Order Checks

Learning Objectives Become familiar with the Order Checking feature and how it is triggered Examine the Order Check Parameters where system values are set Identify the various Order Checks that may be activated by the EHR Team and CAC and determine the values that will be set for the facility The EHR Team and CAC will customize the Order Check system for the facility by completing the Order Checking script

Order Checks & Notifications Order Checks Review existing data and current events to produce a relevant message that is presented to patient care-givers. A real-time process that occurs during the ordering session and driven by responses entered by the ordering provider. Messages are displayed interactively during the ordering session. Example: ALLERGY-DRUG INTERACTION Notifications Review existing data and current events to produce a relevant message that is presented to patient care-givers. Notifications occur behind the scenes, monitoring data as it flows through RPMS and when certain trigger events occur. Example: LAB RESULTS

Order Checks NOTE: All order checks are exported enabled at the system level. When turned on at the system level, they are turned on for everyone. IT, Clinical Coordinators, Individuals, or Services can disable individual order checks if they choose.

Order Checking Component of order entry Based on a system of rules to see if orders meet defined criteria If orders meet the criteria, an electronic message is sent to the ordering provider before the order is completed (such as duplicate order, drug-lab interaction, etc.) The provider can then choose to cancel the order or override the order check and place the order

Order Checks Exported with EHR ALLERGY-CONTRAST MEDIA INTERACTION ALLERGY-DRUG INTERACTION AMINOGLYCOSIDE ORDERED BIOCHEM ABNORMALITY FOR CONTRAST MEDIA CLOZAPINE APPROPRIATENESS CT & MRI PHYSICAL LIMITATIONS DRUG-DRUG INTERACTION DUPLICATE DRUG CLASS ORDER DUPLICATE DRUG ORDER DUPLICATE ORDER ESTIMATED CREATININE CLEARANCE GLUCOPHAGE-CONTRAST MEDIA LAB ORDER FREQ RESTRICTIONS MISSING LAB TESTS FOR ANGIOGRAM PROCEDURE ORDER CHECKING NOT AVAILABLE RECENT BARIUM STUDY RECENT ORAL CHOLECYSTOGRAM RENAL FUNCTIONS OVER AGE 65

Order Checks Order checks are displayed to the clinician when an order is written and signed Order checks with a danger level of high require the clinician to enter a reason for continuing with the order

Enable/Disable Order Checking System This option lets the user determine if any order checking processing occurs in the entire Order Checking system. –E (Enabled). Indicates the Order Checking system is enabled and running. –D (Disabled). Indicates the Order Checking system is disabled and not running. This parameter is set to Disabled in the exported version of Order Checking. This must be set to Enabled as part of the implementation process before order checking can occur.

Enable/Disable Order Checking System

Order Checking Parameters

Set Creatinine Date Range for Contrast Media Orders This order check searches to see when the last creatinine was done for patients when a radiology exam is ordered with contrast media. The package value is 30 days

Set Creatinine Date Range for Contrast Media Orders

CT Scanner Height & Weight Limit Can be ignored if the site does not have a CT scanner. These order checks should also be disabled at the system level.

Set Clinical Danger Level

Lab Duplicate Order Range Set the number of hours backwards in time to look for duplicate lab orders Can set different values for locations such as wards and clinics

Radiology Duplicate Order Range Use this option to set the number of hours backwards in time to look for duplicate radiology orders. This range can be setup differently for different locations.

Orderable Item Duplicate Order Range

Mark Order Checks Editable By User If there are certain order checks that the EHR Team/CAC wishes to remain either on or off for everyone, this option will allow them to be uneditable by users. (uneditable = mandatory) Users will not be able to change the settings in their personal preferences.

Order Checks Made Mandatory

Enable/Disable an Order Check Processing Flags –E (Enabled) –D (Disabled)

Enable/Disable an Order Check

Set Creatinine Date Range for Glucophage-Lab Results This parameter sets how far back to look for a creatinine result for a patient taking glucophage. The package value is 60 days.

Edit Site Local Terms Map local orderable items or laboratory test names to national standard terms used by the Order Checking system. The user picks the national term and matches it to the local test.

Edit Site Local Terms Each item must be mapped to ALL of the sites terms which meet this requirement Most are lab tests which can vary at each site

MRI Scanner Height & Weight Limit Can be ignored if the site does not have an MRI machine or for open MRI and the order check should be disabled at the system level

Set Number of Medications for Polypharmacy The number of medications used to determine polypharmacy. If the patient is taking more than the number of meds indicated by this parameter’s value, polypharmacy exists. This parameter is used by the order check Polypharmacy.

Display the Order Checks a User Can Receive This option displays a list of all Order Checks annotated with the status of each processing flag. The processing flag can be set on one or more of five levels. The flag that is in effect is the one with the lowest entity precedence as given in the following list: ENTITY PRECEDENCE: 1ENTITY TYPE: User ENTITY PRECEDENCE: 2ENTITY TYPE: Location ENTITY PRECEDENCE: 3ENTITY TYPE: Service ENTITY PRECEDENCE: 4ENTITY TYPE: Division ENTITY PRECEDENCE: 5ENTITY TYPE: System

Order Checks a User Can Receive

Personal Preferences Order checks that have not been set to not editable may be changed from the GUI Personal Preferences from the Tools menu

“10” Mandatory Order Checks for Meaningful Use Allergies Un- assessible Allergy-Contrast Media Interaction Allergy-Drug Interaction Critical Drug Interaction Dangerous Meds for Pt. > 64 Estimated Creatinine Clearance Glucophage-Contrast Media Glucophage-Lab Results No Allergy Assessment Renal Functions over Age 65

Questions and Discussion