1. Ordering Lab Tests LAB for Non-Laboratorians Resource Patient Management System

2. Session Objectives Order and describe ways to order Laboratory Tests: Quick Orders. Without Quick Orders. Paper Requisitions. Describe options for “Nature of Order” (Written, verbal, telephone, policy, electronic): Discuss RPMS Computerized Patient Record System (CPRS) Computerized Provider Order Entry (CPOE) Report. Find and review orders.

3. Keys Needed for Using Lab Package BLRZMENU LRLAB LRSUPER LRLIAISON LRVERIFY BLRZMENU BLRRLZ ORELSE VA FileMan (DIUSER) LI access (Big L, little l)

4. Ordering Laboratory Tests Ways to order LAB Tests – POC Button – Point of Care testing – Quick Orders – Provider orders in EHR Ask at order questions can be incorporated into the quick order – Paper Requisitions – May be sent from outside facilities, or will be part of Contingency plan only

5. Ordering Laboratory Tests (cont.) How does your facility do business? How are lab specimens collected in your facility? This information needs to be considered so the quick orders have the correct default. Do you have a uni-directional, or bi- directional reference lab interface installed?

6. Ordering Laboratory Tests (cont.) Point of care button – Used when testing is done at the patient care area, testing is completed and resulted using POC button. Lab test order (Send Patient) - Patient goes to a laboratory department to have sample collected. Lab test order (Ward Collect) – Ward collects sample from patient. Lab test order (Routine Collect) – Used only in Inpatient setup. Lab collects samples at routine collection times on the Inpatient wards. Lab test order (Immediate Collect) – Lab goes to the ward where the patient is being held or seen immediately or at a specific time for sample collection.

7. Laboratory Quick Orders Consider whether the quick order should be a Nursing Quick Order or a Laboratory Quick Order (QO): Laboratory Quick orders: – Places an order in laboratory package – Used when lab is going to accession and result the order in lab package – Used with reference lab tests that will be accessioned and resulted in lab package

8. Laboratory Quick Orders (cont.) Nomenclature: ORZ GLUCOSE – Nursing POC QO LRZ GLUCOSE SP – Lab QO when patient presents to a physical laboratory for collection. LRZ GLUCOSE WC – Lab QO when ward will collect sample and send to lab or reference lab. LRZ GLUCOSE IC – Lab QO when phlebotomist comes to the patient to collect sample.

9. Laboratory Quick Orders (cont.) Anatomy of a Laboratory Quick order Quick orders based on the collection type your facility uses. Select QUICK ORDER NAME: LRZ GLUCOSE NAME: LRZ GLUCOSE// DISPLAY TEXT: Glucose// VERIFY ORDER: y YES DESCRIPTION: 1> EDIT Option: ENTRY ACTION:

10. Laboratory Quick Orders (cont.) Lab Test: GLUCOSE// Collected By: Ward Collect// Collection Sample: BLOOD // Collection Date/Time: TODAY// Enter Order Comment: How often: ONCE// Indication:// 1> EDIT Option: ENTRY ACTION: Lab Test: GLUCOSE// Collected By: Ward Collect// Collection Sample: BLOOD // Collection Date/Time: TODAY// Enter Order Comment: How often: ONCE// Indication:// Indication ICD9:// ----------------------------------------------------------------------------- Lab Test: GLUCOSE Collected By: Ward Collect Collection Sample: BLOOD Specimen: SERUM Collection Date/Time: TODAY Urgency: ROUTINE How often: ONCE -------------------------------------------------------------------------------

11. Quick Orders (cont.) 1.Select Patient 2.Select Visit 3.Open Lab Menu

12. 1.Select Test 2.Note Collection Type 3.Accept Order Quick Orders (cont.)

13. Order number generated from the quick order is displayed with a status of “pending” on the orders tab. In this state it is ready for sample collection and accessioning in the laboratory.

14. Paper Requisitions Use only for: Outside orders When using Contingency plan

15. Outside Orders – Best Practices Send outside paper order and patient to Patient Registration for check in. Patient Registration will check the patient into a Laboratory Clinic. An alternative is for the lab to create a lab only visit in the Electronic Health Record (EHR) and order the outside labs according to facility policy. Another alternative is to send outside paper orders and patient to primary care provider or primary care team for entering orders. The facility needs to determine a process for outside providers ensuring that they get entered into RPMS provider file, receive the results, and ensure credentialing.

16. Deleting orders Orders may be deleted from the EHR orders tab if the order has not been completed. – Orders need to be completed or deleted, so they do not remain pending on the orders tab.

17. How to Delete an Entire order for a Provider

18. How to Delete an Entire order for a Non-Provider

19. Deleting an entire order – Discontinues it on orders tab

20. Delete a single test from an order in Lab Package The provider must delete the entire order in EHR and re-order. A single test may be deleted from an order by using Lab Package.

21. Delete entire order or an individual test on an order from Lab Package From the main lab menu select the “Accessioning menu” Select “Delete entire order or individual tests” Enter the order number Enter the test to be deleted, or delete the whole order Enter a reason for cancellation

22. Nature of Order Default Nature of order is set in the Laboratory Site file 69.9 field 150.1 Written – Order is written on paper copy Verbal – Verbal given by provider Telephone – Order given by phone from provider Policy – Written policy for standing orders in place for facility, and signed by Medical Staff.

23. Nature of Order and Meaningful Use To meet Meaningful Use (MU): CPOE fully meets MU criteria Written orders count against MU – Have a policy for lab only visits and written orders. Verbal orders count against MU – Use only for emergencies Telephone orders count against MU Policy orders do not count for or against MU – Be sure there is a policy.

24. CPOE Order (no Nature of Order) Providers do not get prompted for “Nature of order” CPOE

25. Nature of order Non-Providers must select “Nature of order”

26. Nature of Order (cont.) Signed on chart: Means provider has a wet signature on a paper chart Counts against CPOE for MU Good way to transition to electronic orders while still using paper charts.

27. Nature of Order (cont.) Hold until signed: Order will be posted but not released until the provider places electronic signature Order is not released to service until signed Order may be manually released to service Orders count toward CPOE for MU

28. Nature of Order (cont.) Release to service: Must then select: Verbal – – Should only be used in Emergencies – Counts against CPOE for MU Telephone – – Should only be used when provider is not in facility – Counts against CPOE for MU Policy – – Counts neither for or against CPOE for MU – Must have a written policy on file for ordering.

29. Nature of Order (cont.) Release to service: Policy – – Must have a written policy for “Standing Orders” signed by the Medical Staff to use this option. – On the orders tab, EHR shows the nurse or orderer as Provider – In Lab Package the “Doc in the Box” shows as the Provider – The “Doc in the Box” receives the result notification in the EHR

30. POC orders require -Nature of Order

31. Nature of Order Non-Providers completing orders: A qualified ordering provider must be entered in the yellow visit box, as they will get the test result notification. Ensure the “Doc is in the Box” Notification for lab results goes to the “Doc in the Box”

32. Find and review orders Orders tab in the EHR Reports tab test status Order Test status in Lab Package

33. CPOE Reports EHR>BEH>ORD>RPT>MON Performance Monitor Report Enter starting date: T (DEC 16, 2010) Enter ending date: T (DEC 16, 2010) Do you want ALL providers to appear on this report? Y// Select one of the following: A All orders P Pharmacy orders only Select order category: P// A Select order category: P// All orders

34. CPOE Reports (cont.) Select one of the following: I Inpatient O Outpatient B Both Select patient status: B// Select one of the following: S Summary (includes provider details) D Detail (includes order details) B Both (Summary & Detail) T Summary Report Totals Only (no provider details) Select report: S// Select report: S// ummary (includes provider details) DEVICE: HOME//

35. CPOE Reports (cont.) CPRS Performance Monitor - Summary ReportDec 16, 2010PAGE 1 Selected Date Range: 12/16/10 to 12/16/10 Sort criteria: ALL PATIENTS/ALL ORDERSBREAKDOWN OF ORDERS PROVIDERPROVIDERNOT SELF ENTERED PROVIDERUNIVERSEDEA/STU/POLORDERSENTERED%WR/VE/TE/EL -------------------------------------------------------------------------------- USER, XSTUDENT Outpt Tot 320/0/1 31 3097%1/0/0/0 Sub-tot 32 31 3097% USER, WWSTUDENT Outpt Tot 10/0/1 1 0 0%1/0/0/0 Sub-tot 1 1 0 0% USER, YSTUDENT Outpt Tot 280/0/12 16 1594%0/1/0/0 Sub-tot 28 16 1594% ------------------------------------------------------------------------------ OUTPT 1430/0/1612710885%15/1/0/3 TOTAL 1430/0/1612710885%15/1/0/3

36. CPOE and MU Use the CPOE Report for Meaningful use measures. The Meaningful Use website is available for the latest rulings on MU. The Meaningful Use listserve is also available for latest information. Website for information: http://www.ihs.gov/recovery/index.cfm?module=dsp_arra_meaningful_use

37. Questions & Discussion