Home Forums Discussions General Discussion V5 Orders System--how does it work w/Labs

Ok, I have a silly question.

How is this new Orders system supposed to work with labs? I mean, is it supposed to allow us to have a record of what labs were ordered and then automatically reconcile them when they arrive by electronic download? If so, great, but.... Do we need to manually input our Quest or Labcorp test codes? Can we set up a template with a standard set of test codes? Huh? What? (yeah, I feel like PeeWee Herman right now).

I have the same question does anybody track their orders/labs/referrals using AC

We are only downloading Version 5 at this very moment. I hope to be able to track labs!

I suppose there are a bunch of ways to do it, but I leave them in my inbox and recheck to see if the results have been received. I do not do it for labs, only for xrays.

In version 5 when you send an order it will also show up under the drop down from "view" in the tool bar or by ctrl+O. There you can view orders ( choose show everybody's) and select "orders" ( which shows you orders that have not been moved to the "results pending file". If you select "results pending" it will show you outstanding orders that the staff has sent out but results not recieved. " Completed" orders show the orders sent and completed. The system does require that the staff updates the order when they send it and update the status when they import the result ( I assigned that task to them rather than take that task myself when I sign off). This allows you to check quickly what is outstanding. My staff checks the "results pending" file weekly to determine that we are not missing anything. Not automatic, but really much more convenient and user friendly than our old paper trail/ tickler file method of tracking.

I am new with the 5.0 version. Please explain. When an order is sent to the medical assistant, do all the orders stay in his in box until he updates them? Wouldn't that overload his in-box?also, when I send orders, is there a way it can be printed also?

Hit print before you hit send or save.

I order labs - print/fax the order, then I can send it to my front desk person, MA etc - this is particularly useful for referrals, etc. You would also want to send it to someone if you are going to do order tracking - you could assign one MA to review their mailbox and only save order after the labs are received, etc.

The order is in their in box and also under the "view orders". My staff works from the "view orders" section, updates the order to "results pending" and then deletes the order from their message box. This gives you 2 ways to make sure the order has been taken care of...the message will be in your outbox if they have not deleted it from their inbox and also you can check the "ordered" section under the "view orders".
The message in their in box will contain the ICD codes that you attached to the order, this does not show up in the "view orders" work section unless they click "print orders" button on the left...the window shows what the printed order would look like with the ICD code on it, then they close the window without printing. ( Or print the order if needed...like printing an order for a mammogram to give to the patient or fax to the hospital).
I REALLY like the orders section in the Version 5. Works great and have almost stopped cringing when I hit the send orders button I am not getting the 364 crash since using 5.0.28.
Love it, love it, love it!

My orders for labs and xrays go to labdoctor. When the results are imported, the person doing the importing goes to the view orders section and makes the orders as completed once the results are imported. We then go back and send out reminders when 2 months go by and orders have not been completed. Some labs are drawn in office and we know they are done unless they get lost. Other times we print the order for the patient to do the lab or xray at another time. We track both. I'm really surprised at the # of mammogram that I order that patients just decide not to do. Labs too. I just wish that the "reconcile to order" drop down in the imported items area worked. It would save multiple steps.

I'm using V5.024 and we are upgrading to 5.028 for monday. Can't wait to get rid of bugs! Hope they are gone.

I don't know about you, but we are having a hard time keeping up on orders reconciliation. Do you just reconcile imaging, like mammograms, or do you reconcile the labs as well. Since we draw our labs here, it seems a waste of time to have to reconcile the lab back with the order when it comes in. I am think of just not reconciling any labs, but just images. your thoughts?

I do not reconcile the screening mammograms only the diagnostic studies. Same thing with screening colonoscopy or bone density.
My post above about updating of orders sounds like it is labor intensive,but it really isn't. When they are working on the orders or importing the labs the "orders" is on the tool bar at the bottom and they go back and forth to that screen to update the orders ....click...click...
For sure we reconcile the labs, what rule is it that says the lab that is lost is the one that will bite you?

I have tried to reconcile all orders....finding lots of stuff that isn't coming back as one would expect it to. Right now I have just finished up Feburary. Sent out letters to everybody who didn't do the things I ordered and will clear that month out. Question.....to what extent should I take the follow up on orders not carried out by patients? I think that I will be just sending a strongly worded letter stating that I cannot be responsible for the outcome if they do not follow through with my recommendations. I don't really want to fire every patient who doesn't do every thing that I recommend.

Does anyone have word when they will fix the option to reconcile orders within the import screen? Some other chart programs automatically reconcile labs when they come in.
I also wonder to what extent I am obligated. I order a mammogram, the suggest focused views because of an abnormality, I call the patient, send the order. They don't go. Then I leave messages as they are not home. Eventually send a letter perhaps - but where do you let it go? Shouldn't it be enough that I told them to get the study done? Then it is there choice.

I used to have all I could do with keeping up with forcing patients to do things I absolutely felt were absolutely necessary. We had a paper tickler file and tried to keep up with things but years could go by without patients following through with recommendations. My ace in the hole was always that I would refuse prescription renewals without seeing the patient and I could catch these things when they came in for their forced appointment. Now I can easily see how many of the things I order that go ignored by patients. I have sent some letters reminding them and encouraging them and threatening them with death but where does personal responsibility step in. I think this is our issue....we physicians and it is up to us. Do I have to fire the patient? Do I just send a strong letter telling them that I'm not responsible for the outcome when they don't follow through? Does it have to be certified? Boundaries....where are they?

Wow. For me, it is, here is the lab slip. I think it is really important that you do it because of this and this. After that, I forget about it. This may sound terrible, but I wouldn't waste a stamp to send them a letter nor would I even walk across the street to ask them why they didn't go. This is COMPLETELY their responsibility. I don't think it is our issue at all.

Now, in pediatrics, it is slightly different. I either let it go or I think the child's health will be severely jeopardized if the test isn't done and I call CPS. That is rare, though. But, ultimately, it is the parent's job.

I guess I am not sure what the reason for reconciling all of these labs are. I would have to hire two more staff to check off when labs came back. What did we do before CCHIT and HIT and health maintenance, etc. My doctor gives me a requisition, and he expects me to take it to the lab. The only letter I will get is the bill from him and the lab.

I respect your view and find it highly commendable.

I feel it is more my responsibility to spend my time to educate my patient on why we do or do not want to do studies than to track if they did them. I previously used a messaging service (MedVoice) and now UpDox to let them know the results, and they are instructed to call if they have not heard in X number of days. It's easy to document, and treats my patients like the adults they are.

I think the issue of reconciling labs come from what the malpractice climate is in the state in which one may practice. I take a mandatory risk management course every couple of years to reduce my malpractice costs and I'm pretty sure that the idea of reconciling labs has come from there. I really don't like the idea of lawyers telling me what I need to do in the safe responsible practice of medicine. But without us doing it, they are. It is also quite surprising to me that after I spend and document considerable time explaining the importance and reasoning behind ordering the test, patients still just blow it off. I have had patient refuse to follow up on pulmonary nodules, breast mass, abnormal renal function, hematuria, etc.,etc,etc.

I agree with the comments about patient responsibility, if they did not get the recommended colonoscopy I can choose to talk to them about that again or not, my choice. Yes, the lawyers want to make us responsible because we have the money that they use to pay themselves ( which of course, ultimately also comes from the patients).
The other issue is that the patient can reasonably expect that their doctor's office is organized and well run, that we are compulsive and pay attention to detail and that will will not lose their lab or fail to tell them of an important abnormality. The tracking makes it easier to make sure that the test ordered ( because the information is needed....otherwise we would not have ordered it)has been received, and, therefore , the patient is well taken care of. The patients frequently worry that their test result is abnormal and that the doctor has overlooked it....I think they have had that type of experience with doctor's offices in "the old days" or, perhaps they watch too much TV.
Anyway, they seem reassured when I answer that question with a brief explanation of the tracking system. "Oh, Wow" is what they often say.

As one of those evil lawyers, I make our office reconcile labs to make sure that we didn't "lose" a negative report, and become responsible for a cervical cancer spun out of control on a patient who assumed no news was good news.

We're using the orders screens in A/C. Not great, but it works. Would be much more usable if you could filter or search down to a specific patient when trying to reconcile labs.

I still think it is easier for one person to remember his or her lab than it is for a doctor to remember 2,000. (I know I don't have 2,000 labs out at the same time).

Yes, we do have all sorts of reminders in place, but it is always helpful to involve the patient. If a lab will change the management of the patient even on the same day, I will tell the patient, I will say if you haven't heard from me by 8 pm, please page me. And, they always do. And, I document that I told them this.

It's the same with referrals. My entire staff will say, "Ok, we will let you know the date of your ENT referral. If you haven't heard from us with a week, call us back as these sometimes fall through the cracks. We document this as well. We have safeguards and reminders for these too, but it is really helpful to make sure they know to call. It also helps so that they don't call two days later. There is nothing more embarrassing than their coming in a month later or calling and asking about the referral, and we haven't even started it due to some mix up.

What if you ordered a screening mammmogram and you never got the results and it was a birad 5 and the patient never called back and the facility never sent them the results either and 2 years later the patient has breast cancer and places the blame directly on your shoulders. She did the mammogram. Pretend it is a cxr maybe. You did it because of a chronic cough.