Home Forums Discussions Problems Electronic lab reconciliation

We are using V 7.1.3 and all the electronic labs and results have to be reconciled by staff. What I see is that every single order has to be matched with the result one at a time and there is a separate message generated for each one. How are other people handling it? Is there a way to reconcile as a groups and save the message for the whole order set. I hate to save 10 messages in the chart for 10 labs. Thanks

Is this a change on the old, defunct way of reconciliation from previous versions? Have they made it easier? Still using 6.3.3 and no intention of upgrading any time soon. An easy fix to reconcile when you first import them would be nice, and might convince me. I'm still keeping a paper reconcile notebook, which requires printing an extra order every time one is issued. Yet another workaround for AC inadequacies.

We use paper also but I think CMS attestation requires electronic orders and reconciliation. Looks like it i a lot more work.

I've been doing this for PCMH and use a work around. When the order is generated, I also generate a reminder and set it to be sent to myself. I usually set the date for 2 days from the date the lab was ordered because that is about how long it usually takes to get my labs. When the reminder comes in, I check to make sure the labs are back and then right click on an auto response "labs/x-rays/consults reconciled and found to be complete". I then save the reminder to the chart.

The way AC want you to do this is just too onerous.

That sounds like a good way to do reconciliation. I don't see this as a function that can be delegated to staff or emr itself for a very long time. There is pretty much no way for anyone except the ordering physician to recognize and appreciate the results of ordered tests. I understood the MU2 requirement for lab data to be received in a granular fashion to be impossible in my practice. Research into my patient population shows that my patients come from something like 50 different towns in 26 states. I can quickly name at least 12 different labs that I receive data from, many from other states. It will be a very long time before I will have an interface that will allow 40% of my labs to enter my emr in a granular fashion. Lab reconciliation has been a process that I have focused on for years. At first I tried to work with the old AC reconciliation function. It was not workable. I will not be going to version 7 until after the first of the year but what I have seen does not look much more functional than the old method. I think the computer people need to start looking for a " best practice" physician and try to emulate the system that practice is using.

Monty....have ou gone into the administrative area and asked that your orders come back to you in X days, or are you just needing to remember todo it every time you write an order?

I have often said that order reconciliation is an area where EMR's could provide significant added value. In the old days, reconciliation often meant a notebook with a list of orders, by patient and by date, which would then be crossed out when the result was received and reviewed. An EMR should be able to mimic that process with far less work. Of course that may be easy to say, but hard to implement.

At first glance, it would seem that it shouldn't be too hard. For example, Monty, imagine if you could turn on a feature that would automatically create a future reminder every time you create an order. That should be a simple thing for AC to do, and it would allow your process to work, but with significantly less effort. Nancy, you say that there is no single interface that allows your labs to be entered in granular fashion, and that is true. The common entry point though is your sign-off screen. Additions to that screen (such as a "reconciliation button" and/or a list of outstanding orders on that patient, to be matched and reconciled against the incoming result) would allow for a relatively easy process.

AC is moving past MU and PM, and onto version 8 which will include significant improvements to the weaknesses of the current program. This is an area that is ripe for development. I am not sure how high it is on the developers priority list, but I will suggest (via the Clinical Advisory Board) that it be given some attention.

Interesting subject. My nurse and I do all lab reconciliation. It's moderately time consuming. My secretary goes to orders from 1 week before and leaves a reminder for patients to do labs that are pending, with a comment stating to ignore this if labs were done. This is all for MU2 which I will not continue next year (I'd rather take the hit than go through this experience again). My old EHR, at least 12 years old, had a screen where all orders for all patients were visible by date of order. A lot easier to work with. We didn't reconcile formally, but reminders were generated much easier.

I used the electronic lab reconciliation for over a year with LabCorp & Quest, and I've gone back to simply downloading the labs from each lab's website and importing into AC via Updox. As with most EMR functions, the "eLab" function simply wasn't as good as what it seeks to replace (my comments apply to AC ver. 6.65):
- import function is sketchy, often will not sort patient correctly if lab leaves out initials, shortens first name, etc. Requires multiple clicks to correct.
-- slow download, freezes all other AC use. If your download a dozen reports, go get a cup of coffee.
-- only imports & signs off one lab per selection (unlike other AC imports) -- "doing the multiple mouse click dance"
-- reports are (IMHO) horribly formatted - "typewriter" font, results for a CMP scattered over 3 pages (usual report = 1 page)
-- supposedly the strength of the granular lab import was the ability to generate reports and sort data. But available AC reports are very basic and not more useful than simply glancing at a few reports
Another Meaningful Use FAIL.

I am of a differing opinion of "lab reconciliation" and mind you my answer is based on how I balance the patient portal and #ProjectedEHR and nothing at all to do with MU.

In my opinion, what works best for me is to make the annual visit one year in advance, then send out a postcard reminder one month in advance (reminding to have labs drawn several days before visit) and patient will be the one to do their own reconciliation when they open up their results on their portal.

At the visit the HL7 imported results can then be displayed graphically over time for maximum education, ie. response to treatment such as falling HgA1C, LDL, and triglycerides individually demonstrated on large screen TV as I review along with on my Chromebook remote controlling my dual monitored desktop at visit.

The 250 patients out of 1050 plus without a portal, we send lab results via mail and/or discuss at visit. Those with PDF lab results we cannot graph out over time but can project last year result on large TV while looking at most recent on paper at visit.

I realize this does not meet the MU requirement but in my mind uses the HL7 feature to graph and teach visually on large TV screen at visit, patient able to review labs in comfort of home before visit to conjure up questions right before visit, make better use of every one's time.

I have my own opinion of MU....

http://www.medicalpracticeinsider.com/news/value-saying-no-mu-attestation

http://jimmievanagon.wordpress.com/2014/08/08/a-thank-you-to-madelyn-kearns/

I've asked for a reconciliation button on the sign off labs screen but no movement yet.
Asked a few times
It makes infinite sense to reconcile the labs you've just imported and signed off into the chart at that moment in time.
Right now, since we obtained the PCMH Medcial Home Certification, we are still doing it by hand 6 weeks after order date and it is a remarkable WASTE OF TIME!!!!

CAN WE PLEASE HAVE A RECONCILE LABS DIRECTLY AT THE POINT OF WHERE THE LABS ARE IMPORTED AND SIGNED OFF~!!!!?????

Is it coming!!!!????

Reconcile button next to sign is a great idea. I hope AC is listening.

I like that idea. The workflow has got to be made simpler because the new hoops don't leave us much time or wiggle room.

To be able to reconcile when signing off would be awesome.

We're listening! We've received numerous requests to provide the ability to reconcile at the time you sign off. Votes count..the more people that request it the higher priority it receives and this one just makes good sense to do. I can't promise when but I can say it's definitely on the roadmap consideration list for 2015. We want to make considerable improvements in the overall Order Processing/ reconciliation workflow.

I've tried to use "Orders" a couple of times over the last two years but abandoned it as too time consuming and too complicated--in short, too many clicks. This issue is a big hurdle for MU2 and is the main reason I'm holding off on seriously pursuing Stage 2. It would indeed be great if this aspect of AC is improved.