/eSend/Faxed).
Test Alert: On clicking on this icon,
Rad Test Alert popup is invoked. It is enabled when an alert is defined in radiology test definition from Settings
→ Configuration → Radiology
→ Tests otherwise it remains disabled. The same is observed on Encounter Close for an Order in Entered or Approved status.
X-Ray Jacket No.: Enter the X-Ray Jacket No if applicable. This is an alphanumeric field that also supports special characters and has a character limit of 20. This field is enabled for the User to fill for an Order in Entered or Approved status despite Encounter being closed.
Ready to eSend: Check this checkbox to eSend a Radiology Order. This checkbox is enabled only for a Radiology Vendor that supports eSend otherwise it is disabled. This is true even if an encounter is open or closed for an Entered or Approved status Radiology order.
Medical Necessity: This button is displayed when the property radtest.show.medical.necessity is set to Y. This button is enabled when the selected Radiology test has ICDs assigned for Medical Necessity in the Radiology Test Master screen otherwise it is disabled. On clicking the Medical Necessity button, Radiology - Medical Necessity (Please select Radiology and then the ICDs) popup is invoked. The user can view all Radiology Tests on the Left hand side and available Medical Necessity ICDs on the right hand side. Users can highlight a Radiology test from Left hand side and select/unselect the ICDs from the right hand side and click the ok button. The selected Medical Necessity ICD codes get transferred to the Assessment ICD tab. Same way, a feature exists where the same Medical Necessity popup comes up on the save of the Radiology Order even if one Radiology test selected has Medical Necessity codes associated from the Radiology Test master. On Encounter Close, for an Order in Entered and Approved status, though this button remains enabled under the given circumstances, the OK button on it’s popup is disabled to restrict the user from making any changes i.e. this button becomes 'View Only'. On saving the Radiology Order that was edited after Encounter Close, the Medical Necessity popup is not displayed automatically, even though the Medical Necessity button is enabled and there are Radiology tests present with Medical Necessity codes associated on Radiology Test Master but not selected yet from Medical Necessity popup. This is to prevent any new ICD code to get transferred to Assessment after the close of Encounter.
Attach: Click on the Attach icon 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 ApprovedRadOrderEdit 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 Radiology 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 Radiology Vendor screen. If the One Test Per Order check box is checked and order is created with that Vendor, then that Radiology 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.
PreAuthNos: Clicking on this hyperlink, the Pre Auth Details popup is invoked. If the patient’s Insurance has valid PreAuths present, then this hyperlink remains enabled for an Order in Entered or Approved status. The selected Radiology tests are available on the Left hand side of this popup and the available PreAuth Numbers for the patient for various Insurances are grouped together and shown on the Right hand side. The user can associate one Pre Auth number to each test using the radio button. Even after an Encounter is closed, the hyperlink is enabled for Entered and Approved status Orders in order to associate PreAuths with Radiology tests and save them by clicking on the OK button.
Delete: Click on the Delete icon to delete a test. This icon in front of each test is disabled after Encounter Close for an Order in Entered or Approved status. The user cannot delete a test after the Encounter is closed.
Tests: Click on the
button
to select the applicable tests. The Test Selection pop up has three Tabs:
The first Tab displays a list of Provider preferred Radiology Tests,
The second Tab displays the complete list of Radiology Tests,
The third Tab is Order Set, 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 Radiology Order along with the ICD codes, if they are present.
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.
All the selected tests appear in the table below.
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 → Radiology → 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 → Radiology → 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 Radiology Order. This edited name is tracked for Radiology result also. However note that it does not modify the Test Master. For a new order if the same adhoc test is selected, user will need to edit the name again as per new requirement.
Codes: This is a non-editable, display only field that displays Test Code.
CDSM Notes: The CDSM Notes icon is provided on each Radiology test selected to enter Advanced Diagnostic Imaging CDSM info for each Radiology test. This icon remains enabled for a closed Encounter in Entered or Approved status.
Note:
The CDSM Notes icon is available only when
rad.order.test.show.cdsm property is turned ON.
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 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.
Note: Support has been provided to assign multiple ICDs to a Radiology test on Radiology Order screen (Go To patient Encounter
→ TOC → Radiology Order). The feature is property dependent i.e. if the property,
rad.order.tests.assign.multipleICD is set as 'Y' then it is possible to assign multiple ICDs to individual Radiology tests from Radiology Order screen.User can also add ICDs dynamically to the list box by clicking only
button.
User can add Past ICD codes (from Past Medical History) by clicking on
Add Past ICD Codes icon:
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.assign.icds.rule is set to "N", otherwise remains disabled.
- The limit for the number of ICDs that can be assigned is defined by property order.assign.max.icds. This is an admin level property and values are entered in range of 4 to 25. 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.max.icds 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 assign the ICDs from the Radiology Tests Master screen and when the ICDs are assigned to the Radiology Test and same Test is order from the Radiology Order screen then on clicking the save button the configured ICDs are displayed under the ICD column beside the Test Name.
- On clicking the Select Multiple ICDs icon, ICD Mapping (Assign ICDs) popup is invoked. This popup displays ICDs selected on the Assessment screen. The User can select ICDs from this popup and assign them to one Lab test at a time by clicking this magnifying glass icon in front of each test. This icon is enabled after Encounter Close for Order in Entered or Approved status.
Instructions: The user can add any instruction for the Radiologist for individual tests from here. This field remains enabled for a User even after Encounter Close for an Order in Entered or Approved status.
Actions: This option is available only for Inhouse Radiology and the options available are: Pending, Done, Failed. This dropdown is disabled on Encounter Close for an Order in Entered or Approved status.
MN: MN or Medical Necessity notes that can be entered by clicking on the
MN icon. The MN icon is enabled after Encounter Close for an Order in Entered or Approved status.
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 button: Radiology Order is saved. Note that User is able to create a Radiology Order without having to type in any characters. The system validates if the selected tests are supported by the selected Radiology. If they are not supported an error is displayed. If the Login Person is a Provider, or has Approve rights, the status of Order is set to Approved. If a Nurse creates an Order without Approve rights, an Alert is sent to the Provider, so that he can Approve it. If the Nurse has Approve rights, Only a Notification is sent to the Provider informing him about the Order.
RESET button: Click on the RESET button to reset the changes on the screen. This button is enabled for the User to reset changes done to editable fields of an Order in Entered or Approved status after the last save even after the close of Encounter.
DELETE button: Click on the DELETE button to delete the order. This button is disabled for after Encounter Close for an Order in Entered or Approved status.
STATISTICS button: Click on the STATISTICS button to invoke the Tests Ordered with same ICDS popup.
Send: An order for the test can be sent to the Radiology 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.
Preview: Clicking on the Preview icon, Rad Order popup is invoked. The user can choose any Template from the Template dropdown and select the radio button for Print & Mail or Fax. This button remains enabled on Encounter Close for a Radiology Order in Entered or Approved status. On clicking the send button, the action for the selected radio button takes place. The status of the Radiology Order then changes to Ordered and the screen is no more editable.
Print: Clicking on the Print
icon, the user can print a requisition. This icon remains enabled after Close of an Encounter for a Radiology Order in Entered or Approved status. On printing the requisition, the status of the Radiology Order changes to Ordered.Fax: Clicking on the Fax
icon, the user can Fax Radiology Orders. This icon is enabled after Encounter Close for a Radiology Order in Entered or Approved status.
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
Radiology order → If patient agrees then User clicks on the this button again and the
Radiology Order is processed. The eSend icon is enabled after Encounter Close for a Radiology Order in Entered or Approved status.
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. The Statistics button is enabled on Close of an Encounter for a Radiology Order in Entered or Approved status.
The Radiology orders can be printed as per the Clinic's format. This format can be defined under Settings → Configuration → Report Templates → Radiology Order. Certain Rads can insist on their own pre-printed stationary. The position of every test is fixed on the form. These coordinates (alongwith Vendor specific test code) can be set under Settings → Configuration → Tests → Radiology → Vendor Tests.
Provider Involved:
- Primary Provider: The primary Provider of the Patient, defined in his Registration.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 the same as Primary Provider, unless he is not available.
- Radiology Ordering Provider: The person who actually Created and Approved the Radiology Order. Normally this must be the same as Attending Provider.
Order Set Button: This button is displayed only when a Provider logs in. The current Radiology Order can be saved as a template by the Provider. This button displays the list of all existing Order Sets. The 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 Radiology Order along with their details like ICD, are saved in the selected Order Set overwriting any existing information. The Provider can thus make an Order Set of often ordered tests for various common ailments. This button and the
button
are shown if the property, Order Sheet
→ rad.orderset.use, is set to Y. This button is disabled on Encounter Close for an Order in Entered or Approved status.
Access Control: The user can come to this screen by many routes, in each case the Orders Accessible will be different.
1. Encounter > Radiology Order.
The Orders which can be selected are the ones belonging to:
Selected Patient and
Selected Encounter and
Ignore External Radiology
(No constraints on Status)
2. CPOE - Radiology Order (Log in person is a Provider)
The Orders which can be selected are the ones
whose Status = Entered / Approved / Ordered and
Ignore External Radiology and
Login Person = Attending Provider/ Radiology Ordering Provider/ Primary Provider
(at the time of Ordering)
3. CPOE - Radiology 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 Radiology and
Selected Provider = Attending Provider/ Radiology 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 - Radiology 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 Radiology and
Any Provider to whom she is assigned = Attending Provider/ Radiology Ordering Provider/
Primary Provider (at the time of Ordering)
5. CPOE - Radiology 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 Radiology
6. Messages
If the Provider has received an Alert / Notification for a Radiology Order, he clicks on the Messages, and it brings him to this screen with ONLY ONE Radiology 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 Radiology Order screen for an Order in Entered or Approved status even after the Encounter is closed if the checkbox for Role ApprovedRadOrderEdit has been checked in Settings → Configuration → User Role master.
- Some of the above 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.
