Ordering Lab Tests

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

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.) • Select Patient • Select Visit • Open Lab Menu

12. Quick Orders (cont.) • Select Test • Note Collection Type • Accept Order

13. Quick Orders (cont.) 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 fora 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// 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 Report Dec 16, 2010 PAGE 1 Selected Date Range: 12/16/10 to 12/16/10 Sort criteria: ALL PATIENTS/ALL ORDERS BREAKDOWN OF ORDERS PROVIDER PROVIDER NOT SELF ENTERED PROVIDER UNIVERSE DEA/STU/POL ORDERS ENTERED % WR/VE/TE/EL -------------------------------------------------------------------------------- USER, XSTUDENT Outpt Tot 32 0/0/1 31 30 97% 1/0/0/0 Sub-tot 32 31 30 97% USER, WWSTUDENT Outpt Tot 1 0/0/1 1 0 0% 1/0/0/0 Sub-tot 1 1 0 0% USER, YSTUDENT Outpt Tot 28 0/0/12 16 15 94% 0/1/0/0 Sub-tot 28 16 15 94% ------------------------------------------------------------------------------ OUTPT 143 0/0/16 127 108 85% 15/1/0/3 TOTAL 143 0/0/16 127 108 85% 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