1. NEXTGEN REFERRALS AND DIAGNOSTIC STUDIES DEMONSTRATION This demonstration reviews the ordering of referrals & diagnostic studies in NextGen. Details of the workflow may vary somewhat, depending on practice policy & clinic layout, though this should give you a good idea of NextGen functionality. This has been prepared for EHR 5.8 & KBM 8.3, but you may see some screen shots of earlier versions in the background when they are not germane to the point being illustrated. Subsequent updates may display cosmetic & functional changes. Use the keyboard or mouse to pause, review, & resume as necessary.

2. Referrals Generate a referral when you’re seeking professional services from another provider beyond the performance & interpretation of a test. If you’re just ordering a test, with or without interpretation, that will be done in a different manner, illustrated later.

3. Click Referrals. In this example, say our patient has severe dyslipidemia that we have not been able to control well despite a trial of a number of regimens, due to ineffectiveness or intolerance, so we decide to refer to the endocrinologist.

4. Click the Specialty/specialist name/site bullet. Click in the Specialty box, & choose the specialty from the popup. If you don’t see a specialty that you frequently need, notify the EHR Team, so that it can be added.

5. You can also click in the Provider name box to select a specific provider, though this is not required. (And if you don’t see the name you need, you’ll have another way to indicate it in a minute.)

6. Click in the Diagnosis Description box; a list of the patient’s chronic problems & today’s assessments appears. Select one or more diagnoses. If necessary, you can add or update assessments.

7. Click a requested service; here we’ll select Evaluate and treat. Click in the Reason for referral box. You can choose a selection from the popup if there is a satisfactory choice, but usually you will want to click the blank space, then free-type. You have 250 characters, so there is plenty of space to explain the referral. And here is where you can mention a specific doctor’s name if you couldn’t pick it above. Here we’ll type Lipids unresponsive to fibrates, fish oil, & lifestyle modification; intolerant of multiple statins due to muscle pain (no CPK elevation). Pt requests Dr. Lector.

8. You can specify a time frame, if desired/necessary. You can add further comments if necessary; this is a useful spot to add notes/instructions to the referrals staff.

9. Click Details if you wish to attach a document, such as a visit note or a letter to the consultant; you’ll be given the opportunity to browse available documents. Click Add to add the referral to the Referrals Grid.

10. If necessary, you can repeat this process to create another referral. When done, click Save and Close. The program may offer to generate a task as you add the referral. If not, click Send Task to send a task to the staff member who handles referrals in your office.

11. Diagnostic Studies Generate a diagnostic study order when you’re just ordering a test; a radiographic study would be a common example. If you’re ordering a cardiac test, order a diagnostic study if you’re only ordering the test; order a referral if you actually want the cardiologist to see & evaluate the patient. If you’re ordering upper or lower GI endoscopy, order a referral, since the gastroenterologist will see & evaluate the patient before planning such procedures.

12. Click Diagnostics. In this example, say our patient has migraines, which have changed in nature during the 5 th decade & are no longer responding to previously effective therapy, so we’ll order an MRI of the brain.

13. Select the Migraine Unsp assessment. Click the MRI Head/Spine link, & select the desired study.

14. Add further details as necessary, such as the side for a unilateral study. Here will just add that we want the test within 1 week.

15. When done, click Place Order.

16. For the first diagnostic study ordered, a tasking popup will appear. If you’re ordering a study that needs to be scheduled off-site, use this to task the staff member responsible for this. If you’re ordering an on-site study, such as a plain X-ray, you’ll probably just want to print the order, so you’d cancel out of this tasking popup. In this example, we’d generate the task to the staff member to schedule the MRI, & the order would be complete.

17. If you missed the chance to send a task, double-click on the order in the grid.

18. Another Task button appears here.

19. Sometimes the provider may have difficulty picking the desired test. For example, what if your patient has a chest mass, & you want a CT of the chest? You may have trouble deciding among several listings for “thorax” & “chest.”

20. As a solution to this, we have added a fake CPT code 99999 Other Studies, See Description, which will appear on the Other Diagnostic list. Select this.

21. After clicking Place Order this entry appears on the grid here. But how will our Referrals clerk know what to schedule? Double-click on Other Studies, See Description.

22. Use these boxes to add clinical information & clarifications. The Referrals Clerk will use this to schedule the test when she receives the task. When done click Save then Close.

23. What if instead you have ordered a chest X-ray that you are sending to the radiology office down the hall, & you just want to print the requisition? Click Save & Close.

24. Go to the Checkout tab.

25. Under Today’s Orders select Diagnostics. Here you can print requisitions for most anything you’ve ordered during the visit. Click on the desired order, X-ray, chest in this example. Then click the Requisition button.

26. The requisition is generated. Print by clicking the Printer icon, then close the document window. As 100% of users & numerous small woodland creatures have commented, it would be far faster & more efficient if we could print the requisition back on the Diagnostics Tab where we placed the order. Unfortunately, this is a technical limitation in NextGen; we’ve added our name to the long list of customers who have requested this obvious improvement.

27. If you missed the chance to send a task before & later realize you need to do so, you can generate a task from the Information Bar.

28. This concludes the NextGen Referrals & Diagnostic Studies demonstration. When everything is coming your way, you’re in the wrong lane. R. Lamar Duffy, M.D. Associate Professor University of South Alabama College of Medicine Department of Family Medicine

29. This concludes the NextGen Referrals & Diagnostic Studies demonstration. When everything is coming your way, you’re in the wrong lane. R. Lamar Duffy, M.D. Associate Professor University of South Alabama College of Medicine Department of Family Medicine