For SoftROE (Recurring Order Entry) Whoa! Things have changed! For SoftROE (Recurring Order Entry) Becky Schran, LIS Support Olmsted Medical Center, Rochester, MN

Live with ROE since 11/08 Currently 4.0.4.9:5 4.0.7.3 loaded and validating Until February of 2014 orders were placed directly into SoftLab. Currently most ambulatory orders (including pathology) are ordered in HIS (IEHR-McKesson, formerly Integreat-IcChart). Hospital does not use ROE. Used for nursing home orders entered into LIS

The tear squeezer at the OMC Corral Orders were placed for patient up to 365 days in advance using 1 stay for each location-11 possible locations Patients can (and do) present at any location Had to search through all stays to find the order

Standing Order Screen-”to do list” HIS placed orders Standing order (Type S) -multiple occurrences Pathology- true “now order” (Type N) Future order (Type F), happens once in the future Now order (to be done today) populates as a Future order

Searching for orders- Standing order screen Standing order screen is the “to do” list. The system defaults to this view if there are orders that are not collected, received, or expired. Different order types display-in color-customizable Last DOS Expected date Order expiration (expired orders do not display-no longer “to do”) Orders can be merged based on Hosparam criteria Colors can be customized

Standing Order: Message from HIS to SoftLab MSH|^~\&|ICCHART||||20150324141701||ORM^O01|301858|P|2.3PID||408616|30477665^^^PM1 DR^MR||Omctest^Mc Kenna^A||20070120|F|||210 9th St Se^^Rochester^MN^55904^USA|Olmsted|5072883443||eng|||||||||||||||N PV1||O|||||||||||||||||3018582|11ACC|||0| |0 ORC|NW|3018582|||HD||||20150324000000|200573^Schran^Shawn||71717^ZZ_OMCTest^TestDoctor^^MD|ROCH||||Famil OBR||3018582||LIPID^Lipid Panel|||||||||| Interval Pattern: Every 3 Months; Number of Occurrences: 4; ||71717^ZZ_OMCTest^TestDoctor^^MD||Lab||||||||||||||11|| , , | |20150401000000 DG1|1||250.00|Diabetes 2, controlled

Standing Order Message in Lab-SOH ROE interface <MSH|^~\\&|ICCHAR|ICCHAR||LAB|20150324141701||ORM^O01|301858|P|2.3\r\nZML|ICCHAR |A\r\nPID|||30477665||OMCTEST^MC KENNA^A||20070120|F|||210 9th St Se^^Rochester^ MN^55904^USA||5072883443|||||3047766520150324\r\nPV1|||OMG||||71717^ZZ_OMCTest^T estDoctor|||||||||||||||||||||||||||||||||||||20150324||||||||||||||||O\r\nORC|N W|3018582|||||||20150324000000|200573^Schran^Shawn||71717^ZZ_OMCTest^TestDoctor| OMG\r\nDG1|1|||Empty\r\nDG1|2||250.00|Diabetes 2, controlled\r\nOBR||3018582||LI PID^Lipid Panel||||||||||||71717^ZZ_OMCTest^TestDoctor||||||||||| 4^E3MO^^201504011417^201604011417^R^^STANDING ||||||||||||||||||||LAB|||||||S\r\nDG1|1||999.9|Empty\r\nDG1|2||250.00|Diabetes 2, controlled\r\nOBX|1||LIPID\r\nOBX\r\nOBX\r\nOBX \r\nOBX\r\nOBX\r\nOBX\r\nOBX\r\nOBX\r\nOBX\r\n>

The Little Engine that Could OMC uses PWIM (Pathways Interface Manager) licensed product from McKesson. Core product is Cloverleaf Message out of IEHR is manipulated to meet SCC Interface Specs Message/results back manipulated to meet IEHR specs Some AOE questions he got “creative” and are sent back as OBX’s mapped to the specific result code in the LIS-example demographics for Leads.

Order History View This is the default view if no pending orders. It can also be selected with the drop down. This view shows entire patient history. Canceled Orders Parent Orders Child Orders Indicated by little “r”

Parent Order Screen The system will never default to the parent order screen. Can only be accessed from the drop down. Parent order screen shows ONLY parent orders whether current, fulfilled, or expired. This screen show contains information similar to the Standing Order screen.

Releasing the child order from parent The process is the same for both parent order types. Click the order to be released then click finish.

Child order continued- Looks like any other order at this point. Tests can be added, etc. Hosparams can control: Billing #- Copy from parent order or assign new one to child Insurance-Keep from parent order or update when child order is released. Dx codes-Copy from parent or assign new codes to child order

To finish save the order and labels can then be printed. The Finished order To finish save the order and labels can then be printed.

Some testing occurs at any location ROE is used with: Specimen Tracking, Multisite Set Up including Depot Set Up, Workstation Redirection to direct testing the correct workstation Parent order placed with Pine Island as ordering ward Depot = I

When a child order is released at a different location (Depot) than where parent order was placed: Child order released in Plainview-Depot set up table=E Child order will reflect this and also show correct workstation for testing based on where the child order was released. Controlled by hosparam: OE_depot_by_terminal_force This works with HIS placed orders!!!

Standing order screen: Child order released from Standing type parent (multiple occurrences) Child order now appears as a “Now” order in Standing Order Screen-remember it’s still “to do” because it’s not coll/rec. Parent order also remains since there are more occurrences to happen yet Parent order displays next expected date

Standing order screen: Child order released from Future type parent (one occurrence) Display prior to releasing the child order Display after releasing the child order Parent order no longer displays once it’s fulfilled Child order displays as a “now” order-still to do, not collected or received

Controlling orders from being released to soon: OMC policy: Any order in the standing order screen with an expected date within a 30 day window will be done. Order comment “Do not collect prior to DATE” message pops up as child order is being released Close the order with out saving so it will remain on the “to do list” until the specific request date. These order comments are entered in the HIS and come Soft as NTE

The NTE! <MSH|^~\\&|ICCHAR|ICCHAR||LAB|20150409104901||ORM^O01|303026|P|2.3\r\nZML|ICCHAR |A\r\nPID|||31196298||OMCTEST^JESSICA^L||19900605|F|||1650 4th St Se^^Rochester^ MN^55904^USA||5075296600|||||3119629820150409|323456789\r\nPV1|||OMG||||71717^ZZ _OMCTest^TestDoctor|||||||||||||||||||||||||||||||||||||20150409|||||||||||||||| O\r\nORC|NW|3030263|||||||20150409000000|200573^Schran^Shawn||71717^ZZ_OMCTest^T estDoctor|OMG\r\nDG1|1|||Empty\r\nDG1|2||250.00|Diabetes 2, controlled\r\nOBR||3 030263||HA1C^Hemoglobin A1c||||||||||||71717^ZZ_OMCTest^TestDoctor|||||||||||1^O NCE^^201504091049^^R^^FUTURE||||||||||||||||||||LAB|||||||F\r\nDG1|1||999.9|Empt y\r\nDG1|2||250.00|Diabetes 2, controlled\r\ nNTE|1||DO NOT COLLECT PRIOR TO 4/30/15 \r\nOBX|1||HA1C\r\nOBX\r\nOBX\r\nOBX\r\nOBX\r\nOBX\r\nOBX\r\nOBX\r\nOBX\r\nOB X\r\n>

After 7 years-it’s still not perfect RBS rules do not apply to parent orders Order Update RBS rules are particularly problematic SCR required to change this Info Submitted as SIG request in 2011 but was never added for the initial vote Information from SCC as of 3/30/15 is that it will be coded into 4.0.7.4.x 2. Cannot print labels from parent orders Difficult to supply patients with containers to take home-currently create child orders with an order comment that a container was sent home with the patient. 3. Service modifiers do not copy from parent order to child order Parent order has a No Charge (NC) modifier, the modifier does not copy to child order 4. Users can cycle a resulted child order-last updates from SCC this passed a BUE as an SCC sponsored fix and was going into 4.0.6.2 or 4.0.6.3. We have not yet validated the fix in 4.0.7.x line.

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How do I get SoftROE?? SoftROE is a billable module. Your AE would be more than happy to assist! SoftROE is a billable module.

Contact me any time: Becky Schran 507-529-6668 sschran@olmmed.org