Resulting a Lab Test

1. LAB for Non-Laboratorians Resource Patient Management System Resulting a Lab Test

2. Session Objectives • Result by EA (auto-instruments/ref Lab). • Result by EM (manual/modify). • Result lab results through PCC data entry. • Describe how to use result comments. • Describe Notification process. • Provide an overview of the Reference Lab Interface. • Describe result entry outcome - the difference between Lab Suite and PCC, Diabetes Management System (DM), EHR, Women’s Health (WH) or iCare.

3. Result Laboratory Tests There are 3 main menus to result lab tests in Lab Package. From the main Lab menu, select option 3 Process data in lab menu ... Use: EA (auto-instruments/ref lab) to result tests from auto-instruments or from the reference lab. Results are electronically transmitted via an interface. Use: EM (manual/modify) to result tests by manual data entry. Use: POC which has already been discussed.

4. Result Laboratory Tests • Results are entered into a result field • Results may be numeric, free text, or a set of codes • The “*” entered in the result displays “canceled” • The “#” entered in the result displays “comment” • The “@” can be used to remove an entry and leave the test pending.

5. Result Laboratory Tests • Free text comments can be manually added in the comments section. • Canned comments can be configured to expand into sentences or phrases. • EX: CTR could be configured to expand to “Called to and repeated back by” • Reference labs may result lengthy reports which show up in the comment fields EX: PAP smear results

6. Result Laboratory Tests (EA) From the Main Laboratory DHCP Menu Select: 3 Process data in lab menu Select: EA Enter/verify data (auto instrument) • Select Process data in lab menu Option: EA Enter/verify/modify data (auto instrument) • Do you want to review the data before and after you edit?? Yes// (Yes) • Do you wish to see all previously verified results. ? No// (No) • Select LOAD/WORK LIST NAME: ? • Answer with LOAD/WORK LIST NAME • Do you want the entire LOAD/WORK LIST List ? Y (Yes) • Choose from: • CLINITEK 200 • COULTER ONYX • EKTACHEM 500 • HEME-CELL DYN • SEND-OUT

7. Result Laboratory Tests (EA) • Select LOAD/WORK LIST NAME: SEND-OUT • Would you like to see the list? No// NO • Do you wish to modify the test list • i.e., would you like to add or subtract ATOMIC tests? • Enter Yes or No: No// NO • You have selected 74 tests to work with. • Do you want to review the data before and after you edit? Yes// (Yes) • Select one of the following: • 1 Accession Number • 2 Unique Identifier (UID) • Verify by: 1// Accession Number • Accession Date: TODAY// (DEC 06, 2010) • Accession NUMBER: 1//

8. Result Laboratory Tests (EA) • ABBOTT,RAY MITCHELL HRCN: 144239 LOC: AC • Practitioner: USER,XSTUDENT • ACCESSION: SO 1206 1 • SEND-OUT 12/6 14:25d • FASTING GLUCOSE //145 H • Select COMMENT: • ABBOTT,RAY MITCHELL HRCN: 144239 LOC: AC • Practitioner: USER,XSTUDENT • ACCESSION: SO 1206 1 • SEND-OUT 12/6 14:25d • FASTING GLUCOSE 145 H mg/dl • SELECT ('E' to Edit , 'C' for Comments, 'W' Workload ) • Approve for release by entering your initials: XSU

9. Result Laboratory Tests (EM) EM Enter/verify/modify data (manual) • Do you want to review the data before and after you edit? YES// • Do you wish to see all previously verified results? NO// • Select one of the following: • 1 Accession Number • 2 Unique Identifier (UID) • Verify by: 1// Accession Number • Select Accession: SO 26 • SEND-OUT (FEB 25, 2011) 26 • Select Referring Laboratory: DEMO HOSPITAL// QUEST LABORATORIES • SD • DEMO,PATIENT BABY 888884 LOC:OPD • Sample: NASAL WASH • Specimen: NASAL MUCUS • 1 RESPIRATORY DFA

10. Result Laboratory Tests (EM) • DEMO,PATIENT BABY HRCN: 888884 LOC: OPD • Pat Info: Sex: MALE Age: 4yr as of Feb 25, 2011 • Provider: MORRIS,JANNA L Voice pager: • Phone: 605-355-2331 Digital pager: • ACCESSION: USD 11 24 USD 11 26 • 02/24 1417d 02/25 1518d • Current Ref Range: - Units: • ADENOVIRUS // N NEG • Current Ref Range: "NEG"- Units: • -RSV N//N NEG • Current Ref Range: "NEG"- Units: • -INFLUENZA A //P POS • Current Ref Range: "NEG"- Units: • -INFLUENZA B //N NEG • Current Ref Range: "NEG"- Units: • PARAINFLUENZA 1 //N NEG • Current Ref Range: "NEG"- Units: • PARAINFLUENZA 2 //N NEG • Current Ref Range: "NEG"- Units: • PARAINFLUENZA 3 //N NEG • Current Ref Range: "NEG"- Units: • PARAINFLUENZA 4 //N NEG • Select COMMENT:

11. Result Laboratory Tests (EM) • Demo Clinic 3200 Canyon Lake Drive, Rapid City, SD • DEMO,PATIENT BABY Date/Time Printed: 02/25/11@15:27 • HRCN:888884 SEX:M DOB:Nov 21, 2006 CURRENT AGE:4 • Accession [UID]: SO 11 26 [7111000026] • Provider: XSU,STUDENTL E-SIG STATUS: NOT REVIEWED • Specimen:NASAL MUCUS Spec Collect Date/Time:02/25/11@15:18 • Res • Test name Result Flg units Ref. range Site Result Dt/Time • RSV NEG Ref: NEG [7951] 02/25/11@15:26 • PARAINFLUENZA 4 NEG Ref: NEG [7951] 02/25/11@15:26 • PARAINFLUENZA 1 NEG Ref: NEG [7951] 02/25/11@15:26 • PARAINFLUENZA 2 NEG Ref: NEG [7951] 02/25/11@15:26 • PARAINFLUENZA 3 NEG Ref: NEG [7951] 02/25/11@15:26 • ADENOVIRUS NEG Ref: NEG [7951] 02/25/11@15:26 • INFLUENZA A POS Ref: NEG [7951] 02/25/11@15:26 • INFLUENZA B NEG Ref: NEG [7951] 02/25/11@15:26 • ===================================================================== • KEY: A=Abnormal L=Abnormal Low H=Abnormal High *=Critical TR=Therapeutic Range • [7951] QUEST LABORATORIES 101 E. MINNESOTA ST. #120 RAPID CITY, SD 57701

12. Result Laboratory Tests Comments EM Enter/verify/modify data (manual) Do you want to review the data before and after you edit? YES// Do you wish to see all previously verified results? NO// • Select one of the following: • 1 Accession Number • 2 Unique Identifier (UID) • Verify by: 1// Accession Number • Select Accession: SO 63 • CHEM CHEMISTRY • CHEMISTRY (FEB 25, 2011) 63 • Select Referring Laboratory: DEMO HOSPITAL// QUEST LABORATORIES • DEMO,PATIENT F 999994 LOC:ER WI • Sample: SERUM • Specimen: SERUM • 1 AMMONIA

13. Result Laboratory Tests Comments (cont.) • DEMO,PATIENT F HRCN: 999994 LOC: ER WI • Pat Info: Sex: MALE Age: 22yr as of Feb 25, 2011 • Provider: PSUSER,DOCTOR Voice pager: • Phone: 623-225-2331 Digital pager: 222111 • ACCESSION: SO 0225 63 • 02/25 1630d • AMMONIA 555 H* umol/L CRITICAL HIGH!! • SELECT ('E' to Edit, 'C' for Comments, 'W' Workload): Comments • Select COMMENT: CALL • (CALLED TO AND READBACK BY) • Select COMMENT: XSUSER,STUDENT1635 (XSUSER,STUDENT AT 1635) • Select COMMENT: • SELECT ('E' to Edit, 'C' for Comments, 'W' Workload): • Approve for release by entering your initials: XSU CANNED COMMENT: CALL - Expands to CALLED AND READBACK BY COMMENTS CAN BE FREE TEXT AS WELL.

14. Canceling a test that has not been resulted. • Use the options in lab package: • “Delete test from an accession” • “Delete entire order or individual tests “ • Canceling or deleting tests using the above options does not send CPT codes to Billing. • Do not result the test using an asterisk (*)

15. Canceling a test that has not been resulted. • Entering an * as a result does NOT cancel a test! • Entering an *only puts the word 'canc' as a result! • Using a * does not delete the test from PCC! • NOTE!!! - Unless the correct option to “Delete a test from an accession” is used, the facility may actually end up billing for a test that was never performed and was actually canceled.

16. REMOVING an erroneous result that has been approved and reported. • Once the test has been reported, it can never be totally deleted and still appears in the lab tab. • The test result is removed using the EM option, by replacing the incorrect result with a “*” which displays as a “canceled” result. • The comments automatically reflect the deletion along with who deleted the result and why. • This meets the accreditation requirement of test deletion track record.

17. CHANGING a test result that has already been approved and reported. • The result is changed by using the EM option. • Enter E for editing the result, and/or C for editing comments. • The comments automatically reflect the corrected result along with who and when the result was edited. • This meets the accreditation requirement of corrected test result tracking.

18. Result Laboratory Tests through PCC Data Entry • There is an alternate method to result lab tests directly into PCC through PCC Data Entry. • This may be the only option for some sites that do not use RPMS lab package. • These results are only available in PCC • Results are not populated in the lab package • Results are not visible on the Labs tab in EHR.

19. Result Laboratory Tests through PCC Data Entry • From the Core Menu in RPMS select: PCC>PCDE>ENT>APP APP Append Data To An Existing Visit Record PCC Data Entry ModulE ******************* Append Mode ******************* Select PATIENT NAME: DEMO, PATIENT I

20. Result Laboratory Tests through PCC Data Entry • Enter VISIT date: (SEP 27, 2011) • You are currently processing the following Patient Visit: • Patient Name: DEMO,PATIENT I Chart #: 99999 • Date of Birth: JAN 04, 2001 Sex: M • Visit Date: SEP 27, 2011@16:52 Location: RAPI • Type: I Service Categor • Clinic: EMERGENCY MEDICINE • ============== PROVIDER's ============== • PROVIDER: MORRIS,JANNA L PRIMARY/SECONDARY: PRIMARY • ENCOUNTER PROVIDER: MORRIS,JANNA L • ============== POV's ==============

21. Result Laboratory Tests through PCC Data Entry • MNEMONIC: LAB • Select V LAB TEST: HGBA1C • RESULTS: 14.0 • UNITS: mg/dL • ABNORMAL: YES • SITE: • CURRENT STATUS FLAG: R  RESULTED •   ORDERING PROVIDER:    SMITH,CINDY

22. Result Laboratory Tests through PCC Data Entry • Select V LAB LAB TEST: BUN  UREA NITROGEN •   .04        RESULTS: 22 •   1101     UNITS: mg/dL •   .05        ABNORMAL: N •   1103     SITE: •  1109     CURRENT STATUS FLAG: R  RESULTED • 1202     ORDERING PROVIDER:    SMITH,CINDY • Select V LAB LAB TEST: CREATININE •   .04        RESULTS: 1.0 •   1101     UNITS: mg/dL •   .05        ABNORMAL: N •   1103     SITE: •  1109     CURRENT STATUS FLAG: R  RESULTED • 1202     ORDERING PROVIDER:    SMITH,CINDY

23. Result Laboratory Tests through PCC Data Entry • Select the ENTER key when done entering.

24. Result Laboratory Tests through PCC Data Entry CURRENT LAB TESTS AND RESULTS FOR THIST • Visit Date: SEP 27, 2011@16:52 Patient Name: DEMO,PAI • HGBA1C+EAG 12.0 • UREA NITROGEN 22 • CREATININE 1.0 Is coding complete for this visit (is all data entry completed)? N// YES • Please update the visit status for this visit. CHART AUDIT STATUS: REVIEWED/COMPLETE// Do you want to update the Chart Audit Notes for this visit? N// YES • CHART AUDIT NOTES: • No existing text • Edit? NO// • Looking for ancillary data to merge into this visit...

25. Result Laboratory Tests through PCC Data Entry Lab results available only in PCC which can be seen in EHR on the Reports Tab.

26. Compare and Contrast Laboratory Results Resulted in Laboratory Package vs PCC Data Entry Results from laboratory package - Available on the Lab Tab in the EHR - Link to the CPT code file and go to the Coding Que - Available for statistical searches and clinical reporting -Available for providers to compare current to previous lab results. -Configured to meet future CPOE Meaningful Use requirements.

27. Compare and Contrast Laboratory Results Resulted in Laboratory Package vs PCC Data Entry Results entered and stored in PCC - Available on the Reports Tab in the Health Summary only • Do not show up on the Lab tab in the EHR • Do not link to any CPT codes or billing package (unless put in manually through Data Entry using CPT pneumonic) • Available for statistical searches and clinical reporting. • Difficult for providers to search for previous lab when comparing to current labs. • Meets Stage 1 MU requirements for results reported electronically • No CPOE generated for future MU lab requirement

28. V Lab Entry from Lab Package • LAB TEST:              POTASSIUM • RESULTS:               6.1 • ABNORMAL:              H* • LR ACCESSION NO.:      EKT 0928 70 • UNITS:                 mmol/L • ORDER:                 253665 • SITE:                  SERUM • REFERENCE LOW:         3.5 • REFERENCE HIGH:        5 • SOURCE OF DATA INPUT:  LAB • CURRENT STATUS FLAG:   RESULTED • LOINC CODE:            2823-3

29. V Lab Entry from Lab Package (cont.) • COLLECTION SAMPLE:     RED TOP-SERUM • COLLECTION DATE AND T: SEP 28, 2011@15:28:35 • ORDERING PROVIDER:     WACHACHA,SARAH • CLINIC:                LABORATORY SERVICES • ORDERING DATE:         SEP 28, 2011@15:27 • CPT PTR:               POTASSIUM • CPT - BILLABLE ITEMS:  84132|12.00|||| • LAB POV:               vomiting • COMMENTS:              NOTIFIED SARAH WACHACHA IN URGENT CLINIC @ • COMMENTS:              327PM. RESULT WAS READ BACK. • COMMENTS:              Verified by Repeat Analysis. • V FILE IEN:            7681920 • PROVIDER:     WACHACHA,SARAH • CURRENT STATUS FLAG:   RESULTED

30. V Lab Entry from PCC • LAB TEST:              GLUCOSE • RESULTS:               126 • ABNORMAL:              N • UNITS:                 mg/dL • V FILE IEN:            7682269 • ORDERING • CURRENT STATUS FLAG:   RESULTED PROVIDER:     WACHACHA,SARAH

31. Notifications • When lab results are resulted, the provider receives a notification that there are lab results to be reviewed. • The provider should open the notifications tab and will see that there are laboratory results to review and sign. • When the result is selected, it takes provider to the lab result and asks for signature.

32. Notifications Results show up on Notifications page. Care provider selects the notification. EHR takes them to the patient result where they can sign off on the result.

33. Notifications Provider enters electronic signature.

34. Forwarding a Notification Lab results can be forwarded to another provider for consultation. To forward, highlight the result, right click and it opens the Notification Recipient box.

35. Forwarding Notifications (cont.) Use arrow to move recipients to Recipient column Enter user or group to forward notification to. Select OK when finished selecting recipients.

36. Questions & Discussion