1. Open Orders Processing
Chapter 11

2. Objectives Identify a patient with an open order
Answer open order’s questions
Select from a list of procedure options
Understand open orders workflow
Objectives

3. Key Concepts Waiting times Time counter Discipline columns
Additional question types
Procedural questions
Field indicators
Quality control question
Age and gender specific
Procedure selection options
Cascade of questions
Workflow steps
Wet read
Over-read
Evidence-based medicine
Clinical decision support (CDS)
Key Concepts

4. Identifying Patients With Open Orders
After the physician places order for patient based on his/her examination during initial contact with patient Clinic Status screen displays word
OPEN in ORDER column next to patient to indicate patient has open orders
Waiting room times in discipline columns are in minutes and indicate which discipline is responsible for performing the next step of open order
Identifying Patients With Open Orders

5. Identifying Patients with Open Orders
To review what physician wants them to do for patient-clinical staff and x-ray staff place cursor next to patient and click OPEN ORDERS button-Figure 11-2
Patient name & case number appear at top of screen
Exam room of patient appears in message field
Discipline responsible for carrying out open order and order name appear in body of screen along with questions to be answered
On the screen, clinical staff (TECH)and x-ray staff (XRAY) read physician orders.
Do This! Pg. 154
Identifying Patients with Open Orders

6. Figure 11-4

7. Answering Open Orders Questions
Open orders questions answered same as Clinical Notes screen
Additional questions types include questions to be answered with someone’s initials and procedural questions which require selection of options on another screen
Field indicators (Figure 11-3) appear to left of answer fields
Red asterisk to right indicates this is a quality control question and must be answered before patient can be discharged from facility
Questions without red asterisk are optional
Questions can be age, gender specific
Answering Open Orders Questions

8. Open Orders When completing orders:
Clinical staff member (TECH) needs to document the patient was given what was required and record initials of clinical staff person who gave the patient what was required
Both of these questions are quality control and must be answered
Item number drives the charge to bill
Any other staff members who were required to assist patient need to document any special notes about service/procedure
Open Orders

9. Open Orders After answering open orders questions
Staff member clicks Submit Answers button
MedTrak automatically returns to Clinic Status screen(Figure 11-5)
Word OPEN is still in ORDER column but now time counter is running for physician (DR)
Clinical staff (TC) and other staff cleared their counters.
Open Orders

10. Do This! Pg. 156
Figure 11-5

11. Another aspect of MedTrak’s workflow is processing of open orders
Each order can have own cascade of questions that pass responsibility for the workflow steps from one discipline to another
All orders start with physician placing order
Then depending on workflow steps in facility the order will appear in column of next discipline responsible for completing task
Open Orders Workflow

12. Word OPEN in ORDER column indicates that the patient has at least one open order
Initial read of an x-ray is referred to as a “WET READ”-if something looks abnormal ask for an over-read by a radiologist
Place cursor next to patient on Clinic Status screen and click Open Orders button.
Open Orders Processing screen opens(Figure 11-6)
Cursor in Initial Impression field click Expanded Answer button enter initial read
Click Submit Answer button-Open Orders screen reappears displaying any remaining questions
Open Orders Workflow

13. Do This! Pg. 158
Figure 11-7

14. MedTrak’s rules-based system enables you to build rules for evidence-based medicine It also facilitates clinical decision support(CDS) which complies with Core Measure 11 of Meaningful Use After entering answers click Submit Answers button MedTrak automatically returns to Clinic Status screen Do This! Pg. 160
Figure 11-8

15. If you requested over-read for an x-ray the word OPEN is still in ORDER column and clinical staff(TC) have running time counter in their column indicating they have something to do for the patient(Figure 11-9)
To see what clinical staff need to do a person places cursor next to patient name and clicks OPEN ORDERS button
Next screen to appear is Open Orders processing screen
Clinical staff prepares and documents where order is being sent
Staff person record who prepared it by entering his/her MedTrak employee initials(Figure 11-11)
Red asterisk to right indicates question must be answered
After answering questions clinical staff member clicks Submit Answers button and Clinic Status screen returns
Word DONE is now in ORDER column to indicate their were open orders and they are now complete
Open Orders

16. In addition, MedTrak reset time counter to 0 minutes for physician (DR)
Changed STATUS column back to EXAMINE
MedTrak automatically sets the workflow status to Examine whenever all open orders are completed after the physician has picked up the patient’s chart and placed orders for patient
With all open order complete the responsibility for determining the next step in patient’s care is passed back to physician and Examine workflow status indicates the physician needs to place additional orders for patient or finish with patient and discharge them from this visit
Do This! Pg. 161 & 162
Open Orders