Trace evidence used to create Rules RBS Rules Trace evidence used to create Rules

Objectives RBS interfaces RBS Rule Types RBS rules can: cause messages to appear, call requests to be made, tests to be reflexed, reports to print, control instrument posting via RBS, etc. How to convert normal RBS screen (Grid form) to textual format Enter calculations in an RBS rule

RBS Interfaces More than 1 RBS server can be added. They are virtual so your SCC Lab specialist can add as needed.

RBS Rule Types Only ‘draw charge’ and ‘Positive for Epi Report’ are available in 4.5 and above. ‘Collection Type’ field is available in 4.5 and above.

RBS Rules – Types and Servers Order Entry Autoposting Server RBS Server Test Ordering Restriction Stop Autoverification Reflex Test Ordering Warning Stop Autoposting Pathologist Review OE Add On Send Message OE Update Print Instant Report Test Call Request Posting Draw Type – Lab 4.5 Positive for Epi Report - Lab 4.5 Evaluated every time order is saved. Evaluated for every result from autoposting instruments. Evaluated every time an order is saved or results is posted/verified.

RBS Rules – Types D- test ordering restriction A- OE add-on  W- test ordering warning  R- reflex test ordering  G- draw charge  C- test call request  M- send message/warning  I- print instant report  A- OE add-on  U- OE update  V- Pathologist Review  S- Stop auto-posting  H- Stop auto-verification  B- Positive for Epi Report  P- post result

Events ‘Specimen attribute changed’ is only available in 4.5 and above.

Flags – Type of Search

With a time frame of 1, date of 03/18 at 1300, then: Flags – Type of Search With a time frame of 1, date of 03/18 at 1300, then:

Flags – Effective for not verified results

Flags – Do NOT show results with message

Flags – Do NOT show results with message

Flags – Do NOT create RMOD for Canned Messages

Flags – Do NOT create RMOD for Canned Messages

Flags – Cancel reflex when trigger is canceled Only available for Reflex Rule Type - SoftLab 4.5

Flags – Verified flag

RBS Fields and Examples

Pre-Active status, the system does not actually trigger the rule on any orders/results, but a log is kept that allows the user to see all the times this rule was evaluated and the response of the system to each of the criteria listed in the rule. 4.5.x Only

Start Date RBS rule’s activation date/time. It only tells RBS when rule becomes active, and has no relation to ordering time. This DOES NOT limit the Rule from firing on historical results before the rule became Active ***You can control when the rule is applied based on order level to be collected date, ordered date, or even stay admission date or specific test’s collection date. GETDBF("ACCDATE")>20180126 GETDBF("ASRCDATE")>20180501

Inactivating RBS Rules Containing Canned Message Calculations For the proper ‘shutdown’ of a RBS rule that contains a Canned Message calculation listed in Textual format: If the Canned Massage is Expired, the RBS rule will not do anything but will keep producing syntax errors by RBS since RBS will still try to evaluate it as an Active rule.. It is recommended to: Inactivate the RBS rule and leave the Canned Message as is (No Expiration Date needed in Canned Message setup). Or Expire the RBS rule with End Date

Inactivating RBS Rules Containing Canned Message Calculations Canned Message remains Active in system Expire Option = Select Not Active Expire Option = Select End Date

Tests – Test ID Fields [4] Used differently depending on the Rule Type selection. These fields may indicate the tests that will be affected, canceled, ordered, called, etc. test ordering restriction - Enter up to four test ID’s that will NOT be able to be ordered if the criteria of the rule are met. Enter “@ALL@” to prevent any tests from being ordered if criteria are met. test ordering warning - When the tests listed in these fields are ordered, a warning message will appear in OE if the criteria of the rule are met. Enter “@ALL@” to display the warning if any test is ordered and the criteria are met. reflex test ordering - Enter up to four test ID’s that will be added to current order when rule criteria is met. test call request - There are three possible entries for the fields with Call rules. Enter “@ALL@” to cause the entire order to be marked. If a test ID is entered in this field, only the entered test will be marked in the call list. Leaving the field empty will cause all tests included in the logic section (bottom of window) to be marked on the call list when the criteria are met. send message/warning - Not used. Do not enter any test ID’s in these fields. print instant report - Not used. Do not enter any test ID’s in these fields. OE add-on - Enter up to 4 tests to be added to the current order upon saving. OE update - The test in the first field will be canceled. The tests in fields 2-4 will be added to the order upon saving. Pathologist Review - Enter up to four tests that will be marked for pathologist review based on the included criteria. Tests are sent for pathologist review when the criteria are met. Post Result - Only the first test field is used. The rule will cause a result to be entered or appended for the test entered in the first field. Stop autoposting - Enter up to four test ID’s that should NOT autopost based on criteria setup. Stop autoverification - Enter up to four test ID’s that should NOT autoverify based on criteria setup. Draw Charge - Enter the Test ID of the billing test that will be added to the order 4.5.x Only Positive for epi report - Enter the test(s) to be qualified to the epi report if different than the tests listed in the logic area. 4.5.x Only

Printer Field

Printer Field >T – send to terminal causing the rule to take place >D – send to the Autoprinter designated in the Doctor setup file >C – send to the Autoprinter designated in the Ward/Clinic setup file

Send Message/Warning

Age Range

Age Range Enter an age range in the format X## - X## where X is: D = Day (0-14) W = Week (0-4) M = Month (0-36) No Prefix = Year (default) Can then format as ###-###

Only available for SoftLab 4.5 Collection Type Only available for SoftLab 4.5

Additional Criteria

Additional Criteria Maximum of 60 characters !D Requesting physician (if no requesting physician, attending physician is used.) !C Clinic !I Insurance carrier !P Patient type !G Clinic group !GC Groups of Clinics (4.5 versions only) !IG Insurance group !F Report format !L Report layout !O Group of doctors !LB PRN PRN is printer code for label printing (reflex test ordering) !LBL XXXXXXX Label layout ID for label printing (reflex test ordering) !R Region (Can use single Region character and/or Region-Depot combination) Entering codes within parenthesis indicates negative logic. In other words, a rule can work for every entry “except” what is within the parentheses. EXAMPLE: !D (1324,VAFA); !C PCCU; !I MCR; !P IO; !G ABC

Logic Section – Grid Form

Logic Section – Grid Form Comp column has 4 additional choices COL, REC, TRU, and NOT Only available SoftLab 4.5 COL = Collected RCV = Received TRU = RBS rule ID in ‘Test/Rule’ column is ‘True’ NOT = RBS rule ID in ‘Test/Rule’ column is Not ‘True’

Logic Section – Grid Form Comp column TRU Select TRU from the ‘Comp’ column Select the Rule ID from the dropdown in the Test/Rule column

Logic Section – Switch to Textual Formula

Logic Section – Switch to Textual Formula

Logic Section – Textual Formula

RBS Only Operators/Calculations ^@TID - Returns the same as @TID->"AFLAGS1" but reads the test level data even if there is no result. Invented because "AFLAGS1" can have collection flags set before test resulting and we wouldn't be able to inspect them until resulting. @@TID - Returns the same as @TID->"AFLAGS2“ but reads not just the result but the abnormal Flags of the test. Invented because there was a need to have rules based on result flags (AFLAGS2) as well, not just the result, which is another test field besides ARESULT, to check and fire RBS based on abnormal flags.

RBS Only Operators/Calculations RESETNTEST( ) Sets sequential access to a Test in the current order. Resets the pointer NTHTEST. @NTHTEST does not point to any test GETNTEST() Sets the @NTHTEST to the next test in the current order. First call after RESETNTEST() sets @NTHTEST to the first test in the order. • Example: Entering the following formula in a Reflex rule. This formula returns TRUE if any test in the current order is flagged as absurd or panic. $A:=0.0; RESETNTEST(); WHILE(!$A && GETNTEST()) DO( IF ( @NTHTEST->"AFLAGS2" & FLG("XP")) THEN $A:=1.0 ELSE 0.0 ); $A

RBS Only Operators/Calculations RESETNSPEC( ) Sequential access to Specimens in current order. Resets the pointer NTHTEST. @NTHTEST does not point to any test. GETNSPEC( ) Sets the @NTHTEST to the first test on the next specimen in the current order. First call after RESETNTEST() sets @NTHTEST to the first test on the first specimen in the order. Formula returns TRUE if "LAV" specimen was collected for current order. • Example: $A:=0.0; RESETNTEST(); WHILE(!$A && GETNTEST()) DO( IF ( @NTHTEST->"ASPECIM" = "LAV" && (@NTHTEST->"ASFLAGS"&4))THEN $A:=1.0 ELSE 0.0 ); $A • Example: Add some test (BUN) for any order that has a test ordered that has atwrkid that is defined in the calculation. In this case, "QUEST" workstation. This type of example could be used for something like an extra handling fee for sendouts. $A:=0.0; RESETNTEST(); WHILE(!$A && GETNTEST()) DO( IF ( @NTHTEST->"ATWRKID" == "QUEST" ) THEN $A:=1.0 ELSE 0.0 );$A

Time Frames Calculations can only look back in time if written in a Post Result RBS rule. @TEST[2] Example: @CREAT[2] >3 Search back 2 days for numeric result of CREAT>3 (includes current order) @TEST[-2] Example: @CREAT[-2] >3 Search back 2 hours for numeric result of CREAT>3 (includes current order) @TEST{1}[2] Example: @CREAT{1}[2] >3 Search back 2 days for numeric result of CREAT>3 but skip current order In an RBS posting rule, use this SYNTAX to use the results of tests not on the order (i.e. a PSA done within the last year or a Creatinine done in the last 3 days). The SYNTAX is @, test ID, open bracket, number of days or negative number to indicate hours, close bracket. This SYNTAX would include the current order. To exclude the current order, add braces and a number to indicate which order within the timeframe included in the brackets.

!#@CREAT{1}[3]&&#@UCRCL[0] Time Frames Examples STRSTR($@PTI,"@")>0?$@PTI:($@ACOAG[3] == "COUMADIN"? $@PTI+" @COUM":($@ACOAG[0] == "HEPARIN"? $@PTI+"@HEPA":$@PTI)) MATCH("*@*",$@PTI)?$@PTI:($@ACOAG[3] == "COUMADIN"? $@PTI+" @COUM": ($@ACOAG[0] == "HEPARIN"? $@PTI+"@HEPA":$@PTI)) The MATCH or the STRSTR function at the beginning of the calculation and will stop any looping by looking for a canned message character, specifically the “@” in any position of the result field and returning a ‘true’ value. This example is pronounced- If the alphanumeric value of the test ACOAG on any order in the last two days- including the current order- is HEPARIN- just like that, then report the numeric value of the test PTI plus the canned message @HEP. Otherwise, if the alphanumeric value of the test ACOAG on this order alone is COUMADIN- just like that- then report the numeric value of the test PTI plus the canned message @COUM. Otherwise, report the numeric value of the test @PTI. If there is NOT a CREAT from the last 3 days…excluding this order AND a UCRCL is on the current order !#@CREAT{1}[3]&&#@UCRCL[0]

Time Frames MATCH for Subsequent Order Updates (MATCH("POS*",($@TREP{1}[365])))||(MATCH("POS*",($@TREP{2}[365])))||(MATCH("POS*",($@TREP{3}[365])))||(MATCH("POS*",($@TREP{4}[365])))||(MATCH("POS*",($@TREP{5}[365])))||(MATCH("POS*",($@TREP{6}[365])))||(MATCH("POS*",($@TREP{7}[365])))||(MATCH("POS*",($@TREP{8}[365])))||(MATCH("POS*",($@TREP{9}[365])))||(MATCH("POS*",($@TREP{10}[365])))||(MATCH("POS*",($@TREP{11}[365])))||(MATCH("POS*",($@TREP{12}[365]))) Needed to check all 12 (monthly) results for a POS* match result for test ID = TREP Using @TREP[365] would find the ‘most recent’ result as far back as 365 days. It does NOT account for any POS* result within the 365 days

Specimen age calculation : We have a request to add a canned message to a test PHFLD whenever the test result time and test collection time differ by greater than 4 hrs.

Delta Check on Any Test on the Order This formula checks if any test in the order is flagged with %D. However, it is not possible to check if the current test result is greater than the previous one, i.e. the rule will be triggered for both flags +%D and -%D Create a RBS rule (type = message/warning) to apply to all tests in the client system that flag as a %D (or any other AFLAGS) . $A:=0.0;RESETNTEST();WHILE(!$A && GETNTEST())DO( IF ( (@@NTHTEST & 16)==16)THEN $A:=1.0 ELSE 0.0 ); $A      .  

Reflex Test Based on Container/Tube Type Want test ABC reflexed whenever an order contains specimen GGT. Can use ASPECIM but it requires entering test ID. If there‘ are too many tests that can use specimen LAV, then use formula below (only if the version supports looping). This formula is a loop that goes over all tests on the order and checks a condition on each test until it $A is set to true (1.0) or all tests are checked $A:=0.0; RESETNTEST(); WHILE(!$A && GETNTEST()) DO( IF ( @NTHTEST->"ASPECIM" = " LAV ")       THEN $A:=1.0 ELSE 0.0 );$A   Formula returns TRUE if there is any test on the order with specimen LAV.

Draw Charge Rule for ER Collected Phlebotomy Containers: RBS reflex to trigger charges for VENIP when specimens come from a specific Ward/Clinic (in this case the RBS rule is built for ER Ward/Clinic.) $A:=0.0;                                                                RESETNTEST();                                                        WHILE (!$A && GETNTEST()) DO (IF ( @NTHTEST-> "ASPECIM" == "BLU" ||  @NTHTEST-> "ASPECIM" == "BRL" || @NTHTEST-> "ASPECIM" == "CLO"  ||   @NTHTEST-> "ASPECIM" == "ESR" || @NTHTEST-> "ASPECIM" == "GGG"  ||   @NTHTEST-> "ASPECIM" == "GRN" || @NTHTEST-> "ASPECIM" == "LAV"  ||   @NTHTEST-> "ASPECIM" == "PST" || @NTHTEST-> "ASPECIM" == "XBC"  ||   @NTHTEST-> "ASPECIM" == "XBC" )                                      THEN $A:=1.0 ELSE 0.0); $A && !#@VENIP[1]  

NO Draw Charge Rule for Nurse Collected Phlebotomy Containers: VENP rule active (as is with no changes) except added additional criteria line : !C (ICN,NSY,PNY) 2.  Created new RBS rule ID = VENIP with the same added additional criteria line : !C ICN,NSY,PNY 3.  Added calculation to rule = VENIP to have the system check each specimen on the order for the presence of specific containers (container code) for GRN,LAV,BLU, etc. if the order was a NURSE Draw type. $A:=0.0; $B:=0.0; RESETNTEST(); WHILE(!$A && GETNTEST()) DO ( IF (STRSTR("BLU,BLUE,BT0,G5R,GC3,GEN,GIC,GRN,GRN1,GWB,L1C,LAV,LBB,LCT,LDT,LFL",    @NTHTEST->"ASPECIM") > 0 || STRSTR("LHG,LIM,LMO,LPC,LV0,MDXC,MR9,SDR,SER,SST,STX,PFA,PL9,PNK,PR9,PST", @NTHTEST->"ASPECIM") > 0 || STRSTR("R2C,R3C,RBB,RCF,RED,RGR,RHV,RLB,RMD,RNA,RPR,RRL,RTD,T0C,T1C,T2C,T3C",  @NTHTEST->"ASPECIM") > 0 || STRSTR("T4C,T5C,T6C,T7C,T8C,TTT,VE9,WNL,X1C,XBC,XFU,XIA,XMY,XNB,XPD,YEL,Z1R",  @NTHTEST->"ASPECIM") > 0 || STRSTR("Z2R,Z3L,Z5E,Z6F,Z7A,Z8A,Z9L,ZB9,ZD9,ZE9,ZG9,ZL9,ZR9,ZS9,ZV9,ZY9,AL9",  @NTHTEST->"ASPECIM") > 0 || STRSTR("XZW",@NTHTEST->"ASPECIM") > 0 || STRSTR("AR9,B00,BAL,CR9,DBN,DE9,DG0,DKB,ESR,EVR,FDP,GYT,HEM,HGR,HIV,IM0", @NTHTEST->"ASPECIM") > 0) THEN $A:=1.0 ELSE 0.0 ); RESETNTEST(); WHILE(!$B && GETNTEST()) DO ( IF (@NTHTEST->"ATESTID" == "NUR") THEN $B:=1.0 ELSE 0.0 ); $A && !$B

Questions ????