The orders section has been confusing and fairly useless to me. My approach has generally been to ignore it, or to use it to simply print an occasional order. I would like to report here how we are starting to use it in the hope that others can help to find a way to improve its utility. At the end of the post, I will also propose a (seemingly) simple change that AC could make to improve its functionality. It may be easier to understand what follows with the ?orders? window for a patient open as you read. To those of you who find this to be old news?feel free to skip it. I apologize for the length of the post.
If you have no interest in order reconciliation, and simply want to better understand how the order section functions, the first half of this post may be helpful to you.
When you write an order, you are given three choices:
Print, save (without sending), or save and send.
1. ?Print? gives you a printed copy, but as far as I can tell, does not record the order anywhere.
2. ?Save (without sending)? puts the order in the current note (in the plan section) and in the list of orders that you can see by going to "View...orders?. From there it can be reconciled.
3. ?Save and send? puts it in the current note, and in the list of orders to be reconciled, and also puts it in a message sent to a user.
So if you want AC to simply act like a printer and print the order (which saves time because the patient?s demos, insurance, and diagnosis are on it) then create an order and use ?print?. To record that order in any way in the chart, you must then re-type it into the note.
If you want the order to be automatically recorded in the plan section of the patient?s current note, use one of the two ?save? options. Realize that you will also be saving the order in a separate list to be reconciled at a later time. That is helpful if you plan to reconcile the order, but it creates a potential problem if you do not: apparently, accumulation of a large number of un-reconciled orders can eventually lead to slowing-down AC, so you should plan to remove these later.
(A note about removing these old orders: you can see the list of all un-reconciled orders by going to ?View?orders? on the main screen. You have two choices to clear an item from the list. They can be deleted, one by one. Or they can be marked ?completed?, and this you can do in large numbers, all at one time. This makes ?completing? much easier if you have a lot of old orders to clear out. The database does keep a record of which orders were ?deleted? and which were ?completed?.)
One would think that an electronic medical record would dramatically ease the process of order reconciliation. In practice, this is not easy to achieve. You need a list of all of your orders, and then sometime later you need to go back and cross-match that list with each patient?s chart to look for the result of each order and see if you can ?cross it off the list?. AC currently does a good job of creating the list of orders but does not make it easy to match it with results. Users tend to take an ?all or none? approach to this reconciliation process, which means ?none? for nearly all of us. What I propose, and what we are now instituting is to prioritize and decide which orders we choose to make the effort to reconcile. Here is how we do it:
First, decide which orders are sufficiently critical to require reconciliation. At the beginning, be very selective; after all, even reconciling a few orders is better than none at all. This will give you a chance to decide if the effort is worth it to reconcile a larger number of orders. It is your choice: mammograms, colonoscopies, cultures, x-rays, etc. Choose the things you most want to be sure are really done.
Then create a low level provider with the user name ?Reconcile?. Let everyone who will do reconciliation have that user?s password.
When the provider creates an order, he/she decides if it is one which will be reconciled or not (you can follow the rule you made above, or make exceptions). When the order is written, the provider chooses ?Save (without sending)? if the order is NOT to be reconciled. If you DO want it to be reconciled, click ?Save and send?; it is sent to the provider named ?Reconcile?.
One benefit of this system is that now orders which are to be reconciled are segregated and easily viewed in one place: the message box of the user named ?Reconcile?. Anyone (provider or staff) who has time can go through those messages and reconcile them. (It is a bit easier to do this from a message box rather than from the ?view?orders? box because when you double-click on the message, it opens a box which shows only that patient?s orders). You click on the button labeled ?Find imported items (not yet reconciled)? and it is generally pretty quick to find the result of the test. Double click it, and the order is reconciled. After going through this a few times, it doesn?t seem that laborious. When the ?Reconcile? user?s message box is empty?all of the orders are reconciled.
Another benefit of this system is that all of the orders that are NOT to be reconciled are kept elsewhere. You will periodically want to clear them out by going to ?View?orders? and deleting a large batch. Delete the old ones, and just be careful not to delete any recent ones that are still in the ?Reconcile? message box.
This may sound very complicated, but in practice it is not. We are finding that reconciliation of a fairly small number of key orders can be done without undue effort.
I am pretty sure my suggestion for AC has been made by others: create a ?reconcile? button which would become visible (like the one in the orders described above) when you sign-off AND when you import items (within the program and in Updox). That way, reconciliation could be done as the results come in which would be much more efficient than going back to check them off later. With that (fairly simple) change, I think ?orders? and ?order reconciliation? in AC could actually be very useful.
Maybe I am making this too complicated; if anyone has an easier way to utilize this aspect of AC, I would be happy to hear it.
Last edited by JBS; 01/22/2012 8:02 PM.
