Hi,
does anyone have any suggestions on how to track pending and completed tests and consultations. I have a standard batch of pre-operative tests for my bariatric patients and would really like to be able to review the status of these tests/consults for individual patients and for groups of patients. For example, I may want to review who has completed which tests and what is pending so that I could move the patient up the preop process. I saw some earlier discussion about using ‘procedures’ or procedure groups for manual entry of lab results but have not been able to work it out for my needs.
Any suggestions most welcome.
Paul
Hi
After you place and transmit the procedure orders to the lab, the results from the lab will be processed when you click “Check Lab Results” menu.
All the results that need to be reviewed by the physiscian will be displayed under the “Procedures->Pending Review” menu. From where the physician can review the same and sign it to approve. Once it is signed and approved it will be removed from the “Pending Review” menu.
All the patient results can be viewed either individually or in batch from the menus Patient Results and Batch Results under Procedures menu.
Thanks. I set up a few procedures (groups, procedure orders, discrete results, etc). Then tried it on a test patient. Remember, most of these ‘tests’ are not transmitted to any lab. One is an upper endoscopy, with discrete results being of boolean type for ‘H. pylori status’. hiatal hernia, etc. The idea is that when I receive the endscopy report, I will have to manually update the ‘results’ for endoscopy. How do I do this?
I have a further problem: when I try to edit a procedure order already saved, the number of procedures ordered grows exponentially, automatically - there must be a bug. See attached image after three edit attempts, the number of procedure has grown to >10K.
Further question - is it possible to create an order set under the ‘procedure order’ feature?
Hi
In OpenEMR 4.1.1,
After placing the order, it will be added in the Pending Review screen, where the physicians can edit the results manually and can sign it to approve. Once it is approved it will be available in the Patient Results screen.
In OpenEMR 4.1.2 the electronic Procedure orders have been introduced where, you can directly save and transmit the procedure orders to the external labs, only after receiving the result from the lab the “Pending Review” section will be updated(Without which manual entry is not possible).
Regarding your 2nd question: Cannot able to reproduce that issue. Need to test further with detailed scenario.
And to create procedure order set, you can make use of procedure type “Group”, while creating procedures in configuration screen.
Another option is to store the labs in Documents>Medical Record or create a NationNote form to store the .jpeg file of the scanned result. The latter has the advantage of attaching lab results to a particular encounter.
Seems like in 4-1-2, it is NOT possible to do what I have described. If you order an EGD, there is no means for tracking it because you cannot ‘transmit’ it to any lab and as such does not appear under ‘pending results’ and therefore one cannot manually update the results. The electronic dashboard CANNOT be used to track procedure orders that cannot be transmitted to an external lab.
Has anyone in fact tried out their recommendations on tracking on test patients and found that it does what you are describing as possible above??
The Procedure Module is rather complex to set up and to use, as evidenced by the 4 Wiki articles for manual imput of data and the 2 extra articles for electronic results.
In addition to configuring the module for the practice, an encounter must be generated and a Procedure Order from the Administrative tab of that encounter must be selected to manually enter the result for that patient (see attachment).
Encounter generation causes a problem with billing because most practices don’t have their own labs and therefore don’t bill for the service. As a result there will be a bunch of orphaned encounters that never will be billed. The encounter cannot be deleted because that will probably delete the lab result as well. The work-around is to use the encounter from the pre-operative/initial consult visit. Additionally there may be a problem with the lab reporting measure for Meaningful Use.
It may be simpler to scan the pre-operative lab results into Documents>Medical Record for the paticular patient, thus no encounter will be generated and the result is entered.
There should be a schedule set up for the surgical patients in the Calendar with the hospital as a secondary facility. Then it is a matter of checking the lists of patients against their lab results in Medical Record to decide how to rearrange the operative schedule.
Lab results in Medical Record is simpler for staff to execute and thus reduces the error rate. Once staff has been properly trained, the surgeon needs only to look at the data and make the scheduling decision because staff has done all the preliminary work.
I would like to suggest that this feature (the ability to track and report the progress, or lack thereof, of labs, procedures or referrals, etc in a patient or groups) be put to the developers forum. It is a feature set that impacts every physician, not just surgeons. Imagine ordering a surveillance EGD for Barretts with mild dysplasia or a colonoscopy for high-risk symptoms or an eye exam for a diabetic. In a busy practice, tracking these may fall between cracks. Imagine the consequences to the patient and the physician when these tests dont happen for one reason or another and a potentially preventable disaster follows - esophageal or rectal cancer or retinal detachment?
Paul
Tracking of lab results with the Procedure Module appears to work from using the Demo’s. It is not the lack of a module that is the problem rather it is the complexity in setup.
If one’s needs are simple, Documents->Medical Record is quite effective. For our patients requiring Cataract Extraction, the .jpeg files of pre-operative lab results are entered after review. Documentation is quickly and readily accomplished with the added bonus of satisfying the Menu Measure for Meaningful Use.
Diabetic Fundus exams are generally not forgotten if the Clinical Decision Rule has been properly set up for a Passive Alert which appears in Patient Reminder or an Active Alert which pops up as a dialog in the middle of Patient Summary.
If the front desk has been carefully trained in triage for a patient with Retinal Detachment, it is not likely that the finding will be missed. The Achilles Heel is getting him into the office in a timely fashion. It’s like missing the fact that a patient is obese but it would not be obvious until he is physically in the office.
Since it is holiday season, let’s attribute NOT and CANNOT to our lack of communication skills otherwise 10s of orders processed in our installations would be fictional.
In 4.1.2 demo there is a new patient, new lab, new test, new result, new encounter and new order waiting for you to track from electronic reports and update from pending results. Of course it being the demo site, at the stroke of midnight magic spell is broken and all setup goes poof!
Just to make sure, you are most welcome to tailor the process to your requirements by changing the code. If you do, please submit it for the benefit of others.
The fact that the Procedure Module is in the left Navigation Bar as a default setting, demonstrates the developers’ implicit, yet emphatic, acknowledgment of the importance of diagnostic studies documentation.
It is up to the user to decide whether the documentation will be simple or complex. If complex is too complicated, there is the third option of professional support.
There are times when one cannot have the cake and eat it too (but OpenEMR gets pretty darn close).
Prior to 6:31 a.m. PST, in the 4.1.2 Demo, from Administration > Electronic Reports:
I thank all on the forum for the helpful discussion - including those who tried out test patients on the 4-1-2 demo machine despite the holidays - I really appreciate it.
I can now say that the tracking features of ‘procedure order’ works not only on the demo machine but also on my office server running 4-1-2. This is what I learnt from this exercise -
In order for a test to appear on the “pending review” tab, the tests ordered must be correctly configured - otherwise it fails silently.
a. each ‘procedure order’ must have a ‘discrete result’ under it.
b. Once an order is placed, click save and transmit. These orders do not have to go to any external lab for it to appear under ‘pending review’ in version 4-1-2. Even a referral can be ‘transmitted’.
c. Once under ‘pending review’ one can update its status, add results manually. I usually have the result document (eg an EGD report) saved under documents - but once reviewed, I will now be updating it under ‘pending review’, so I know for future it was reviewed and I dont have to keep going back to the primary documents.
d. once it is signed off under ‘pending review’ the status automatically appears under ‘patient results’ and updates the ‘procedure order’ for that specific encounter. Very nice feature!
I agree with fsgl that some tasks, especially recurring or that which could be encapsulated in a rule, are best handled using clinical rules.
The 4 Wiki articles cited above are well written but the screenshots are microscopic even after enlargement.
It is always good to have the user’s point of view. If you feel up to writing another article with generous size images, it would be great. Just read this and Brady will give you an account.
Just when I thought this was laid to rest - A related question …
Order sets. I am unable to create order sets despite creating a top level ‘Group’. I order the same panel of tests for most new bariatric patients and would like to create an order set. It turns out one can only order a procedure, not a group. If you have ‘children’ procedures under a ‘parent’ procedure, I don’t seem to be able to track them under ‘pending review’. I had previously correctly observed that a ‘procedure order’ needed ‘discrete results’ in order to appear in ‘pending review’ and hence become trackable.
I presume that you don’t mean that which is depicted in the first attachment.
If you don’t want to select tests individually, then consider configuring a “Bariatric Panel” and list all the tests in the Description of one Procedure Order. See 2nd attachment.
It would be a bit of a squeeze to configure Results, so abbreviate and maintain the same order of results entered manually.
Thank you for posting the helpful hint in the ImageMagick thread.