Home Forums Discussions Problems Orders, or disorder.

I would like input on how other users use, or not use, the "orders" put in AC. I am currently using ac version 6.6.7. I would love it if someone told me this has been improved in newer versions of AC. I would upgrade asap.

AC 6.6.7 has a way to write "orders" for patients. These can be Nursing, labs, imaging, referrals, follow-up, patient ed, and "other." My staff usually print orders which are given to patients for labs, xrays, surgeries. Once printed, these "orders" usually just sit in the "order" section without ever being touched again. I recently deleted almost 10 years worth or "orders" which were just clogging the system. Part of the problem is how cumbersome it is to "reconcile" these orders.

Today I decided to try to learn how to use these "orders" to streamline the process and found this feature to be pretty much useless. Maybe someone has a trick on how to use this feature better. If so, please enlighten me.

Some of my issues:

1. As far as I can tell there is no way to look at "pending" or "completed" orders written for a particular patient within the patient's chart. You have to go to AC's main window and click on view -> orders. A list pops up with all orders "pending" for ALL patients. You can select your orders or everyone's orders, and select a date range. (In 6.6.7 there is a grayed out option for "show this patient" but it can't be selected.) There is a sub window that shows you what you actually ordered. Below it is a another sub window where you can "find an imported item (not yet reconciled) button, a "Remove" button, and a small checkbox for "partial results." However, when you click the "Find imported times (not yet reconciled)" button all you are given is a list of the imported items in the patient's chart. There is no "preview" window to show you want the import is actually. So, if you have a lot of imports (I have patients with over LOTS of imports) you are S O L.

3. I guess the easiest option is to just use the "Update order status" sub window where you can select "ordered" "results pending," or "Completed (There are no results pending)" If you click the "update Order" button a window opens that gives you the option to send a message to the physician. The physician will get a message that the order is completed but it would be nice if the message would open the particular import or result.

A suggestion: Since most "orders" usually result in an import (lab, xray, consult, etc) why not set up a way to "reconcile" an order in the import window, perhaps as a right clock drop down option which would bring up the particular patient's pending orders?

Yeah! I think I suggested this 4 or 5 years ago. Another option would be to look at the orders for a specific patient under the Past Encounters tab. Click the Orders radio button and the orders for that patient will be displayed. You can print previous orders here but that is all. It would be nice if we could here note that orders were completed or otherwise reconcile a patient's pending orders.

Gerardo,

Sadly the ORDERS section of Amazing Charts has never been amazing. I just doesn't work. We haven't been reconciling orders in our office but have to start as part of being a PCMH (Patient Centered Medical Home). Until they fix it, the only thing I do is go in and clean out the ORDERS section once in a while. I like your suggestions. Have you guys submitted those suggestions recently?

Sad. What a wasted opportunity. It would be better if the order just deleted itself after being printed rather than clogging the system. I am sure there are lots of users out there with slow running ac's due to thousands of "un-reconciled" orders. Pathetic.

Agree with the need for this to change. We have a large amount of orders that take place and the system is very inefficient for staff to the point that one of our offices tracks the referral orders through excel. One of the big problems in practices that have a lot of orders is just scrolling down to the correct patient to find the order (even for staff that are fast at using the sort functions).

Even if the orders in the past encounter tab would "Link to" or pull up the specific order in the "View Orders" section so that you can update / change the status, that would save A LOT OF TIME.

I recently submitted this recommendation again, and encourage others to emphasize this issue going forward.

Gerardo et al,
This is a major weakness of Amazing Charts that has been recognized for years. It is important and so it is a recurring topic here; lately it comes up every couple of months, in part because of MU. It has never really been addressed. My understanding is that it is now on the radar screen of the development group at the company and perhaps sometime this year will get significant attention. We will continue to bring it up at clinical advisory board meetings.

I wrote a long post about this a few years ago. If you are a masochist, go here for the full text.

To address a couple of your particular questions (some of what follows is quoted from that post):

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.

To address your issue, have your staff hit "print". The order will not "clog the system" because it will not be saved.

Go to "Past Encounters" in the patient's chart (by right-clicking on the name, or hitting F8, etc). Click on "orders". All of the orders will display. (Looks good at first, but this does not help with "reconciliation"...you cannot manipulate the orders in any way, so I am not sure if this helps you).

This has been suggested multiple times by multiple people and has been presented as a suggestion to AC developers. It should be at least part of the answer to making order reconciliation practical.

It is unclear exactly how much effect these orders have on system speed. We have avoided the problem by printing orders without saving (as I mentioned above). Even so, I think it is worth periodically going to the main screen...View...Orders, and then clear out the list by clicking on the top of the list, holding shift and clicking the bottom of the list, then hitting the "Completed" radio button.

Thank you Jon
I thought if I chose save without sending that it wouldn't go into the order queue.
Wrong.
There were hundreds of orders in there.
System seems to run faster since I followed your instructions.

Also, the multiple select doesn't behave like normal Windows -- you have to select the first entry, hold down the shift key and point to the last -- but then you can use the mouse to scroll down by pointing at the scroll bar to the very end of the list, select it, and everything turns blue.

I use an alternative method to deal with the orders
Pull patients name and right click
Open checkin/check out
Go to checkout tab
Orders sent to all
Open order on right upper area
you can pull up orders on a single patient.
You can Orr orders by tabs nursing, labs, imaging
And by ordered results pending etc

Staff completes orders as faxes from radiology or labs come in
This appears to be simpler than going through all the orders under the view and orders

Jon and Sunil:

Thanks for both of those shortcuts to looking orders for particular patients. Very useful.

I am not an expert on lab logistics in AC by any means, but I am confused by this statement. I don't see why you would have to re-type the order. After printing, the Print Window disappears, and you still have the same options to Save "without sending" or Send Orders, either of which will save the order to the Plan section while the Send Orders also sends them to the user's inbox, therefore allowing you to save it to visit history and View --> Orders.

Bert,
The underlying issue is that most people (including me) never reconcile their orders, creating a large number of saved, un-reconciled orders which eventually slow down AC. It is useful to be able to create an order without AC keeping a record of it to prevent that slow-down.
Option 1 ("print") does that. As you point out, you still can choose the other two options AFTER "print" but that would defeat our purpose. That would put the note in the Plan section of the chart, but would create an order to be reconciled.
Maybe my original statement should have been "To record that order in any way in the chart without adding it to the list of un-reconciled orders, you must then re-type it into the note."

I was sending an order to my nurse today for a cardiology referral, but when she double clicked and opened the Orders screen, she could not find it.... I tried numerous times, printing, not printing, sending to different office staff, etc., but it seems that referrals are not showing up in the View ORders screen. Labs and radiology requests are showing up fine. Has this always been the case?

I'm on 9.4.2. Although the new version has made it easier to reconcile orders, reconciliation remains a difficult endeavor if attempted at all as below.
1.) Has there been any way to disable adding orders to the list to be reconciled in the newest version?
2.) Or maybe I'm not thinking about this correctly, and would appreciate any suggestions?

I can think of lots of reasons why reconciling orders when complete, etc might be good care, but it is not practical in my workflow at this time, and I'd like to avoid having to periodically delete or falsely label as "completed" every order since my 2010 initial purchase of AC that is still there - 1000s. I'd prefer that they not be tracked at all.

Many of my orders go something like this: "If thus and such doesn't or does happen in the next x weeks (e.g. cough resolved), then go ahead and get this test done (eg cxr)." Many many of these orders will be ignored appropriately by the patient, no result will ever trigger a reconciliation. Also, a single order for a cbc may have half a dozen different order lines generated, for instance:
1.) cbc
2.) suggested labs, use one contracted by your insurance (otherwise health plan wants to fine me for sending to non-contacted lab, and who can remember 30 health plans different contracted labs?)
3.) Quest local address and ph no.
4.) Labcorp local address and ph no.
5.) call for results 1w after lab drawn.
That's 5 different orders to reconcile for just one cbc.
If you order 6 tests on one printed requisition, that's 6 separate reconciliations just for one interfaced downloaded report.

We already have more clicks per day then we can handle, and already stay way too late without tackling reconciliation at all.
For the few (<1%) of patients who I feel have a genuine health risk (solitary lung nodule) for which I need to know if they got the test (interval cxr) done or not, I create a reminder and chart check when due. But for most (for random example) controlled diabetics, I really don't care if they do or don't get their next aic done. When I next see them, if they didn't get it done, I just order it again. Most patients comply, and reconciling would unlikely save a life in my practice, but probably add more than an hour every day to my workflow and is impractical. For the 10% of my patient who are capitated and waste my time and create an expense if they haven't gotten labs done in advance, I might review their chart 2d in advance and have my staff call them if the labs aren't done yet and r/s the appt. If there's some medical-legal liability here, I've decided I'll have to live with it until there is a more practical way to address this, as I do not have any more hours to spend in the office.

I'm wondering if someone else has a more practical way of making this useful or making it go away?

After playing around a bit more with the program, I realize that I need to rephrase my question:

"If a user has decided to forego the benefit to patient care, compulsiveness, or third party bonus payments of order reconciliation due to the extra time and work and clicks required to do so, is there any speed or other penalty in Amazing Charts?"

After playing around with order reconciliation, it appears to me that the list of orders never ever gets any shorter. The orders just get shifted among four sortable lists which appear to be values in the field I arbitrarily named <reconciliation status>: "Ordered", "Results Pending", "Completed", or "Deleted". Even "Deleted" orders are still maintained in the database, just with a different value in the field for <reconciliation status>.

There are numerous posters above implying that not reconciling orders imposes a speed impairment on program response ( 02/05/15 01:32 AM, 02/05/15 03:34 AM, 02/06/15 01:00 AM). Is there any veracity to this?

Mike, I think I understand your concerns. I agree with your statements about the reasons both to do-and not to do- order reconciliation. AC has finally made some changes to make the process easier, but we have not made the decision to incorporate them into our work flow as of yet so I cannot speak to how much they might influence your decision to reconcile.

In answer to your questions, as I noted above on my long post on 2/5/15, you can avoid adding orders to the reconciliation list by printing them without saving or sending.

The reduction in speed that comes from having many unreconciled orders was suggested originally by AC and has been described by users. On the other hand, I do not believe it is a common problem. If it were, that "slowing" would be much more common because so many people have thousands of unreconciled orders in their system.

If you prefer to do so, in the same post I describe how to delete those old orders, though sometimes people report problems with that process.

AC has made some changes in the completion of 0rders by having it available during signing off labs and inbox items.
It makes the process of completing orders much easier.
If you use the quest order entry mapping, the completion of lab orders and resulted from Quest is automatic.
Thank you AC.

I have asked AC for many years to tweak the orders in the past encounter screen:

1. Have a checkbox to hide completed orders
2. Have a date range similar to the imported items (3 months, 6 months etc)
3. Better arrangement and renaming columns Do not need date and time of order.




Have made these recommendations to AC, hope the board members are in agreement and push these small tweaks forward.