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Presentation on theme: "NEXTGEN LAB ORDER AND RESULT DEMONSTRATION"— Presentation transcript:

This demonstration reviews ways in which you can order lab tests, then view and respond to the results. Details of the workflow will likely vary somewhat, depending on specialty and clinic policy, though this should give you a good idea of NextGen functionality. This has been prepared with EHR and KBM Subsequent updates may display cosmetic and functional changes. Use the keyboard or mouse to pause, review, and resume as necessary. There is no audio with this exercise.

2 Ordering Outside Lab Tests
There are a few different ways to place outside lab orders, depending upon specialty, preference, or the nature of the tests you’re ordering. Note to those who have previously received training on this topic: This lesson updates the user to the new alternatives and recommendations in place as of October 2012.

3 Specialties using the Advanced Template Set would most commonly begin by clicking My Plan/Orders.

4 Other specialties that don’t currently use the Advanced Template Set usually have a similar link or button, such as the Custom Plan link on the GYN template.

5 A simple way to order lab tests is to use the My Plan tab
A simple way to order lab tests is to use the My Plan tab. Here we’ve selected the Diabetes diagnosis, and picked several tests by clicking their checkboxes. When you’ve picked all the tests you need, click Place Order.

6 If necessary, select another diagnosis and add more tests.
You can save the tests you commonly order for specific diagnoses as Order Sets, and you can continuously modify these on an ongoing basis. (Info on the setup of Order Sets is covered in the User Personalization lesson.) If you haven’t set up an Order Set for a particular diagnosis, you can also use the built-in Quick assessments to order tests.

7 You can also use disease management protocols to order tests here.
As of this writing, we haven’t emphasized Protocols due to some technical problems. We hope to introduce the use of Protocols when these issues have been addressed.

8 After placing orders in any of these manners, note that the Lab/Diagnostics/Radiology Order Module Processing link changes color and has a solid diamond. Click on this link to open this popup. (The popup will usually appear automatically as well if you click Save and Close.) Note: Depending upon clinic-specific policies and workflow, these next steps may be performed by the nursing or front office staff.

9 If necessary, select the Labs bullet
If necessary, select the Labs bullet. The tests you’ve ordered will display. You may note that diagnostic studies you’ve ordered on the encounter will display if you select the Radiology bullet. At present we cannot submit such studies to the Radiology Department using NextGen, so you can disregard these.

10 Click in the Vendor box and select LabCorp.

11 From here you have a couple of ways to proceed
From here you have a couple of ways to proceed. You can select each test one at a time and click the Include selected order button.

12 The test will move to the bottom list.

13 Alternately, you can select the Automatically perform… checkbox
Alternately, you can select the Automatically perform… checkbox. If you do this, just clicking on the tests will move them to the bottom list.

14 To avoid sending invalid orders to LabCorp, please don’t click the Process/Submit button on sample or practice encounters. When all of the tests are on the bottom list, click Process/Submit. Your lab requisition has been sent to LabCorp, and the patient may go to have the studies done. Click Save and Close.

15 For common tests and common diagnoses, this is the easiest way to order lab studies. But sometimes you’ll need to order an infrequently-used test, or request a test related to a less common diagnosis. For this, click on the Labs tab.

16 To order labs from here, first select the diagnosis at the top, then select the test. Here, we’ll order a Uric acid level for the diagnosis of gout. Then click Place Order. Repeat this process for all tests needed, matching them up to the corresponding diagnosis.

17 You can click on any of the categories at the top to launch a popup with more studies within that category. Here the Chemistry popup has been launched. When you’ve selected all the tests you need, click Save and Close.

18 If you still haven’t been able to find the test you need, click the Other Tests link, launching the Other Labs popup.

19 Select the diagnosis, then click in the 1st Description box.
A pick list appears. Say we want to order thyroid antibodies. Click anywhere in the pick list and begin to type thyr.

20 The list scrolls down. Double-click on Thyroid Antibodies.

21 Select other tests as needed
Select other tests as needed. When done, click Place Order, then Save and Close. A tasking popup may appear; you can use it if necessary, or just dismiss it.

22 When you’ve placed all the orders you need, you would use the Order Module Processing popup as demonstrated above.

23 Notes about this method of lab ordering
When possible, the easiest thing for the provider to do is to place orders via My Plan. The next best bet is to place them through the Labs tab. This also provides another behind-the-scenes advantage: Your orders are posted to the Order Management template, so that they can be followed to completion, just like all other diagnostic and referrals orders. However, sometimes using the Labs tab can be a little frustrating, since you may have trouble finding the exact test you want on the pick lists you’re given. When this happens, the user may wish to use the Order Module.

24 Begin by clicking the Order Module at the bottom of the History Bar.
Most users will find it helpful to add the Order Module to the Menu Bar as well.

25 The Orders Module opens with the Results tab displaying
The Orders Module opens with the Results tab displaying. Change to the Orders tab.

26 Click New. You may notice that if you click the dropdown arrow, you’ll have the choice of Lab Order or Radiology Order. We’ll only be placing Lab Orders via this method.

27 The New Lab Order popup appears.
Note these 3 tabs. The popup opens on the Select Tests tab, which is where you will do most of your work. However, there are times when you might want to go to the General tab, so let’s look at that.

28 Routine will be selected as the default Order Priority, but you can change that to STAT as necessary. Billing type will be Third Party by default, with insurance information displaying spontaneously. The provider usually won’t have to do anything here, though it would be best to change Billing type to Patient if the patient has no insurance at all, to avoid an error message/task upon sending the order. Now let’s go back to the Select Tests tab.

29 Select the Performing Entity
Select the Performing Entity. For most of our lab work, this will be LabCorp. (This may display by default).

30 Next select the diagnoses that are to be associated with the order
Next select the diagnoses that are to be associated with the order. You’ll see the patient’s chronic problems and any assessments you’ve added today. You can also search for additional diagnoses.

31 Now select the tests you would like done
Now select the tests you would like done. You will initially see your Favorites List.

32 You can use the Show Favorites button to toggle back and forth from your Favorites List and the pre-populated Practice Favorites List.

33 An alphabetical list of Practice Favorites tests will display.
If you don’t see the test you need, click Search All….

34 Enter some search criteria then click Find.
Click the Checkbox for the desired test, then click OK.

35 If you click This Order, you will also see all the tests you’ve ordered here.
Your test will be added to the bottom list.

36 However you have selected tests, you can click Add to Favorites to add them to your personal Favorites List.

37 Whichever way you pick the test, when you click the checkbox, it will appear on the list at the bottom. If desired, you can fine-tune which diagnoses are assigned to which test. When selections are complete click Save & Send, and your orders will be sent to LabCorp.

38 When your tests have been successfully submitted, they disappear from the list at the bottom. You can add more tests if desired.

39 Occasionally you may need to generate an ABN (Advance Beneficiary Notice); this can be done by clicking ABN Options. Most of the time, however, LabCorp will deal with this.

40 Occasionally you may see this [. ] symbol
Occasionally you may see this [!] symbol. It means there are Ask At Order Entry questions that you need to answer. Clicking it takes you to the Test Details tab.

41 Respond to these questions by clicking in the Answer box and selecting from the dropdown list.
(You don’t have to worry about any of this middle section.)

42 If you try to Save without addressing the Ask At Order Entry questions, you’ll get this popup. After clicking OK you’ll have the chance to answer the questions again.

43 Note that you can check the STAT box if you wish a test to be completed stat. (This gives you a way to make an order STAT without having to go to the General tab at the bottom.) Unfortunately, in the past there was a flaw that resulted in such orders not getting flagged as STAT when transmitted to the lab. While this is supposedly corrected now, there have been ongoing sporadic reports of this problem persisting. To be on the safe side, the user may wish to click Save & Print, giving the patient a paper copy of the test requisition to take to the lab, highlighting in writing that it is STAT.

44 Note that you can use the Schedule Date/Time dropdown on the Test Details tab to indicate a test you wish to have done in the future.

45 You can also type in the Test Comment field, adding any other details you wish.

46 More notes about lab ordering
It can be confusing to the user that NextGen has two totally different ways to order labs: Template-based (via My Plan or Labs tabs) and Module-based (via the Order Module). You will be even more frustrated to learn that these two methods don’t communicate with each other under all circumstances. NextGen is aware of this problem, and is working to merge the two systems into one. In the meantime, here are some tips to help you choose the best/easiest method.

47 More notes about lab ordering
Whenever possible, place orders via My Plan; for over 90% of your common orders this is fast and easy. If you can’t figure out how to order your lab via My Plan, try to do so via the Labs tab. Either of these methods posts the order to the Order Management template, which makes it easier to track the fact that we get results back. If you can’t figure out how to place an order via either My Plan or the Labs tab, use the Order Module. It can be an easier way to search for uncommon tests.

48 More notes about lab ordering
Another consideration is tests that require AOE: Ask at Order Entry questions. We have tried to turn off the AOE requirement for most tests, since they are actually questions that would be better completed by the phlebotomist than the provider. However, a few AOE questions must still be answered by the provider. Prenatal Quad Screening is an example, since the questions include data about gestational age that the lab tech would not be privy to. Currently, AOE questions can only be easily addressed via the Order Module. Whether you place the order via templates or the Order Module, you will still need to go to the Order Module to answer the AOE questions.

49 Reviewing Lab Results You will be notified about test results through your Task List. After reviewing results, you’ll use the Provider Test Action template to address them. You review test results through the Order Module, regardless how you placed the order.

50 The primary way in which you will be notified about test results is through your Task List. Select the task and click the Go To Chart button (you will accept the task along the way).

51 Click on the Order Module button; alternately, you can select the Order Module from the Encounter History.

52 You can select a particular test and click Graph… to see a graph of that test over time.
The Order Module will open on the Results tab; test results will display in a grid.

53 Results in RED are high. Results in BLUE are low. You can click on any result to display full details, such as the normal range.

54 Results that are underlined have additional comments
Results that are underlined have additional comments. Click on the result to display them.

55 To sign off on a result, go to the Orders Tab.
Alternately, you can click the Go to Order button to go directly to that one test on the Orders Tab.

56 Note that you can select a test then click the Results dropdown arrow to see the results here, too.

57 Select the test and click the Sign-off… button.

58 Provide your User Name and Password, then click Sign-off.
Check the Sign-off All Assigned Orders box if you want to sign off on all the results at once.

59 Sign-off details will display, though you may have to scroll all way to the right to see them.
Signing off your lab orders here has the additional effect of marking this lab result notification as “Completed” in your Task List.

60 Note there is an area here to enter sign-off comments
Note there is an area here to enter sign-off comments. If you use this, these comments can be viewed later by clicking the Sign-off Comments dropdown arrow. While this is usable, we recommend another method, which is somewhat more versatile, and can also be used with other types of test results (X-ray reports, outside paper reports, etc).

61 To document plans, patient instructions, etc
To document plans, patient instructions, etc., open the Provider Test Action template, which should be one of your preferred templates. (This has since been replaced by the USA Provider Test Action template.)

62 With the Lab results bullet selected, lab results are also visible here.
Using the Action details/Notes box and/or the checkboxes below, acknowledge the test results and indicate plans.

63 Also document how these plans were communicated to the patient (phone call, mail, patient portal, etc.), or send a task to other staff if they are to be the ones contacting the patient. Finally, click the Test Action button to generate a document that includes these plans.

64 There are a few ways to print lab results, e. g
There are a few ways to print lab results, e.g., if you need to give a copy to the patient. If you just want to print one lab order, on the Order Module Orders tab, click the Results button to display results at the bottom. The Print Results button will allow you to print that report.

65 You have other options through the Document Module.
Selecting LabResults.NGN will generate a report with all tests done in the last 30 days. (LabResults_ALL.NGN will generate a report with all tests done on the patient since LabCorp ordering went live circa June 2011.)

66 Click the Printer icon to select a printer and print the report.

67 As mentioned previously, signing off the lab order should automatically mark the task as Completed. If necessary, however, click the Completed checkbox.

68 This concludes the NextGen Lab Orders and Results demonstration.
How is it that we put man on the moon before we figured out it would be a good idea to put wheels on luggage?

69 This concludes the NextGen Lab Orders and Results demonstration.
How is it that we put man on the moon before we figured out it would be a good idea to put wheels on luggage?


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