Open Orders Processing Chapter 11

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

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

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

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

Figure 11-4

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

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

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

Do This! Pg. 156 Figure 11-5

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

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

Do This! Pg. 158 Figure 11-7

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

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

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