Home Forums Asking for help with workflow: reviewing labs

Hi everyone,

We are using Quest with an interface to directly import structured data into AC. I'm so grateful to MU for forcing us to abandon a really good workflow for one that is driving us nuts.

We used to get faxes that the doc and np would "draw" on using the pen tablets and an inexpensive software program. We'd end up with a digital pdf that looked like a regular old fashioned lab report with comments written in the margins, lab values circled, and instructions to the medical assistant. The ma would then carry out the instructions and document that using a different color "ink" and put in a folder to be imported to the patient chart. The doc then reviews and signs off on the imported item. Nothing missed, easy to look back and see what was done.

Now the labs are imported and the doc has a little space to type in comments and directions to the medical assistant, but the comments aren't saved so we can look back and review.

So today when the doc is looking back at a U/A and it's not immediately clear why it might have been ordered
)

What are we doing wrong? How should we be reviewing labs so that comments and directions are saved with the lab data?

Thanks,
Barb
(the in over her head it wife that's tired of not knowing the answers)

I don't know if there is a good answer to this question.
I don't import the labs directly even though one of our local labs (NorDx) has an interface with A.C. I want to SEE the lab result and mark it up if needed. So our labs come in via faxed PDF images. I use Adobe to write on them, mark them up. Then we save to the Import Items folder. I do this way for the very reason your doctor is grumbling. I need to see my thought process when I have to go back and review a lab.

I successfully met and attested to M.U. criteria. however I did not select Menu Item #2 to report on(labs imported as granular data).

I don't know if this can help, but we use Quest that interfaces with AC and I know what you mean about no room. So the Dr. now just reviews the labs, goes into messages, types her notes, then sends the message to me to call pt. After I add my notes, I save to chart. This will be seen in "past encounters". I add the name of the lab (stool, blood, etc) in the subject line before I save it so that it is easy to pick out.

My dream EMR would allow me to attach a message to a report and a report to a message. When you click on a report in imported items, it would also bring up any messages that were associated with that report. And, when you looked in past encounters at the past messages and click on one, it would also bring up the report to which the message refers.
Currently, I mark up reports in Paperport, e.g., a CT of the chest returns recommending a PET scan. I write on the report and ask my staff to call the patient and schedule this, sign the note and then place in the corresponding staff member's Paperport folder. They then open the report and write that they called the patient and, as an example, write that the patient thinks it is stupid and they do not want to have it done. They then put the report back into my Paperport folder. I open it and write "Call the patient again and tell them I feel this is very important and I advise they have it done" and send it back to the staff member. They open it and call the patient who proceeds to call me an idiot and refuses to have the test. While all of this documentation is critical, it really should be done somewhere other than on the report itself because then when the patient wants a copy of the report, all of this chatter is now printed out too.
I do not know how this transpires with UPDOX but I hate the thought of having to pay more for an add-on in order to accomplish what should be a simple task.
If the report pulled up an attached message screen with this info on it, the message would still document what we did but not have the conversation on the report itself.
If the message pulled up the report, the staff would immediately have the results in front of them in order to discuss them with the patient or anyone else needing the info.
Going another step further, I would then like to see the Past Encounters tab divided into actual Encounters, Saved Orders and Messages. It would make finding things much easier. Also, the ability to nest folders and condense the files in the Imported Items section would make my life much better. But, this is a request that has been made previously on nujmerous occasions.

I bring up the lab and review - type letter or message to staff and this is saved on the bottom of the labs so later if I pull up that lab it has a copy of the text of the letter attached or the note to the staff telling them what I want done - this is how it works with an imported lab from a lab interface (PAML).

But that is only good for those documents coming in from that lab. What about other documents coming in from a multitude of places? Scanned mail documents? Consultations with recommendations?

For people who want to have things scanned in and then when they review to sign you can then do a note to staff, etc as you sign them.

your complaint is exactly why I gave up on lab interfaces. I could not figure out the work flow and it cluttered up the imported items section terribly. I use updox and I am sticking with it. I guess my data will stay unstructured, like the rest of my life.

My work flow is that as documents come in, my staff place them in imported items (unlike others above who sign off before importing). Then in the AC II sign off window, I can add comments or send a message to staff for actionable items.

A message goes back and forth until it is resolved, and then is saved, so it appears in past encounters.

The comments added are saved with the import and can be viewed when looking back at at item. Also, one can print the comment from the II viewing window.

Is this the only way to print these comments, one at a time within each II? So, for instance, if you copy the II folder for a records transfer, none of the comments are attached, and a log of the comments cannot be printed?

This got lost in the shuffle over New Years, so I am bumping it.

Does anyone know if there is a way to access the comments saved with the II other than one at a time?

Thank you all so much for your help. I know how busy everyone is and I truly appreciate all of you taking the time to try to help.


-JuliaPeds, we'll try your solution this week while the doc is away since our NP has a lot more patience with messages going back and forth. If that doesn't work, we'll go back to our "old" way of doing things since Quest will send us a fax AND data. We'll end up with bloated charts since the lab info will be duplicated. Oh well.

Frankly, I'm ticked at having to follow a stupid government mandate that makes it more difficult for us to take care of our patients.

The single most important criteria I used when searching for an EMR was finding one that would SUPPORT how my hubby ALREADY practices medicine, not something that would require him to CHANGE what has already been proven to work extremely well. Amazing Charts fit the bill beautifully.

Frankly, I'd rather my doctor concentrate on my medical condition and not wasting a single brain cell on using @#$-ing software! And if my doctor can't do what's necessary for my health without the government telling him what to do ...
I'm ranting.



Thanks again for all your help, everyone!
Barb

I find the lab interface, while not perfect, works fine as I import lab reports with the Labcorp AC interface. The staff downloads these each morning and I write my notes at the bottom, i.e. LMOM, DWP, etc before saving. You can write much more too, but if there is a lot of discussion, ordering, etc, sometimes better to just bring the patient in for a f/u on the labs.

Another suggestion:

Set up a computer with a dual monitor.

Remote into a second computer, pull up AC and the labs.

Use AC on the first screen and you can page through your notes and type a message to the MA on the interoffice email.

OR: use the message function on the Quest interface that is on one screen (this works well) and use AC on the other screen to page through the office notes.

Rick

I have the Quest interface and have no problem saving my comments to the lab. I pull up the lab to sign off. Then I click the Orders button. Under "orders" I select the "Other" tab and then type as much as I want. I send the orders to nursing who adds their comments regarding contact with the patient. The entire thing is saved. When I go back later to pull up the lab, the comments are still connected. I do the same when I sign off the labs that are imported from paper.

If I want to compare the labs to the rest of the chart, I first open the patient's imported before opening the labs so I can have full access to the record and open the labs.

Here is my flow:

Import from quest. Print to Updox,sign off lab. This lets me open chart and other labs. Then in updox, send to patient with comments, save comments to chart, message to staff from within Updox. Unlimited comment room, and comments saved with lab copy.