General Laboratory Overview

General Laboratory Overview
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File Structure Laboratory Test (#60) Topography File (#61)
NAME: GLUCOSE// TEST COST: // Select SYNONY// TYPE: BOTH// SUBSCRIPT: CHEM, HEM, TOX, SER, RIA, ETC.// LOCATION (DATA NAME) :Glucose Select INSTITUTION: DIRDEV HOSPITAL/CLINIC// INSTITUTION: DIRDEV HOSPITAL/CLINIC// ACCESSION AREA: CHEMISTRY// UNIQUE ACCESSION #: NO// UNIQUE COLLECTION SAMPLE: NO// LAB COLLECTION SAMPLE: BLOOD// REQUIRED TEST: YES// EXTRA LABELS: HIGHEST URGENCY ALLOWED: STAT// FORCED URGENCY: ROUTINE// PRINT NAME: GLUCOSE// Reserved: PRINT CODE: PRETTY PRINT ENTRY: PRETTY PRINT ROUTINE: PRINT ORDER: 14// . Select SITE/SPECIMEN: BLOOD// REFERENCE LOW: 70// REFERENCE HIGH: 110// CRITICAL LOW: 40// CRITICAL HIGH: 350// INTERPRETATION: 1> UNITS: mg/dL// TYPE OF DELTA CHECK: DELTA VALUE: Select COLLECTION SAMPLE: BLOOD// Topography File (#61) NAME: BLOOD// ICDO CODE: HL7 CODE: BLD// LEDI HL7: Whole blood // SNOMED CODE: 0X000// SEX SPECIFIC: Select SYNONYM: BL// WEIGH: COLLECTION SAMPLE: Select TITLE OF ARTICLE: ABBREVIATION: B// *NEGATIVE BACTERIOLOGY COMMENT: Accession (#68)AREA: CHEMISTRY// LR SUBSCRIPT: CHEM, HEM, TOX, RIA, SER, etc.// COMMON ACCESSION #'S WITH AREA: ACCESSION TRANSFORM: DAILY// ACC CODE: S LRAD=DT// VERIFICATION CODE: VER CODE: *IDENTITY CONTROL: PRINT ORDER: 1// BYPASS ROLLOVER: ABBREVIATION: CH// Collection Sample (#62) NAME: BLOOD// DEFAULT SPECIMEN: BLOOD// TUBE TOP COLOR: MARBLE// VOLUME LARGE: 10// VOLUME SMALL: 1// LAB SECTION: CHEMISTRY// CAN LAB COLLECT: YES// Select SYNONYM: TIGER// Select ACCESSION AREA This slide shows how there are many dependencies between the file. Specimen is a real stickler. The system looks at the default specimen in the collection Sample file before it gets to field 100 (site/Specimen in file 60. Everything is driven by Specimen, ranges, calculations, cumulative report. If a collection sample is in File 60 that the default specimen is different, like serum, none of the definitions for the defined specimen (Blood) in file 60 will be used. Medsphere Confidential and Proprietary. Copyright All Rights Reserved

The Laboratory Package is made of up three different/ distinct modules General Lab Microbiology Anatomic Pathology General Lab subscripted tests (CH Microbiology subscripted test MI Anatomic Pathology EM, CY, etc Medsphere Confidential and Proprietary. Copyright All Rights Reserved

General Laboratory Overview Section 1 - Phlebotomy
Enter ?? for more options, ??? for brief descriptions, ?OPTION for help text. The phlebotomy menu is Option 1 Medsphere Confidential and Proprietary. Copyright All Rights Reserved

This menu allows the laboratory to: Work with scheduled collections List labels Add to an existing order Add to an existing accession Print reports Future order Not collected Usually during or at the end of each shift, phlebotomists will run these reports in order to make sure that mo collections were missed, or to check on scheduled draws. Medsphere Confidential and Proprietary. Copyright All Rights Reserved

General Laboratory Overview Section 1 - Accessioning
Enter ?? for more options, ??? for brief descriptions, ?OPTION for help text. Accessioning Menu is Option 2 Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Accessioning allows the lab personnel to: Create an new order/accession Accept an order created by CIS Allows the separation of accessions Chemistry Hematology Urinalysis Microbiology Etc. Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Enter ?? for more options, ??? for brief descriptions, ?OPTION for help text. Most labs do not use all of these so we create custom menus according to the client’s wishes so they don’t have to wade through all these choices Medsphere Confidential and Proprietary. Copyright All Rights Reserved

General Laboratory Overview Section 1 - Resulting
Enter ?? for more options, ??? for brief descriptions, ?OPTION for help text. Processing = Resulting tests, option 3. Can also be renamed Resulting Menu or something similar to be more clear Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Order Test/Status Verification of results Manual Automated Instrument Interface Worklists Batch data input Workload Statistics Pending workload Medsphere Confidential and Proprietary. Copyright All Rights Reserved

General Laboratory Overview Section 1 – Misc. Processing menu
Miscellaneous Processing Menu Allows the lab to perform miscellaneous reports Incomplete work Statistics By provider Turnaround time Manipulate loadlist/worklist entries Insert/remove load or worklist entries Medsphere Confidential and Proprietary. Copyright All Rights Reserved

General Laboratory Overview Section 1 – Processing (Misc. menu)
Select Misc. Processing Menu Option: Medsphere Confidential and Proprietary. Copyright All Rights Reserved

General Laboratory Overview Section 1 – Reports
This menu contains several report options Allows the review of laboratory results Interim reports All results by time frame By provider By location By selected test Graphing of result By grouping of selected tests Medsphere Confidential and Proprietary. Copyright All Rights Reserved

General Laboratory Overview Section 1 – Reports
Reports Menu Options Medsphere Confidential and Proprietary. Copyright All Rights Reserved

INTRODUCTION TO VA FILEMAN
Super User Training Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Training Goals and Objectives
Define VA Fileman Identify VA Fileman Options Enter/Edit Print Search Inquire Utilities Establish Access Assignment Rules Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Definition of VA Fileman
VA Fileman is a database management system written in MUMPS. A database management system manipulates data and interacts with the user. VA Fileman runs on computers in an interactive dialogue with a variety of users working on their terminals. It is used to define, enter, and retrieve information from a set of computer stored files, each of which is described by a data dictionary (DD). Fileman is essentially OpenVista Medsphere Confidential and Proprietary. Copyright All Rights Reserved

VA Fileman Options Enter/Edit File Entries
use to enter or edit entries in existing files Print file entries: use this option to create reports Search File Entries: use to select and display entries that conform to predetermined criteria Inquire to File Entries: use to display file entries and values Data Dictionary Utilities: use this file to print a file’s data dictionary File Man functions Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Enter or Edit File Entries
INPUT TO WHAT FILE: LABORATORY SITE// Collection CHOOSE 1-2: 2 COLLECTION SAMPLE (83 entries) EDIT WHICH FIELD: ALL// Select COLLECTION SAMPLE NAME: blood CHOOSE 1-5: 1 BLOOD BLOOD LAVENDER NAME: BLOOD// DEFAULT SPECIMEN: BLOOD// TUBE TOP COLOR: LAVENDER// VOLUME LARGE: 7// VOLUME SMALL: 1// LAB SECTION: HEMATOLOGY// CAN LAB COLLECT: YES// Select SYNONYM: PURPLE TOP// Select ACCESSION AREA: Example of enter/edit Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Print File Entries OUTPUT FROM WHAT FILE: COLLECTION SAMPLE//
SORT BY: NAME// START WITH NAME: FIRST// FIRST PRINT FIELD: NAME;L25 THEN PRINT FIELD: DEFAULT SPECIMEN;L20 THEN PRINT FIELD: ************************* Heading (S/C): COLLECTION SAMPLE LIST Replace STORE PRINT LOGIC IN TEMPLATE: DEVICE: COLLECTION SAMPLE LIST AUG 3, :23 PAGE 1 NAME DEFAULT SPECIMEN ASPIRATE WOUND-DEEP/SURGICAL ASPIRATE WOUND-SUPERFICIAL BIOPSY LUNG BIOPSY LIVER Example of print file Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Search File Entries OUTPUT FROM WHAT FILE: LABORATORY TEST//
-A- SEARCH FOR LABORATORY TEST FIELD: DATA NAME -A- CONDITION: CONTAINS -A- CONTAINS: ANTI -B- SEARCH FOR LABORATORY TEST FIELD: IF: A// DATA NAME CONTAINS "ANTI" STORE RESULTS OF SEARCH IN TEMPLATE: SORT BY: NAME// START WITH NAME: FIRST// FIRST PRINT FIELD: NAME;L25 THEN PRINT FIELD: DATA NAME;L25 Heading (S/C): LABORATORY TEST SEARCH Replace STORE PRINT LOGIC IN TEMPLATE: DEVICE: LABORATORY TEST SEARCH AUG 3, :34 PAGE 1 NAME DATA NAME A2 HEMOGLOBIN BY COLUMN ANTI-DNA SINGLE-STRANDED ALPHA-1-ANTITRYPSIN ALPHA-1-ANTITRYPSIN AMOEBIC IHA ANTIBODY AMOEBIC IHA ANTIBODY Example of the search function Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Inquire to File Entries
OUTPUT FROM WHAT FILE: LABORATORY TEST// Select LABORATORY TEST NAME: glucose ANOTHER ONE: STANDARD CAPTIONED OUTPUT? Yes// (Yes) Include COMPUTED fields: (N/Y/R/B): NO// - No record number (IEN), no Computed LABTEST IEN: NAME: GLUCOSE TYPE: BOTH SUBSCRIPT: CHEM, HEM, TOX, SER, RIA, ETC. LOCATION (DATA NAME): CH;2; UNIQUE ACCESSION #: NO UNIQUE COLLECTION SAMPLE: NO LAB COLLECTION SAMPLE: BLOOD TEST COST: FIELD: DD(63.04,2, HIGHEST URGENCY ALLOWED: STAT REQUIRED TEST: YES FORCED URGENCY: ROUTINE COMBINE TEST DURING ORDER: YES PRINT NAME: GLUCOSE PRINT ORDER: 14 DATA NAME: GLUCOSE SITE/SPECIMEN: BLOOD REFERENCE LOW: 70 REFERENCE HIGH: UNITS: mg/dl SITE/SPECIMEN: SERUM REFERENCE LOW: 70 REFERENCE HIGH: UNITS: mg/dL Example of an inquiry in fileman Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Data Dictionary Utilities
START WITH WHAT FILE: LABORATORY TEST// GO TO WHAT FILE: LABORATORY TEST// Select SUB-FILE: ? Select SUB-FILE: 6 ACCESSION AREA Select LISTING FORMAT: STANDARD// DEVICE: STANDARD DATA DICTIONARY # ACCESSION AREA SUB-FILE /3/99 PAGE 1 STORED IN ^LAB(60, (1088 ENTRIES) SITE: TUCAPD UCI: DEV,DEV DATA NAME GLOBAL DATA ELEMENT TITLE LOCATION TYPE 60.11, INSTITUTION ;1 POINTER TO INSTITUTION FILE (#4) INPUT TRANSFORM: S DINUM=X LAST EDITED: JUL 31, 1985 DESCRIPTION: This is the appropriate institution/division this test is performed at. If this test is part of a panel that does not have an accession area defined for the panel, that panel will be expanded based on the institution/division the program is operating under. Data dictionary search Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Access to VA Fileman Access to Fileman must be assigned by the site manager to the individual(s) responsible for editing the laboratory files #60-#69.9 Fileman access of “L” (General Fileman) and “l” (Supervisor) will be needed Certain files and fields may contain mumps code and require great caution when editing or entering data. These files require a fileman access code of programmer and may not be accessible to the LIM. The assignment of programmer access codes is a local issue. Medsphere Confidential and Proprietary. Copyright All Rights Reserved

VA Fileman Access Access to fileman can be viewed using “tbox”, “Display user characteristics” Select User's Toolbox Option: display User Characteristics MOORE,CATHERINE (#2041) DEVICE: CHC417 ($I: 417) JOB: 97 ENVIRONMENT ATTRIBUTES Site NAVCHA Type-ahead Y UCI IHS,CHC Time-out Signed on : Fileman code(s) .. M#L Terminal type C-VT100 Medsphere Confidential and Proprietary. Copyright All Rights Reserved

VA Fileman Summary A database management system: Written in mumps
Manipulates data interacts with user Runs on an interactive dialogue Used to define, enter and retrieve information from a data dictionary Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Lab Configurators Before the Clinical Team can start building orders in CPRS or CIS, there is setup the Lab Consultant will need to do. The Laboratory Test File configurators need to be run. - File 60 Configurator Data Name Configurator Site/Specimen Configurator Panel Configurator Loadlist Configurator Autoinstrument Configurator What is a configurator?? A configurator is an excel spreadsheet populated with the information necessary to upload to file 60 and various other files in order to build the lab tests. This is done by the TPM using a macro script Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Site file set up-File 69.9 There are many Domain settings in the Laboratory site file required to be defined before lab order build can begin: Using the Enter/Edit option in File Man, define the following: Input to what File: LABORATORY TEST// 69.9 LABORATORY SITE (1 entry) EDIT WHICH FIELD: ALL// Select LABORATORY SITE SITE NAME: HOSPITAL SITE NAME: HOSPITAL// BLOOD DONOR UNIT ID PREFIX: 1// DEFAULT LAB OOS LOCATION: LAB DIV 050 OOS ID 108// DEFAULT INSTITUTION: GENERAL HOSPITAL CA 058 Select IMMED COLLECTION DIV.: GENERAL HOSPITAL CA 058 Are you adding 'GENERAL HOSPITAL' as a new IMMED LAB COLLECT DIV. (the 1ST for this LABORATORY SITE)? No// Y (Yes) HOLIDAYS ?: Y YES IMMED LAB COLLECT PRINTER: After Lab printers have been defined, enter The STAT Order printer here MINIMUM RESPONSE TIME: 15 MAXIUM HOURS AHEAD ALLOWED: 2 SUNDAY: 1 YES SUN START TIME: 0001 SUN END TIME: 2359 MONDAY: 1 YES MON START TIME: 0001 MON END TIME: 2359 Default institution, Stat collect printer, days of the week the hospital is open Continue defining the rest of the days of the week to enable Immediate collect, or STAT orders Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Site file set up-File 69.9 Anatomic Pathology subdivisions: Using the Enter Edit option in File Man define the following: Input to what File: LABORATORY TEST// 69.9 LABORATORY SITE (1 entry) EDIT WHICH FIELD: ALL// Select LABORATORY SITE SITE NAME: HOSPITAL . ASK FROZEN SECTION: YES// ASK SURG PATH DIAGNOSIS: YES// ASK CYTOPATH DIAGNOSIS: YES// ASK EM DIAGNOSIS: SURE YOU WANT TO DELETE? Y (Yes) For the AP Module, if all sections will be used, accept defaults. If, for example EM, is not used, delete as displayed below. Either Yes or delete Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Site file set up-File 69.9 Default Workload Setting: Using the Enter/Edit option in File Man define the following: Input to what File: LABORATORY TEST// 69.9 LABORATORY SITE (1 entry) EDIT WHICH FIELD: ALL// Select LABORATORY SITE SITE NAME: HOSPITAL . CHOICE OF ACCESSION NUMBERS: NOT ALLOWED// GRACE PERIOD FOR ORDERS: 90// GRACE PERIOD FOR CUMULATIVE: 30// WKLD STATS ON: YES// NO?? Enter YES to have WKLD Workload statistics collected. Choose from: 1 YES WKLD STATS ON: SURE YOU WANT TO DELETE? Y (Yes) *AMIS/CAP DEFAULT: YES// *GRACE PERIOD FOR STATISTICS: 10// The default setting for Workload is on, set to off if the client will not be implementing workload. Wkld is either Yes or nothing at all Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Site file set up-File 69.9 Default Nature of an Order: Using the Enter Edit option in File Man define the following: Input to what File: LABORATORY TEST// 69.9 LABORATORY SITE (1 entry) EDIT WHICH FIELD: ALL// Select LABORATORY SITE SITE NAME: HOSPITAL . DEFAULT NATURE OF ORDER: ? Enter the default nature of order for the package. Data Standardization of NATURE OF ORDER file #100.02 Answer with NATURE OF ORDER NUMBER, or NAME, or CODE Do you want the entire NATURE OF ORDER List? Y (Yes) Choose from: 1 WRITTEN W 2 VERBAL V 3 TELEPHONED P 4 SERVICE CORRECTION S 5 POLICY I 6 DUPLICATE D 7 REJECTED X 8 ELECTRONICALLY ENTERED E 9 AUTO A 10 CHANGED C 11 MAINTENANCE M DEFAULT NATURE OF ORDER: 5 POLICY I With Client input, select the default nature for an order Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Site file set up-File 69.9 Default DC Reason: Input to what File: LABORATORY TEST// 69.9 LABORATORY SITE (1 entry) EDIT WHICH FIELD: ALL// Select LABORATORY SITE SITE NAME: HOSPITAL . DEFAULT DC REASON: ? Enter the Default DC Reason for the package. Data Standardization of ORDER REASON #100.03 Answer with ORDER REASON NAME, or SYNONYM, or CODE Do you want the entire ORDER REASON List? Y (Yes) Choose from: Admit CLOTTED SPECIMEN DUPLICATE TESTS Death Discharge Duplicate Order Entered in error HEMOLYZED SPECIMEN INSUFFICIENT SPECIMEN OTHER CANCEL REASON Obsolete Order PATIENT UNAVAILABLE REQUESTING PHYSICIAN CANCELLED Requesting Physician Cancelled SERVICE CORRECTION Surgery Transfer Treating Specialty Change DEFAULT DC REASON: OTHER CANCEL REASON With Client input, select the default Discontinue reason for an order Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Site file set up-File 69.9 Cancellation settings that should be left blank: Input to what File: LABORATORY TEST// 69.9 LABORATORY SITE (1 entry) EDIT WHICH FIELD: ALL// Select LABORATORY SITE SITE NAME: HOSPITAL . CANCEL ON ADMIT: CANCEL ON DISCHARGE: CANCEL ON SPECIALTY TRANSFER: These settings for cancelling lab orders that have not been collected, need to be left blank. CPRS/CIS control these actions now, not the Open Vista Lab application. Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Site file set up-File 69.9 Collection List Setup (see separate presentation also): Input to what File: LABORATORY TEST// 69.9 LABORATORY SITE (1 entry) EDIT WHICH FIELD: ALL// Select LABORATORY SITE SITE NAME: HOSPITAL . Select PHLEBOTOMY ORDER CUT-OFF TIME: 0545 Are you adding '0545' as a new PHLEBOTOMY ORDER CUT-OFF TIME (the 1ST for this LABORATORY SITE)? No// Y (Yes) PHLEBOTOMY COLLECTION TIME: 0600 DIVISION: ? Enter the Division this collection time applies to. Answer with INSTITUTION NAME, or STATE, or STATUS, or STATION NUMBER, or OFFICIAL VA NAME, or CURRENT LOCATION, or CODING SYSTEM/ID PAIR, or NAME (CHANGED FROM), or CODING SYSTEM DIVISION: GENERAL HOSPITAL CA 058 Collection List setup is done by Division. Enter the cut-off first , allowing enough time for the task to run in the background, at least 5 minutes. Enter as many schedules as the client would like. Be sure the cut off time is far enough in advance of the actual collection time Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Site file set up-File 69.9 Collection List Setup (see separate presentation also): Input to what File: LABORATORY TEST// 69.9 LABORATORY SITE (1 entry) EDIT WHICH FIELD: ALL// Select LABORATORY SITE SITE NAME: HOSPITAL . BUILDING COLLECTION LIST: NO// COLLECTION LIST BUILD $H: COLLECTION LIST BUILDER (DUZ): COLLECTION LIST TIME: COLLECTION LIST PRINT COUNT: Leave the following fields blank. The system will update once the collection list task has been built in Task Manager, and will run to completion Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Site file set up-File 69.9 All other fields in the Site File
AP Esig and Lab Reflex Orders: Input to what File: LABORATORY TEST// 69.9 LABORATORY SITE (1 entry) EDIT WHICH FIELD: ALL// Select LABORATORY SITE SITE NAME: HOSPITAL . AP ESIG ON: Y YES REFLEX ALERT MAILGROUP: LAB REFLEX ORDERS All other fields in the Site File would have the defined settings accepted If the AP module will be used, enter Yes for the AP E-signature to be activated. If the auto reflex order feature will be used, enter the name of the Mail group that will be defined via FileMan for alerts, or notifications . Finally, once locations have been defined for the Hospital the administrative schedules can be set up. Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Data Name Definitions Used for tests with a CH subscript and a type of BOTH or OUTPUT (more information to follow) Displays in the LOCATION (DATA NAME) field of the file Defines what type of value you can enter as a result (free-text, numeric or a set of codes). Note: Panels, profiles, and tests with subscripts other than CH do not have data name entries. Note: Data Name must be built FIRST before building the actual lab test (if the test qualifies) In the Laboratory Test file (#60), each test entry with a CH subscript and a type of BOTH or OUTPUT has a location or data name that displays in the LOCATION (DATA NAME) field of the file. This location or data name points to a unique field in the Lab Data file (#63) where data for that test is stored. This unique field also defines what type of value you can enter as a result for the test (free-text, numeric or a set of codes). Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Data Name Definitions Example of test inquiry in FM for single test:
NAME: PLATELET COUNT TYPE: BOTH SUBSCRIPT: CHEM, HEM, TOX, SER, RIA, ETC. LOCATION (DATA NAME): CH;1108; UNIQUE ACCESSION #: NO UNIQUE COLLECTION SAMPLE: NO LAB COLLECTION SAMPLE: PURPLE-WB FIELD: DD(63.04,1108, HIGHEST URGENCY ALLOWED: STAT REQUIRED TEST: YES REQUIRED COMMENT: ORDER COMMENT PRINT NAME: PLT CNT PRINT ORDER: 169 DATA NAME: PLATELET COUNT SITE/SPECIMEN: BLOOD UNITS: K/mm3 COLLECTION SAMPLE: PURPLE-WB MIN VOL (in mls.): 1 CONTAINER (c): PURPLE SYNONYM: PLT CNT INSTITUTION: GENERAL HOSPITAL ACCESSION AREA: HEMATOLOGY INPUT TRANSFORM (c): S Q9="0,999,0" D ^LRNUM DATA TYPE (c): NUMERIC Ch=subscript 1108 = data name subfield 0 = MIN 999 = max 0 = decimal places Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Data Name Definitions Example of a test inquiry in FM for a panel:
NAME: FREE&TOTAL TESTOSTER TYPE: BOTH SUBSCRIPT: CHEM, HEM, TOX, SER, RIA, ETC. UNIQUE ACCESSION #: NO UNIQUE COLLECTION SAMPLE: NO LAB COLLECTION SAMPLE: RED-SP HIGHEST URGENCY ALLOWED:ROUTINE REQUIRED TEST: YES REQUIRED COMMENT: ORDER COMMENT PRINT NAME: TES T-F NUMBER: LAB TEST: TESTOSTER FR M NUMBER: LAB TEST: TESTOST ADULT MALE NUMBER: LAB TEST: SEX HORMON BIND GLOB NUMBER: LAB TEST: TESTOSTERONE % FREE COLLECTION SAMPLE: RED-SP MIN VOL (in mls.): 1 CONTAINER (c): RED SYNONYM: F&T INSTITUTION: GENERAL HOSPITAL ACCESSION AREA: SENDOUTS Note no data name necessary here Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Adding a Data Name Data names should be created before entering test definitions. This is done in OpenVista Lab Select Supervisor Menu, then Lab Liaison Menu Choose option DATA (Add a new data name) Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Adding a Data Name Respond to the prompts as shown below:

Modifying a Data Name If you need to modify a data name for any reason, this also needs to be done through the Lab Liaison menu. Use the MOD option: Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Adding or Modifying a Data Name
Follow the prompts as shown below: Note you can only modify the data TYPE using this option. You can modify the actual name using FileMan. Medsphere Confidential and Proprietary. Copyright All Rights Reserved

File 60 Field Definitions

File 60 Overview File 60 is the Laboratory Test file
The factory build will have tests already defined in this file Before creating a new test entry, verify the test does not already exist. Adding a synonym is preferable to adding a similar test Many other files which cross reference with file 60 will need to be created in addition Never delete a test, only inactivate it and remove from view Create a Data Name prior to creating a test Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Test definition changes and look up are done in File Man Use the Edit option in File Man It is easier to enter the number of the file or field to save on keystrokes For example instead of LABORATORY TEST enter 60 Input to what File: LABORATORY TEST// EDIT WHICH FIELD: ALL// ?? Enter question marks to display all fields The field number and the name of the field displays NAME- The Name of the Test (must be less than 30 characters) TEST COST- Not used SYNONYM (multiple) Useful look up tool for common names, for instance NA for Sodium. Be sure to work with the CIS team to add terms known by the clinical users for ease in test selection when ordering Medsphere Confidential and Proprietary. Copyright All Rights Reserved

TYPE: BOTH// ?? Displays details on this field I == (Input) test can be ordered but not displayed by the computer Recommended for charge only tests, like venipuncture O == (Output) test can be displayed but never ordered by itself This tests are commonly orderable in a Panel only, and on the test definition itself it is non orderable. It will not be displayed in CIS, or capable of being ordered in CIS B == (Both) test can be ordered and displayed All Panels and orderable tests are set to Both N == (Neither) test is internal to lab only Inactivated tests, and tests that are add on via the lab are set to neither, they will not be viewable, or orderable in CIS Medsphere Confidential and Proprietary. Copyright All Rights Reserved

SUBSCRIPT CHEM, HEM, TOX, SER, RIA, ETC.// ?? SUBSCRIPT is the pointer to the legal subscripts in the LR SUBSCRIPT file. CH for Chem, Hem, Tox, Ser, RIA, etc. this is a General Lab subscript Blood Bank tests (report only) MI for Microbiology Anatomic Pathology EM for Electron Microscopy SP for Surgical Pathology CY for Cytology AU for Autopsy This field is required for all orderable tests Subscript value is not the same as accession areas. They will be a different field. Blood Bank is considered Gen Lab or CH subscript because we do not use the VA’s Blood Bank Module. We do not have 510K FDA clearance and the BB tests entered are for reporting information out, not for decision making in the lab. There isn’t any coding for checking antibody against a unit or a patient. Medsphere Confidential and Proprietary. Copyright All Rights Reserved

LOCATION (DATA NAME) This field will contain the Data Name defined in the menu option It is recommended Data Names and test names be the same ACCESSION AREA ACCESSION AREA: CHEMISTRY// ?? This will be the default accession area for this test If the test is a panel, all tests on that panel will be assigned to the entered accession area Must be defined in the Accession Area file Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Accession Areas already assigned in the Factory Build are: AUTOPSY BLOOD BANK CARDIOPULMONARY CHEMISTRY COAGULATION CYTOPATHOLOGY ENVIRONMENTAL CULT HEMATOLOGY LAB ASSISTANT MICROBIOLOGY MYCOBACTERIOLOGY SEROLOGY SENDOUT AMBIENT SPECIAL CHEMISTRY SENDOUT FROZEN SURGICAL PATHOLOGY SENDOUT REFRIG URINALYSIS Medsphere Confidential and Proprietary. Copyright All Rights Reserved

UNIQUE ACCESSION # If this field contains YES then this test will have a unique accession number whenever it is accessioned, even though it may be ordered with other tests If the test may be performed with other tests on the same specimen, this field should be blank. UNIQUE COLLECTION SAMPLE UNIQUE COLLECTION SAMPLE: NO// ?? This field should be entered only if the test is never done on any other collection sample than the ONE designated in Select COLLECTION SAMPLE field, later in these definitions: The system will then not bother asking if the sample is the correct one. Medsphere Confidential and Proprietary. Copyright All Rights Reserved

LAB COLLECTION SAMPLE See other worksheet REQUIRED TEST For tests in a DIFF, set to NO, most others you want to see PENDING display until a result is filed. YES NO PROCEDURE (SNOMED) Not needed Medsphere Confidential and Proprietary. Copyright All Rights Reserved

*QUICK INDEX No longer used. EXTRA LABELS If blank, the minimum number of labels (accounting for required volume) is generated. Enter a positive number for extra copies, -1 if NO label is desired. HIGHEST URGENCY ALLOWED The smaller the number, the more urgent. Choose from: STAT ROUTINE TIMED FORCED URGENCY This specifies the default urgency status of this test. It points to the URGENCY file. Medsphere Confidential and Proprietary. Copyright All Rights Reserved

PRINT NAME Required field (must be unique) Default test heading for cumulative results reports. May be different in LAB REPORTS file refer to Cumulative Reports documentation Reserved (not used) PRINT CODE (not used) PRETTY PRINT ENTRY (not used) PRETTY PRINT ROUTINE (not used) PRINT ORDER This is the print order of the test within its accession area. Print Order needs a global view- What accession are should print first What panel should print firs What tests in the panel should print first One way to do this is to have an accession area be a range like 100 to 200 Then have a panel be number in that range- like 101 Then the tests in that panel be 101.1, etc Medsphere Confidential and Proprietary. Copyright All Rights Reserved

NATIONAL VA LAB CODE In order for a test to qualify across the reference lab interface it needs to have a value in this field RESULT NLT CODE CATALOG ITEM (not used) EDIT CODE For Micro to be defined later *BATCH DATA CODE (not used) EXECUTE ON DATA REVIEW (not used) The National VA LAB Code and Result NLT Code fields have data to be selected from, they look like VA workload codes. When setting this up you try and match the test name to a defined code in the system. These values will print on the shipping manifest – refer to the Reference Lab set up documentation for more details. Medsphere Confidential and Proprietary. Copyright All Rights Reserved

SITE/SPECIMEN (multiple) for example BLOOD The site specimen needs to match the default specimen defined in the Collection Sample file Multiple specimens can be defined Example: Sodium can be determined on serum and urine. Details that are specimen related, like ranges, calculations and units are entered here for each specimen defined on the test. SITE/SPECIMEN: BLOOD// REFERENCE LOW: 137// REFERENCE HIGH: 145// CRITICAL LOW: 120// CRITICAL HIGH: 160// NOTE: To enter a Site/specimen, a data name must also be entered. Age and sex reference ranges can be entered via Mumps/cache code If you cannot enter a specimen, it may because the system assumes this test is a panel, meaning it does not have a data name Reference ranges added will display and flag in CIS Medsphere Confidential and Proprietary. Copyright All Rights Reserved

SITE/SPECIMEN (multiple) Continued INTERPRETATION THERE ARE NO LINES! Edit? NO// This is a text field , entering data specific to this specimen, or the interpretation of the result is helpful. For example, explaining the ranges by age for a hormonal level UNITS: mmol/L// Enter units of measurement TYPE OF DELTA CHECK: Enter Calculation defined in the Delta Check file to fire a calculation, refer to Calculations documentation for more details DELTA VALUE: DEFAULT VALUE: Data can be entered her for a result to be defaulted in automatically, refer to documentation for more details Medsphere Confidential and Proprietary. Copyright All Rights Reserved

SITE/SPECIMEN (multiple) Continued DEFAULT VALUE: Data can be entered her for a result to be defaulted in automatically, refer to documentation for more details THERAPEUTIC LOW: THERAPEUTIC HIGH: Select *AMIS/RCS 14-4: (not used) USE FOR REFERENCE TESTING: (not used) Select FOREIGN COMPUTER SYSTEM: (not used) LOINC CODE: (not used) Medsphere Confidential and Proprietary. Copyright All Rights Reserved

COLLECTION SAMPLE (multiple) The test can have more than one collection sample This can aid in combining specimens COLLECTION SAMPLE Enter Collection Sample Name FORM NAME/NUMBER (not used) MIN VOL (in mls.) Enter volume The following fields are not used: MAX. ORDER FREQ. SINGLE DAY MAX ORDER FREQ WARD REMARKS (word-processing) LAB PROCESSING INSTRUCTIONS (word-processing) REQUIRED COMMENT SAMPLE WKLD CODE (multiple) Medsphere Confidential and Proprietary. Copyright All Rights Reserved

GENERAL WARD INSTRUCTIONS (word-processing) This text editor field displays data at time of ordering REQUIRED COMMENT This is set up in the Factory Build for all tests to have the required comment of Order Comment Choose from: DOSE/DRAW TIMES C ORDER COMMENT C ORDER COMMENT MODIFIED C SPECIMEN SOURCE C TDM (PEAK-TROUGH) C TRANSFUSION C URINE VOLUME C For Micro tests having the choice of Specimen Source might be helpful Medsphere Confidential and Proprietary. Copyright All Rights Reserved

DATA NAME This will contain data for single tests, not Panels or Micro test Data can be selected from a cross reference to prebuilt data name entries only This data has to be in system prior to building the test CULTURE ID PREFIX Used by the Vitek to make the accession number unique for download. This number should be zero to nine. This number is appended to the front of the accession number. If there is no entry in this field, this test will not be downloaded. VERIFY WKLD CODE (multiple) Used with Workload only ACCESSION WKLD CODE (multiple) *ASK AMIS/CAP CODES (not used) Medsphere Confidential and Proprietary. Copyright All Rights Reserved

COMBINE TEST DURING ORDER This field works in conjunction with combine test field in 69.9 If you do not want this to be combined with any other test answer NO --- A NULL ANSWER MEANS YES CIS TEST CODE (not used) SITE NOTES DATE (multiple) (not used) Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Load List and Auto Instrument Configurators
Instrument Set up Load List and Auto Instrument Configurators Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Instrument Set Up Overview
The factory build has data populated that can be used to edit or create new instrument/test information for a client The Loadlist file contains the listing of tests for an instrument The tests need to be entered in the resulting display order The Auto Instrument file contains the test and instrument code Data Innovations - DI is the instrument interface contains communication definitions All tests and instrument codes need to be defined on this 3rd party product Devices interface to OV DI passes the information from Open Vista to the instrument. The instrument can still run a test, but will not update Open Vista unless all data is in sync. Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Data Flow Instrument CIS Data Orders Innovations Orders Results
Open Vista Lab Keyboard Reference Lab Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Instrument Configurators
Instrument configurators are used to add a new instrument’s data into Open Vista Lab The factory build has data populated that can be used to edit or create new instrument/test information for a client A client may use additional instruments not currently defined in the system The instrument will need to be defined on DI A LoadList entry created An Auto Instrument entry created DI passes the information from Open Vista to the instrument. The instrument can still run a test, but will not update Open Vista unless all data is in sync. Details from PIG: Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Load List File details When building a new Load List file
The tests need to be entered in File 60 prior to creating a Load List entry A load list needs to be created prior to the Auto Instrument file It is suggested to name the loadlist the name of the instrument The order the tests are entered in this file is the order the resulting/verifying tech will see the tests displayed The load list tells the instrument the order in which the tests should display in ov Lab Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Auto Instrument File details
Auto Instrument file is used for all interfaced devices Instruments Keyboards Diff keyboards Urine keyboards Reference lab interfaces LEDI set up and menu options It is suggested to name the auto instrument file to match the load list file name Each interfaced device has different criteria Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Data Innovations Data Innovations is an Instrument Manager
Instruments and interfaces need to have ports allocated on the DI Sending and receiving Calculations and QC can be set up on DI, if the client bought those packages We do not log on to DI Client is responsible for maintaining the definitions on DI If a new online test is defined in Open Vista, it will need to be added in DI for the information to flow between the instrument and OV. Microbiology Instruments are currently unidirectional Microscan and Vitek DI is a third party product. The client needs to download the device drivers from their website. They are responsible for configuration on the DI for their instruments. They need to know the check digit, parity etc. settings for their instruments. The client is responsible for the network connectivity from the instruments to DI The MSC Technical Project Manager will work with DI to assist you. The client will need to add all tests and instrument codes on the DI. Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Laboratory Unit Testing

Unit Testing There are four parts to laboratory unit testing:
Ordering a lab test in CIS; Accessioning the lab test in OpenVista Laboratory; Resulting the lab test in OpenVista Laboratory; Viewing the results of the lab test in CIS. Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Ordering a Test Log into CIS and select a test patient:

Ordering a Test Click on the Orders tab:

Ordering a Test Right click on the test and select Sign:

Ordering a Test Enter your signature code in the Electronic Signature box and click Sign: Signature code may be different than your access code Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Accessioning a Test Select Order number: 32
Enter the order number, which in this case is 32. The order details pop up. If this is the correct order, press Enter to accept the default of Yes: Select Order number: 32 PATIENT,LABORATORY TST Requesting location: MS Date/Time Ordered: 01/20/ : By: HOLMAN,JOY -Lab Order # Provider: HOLMAN,JOY PURPLE-WB BLOOD HEMATOCRIT ROUTINE Requested (LAB COL) for: Is this the correct order? Yes// Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Accessioning a Test Enter the collection date and time (N = Now): PATIENT,LABORATORY TST Requesting location: MS Date/Time Ordered: 01/20/ : By: HOLMAN,JOY -Lab Order # Provider: HOLMAN,JOY PURPLE-WB BLOOD HEMATOCRIT ROUTINE Requested (LAB COL) for: Is this the correct order? Yes// YES Collection //N Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Accessioning a Test The collection labels will print on the printer you designate. The name of the printer that was used last will be the default, or you can type 0 so that the accession number only prints to the screen: PATIENT,LABORATORY TST Requesting location: MS Date/Time Ordered: 01/20/ : By: HOLMAN,JOY -Lab Order # Provider: HOLMAN,JOY PURPLE-WB BLOOD HEMATOCRIT ROUTINE Requested (LAB COL) for: Is this the correct order? Yes// YES Collection //N Print labels on: LABLABEL//0 Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Accessioning a Test The accession number and the UID number will print to the scrreen. Make a note of the accession number (shown below in red). It will be needed in order to enter the result: ACCESSION: HE < > HEMATOCRIT PURPLE-WB BLOOD Select Order number: Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Resulting a Test Choose EM Enter/verify/modify data (manual):

Resulting a Test Choose all the defaults by pressing Enter and enter your initials when prompted. The result will be released for viewing in CIS: HEMATOCRIT //43.5 Select COMMENT: PATIENT,LABORATORY MRN: TST LOC: MED/SURG Pat Info: Sex: MALE Age: 48yr as of Jan 20, 2009 Provider: HOLMAN,JOY Voice pager: Phone: Digital pager: ACCESSION: HE 1/20 10:53d HEMATOCRIT % SELECT ('E' to Edit, 'C' for Comments, 'W' Workload): Approve for release by entering your initials: JH Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Viewing the Result in CIS
Log into CIS, select the patient whose lab result you want to view, and click on Lab Results: Medsphere Confidential and Proprietary. Copyright All Rights Reserved

The lab result shows in the center of the page, along with any comments in the Comments box at the bottom: Result data displays with units, reference ranges, and flags (if any) Comments are displayed here Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Reflex Ordering The purpose of reflex ordering is to enable tests to be added on, automatically by the system, when certain defined prerequisites are met. This is best used for conditions that typically require additional tests. For example, a reflex order can be triggered by abnormal results of an autodiff and automatically order a manual diff, without the lab staff needing to intervene. There is an alert that can be set to notify the tech or management so they can be aware of the order Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Reflex Ordering The new test will be combined on the same accession when the specimen is the same A new order will be created if the specimen of the new test is different or if the DO NOT COMBINE parameter is set An alert will be sent including the patient information and a new order number if created. The functionality to turn on Reflex Ordering is found in the Site File (69.9) Data is built in the Lab Reflex file and set up can be via FileMan Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Definitions required Conditions to qualify the resulting test for a reflex order If the finding value is text, enclose the condition value in quotes (e.g., "positive"). If the finding value is numeric, do not use quotes (e.g., 3). An IF statement is used to evaluate the value. The value is always identified as V in the statement regardless of the type of finding. If the condition logic statement evaluates to true, the finding is considered as found (true), otherwise the finding is considered as not found (false). Relational operators that may be used include: = equals, < less than, > greater than [ contains ] follows ? pattern matches. Logical operators may be used to check multiple values: & And, ! Or, ' Not. Examples of the M code are I V>2.0 I V="positive" I (V>5)!(V<2) Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Example TEST: HEMOGRAM W/AUTO DIFFERENTIAL
SPECIMEN: BLOOD COLLECTION SAMPLE: PURPLE-WB ITEMS: WBC CONDITION: I (V<2.1)!(V>29.9) LOGIC: OR ITEMS: Hemoglobin CONDITION: I V<6.1 ITEMS: Platelet Count CONDITION: I (V<51)!(V>799) COLLECTION TYPE: Send patient to Lab REFLEX TEST: MANUAL DIFFERENTIAL DEFAULT SPECIMEN: BLOOD The reflex can look at several conditions not just one Send to patient to Lab means we already have the blood (in this case) Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Example TEST: RAPID STREP GRP A SC
SPECIMEN: PHARYNX COLLECTION SAMPLE: THROAT SWAB ITEMS: RAPID STREP GRP A SC CONDITION: I V["N" LOGIC: AND ORDER: CULTURE THROAT COLLECTION TYPE: Ward Collect REFLEX TEST: CULTURE THROAT DEFAULT SPECIMEN: PHARYNX Nurses will need to collect another throat swab (unless they send down two at a time) Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Building Lab Menus Refer to the “Menu Options” Excel worksheet when building menus to the client’s specifications. It will give you all the choices available to create the menus in a way that makes the most sense and is as intuitive as possible for the client. Let’s take a look at an example of a main Laboratory Menu on the following slide: Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Building Lab Menus This is a very simple main Lab Menu built for a client. It differs greatly from the standard Lab menu, seen on the next slide: Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Building Lab Menus The standard Lab menu in OpenVista is seen below:

Building Lab Menus We can build the Lab menus to the client’s specifications by Removing options Renaming options Rearranging options Numbering options Configuring shortcuts for options Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Building Lab Menus The best way to start is to build a spreadsheet for the client using the menu template (MENU_OPTIONS.xls). This lists all the lab menu options available. Start by building from the bottom up; in other words, build the sub-menus first. For example, when building the Phlebotomy Menu for the Factory Build, we did not need all the options available in the Standard Phlebotomy Menu. Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Building Lab Menus PHLEBOTOMY MENU LR GET
Add tests to a given accession. LRADD TO ACC Add tests to an already existing order number. LRADD TO ORDER Add to collection list LRPHMAN Delete entire order or individual tests LRCENDEL Itemized routine lab collection LRPHITEM Lab orders by collection type LRRP5 Lab test order LROW List of lab orders not collected LRNODRAW List of orders not collected (Long form) LRNDLST Order/test status LROS Print collection list/labels LRPHLIST Print future collection labels LRUFCL Print single future collection label LRUFCLS Receipt of routine lab collection from wards LRPHEXCPT Test description information LREV Ward lab menu ... LRWARDM Pending Orders MSC LAB PENDING ORDERS Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Building Lab Menus We pared down the standard choices for the Phlebotomy Menu from the ones listed on the previous slide to the ones on the following slide. We also left out another part of the Phlebotomy Menu called the Ward Lab Menu, which lets clinical personnel perform Phlebotomy functions. Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Building Lab Menus PHLEBOTOMY MENU
FAB LR GET Add tests to a given accession. LRADD TO ACC Add tests to an already existing order number. LRADD TO ORDER Add to collection list LRPHMAN Delete entire order or individual tests LRCENDEL Lab test order LROW List of lab orders not collected LRNODRAW Order/test status LROS Print collection list/labels LRPHLIST Print future collection labels LRUFCL Print single future collection label LRUFCLS Test description information LREV Pending Orders MSC LAB PENDING ORDERS Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Building Lab Menus We then began building a new menu called FAB LR GET. FAB stands for Factory Build and LR GET is the naming convention in OpenVista for the Phlebotomy Menu. Following the spreadsheet we created for the custom Phlebotomy Menu, we added only the options we wanted for that menu. The options can be added in any order the client would like to see. The options can also be numbered if the client would like. Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Building Lab Menus Select the option (menu) to edit. Type a new name if you are beginning to build a new one. Answer Y to “Are you adding a new option?” To build a new menu, enter the menu text: Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Building Lab Menus <Enter> through the rest of the prompts. OpenVista then prompts you for your next menu. Press Enter to go back to the main menu. Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Adding Comments to a Test

Objective: To add helpful information in the comments field Comments are entered in File 60, the test definition, via a VT100 text editor Comments can display at time of ordering in CIS. Information can aid in the collection of the specimen Advise clinical users of a reference lab, or send out test This can aid in the expectation of receiving results The lab team will need to work jointly with the CIS, or clinical users to include pertinent information for Nurse to Collect (or ward to collect) orders. This information is added via File Man because the configurator does not update this field. Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Prior to entering the editor please verify your terminal emulator, Putty, is set correctly to VT100. Right click on the top bar of your session. Select Change Settings , under Terminal, select Keyboard. Click the VT100+, select apply and then save settings. When a User is being set up the terminal type can be defined, verify this definition is also set to VT100 for the VT100 test editor to function properly. Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Choose Option E to Enter or Edit File Entries

Choose File 60 to edit: Input to what File: LABORATORY SITE// 60 LABORATORY TEST (1695 entries) Type in “GEN”, the first three letters of the field, to edit the GENERAL PROCESSING INST. field: EDIT WHICH FIELD: ALL// GEN 1 GENERAL PROCESSING INST. (word-processing) 2 GENERAL WARD INSTRUCTIONS (word-processing) CHOOSE 1-2: 1 GENERAL PROCESSING INST. (word-processing) THEN EDIT FIELD: Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Choose Field GEN to edit:
Enter the Name of the test, the comments will be added to: Select LABORATORY TEST NAME: BAL ETHANOL, BLOOD GENERAL PROCESSING INST.: THERE ARE NO LINES! Edit? NO// Yes- this will execute the VT100 editor ==[ WRAP ]==[INSERT ]=======< GENERAL PROCESSING INST.[Press <F1>H for help]==== This is a test to show how to add a comment. I will now select the F1 and E keys to exit <=======T=======T=======T=======T=======T=======T Refer to the VT100 editor command sheet for details on how to use the VT100 editor Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Verify that the edit took place:
The system exits the editor and is waiting for the next test.Enter another test, or hit enter to exit File 60. Select LABORATORY TEST NAME: To verify the edit took place and is correct, use Inquire to File Entries in FileMan. Select VA FileMan Option: Inquire to File Entries Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Verify that the edit took place (cont’d):
Output from what File: LABORATORY TEST// (1695 entries) <enter> Select LABORATORY TEST NAME: BAL ETHANOL, BLOOD Another one: Standard Captioned Output? Yes// (Yes) <enter> Include COMPUTED fields: (N/Y/R/B): NO// BOTH Computed Fields and Record Number (IEN) NUMBER: NAME: ETHANOL, BLOOD TYPE: BOTH SUBSCRIPT: CHEM, HEM, TOX, SER, RIA, ETC. LAB COLLECTION SAMPLE: PLASMA-GRY HIGHEST URGENCY ALLOWED: STAT REQUIRED TEST: YES REQUIRED COMMENT: ORDER COMMENT PRINT NAME: ETHANO NUMBER: LAB TEST: BLOOD ETHANOL NUMBER: LAB TEST: SPECIAL HANDLING COLLECTION SAMPLE: PLASMA-GRY CONTAINER (c): GRAY GENERAL PROCESSING INST.: This is a test to show how to add a comment I will now select the F1 and E keys to exit Review comment by selecting the test in CIS in the Orders Tab. Refer to adding an order in CIS for details on reviewing the comment in CIS. Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Entering/editing Specimens/Ranges on Tests

Log into OpenVista and enter FM to access FileMan. Input to what File: LABORATORY TEST// (1772 entries) EDIT WHICH FIELD: ALL// 100 SITE/SPECIMEN (multiple) EDIT WHICH SITE/SPECIMEN SUB-FIELD: ALL// <enter> THEN EDIT FIELD: Select LABORATORY TEST NAME: HEMOGLOBIN Select SITE/SPECIMEN: Since the Select SITE/SPECIMEN line is blank, there is no specimen entered. Medsphere Confidential and Proprietary. Copyright All Rights Reserved

We’ll enter the specimen BLOOD. NOTE: A data name must be entered in order for a specimen name to be accepted. You may enter a new SITE/SPECIMEN, if you wish To enter a Site/specimen, a Data name must be entered. Answer with TOPOGRAPHY FIELD NAME, or LEDI HL7, or SNOMED CODE, or ABBREVIATION, or SYNONYM Do you want the entire 8578-Entry TOPOGRAPHY FIELD List? <enter> Select SITE/SPECIMEN: BLOOD 1 BLOOD X000 2 BLOOD BAND CELL X161 3 BLOOD BASOPHIL X180 4 BLOOD EOSINOPHIL X170 5 BLOOD ERYTHROCYTE X120 Press <Enter> to see more, '^' to exit this list, OR CHOOSE 1-5: 1 BLOOD 0X000 Are you adding 'BLOOD' as a new SITE/SPECIMEN? No// Y (Yes) Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Continue entering test parameters as needed. REFERENCE LOW: 12 REFERENCE HIGH: 16 CRITICAL LOW: 6 CRITICAL HIGH: 18 INTERPRETATION: THERE ARE NO LINES! Edit? NO// <ENTER> UNITS: g/dL Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Entering Defined Text Codes

The file called LAB DESCRIPTIONS contains data called text codes. Below is an example of the setup for a text code called ‘SEE’, which will enter the phrase ‘See NOTES tab for scanned documents’. Begin in the LAB DESCRIPTIONS file by logging into FileMan: Input to what File: LAB DESCRIPTIONS// (267 entries) EDIT WHICH FIELD: ALL// An example of a text code could be something such as ‘N’, which when entered, could insert a result of Negative. This is a powerful tool to save time and effort when entering frequently used results. Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Select LAB DESCRIPTIONS NAME: SEE Are you adding 'SEE' as a new LAB DESCRIPTIONS (the 268TH)? No// Y (Yes) LAB DESCRIPTIONS EXPANSION: See the NOTES tab for scanned documents LAB DESCRIPTIONS SCREEN: ? Choose from: L LAB M MICRO G GRAM STAIN F FUNGUS LAB DESCRIPTIONS SCREEN: L LAB SYNONYM: EXPANSION: See the NOTES tab for scanned documents Replace SCREEN: LAB// SORTING GROUP: PLURAL: SPECIMEN DESCRIPTION Medsphere Confidential and Proprietary. Copyright All Rights Reserved

You can add any code(s) as the only entry for a test result by modifying the data type to Set of Codes (S). This limits the data that can be resulted. For example, you could enter CL (Cloudy), or CLR (Clear) for the test Urine Appearance. When resulting that test, all other entries would not be valid. A ‘?’ could be entered to display the valid choices for a text coded result. The example below is for our TEST DATA NAME and using the newly defined ‘SEE’. Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Setting Up a Default Result

To set up a default result, the default result must first be defined in the LAB DESCRIPTION file. Below, the default result SEE is setup in the LAB DESCRIPTION file: Output from what File: LABORATORY TEST// LAB DESCRIPTIONS (269 entries) Select LAB DESCRIPTIONS NAME: SEE See the NOTES tab for scanned documents Another one: Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Test must also be setup to accept a default result in the data name definition. For more detail on data names, see the Data Name Definitions document. Select CHEM, HEM, TOX, RIA, SER, etc. SUB-FIELD: SODIUM Data Name: SODIUM Subfield #: Type: NUMERIC Input Transform: S Q9="1,9999,1" D ^LRNUM Minimum value: 1 Maximum value: 9999 Maximum # decimal digits: 1 Do you wish to modify this data name? No// Y (Yes) Enter data type for SODIUM-WEL: (N)umeric, (S)et of Codes, or (F)ree text? S INTERNALLY-STORED CODE: // SEE WILL STAND FOR: // See NOTES tab for scanned documents INTERNALLY-STORED CODE: // 'SODIUM' has been modified to: Data Name: SODIUM Subfield #: Type: SET OF CODES SEE - See NOTES tab for scanned documents Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Specimen level setup: Input to what File: LABORATORY TEST// (1924 entries) EDIT WHICH FIELD: ALL// 100 SITE/SPECIMEN (multiple) EDIT WHICH SITE/SPECIMEN SUB-FIELD: ALL// DEFAULT VALUE THEN EDIT SITE/SPECIMEN SUB-FIELD: THEN EDIT FIELD: Select LABORATORY TEST NAME: SOD 1 SODIUM 2 SODIUM, URINE 3 SODIUM, URINE 24 HOUR CHOOSE 1-5: 1 SODIUM Select SITE/SPECIMEN: PLASMA// DEFAULT VALUE: 1.// SEE Select SITE/SPECIMEN: Check the LAB DESCRIPTIONS file to check that the default result is defined correctly: Output from what File: LABORATORY TEST// LAB DESCRIPTIONS (269 entries) Select LAB DESCRIPTIONS NAME: SEE See the NOTES tab for scanned documents Medsphere Confidential and Proprietary. Copyright All Rights Reserved

When entering the test result, the default result will automatically expand out. All you need to do is press Enter: ACCESSION: WCHEM WCHEM 8/27 11:19d 8/27 11:25d SODIUM-WEL SEE// <Enter> See NOTES tab for scanned documents Select COMMENT: Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Technical Values (Upper and Lower Result Limits)

Technical values are used by the lab to set boundaries on numeric results. This counts down on invalid entries Only discrete data can be added in the system This is a numeric result qualifier and is entered when creating the Data Name Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Where to enter technical values When using the configurator On the Data Name spreadsheet Column C (minimum) Column D (maximum) Are used to enter the lowest and highest value of a result entry. Medsphere Confidential and Proprietary. Copyright All Rights Reserved

See below for an example of adding the values manually into the system DATA NAME: Test ARE YOU ADDING Test (SUBFIELD # 1001) AS A NEW DATA NAME? No// Y (Yes) Enter data type for test: (N)umeric, (S)et of Codes, or (F)ree text? N Minimum value: : ? The smallest result value: .2 Minimum value: : .2 Maximum value: : 1// ? The maximum result THIS TEST will ever be: Maximum value: : 1// 10.0 For this Test the lowest value the system will accept is .2 and the highest is 10.0 Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Changing the Name of a Test

To change the name of a lab test, log into OpenVista and open FM: VA FileMan Version 22.0 Enter or Edit File Entries Print File Entries Search File Entries Modify File Attributes Inquire to File Entries Utility Functions ... Data Dictionary Utilities ... Transfer Entries Other Options ... Select VA FileMan Option: E Enter or Edit File Entries Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Be sure to choose file 60 (LABORATORY TEST) as the file to edit: Input to what File: URGENCY// 60 LABORATORY TEST (1772 entries) Select the fields you would like to change or view. The two needed to change the name and/or synonym were entered, as NAME and SYN, instead of ALL. EDIT WHICH FIELD: ALL// NAME THEN EDIT FIELD: SYNONYM (multiple) EDIT WHICH SYNONYM SUB-FIELD: ALL// <enter> THEN EDIT FIELD: <enter> The system then prompts you for the test name you would like to change: Select LABORATORY TEST NAME: DILA The system displays the possible choices. Choose #1: 1 DILANTIN-BAT PHENYTOIN (DILANTIN)-BAT 2 DILANTIN-WEL PHENYTOIN-WEL CHOOSE 1-2: 1 PHENYTOIN (DILANTIN)-BAT Medsphere Confidential and Proprietary. Copyright All Rights Reserved

The system displays the name and then has a Replace prompt. To remove all letters, enter “…”; this is a shortcut. If you are only going to change a couple of characters, enter them. Then the system requests WITH, where you type in the new entry. If you don’t enter the new name, the name field will display as blank. NAME: PHENYTOIN (DILANTIN)-BAT Replace ... With PHENYTOIN-BAT The system redisplays Replace PHENYTOIN-BAT <enter> If you need to change the synonym information, it can be done at the next prompt. Select SYNONYM: DILANTIN-BAT// <enter> Enter the next test name <enter> Select LABORATORY TEST NAME: Medsphere Confidential and Proprietary. Copyright All Rights Reserved

NEVER DELETE A TEST IN THE SYSTEM. There are too many cross references and will cause corruption in the database. Instead, we rename the test with a “ZZ” prefix and make it non-viewable. Input to what File: LABORATORY TEST// (1775 entries) EDIT WHICH FIELD: ALL// Select LABORATORY TEST NAME: CBC 1 CBC STN 2 CBC W/AUTODIFF-BAT 3 CBC W/AUTODIFF-BAT 4 CBC W/DIFF/PLATELET 5 CBC+PLATELET+HEM REVIEW Press <Enter> to see more, '^' to exit this list, OR CHOOSE 1-5: 3 CBC W/AUTODIFF-BAT NAME: CBC W/AUTODIFF-BAT// ZZCBC W/AUTODIFF-BAT TEST COST: Select SYNONYM: TYPE: BOTH// NEITH NEITHER Setting the TYPE to NEITHER keeps the test from being viewable and orderable. The only time we would set the type to OUTPUT is if the test was previously used and contained results for patients. This way we can still view the old results in CIS. Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Calculations Calculations are used in the lab to automate mathematical expressions , or to combine tests for a final result. Open Vista lab supports calculations in a multistep fashion The internal identifier number of the tests that are part of and the reporting test of the calculation is needed The calculation is written in Cache or Mumps programming language and entered in the Delta Check file The reference to the entry in the delta check file is defined on a test prior to the test that reports out the value in the Panel The factory build has many calculations defined that can be modified as needed Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Calculations Below is an example of how to set up a calculation for % saturation using Iron and TIBC. Data Name Subfield contains the internal identifier number (highlighted in red): NUMBER: NAME: IRON TYPE: BOTH SUBSCRIPT: CHEM, HEM, TOX, SER, RIA, ETC. LOCATION (DATA NAME): CH;750; UNIQUE COLLECTION SAMPLE: NO LAB COLLECTION SAMPLE: GREEN FIELD: DD(63.04,750, SITE/SPECIMEN: BLOOD REFERENCE LOW: $S(SEX="M":49,1:37) REFERENCE HIGH: $S(SEX="M":181,1:170) UNITS: mcg/dl TYPE OF DELTA CHECK: SAT CAL COLLECTION SAMPLE: GREEN CONTAINER (c): GREEN Note SAT Cal calculation is defined on this test Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Calculations The second test:
NUMBER: NAME: TOTAL IRON BINDING CAPACITY TYPE: BOTH SUBSCRIPT: CHEM, HEM, TOX, SER, RIA, ETC. LOCATION (DATA NAME): CH;1018; UNIQUE COLLECTION SAMPLE: YES LAB COLLECTION SAMPLE: RED-SP FIELD: DD(63.04,1018, SITE/SPECIMEN: SERUM REFERENCE LOW: 250 REFERENCE HIGH: UNITS: mcg/dL INTERPRETATION: TAKE EXTRA LABELS TO CHEMISTRY COLLECTION SAMPLE: RED-SP CONTAINER (c): RED Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Calculations The Third test
NAME: SAT CAL TYPE: OUTPUT (CAN BE DISPLAYED) SUBSCRIPT: CHEM, HEM, TOX, SER, RIA, ETC. LOCATION (DATA NAME): CH;1439; UNIQUE ACCESSION #: YES UNIQUE COLLECTION SAMPLE: YES LAB COLLECTION SAMPLE: RED-SP SITE/SPECIMEN: SERUM REFERENCE LOW: 20 REFERENCE HIGH: UNITS: % USE FOR REFERENCE TESTING: NO NUMBER: 1 COLLECTION SAMPLE: RED-SP MIN VOL (in mls.): 1 REQUIRED COMMENT: ORDER COMMENT Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Calculations Login to FileMan and choose Enter/Edit. Choose the Delta Checks file to edit: Enter or Edit File Entries Print File Entries Search File Entries Modify File Attributes Inquire to File Entries Utility Functions ... Data Dictionary Utilities ... Transfer Entries Other Options ... Select VA FileMan Option: Enter or Edit File Entries Input to what File: LABORATORY TEST// DELTA Checks EDIT WHICH FIELD: ALL// Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Calculations The actual calculation resides in the delta Check File and contains the test numbers obtained. Select DELTA CHECKS NAME: SAT CAL Are you adding 'SAT CAL' as a new DELTA CHECKS (the 35TH)? No// y (Yes) XECUTABLE CODE: I $G(LRSB(750)),$G(LRSB(1018)) S LRSB(1439)=$J((LRSB(750)/LRSB(1018)*100),"",2) Iron= 750 Sat CAL =1439 Total Iron Binding Capacity= 1018 The $I= If The $G =get the value, ensure it is a defined value before using it in the calculation $S= set the value of the Sat Cal test – this test will report out the value Equal to $J obtains the value of the Iron divided by the value of the Total Iron Binding Capacity multiplied by 100 Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Calculations The actual calculation is defined to fire on the IRON test, the TYPE OF DELTA CHECK field in file 60 contains the name of the calculation- SAT CAL The result of the calculation will be reported on the SAT CAL test. In the panel these tests are defined on, it is important to have the IRON be resulted before the SAT CAL test. All tests involved in the calculation need to have the same specimen. Review the calculations defined in the Delta Check file in the factory build before creating new ones. Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Keyboards Overview Keyboards are used in the labs to combine counting cell types and accepting the result automatically into the Open Vista laboratory system. When the information has been verified it will become visible to the clinical users via CIS. The steps to set up this functionality Menu option using a special routine Auto Instrument File entry to interface the data Keys and formulas defined Open Vista currently supports 4 keyboards The keys can be changed to be site specific Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Menu Option The factory build comes with the menu option created for all the keyboards Identify which keyboards the client would like to use Refer to the Menu Build documentation for details on modifying the clients menu options to fit their needs. 1 MSCKBBS BAND/SEG KEYBOARD 2 MSCKBRM RBC/MORPH KEYBOARD 3 MSCKBSB SEG/BAND KEYBOARD 4 MSCKBUR URINE KEYBOARD Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Auto Instrument File The Factory Build contains an entry for each Keyboard the client will use in the Auto Instrument file It contains the specific routine and tests for that keyboard Any changes for a key to represent a certain test, will need to be made in this file NUMBER: NAME: SEG/BAND PROGRAM: MSCKBSB LOAD/WORK LIST: DIFF KEYBOARD LOAD CHEM TESTS: TMP GLOBAL ENTRY for LAGEN ROUTINE: Accession cross-reference CROSS LINKED BY: IDE MESSAGE CONFIGURATION: UNIVERSAL INTERFACE *ECHO ALL INPUT: NO METHOD: KEY DEFAULT ACCESSION AREA: HEMATOLOGY OVERLAY DATA: YES NUMBER: TEST: SEGMENTED NEUTROPHILS PARAM 1: S:V V=V/TOTAL*100\ PARAM 2: 1 PARAM 3: ROUTINE STORAGE: TV(1112,1) NUMBER: TEST: BANDS PARAM 3: ROUTINE STORAGE: TV(395,1) NUMBER: TEST: LYMPHOCYTES PARAM 3: ROUTINE STORAGE: TV(1113,1) Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Auto Instrument File Let’s break down the file and where changes can be made NUMBER: NAME: SEG/BAND PROGRAM: MSCKBSB LOAD/WORK LIST: DIFF KEYBOARD LOAD CHEM TESTS: TMP GLOBAL ENTRY for LAGEN ROUTINE: Accession cross-reference CROSS LINKED BY: IDE MESSAGE CONFIGURATION: UNIVERSAL INTERFACE *ECHO ALL INPUT: NO METHOD: KEY DEFAULT ACCESSION AREA: HEMATOLOGY OVERLAY DATA: YES NUMBER: TEST: SEGMENTED NEUTROPHILS PARAM 1: S:V V=V/TOTAL*100\ PARAM 2: 1 PARAM 3: ROUTINE STORAGE: TV(1112,1) Keyboard Routine Name of the Keyboard Do not change any of the data above the line Test name Test data can be modified Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Auto Instrument File Test Data information
NUMBER: TEST: SEGMENTED NEUTROPHILS PARAM 1: S:V V=V/TOTAL*100\ PARAM 2: 1 PARAM 3: ROUTINE STORAGE: TV(1112,1) WBC count is internal numbers There can be 3 rows of keys displayed, location is by internal number. ROW 1 (1 - 9) ROW 2 ( ) ROW 3 ( ) PARAM 1 can change the value of V. The keys '-' (MINUS), '!' (Comment), '?' (show values) are reserved functions. PARAM 2 is set to 1 if the test is included in the total count, or to 2 if not included in the total count e.g. NRBC set to 2, SEGS set to 1. PARAM 3 stores the character on the keyboard used for entry. RBC MORPHOLOGY is internal numbers , layed out the same as the WBC Row ( ), ( ), ( ) The '\' is used to display the WBC values. NUMBER: TEST: ANISOCYTOSIS PARAM 3: A ROUTINE STORAGE: TV(408,1) Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Auto Instrument File Test Name
NUMBER: TEST: SEGMENTED NEUTROPHILS PARAM 1: S:V V=V/TOTAL*100\ PARAM 2: 1 PARAM 3: ROUTINE STORAGE: TV(1112,1) NUMBER: TEST: BANDS PARAM 3: ROUTINE STORAGE: TV(395,1) NUMBER: TEST: LYMPHOCYTES PARAM 3: ROUTINE STORAGE: TV(1113,1) 4,5 and 6 are the keys these tests are defined to, every time the key is depressed, a count towards 100 is recorded Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Auto Instrument File Use the Enter /Edit option in FileMan to change a test to be assigned to a different key Either change the key (PARAM 3) or TEST field NUMBER: TEST: SEGMENTED NEUTROPHILS PARAM 1: S:V V=V/TOTAL*100\ PARAM 2: 1 PARAM 3: ROUTINE STORAGE: TV(1112,1) NUMBER: TEST: BANDS PARAM 3: ROUTINE STORAGE: TV(395,1) NUMBER: TEST: LYMPHOCYTES PARAM 3: ROUTINE STORAGE: TV(1113,1) Test Name Key Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Resulting/Verify Accepting/Verifying the data entered on the keyboards into the system to be released for viewing into CIS. There may be a reflex order defined to order a manual diff based on results in the automated diff In the menu option select keyboards Select Result Tech Menu Option: KB Keyboards BS BAND/SEG KEYBOARD SB SEG/BAND KEYBOARD RM RBC/MORPH KEYBOARD UR URINE KEYBOARD KEYPAD DIFF ENTRY Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Resulting Continue through the prompts :
Update display on each key press? YES// Accession Date: TODAY// (FEB 05, 2009) Accession Number: ( ): 44// 49 Patient name: TESTPATIENT,THREE SSN: MHS-C Acc: HE Is this the correct patient? YES// Patient name: TESTPATIENT,THREE SN: MHS-C0-0003 > CBC PROFILE *=unverified < Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Resulting The system displays the test results for the CBC:
WBC H MCV L MCH L MCHC L RBC H HGB H HCT L* PLT CNT. 19 L RDW L MAN DIF. pending RBC MOR. N %NEU %LYM %MON %EOS %BAS Then the keyboard entry CELL DIFFERENTIAL ('?' = DISPLAY, '!' = COMMENTS, '-' = MINUS, <RETURN> = EXIT) Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Resulting Then the keyboard entry KEY 4 5 6 + 7 8
CELL DIFFERENTIAL ('?' = DISPLAY, '!' = COMMENTS, '-' = MINUS, <RETURN> = EXIT) KEY TEST BANDS SEGS LYMPH MONOS EOS BASOS KEY TEST ATYPLYM MYELOS METAS PROMYEL BLASTS NRBC As each key is depressed the keyboard counts that as a cell identified Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Resulting TOTAL:100 Patient name: TESTPATIENT,THREE SSN: MHS-C0-0003
Test Count Value BANDS SEGS LYMPH...... MONOS EOS BASOS...... ATYPLYM MYELOS..... METAS PROMYEL.... BLASTS..... NRBC Total 100 Cells counted The system displays the count Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Resulting Are you finished with this patient? Y// YES
CONTINUE counting to 200 or STOP: (C/S): STOP// Patient name: TESTPATIENT,THREE SSN: MHS-C0-0003 Then the Morphology is avialable for data entry RBC MORPHOLOGY ('?' = DISPLAY, '!' = COMMENTS, '\' = WBC, <RETURN> = EXIT) KEY A P M I L TEST ANISO POIK MACROCY MICROCY POLY……. Are you finished with this patient? Y// YES Would you like to see the test list? No// NO Do you wish to modify the test list? NO// Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Resulting You have selected 78 tests to work with.
TESTPATIENT,THREE MHS-C0-0003 Sample: PURPLE-WB Some results have been approved by GRAY,CATHY on Feb 05, Specimen: BLOOD WARNING - NO MATCHING ACCESSION WAS FOUND. You may need to Clear instrument/worklist data, or correctly identify the sample to the system. ARE YOU SURE THIS IS THE CORRECT DATA? No// Y (Yes) Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Resulting TESTPATIENT,THREE MRN: MHS-C0-0003 LOC: MED
Pat Info: Sex: MALE Age: 41yr as of Feb 05, 2009 Provider: USER,DOCTOR Voice pager: Phone: Digital pager: ACCESSION: HE DIFF KEYBOARD /5 14:23d SEGMENTED NEUTROPHILS % BANDS % LYMPHOCYTES MONOCYTE % EOSINOPHILS % ATYPICAL LYMPHS % MYELOCYTES METAMYELOCYTES % PROMYELOCYTES . DIFF MISC MANUAL DIFF CORRECTED WBC DIFF does not equal 100. count = 22 SELECT ('E' to Edit, 'C' for Comments, 'W' Workload): Approve for release by entering your initials: CG Accession Number: ( ): ^// Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Collection Sample File

This file contains all information specific to the collection sample requirements for a particular laboratory. Each collection sample entry is defined in this file, and the site specific information contained includes the following: • Default type of specimen • Color of the collection tube stopper • Type of collection container • Large and small volumes • Whether or not the sample can be collected by the laboratory personnel • Synonyms Information in the file is used in various calculations involved in the printing of the specimen labels and phlebotomy collection lists. Medsphere Confidential and Proprietary. Copyright All Rights Reserved

The following table lists the fields in the Collection Sample file with descriptions of how to enter text into each field. Collection Sample Field Name Description NAME- 3–30 character field Name of the collection sample you want to edit or add to this file. The name entered here displays to the ordering personnel when the order is initially placed and when the order is presented for review. Tip: Use a simple, self-explanatory name to ease the ordering process. Example: Using names such as Urine-24 hr, Urine-12 hr, and Urine-2 hr lets the ordering personnel choose the sample appropriate for the test they re trying to order. Tip: If you must enter duplicate names that have different default specimen types or tube top colors, use quotes around the duplicate names. Example: If you have a collection sample of BLOOD (green top) but need to have both a default specimen of plasma and a default specimen of blood, you may need to use this convention. Medsphere Confidential and Proprietary. Copyright All Rights Reserved

DEFAULT SPECIMEN (Input site/specimens from Topography Field file) This entry points to the Topography Field file (#61) and must contain an existing site/specimen entry from that file. This site/specimen is then predefined or linked with the collection sample name. TUBE TOP COLOR 2–11 characters Description of the type of container or tube used to collect the sample. This entry combines with the sample name in prompts to the ordering personnel. Example: A tube top color of blue for the sample blood displays as BLUE BLOOD on the computer screen. Note: This information also appears on the Test Description Information option [LREV], on labels, and on collection lists. Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Collection Sample Guide

Collection Sample Guide
NAME: BLOOD// (Name of collection specimen) DEFAULT SPECIMEN: BLOOD// (Refers to SNOMED specimen in Topography file (#61)) TUBE TOP COLOR: LAVENDER// (Specimen container, e.g. lavender, culturette, jug) VOLUME LARGE: 7// (Required volume for this specimen container) VOLUME SMALL: 1// (Alternate volume if smaller specimen container is used, e.g. pediatrics) LAB SECTION: HEMATOLOGY// (Can specify an accession area where this specimen is typically used however the system will allow you to use it anywhere) CAN LAB COLLECT: YES// Select SYNONYM: PURPLE TOP// (Other names or abbreviations for this specimen container) Select ACCESSION AREA: (For workload accrual. Workload must be turned on) Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Collection List Setup Build the options first: Log into FM Enter/Edit
Input to what File: OPTION <Enter> Edit which fields: ALL <Enter> Select OPTION Name: CCDH LRTASK PHSET 0800 Are you adding as a new option// YES Menu Text: CCDH LRTASK PHSET 0800 TYPE: R (Run Routine) PACKAGE: LAB SERVICE ROUTINE: LRPHSET SCHEDULING RECOMMENDED: YES Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Collection List Setup NEXT STEPS: At EVE menu Select Taskman
Schedule/Unschedule Options Select OPTION to schedule or reschedule: CCDH LRTASK PHSET 0800 This will open a screen tab down to QUEUED TO RUN AT WHAT TIME: Enter or (this is the time your job will run) Do this for all your collection list times. RESCHEDULING FREQUENCY: 1D Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Collection List Setup LAST STEPS: At the EVE menu: Log into FM
Enter/Edit Input to what File: LABORATORY SITE (69.9) EDIT WHICH FIELD: ALL// Select LABORATORY SITE NAME: HOSPITAL SITE NAME: HOSPITAL// Enter to Select PHLEBOTOMY ORDER CUT-OFF TIME: 0730 ( for each collection created enter the time that orders will go to next collection list--this has to be before your queued job time) PHLEBOTOMY ORDER CUT-OFF TIME: -0730 PHLEBOTOMY COLLECTION TIME: 0800 DIVISION: (your hospital name) COLLECT THURSDAY ORDERS IN: 1// (do this for all days) COLLECT FRIDAYS ORDERS IN: 1// (etc.) Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Setting Up Phlebotomy Collection Times

Log into FileMan. Enter/Edit Input to what File: OPTION// LABORATORY SITE (1 entry) EDIT WHICH FIELD: ALL// PH 1 PHLEB/STOP CODE RUNNING 2 PHLEBOTOMY ORDER CUT-OFF TIME (multiple) CHOOSE 1-2: 2 PHLEBOTOMY ORDER CUT-OFF TIME (multiple) EDIT WHICH PHLEBOTOMY ORDER CUT-OFF TIME SUB-FIELD: ALL// THEN EDIT FIELD: Select PHLEBOTOMY ORDER CUT-OFF TIME: 0945// ?? Choose from: You may enter a new PHLEBOTOMY ORDER CUT-OFF TIME, if you wish The order cutoff time for associated collection time. Time is in 24 hour format. Orders placed after the cut-off time will be put on the next routine lab collection. Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Select LABORATORY SITE NAME: HOSPITAL Select PHLEBOTOMY ORDER CUT-OFF TIME: 0945// PHLEBOTOMY ORDER CUT-OFF TIME: 0945// PHLEBOTOMY COLLECTION TIME: 1000// DIVISION: GENERAL HOSPITAL// Select PHLEBOTOMY ORDER CUT-OFF TIME: 0345 PHLEBOTOMY ORDER CUT-OFF TIME: 0345// PHLEBOTOMY COLLECTION TIME: 0400// Select PHLEBOTOMY ORDER CUT-OFF TIME: 0545 PHLEBOTOMY ORDER CUT-OFF TIME: 0545// PHLEBOTOMY COLLECTION TIME: 0600// Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Lab Collect or Ward Collect?

Is the test a Lab Collect or Ward Collect?
Log into OpenVista and enter FM to access FileMan. Enter or Edit File Entries Print File Entries Search File Entries Modify File Attributes Inquire to File Entries Utility Functions ... Data Dictionary Utilities ... Transfer Entries Other Options ... Select VA FileMan Option: E to Enter or Edit File Entries Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Input to what File: LABORATORY TEST// (1772 entries) EDIT WHICH FIELD: ALL// LAB 1 LAB COLLECTION SAMPLE 2 LAB TEST INCLUDED IN PANEL (multiple) CHOOSE 1-2: 1 LAB COLLECTION SAMPLE THEN EDIT FIELD: Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Select LABORATORY TEST NAME: URINAL 1 URINALYSIS COMPLETE 2 URINALYSIS, DIPSTICK 3 URINALYSIS, ROUTINE CHOOSE 1-5: 1 URINALYSIS COMPLETE LAB COLLECTION SAMPLE: The Lab collection sample field is blank; this means it is a Ward Collect sample. Ward collect = collected by nurses or PCT (other than lab) Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Select LABORATORY TEST NAME: CBC 1 CBC 2 CBC W/AUTODIFF 3 CBC W/DIFF/PLATELET 4 CBC+PLATELET+HEM REVIEW CHOOSE 1-5: 5 CBC LAB COLLECTION SAMPLE: BLOOD-LAV// Since this is a Lab Collect test, the lab collection sample is defined. If it should be a Ward Collect test, the Lab Collection sample can be deleted by using sign. Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Switching between Ward Collect and Lab Collect

Issues with switching between Ward Collect and Lab Collect defaulted orders
When the first order is a Lab Collect test (Uric Acid) the collection defaults are fine: Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Issues with switching between Ward Collect and Lab Collect defaulted orders (cont’d)
The order is accepted, then a Ward Collect test is ordered and the Collection date and time field is blank: Medsphere Confidential and Proprietary. Copyright All Rights Reserved

Issues with switching between Ward Collect and Lab Collect defaulted orders (cont’d)
Then you can close the order dialog box, start over and place a Ward Collect order, accept it, and then a Lab Collect test (Uric Acid) is selected. The Ward Collect is still active, instead of switching to Lab Collect as defined as the default for the test. When ordering tests, the recommended procedure is to order the lab collects first if possible, otherwise keep this in mind. Medsphere Confidential and Proprietary. Copyright All Rights Reserved