Section 10: The NextGen Lab Module & Lab Assign ModulePage 1 of 20
NextGen’s EHR Lab Module & Lab Assign Module
Within the NextGen EHR umbrella, exists one of the strongest clinical modules associated with healthcare, the Laboratory module. The Lab module allows the healthcare provider to order labs, evaluate labs and so forth. This section will cover the various aspects of the Lab Module, the Lab Master template, and the Lab Assign Module.
The Lab Master Template
Within NextGen’s EHR application, Users have the ability to order laboratory testing on each and every patient. This data is stored within the patient’s chart as the provider delivers healthcare solutions to his/her patients. In addition, there are several options available to result these same Laboratory tests within the EHR system. These options will be further discussed, along with examples.
I.Ordering Laboratory Testing
1.There are basically three (3) different types of laboratory tests that can be ordered:
a)In-House Testing
b)Core Lab Testing (either Indiana or Ohio)
c)Reference Lab Testing (MACL-Indiana, Quest-Ohio)
2.All Lab orders, regardless of where they are to be performed, MUST be entered within the EHRLabModule, especially if the practice is going to take advantage of the electronic interface.
3.To begin, the user should launch the MASTER_IM template.
4.The user should choose the encounter created for today’s visit.
a)Click the NEW button from the HISTORYTool Bar if the patient is not being seen today, but requires a note or a Telephone template to be placed within their chart. This will be done very rarely.
5.Click the Templateicon in the Tic-Tac-Toe area.
a)If the Master IM template already exists, then click on the Master_Im template from the HISTORYTool Bar area.
6.Using the left-hand side navigation pane on the Master_Im template, you will find the Lab text link.
a)Click on the Lab text linkto launch the Lab Orders(Ahn_Lab_Masters) template.
b)Or choose Lab Draw from the pop-up listwhen prompted for Visit Type on the Master_IM template. This link will take you to the Lab Orders template as well. The following screen will appear. (see image on next page)
**The ORANGE square highlights the Categories of Testing available for the End-User to select when ordering LAB tests. (i.e. Chemistry will display ALL Chemistry testing available, In-House is for all testing done on site, etc.).
We are currently testing MACL reference lab interface. In order to make it easier for the users to choose the appropriate Lab test, we had re-arranged the lab tests on the Lab templates. We also included the MACL reference lab codeon the templates for your convenience.
Below are the screenshots for each Lab template, you can use it as a reference to which template the Lab test is located.
Lab Chemistry:
Lab Hematology:
Lab Therapeutic Level:
Lab Microbiology:
Lab Serology:
Lab Tumor Marker:
7.With the Lab Template open, specific criteria regarding the order can also be added here, (Fasting status, Urgency, test location, Drawn By, Draw Date, Call results, etc.)
8.For proper coding of Lab orders make sure that prior to selecting the desired lab order, to choose or enter the appropriate Chronic Condition (CC), from the upper right-hand corner of Lab Orders screen.
(NOTE: The CPT code of each chronic condition will be mapped to the associated lab order selected until either all labs have been selected or the CC changes for any additional test selections. See Example below.)
9.In the above example, three Lab tests were ordered for 3 different Chronic Conditions, as evidenced by the three (3) different CPT/ICD9 codes. Also, please note that Future Lab Order will now generate on Master IM document.
10.(NOTE: In the event that an incorrect CPT4 Code is entered, and the labs have been submitted, this situation can be fixed. First, go into the LAB module (3 Test tubes). Click on the ORDERS button. Double-click on the lab order that was entered incorrectly, and then double-click on the specific test. Make the necessary edits to the Code, then press SAVE, and not SAVE & SEND. Call the Core Lab to inform them of the change.)
11.If you are the end-user who will be responsible for collecting the lab specimen at the time of the order…press the SUBMIT button once all labs have been selected. This will order the testing and the billing will flow to the EPM module, and orders will go to the respective Core lab. Collect all laboratory specimens as per the laboratory protocol. Otherwise, use the following protocol:
a)If the labs will NOT be collected at the time of ordering, (Due to fasting/non-fasting issues, etc.), then the user must click on the “Future Labs” text link. This will launch the “Future Labs” template.
b)The User should then enter all labs and the number of days in the future that they will be needed. The labs may be collected as a group if there is more than one, or there may be specific dates that each lab has been requested to be collected on. Refer to the provider’s orders for specifics. This “Future Labs” printout can then be given to the patient to bring in when they return for the lab draw.
c)This Future Labs document will continue to be a part of the patient’s chart and can be referred to for reference when the patient returns for the blood draw.
12.If the provider is entering the orders for Nursing/Laboratory to collect the specimen, they will need to click on the “SEND TASK” button once they have checked all of the labs that need to be performed on the patient.
This will allow the provider to assign the task of performing a blood draw to either a specific individual or a groupthat is responsible for collecting specimens.
13.Once the specimen has been collected, the user should then click the “SUBMIT” button to send the order across the interface and to send billing information to the EPM module. (EPM billing will actually occur at a later date.)
(Special Note: Remember to press SUBMIT only ONCE!! Each time the SUBMIT button is pressed, an additional order is sent across the interface.)
14.Once the specimen has been collected either at the time of ordering or on a future date, the specimen should be sent to eitherthe Core lab or the Reference lab.
a)The Lab personnel should then generate the “LAB REQUISITION” to send with the specimen.
b)The Lab Requisition must accompany the specimen to the Core/Reference lab.
15.At this point…ALL Labs have now been officially ordered.
a)For either an In-house lab
b)or the Core lab
c)or a Reference lab
II.Resulting Lab Results
A.In-House Labs
1.To review all currently ordered In-House labs:
a)Select the appropriate patient encounter
b)SelectNurse Documentation from the left-side navigation pane.
c)Click the text link“All Labs ordered this encounter”(circled in image below).
d)All currently ordered labs will be displayed for your review.
2.Once you are ready to enter Lab results, you will need to go to the Lab Assign module for resulting.
3.You can get to the Lab Assignmodule in one (1) of two (2) ways.
a)By minimizing your current window and clicking on Lab Assignfrom the NextGen Application launcher or menu.
b)From the EHRmodule by clicking on UTILITIES from the top toolbar, then choosing Lab Assign.
4.The main screen for Lab Assign will appear.
5.The first step is to enter the “MATCH” rules that NextGen will use to automatically match up patients and lab results.
a)On the Menu Bar click on EDIT, and then choose OPTIONS. The following screen will appear: Lab Assign Options.
b)Click on the icon circled adjacent to “1st”, this will create the first two rules. Then click on the icon adjacent to “2nd”, this will add rule number 3. See example below.
c)The user should now configure each of the 3 “matching” rules.
(1)Click on “MatchLevel1”. To configure the settings for this rule, click in the checkboxes adjacent to Order Number and Person Number.
(2)For “MatchLevel2”, click the checkboxes next to Order Number, Social Security Number, and Date of Birth.
(3)For “MatchLevel3”, click the checkboxes next to Order Number, Date of Birth, and Patient Name.
6.Following is the process for locating the In-house lab orders for resulting.
a)The user will click the New Lab Panelbutton or the first icon on the top toolbar (Appears as a blank sheet)
b)This will launch the Edit Test Results window.
c)At this point the user will click on the “binoculars” next to the Order# field.
d)This will launch the Find Order screen.
(1)At this point the user can enter the Order#, if known. (Note: This unique Order# is associated with each lab order placed in the EHR Lab module.)
(2)If the patient name is known, the user can narrow the search by entering that information. Then only orders that match that criteria will be returned.
(3)If the Order# or other search criteria is NOT known, then click on the FIND button (w/ binoculars). Once clicked, you will see the following message. Click OK.
e)The user will now be presented with a list of lab orders.
(1)This list can be sorted, (Ascending or Descending), by any column present in the list. Simply click on the desired column title and the list will sort based on that column.
f)Once the desired lab order has been located, double-click the order row or highlight the row and then click on the OK button. This will return you to the Edit Test Results screen.
7.Editing or Entering Lab Result Data for In-house Labs
a)Once the desired lab order has been selected, the following screen will be displayed.
b)The box above is highlighting all tests associated with this Order#.
c)To enter results on the above test requests, the user must expand each test request. This is achieved by clicking on the “+” to the left of each test request or by pressing “Add Result” button, (Sheet of paper). Below is an example of how the test request can be expanded by clicking on the associated “+” sign.
d)Below, is an example of when the user selects the desired test parameter to enter the associated test result. **Note that the row itself will change color and a forward triangle will designate that this row has been selected by the user.
e)The user can NOW enter the test results for “Glucose, Bld reagent strip” by clicking the column labeled “Result”.
f)The user can also enter values for Unit, Range, Flag, Date, and Time depending on the specific protocol used by each clinic’s lab. See example below.
g)Once all Test result data has been entered, the user must click on the OK button. This will return the user to the Lab Assign Main menu screen.
h)In the above example, the Order# n/a1236 appears twice in the list. This is because there were two distinct Tests selected at the time of order.
(1)The user has the ability to enter results on one of the ordered tests and not the other. (This may occur if one test is performed more frequently than another)
(2)This also allows the provider to obtain test results on Test A without having to wait several days for Test B to be completed.
(3)The arrows above also show the link between result panes and allow the user to view what data was entered for the associated Test.
i)If the entered results are correct, the user is ready to process the data for transmission to the patient’s EHR.
8.Saving Results of In-house labs to the patient’s EHR
a)From the screen shot above, the column labeled “MATCH” shows a value of “0” for each of the records.
(1)Select the row or rows that are to be saved.
(2)Once the row (lab test) has been selected, click the button from the top toolbar labeled
“Refresh lab panels” or the following icon.
(a)This will re-evaluate the patient and lab orders and match the results based on the Match Rules that were entered previously. If the selected patients and results match
within the EHR Lab module, then the Match Rule that was successful will appear within the MATCH column, (i.e. 1, 2, 3) or 0 if no match rulewas successful.
(b)To Manually match patients and lab orders and bypass the automated routine, follow this procedure:
(i)Select the desired order.
(ii)Click on the icon labeled Manually Match Lab Panels, or
(iii)Now the FIND ORDER screen will appear. Click on the FIND button with binoculars on the right side of the screen or you can enter the ORDER# if it is known.
(iv)This will retrieve the specific order or all orders for this location, depending on what was entered in the previous step. The default sort order for the list is DATE, most recent to oldest order. Select the order that matches the patient and test orders that you entered lab results on earlier. Then click OK.
(v)You will be returned to the main menu for Lab Assign, and the value for the selected test in the “MATCH” column will be updated to “Manual”. See example below.
(3)The final step is to save the information. To do this, click the diskette iconfrom the top toolbar; this will save or Commit the information to the database.
(4)The screen will refresh and the test result row that was saved will be removed from the screen.
(5)You can verify that the results were saved to the patient’s EHR, bring up the same patient within the EHR application.
(6)Once you are back in the EHR application, launch the LAB module from the lower right-hand corner,
(7)The following screen will appear. Note the lab result from 3/27 next to the arrow.
9.Since the way to enter in-house lab results in Lab Assign is not very efficient, we have developed a template for users to document in-house lab results. We now have three (3) buttons on the Record Vital Signs(Ahn_VS_WA_Std) template (see items circled in red on screen shot below).
a)Enter in house lab results – allow users to enter all in-house lab results.
b)Enter UA Results – allow users to enter UA results as we have before.
c)Results summary – Show all lab results
III.Future lab documents
A.Two (2) Future Lab documents have been created. One of the documents is for the offices that require their patients to make an appointment prior to the lab draw. The other one is for the offices that do no’t require their patient to make an appointment prior to the lab drawn.
This is what we have in the document for the offices not requiring patients to make an appointment prior to Lab draw:
AHN / NextGen Laboratory – Lab Assign Training Checklist
Attendee Name:______Date:______
Location:______
(**Checkmark each agenda item as it is covered and you the attendee understand the principle and/or usage.)
Created: cb/1_2005
Reviewed: JJ/10_2011
Section 10: The NextGen Lab Module & Lab Assign ModulePage 1 of 20
Section I: General/Setup
___Logging into the EHR application
___Ensure proper access
___Location of the Top toolbar & components
___Icons
___Drop-downs
___Location of the History toolbar & components
___Tabs
___Encounter
___Demographics
___Categories
___Patient’s Encounter window
___Types of Items drop-down
___“Tic–Tac–Toe” region
___Setting up preferences w/in EHR
___General tab
___Main Toolbar tab
___Medical Records tab
___Templates tab
___Medications & Formulary tabs
___Process for activation
Section II: Inbox / Workflow
___Activating Inbox/Workflow screen
___Workflow components
___Appointments Window
___Preferences
___Utilization
___Tasks Window
___Task tab creation & order
___Preferences
___Task displaying
___Utilization
___Email Window
Section III: Template Usage/Migration
___Choosing a Patient encounter
___Launching the Master_IM template
___on Creating a NEW encounter
___from Select Template routine
___from the Patient encounter window
___Master IM data entry
___Patient status (New/Established)
___Department
___Visit type
___Department dependent
___Various reasons
___Lab Draw only
___Chart update
___Utilization
___Use of Navigation Pane
___Document / template saving
Section IV: Lab Master Template
___Navigation to the Lab Master template
___Navigation Pane
___Link from Visit Type (lab draw only)
___Lab template components
___1st of 3 tabs
___Today’s assessment & Chronic Conditions
___Entering assessments
___Entering Chronic Conditions
___Lab specimen information area
___Lab testing menus
___Primary order/testing window
___In-House testing menu
___Future Labs template/pop-up
___“Other” labs pop-up
___Miscellaneous Comments field
Section V: Lab Order Entry
___Lab Ordering Workflow
___Pre-EHR (Paper & lab req)