Home Forums Discussions Problems Lab importation nightmare

After waiting 3 months for Quest for our bridge, today they came.

They uploaded 3 weeks of already signed labs...ok not so bad as I can use this but....

Each lab takes 3 clicks to sign off, the viewing is multiple clicks to get to the bottom (can't be resized), and at the end, it dumps me back to the main screen, not to the next lab (unlike messages). THERE ARE 165 OF THESE!!!!!!!! This will take me a week!

In addition, this makes this system very unuser friendly.

Please advise asap!

Thanks

Oh yes..... That is ugly. However, once you are past that and dealing with one day at a time, it becomes a lot easier. Take heart.

Are all of your (and anyone else's) other imported items signed-off?
Do you really not need to review ANY of these now?

If so, go to View...admininstrative options...Tools...Imported items: sign off all unsigned items.

I am not certain that this will sign off imported labs, but I think it will.

Thanks...current crisis averted.

Recommendation to AC to tune this up a little...as lab bridges are here to stay...need to make it user friendly!

Jon, when doing the batch signoff, you are given the option whether it will apply to labs as well. However, I don't know if you have to associate them to the patient first, which is 3/4 of the effort.

Neil, I agree that it seems I have to tell AC the same thing 3 times to import and signoff the lab... one mouse click should suffice. But remember... you will probably be getting maybe 6-10 labs a day tops, and it just doesn't take that long. My main gripe is that when you hit Import -> lab and x-ray, the import is painfully slow, and it totally ties up the computer on which you do the import. You cannot do e-mail, UpDox, or anything else while the import is happening. Our 4 provider practice gets usually about 6-7 labs a day, and I have to do something not requiring the computer for several minutes if I am the one clicking the button.

As a nephrologist, I get a whole lot more that 8 - 10 labs a day, ,
What the fact that there are extra clicks does is: I don't' review all the labs = at least not until the patient comes in (almost all of my lab orders are just prior to the visit anyway). But once in a while . . . .
So I agree heartily with (I think it is) Jon's signature: Stamp out needless clicks

Roger,

I have Quest with the interface and share your irritation about all the clicks. I've gotten used to it, but wish it were easier. I've been tempted to go back to having labs come in as faxes through updox. It was a lot easier that way.

After reading your posts, I'm glad my faxes come through as PDF images that will keep going into imported items. Not as granular data, at least not until I am forced to do so.

Adam, I still throw my weight behind the granular data and direct import. Every once in a while, it is really important to be able to compare a lab test over time, and it is almost impossible to do with a bunch of faxes. With the Quest import, it is the push of a button. It is 4 button clicks per lab with Quest import (select lab to import, Import lab, sign off, confirm), while importing a fax with UpDox is 7 steps (Attach lab, select patient(typing part of name), click to select from list, click send to EMR, select folder (if lab is not default), click signoff, enter). 4 clicks is better than 7, and the data is usable.

David, The database of the incoming labs doesn't always match the AC database, so sometimes I have to manually match them. I would say this occurs with about 1 of 10 results for me. Is that what you are referring to?

This is annoying. We have thought of creating an automated routine that would run this in off hours to avoid this annoyance. Of course if it gets "stuck" as above, the routine would not complete.
Absolutely! This is where we have got to be headed. At some point the labs will come in to a (prettier) spreadsheet, but what we get now is not too shabby.
Roger, I too dislike those extra clicks, but really I think there is only one extra on our LabCorp interface (I think you hit "sign off" twice). By leaving the lab till later, don't you end up with even more extras?

At times, I use the Admin utility to "sign all", and review at the time of the patient visit.

Roger, Jon..

This was the part I was unsure about. If you sign all in the admin section, do you not first have to choose to import the lab first? The signoff seems to be just part of the process.

All my patients are on immunosuppressive therapy and check 15 labs per day. Becomes very problematic to just sign them off administratively.. What if the patient doesnt show up for their visit?

Think we need to all send suggestion to ac... Not sure how successful this is, but being quite will surely not get it addressed. Think this is critical as data in usable form is standard across all emrs and is necessary for MU as well as for our own proper patient management.

Neil,

My flow is this( unless I send a copy to the patient portal via UpDox, which takes extra steps)

Click on lab in message window
Click "pull labs"
Review the lab
Hit sign off in two windows; send message to staff if needed
Click Ok to delete lab from message window
Repeat

For 10 labs, including the extra steps of sending a copy to the patient portal with comments, this takes less than 15 minutes in the morning. I am not sure that any programming rework would cut this down significantly. I am not clear what part is causing you problems?

>>>>this takes less than 15 minutes in the morning.


David,

Current lab sign off, initials...takes about 1 minute. 10-15 minutes daily is therefore a big deal... especially when it does not need to be.

Look at the regular imported items in AC.....

1 click for signature and you move on to the next import....they obviously understand how to make this work easily. However, just don't think labs is on their radar as only now is there real growth in the system and MU requirement (I know you don't really need to pick this as your menu choice, although likely to change in the future).

In addition, the size of the boxes are way off. Why are CBC boxes small and Chem 20 big? Due to this size issue, it is not really 3 clicks, it is many as you have to click many times on the side bar to get to the bottom (you know us rheumatologists like to order lots of blood tests!). With smaller boxes, less clicks.

These are really simple programming changes (IMHO as I am not a programmer) and can be fixed to make this more user friendly...just like the regular import items.

Just stupid things that make your day longer. If everything adds 10 minutes, my day and productivity goes down.

Ok, got it. We have different practice patterns. I have a pretty leisurely practice, and I get to work an hour or so before the first 8:00 am patient, so I use the time to do labs, review business and financial stuff, fix whatever broke overnight, have a cup of coffee, and generally warm up my brain. That 15 minutes is warm up time for me.

David,

When you bring your labs in are they in structured data format? Currently our labs come in as pdf files to a designated "Lab" folder where we could drag them into the patient's chart as Imported Items. Trying to get with our Hospital Lab to see about an AC interface. Have not gotten any response back although AC advertises the lab as having an interface.
Also, what process do most users use for ordering labs and determining if they are complete?

Peter,

Here's a prior post on lab orders and reconciling them

http://amazingcharts.com/ub/ubbthre...Re_Trying_to_make_some_sense_o#Post40344

Peter,
The labs from Quest come in as an HL-7 format, what I think you mean by structured, and others seem to call granular. Hospital labs come as PDF ,, and they have no interest in an interface. Our Health Information Exchange promises us it will serve as the interface. I don't hear a lot of good about HIE's here, but have got to say ours has all the right things as their stated goals. Maybe it helps that Alaska is medically small enough that they know each of us by name and can't hide. You might check with yours.

Thanks Marty,

Do you order labs through the AC program or fill out the paperwork?
I guess I could still order labs through my own online form I created and reconcile through AC. Would be better if I had the hospital lab form right in AC.

The one issue about labs from a HIE is that there is a special hidden code called something like LOINC that has to be with the granular labs to make them count for MU purposes - hopefully that will eventually get ironed out.

I think it is funny that we want special order sheets - granted ours is a little hospital but they take the AC order sheet without an issue at our hospital (I guess the 2-3 million per year in charges is something they want to keep). Our hospital sheet is actually something with carbon type copies and you circle and then print diagnosis - AC orders are much better.

Peter,

We use the lab slips that can be printed directed from Amazing Charts. It has the patient demographics, diagnosis, insurance info. You can easily create custom order templates as well.

We've been doing this now for over a year and I've never received a call from a lab who refuses to accept the requisition.

Marty,

I am interested in the lab sheets that you print from AC. We place orders for many labs for each patient.
My lab just contacted me and they do not have an interface with AC and that I should contact Amazing Charts to get a quote for the interface for labs, radiology, and documents.

Peter,

What lab do you use? Many labs already have interfaces for AC.

When I order a lab in AC, I make sure to have a diagnosis already for the patient. I then select which labs I want ordered (we have some custom lab orders already set). All I do is hit the print button. From there you can hand it to the patient to take to the lab (we draw most of our labs here for the patients).

The lab we use currently is working on their interface, so currently all our labs are faxed to our office. We use UPDOX to import them into the patient chart. Many on here use Paperport to import items into AC. I like UPDOX as you can make custom categories for imported items but it does cost money.

Once items are imported into AC, they can easily be viewed in the "Imported Items" area.

Marty,

We use St. Joseph Mercy Oakland in Pontiac, Mi. All the labs get drawn in our office too. The hospital provides a full time person and supplies to draw in our office. The results are automatically imported into a directory on our server in pdf format. In AC we could drag them into the patient's chart as imported items. (probably would have to do this) What we currently do is have the lab tech enter the lab results into a database. This is great for scrolling through results for a patient. Perhaps I am a bit spoiled on what we currently have. But I think we are all going to have to have the labs come in as structured data soon. I requested some information from AC about integrating with St.Joseph Mercy. Perhaps the set up we have now is all we need to pull the information into AC.

Peter,

Having your tech enter labs into a database is good for tracking data as you can't do that with PDF's but it is time consuming.

You are going to have to have someone drop & drag results into AC from your server. They will then have to be signed off.

As I posted in another thread,

http://amazingcharts.com/ub/ubbthreads.php/topics/42472/A_programming_question_for_the#Post42472

I pre-process the txt file that the HL7 labs from the hospital FTP to my server so that there is no demographics mismatch. Perhaps then you can automate the process.

My gripe is that there is no "last note" view in lab sign off, so I have to go to another computer to see if the patient has an appointment and what I said I would do next. Those data are available on regular Updox sign-offs, why not on labs?

Yeah, that is but one place the lack of multiple windows is frustrating. The letter writer is another. Sure wish this would make on the "to do" list. Actually, I wish there were a public "to do list" at all.

The multiple windows issue is a programming decision.
When one window (Main AC) launches another (The chart, eRx, etc.) the programmer decides whether to make the "child" window "modal". A "modal" window means all other windows for that program remain in the background until the top most window is delealt with.
There are good reasons to do so, e.g. so as not to change patients in the "pareent window" and NOT do so in the child (there are ways around that as well that don't require modal forms)
SO it is a choice made by the programmers.