List Reconciliation

Reconciling the medication and allergy lists – Every Patient, Every Visit.

Have you seen your List Reconciled function?  I hope so!  When a patient is placed in a room by the nurse or medical assistant, part of the standard workflow, for every patient at every visit, is to reconcile both the medication and allergy lists.  The good news is that you’re probably already doing this and have been ever since you started; Allscripts has just made it easier to do this officially in a way so that it can be tracked and proven. 

This is simple to do, and much easier than the old way of annotating on every allergy. 

Begin by doing what you’ve always done, asking the patient if they are still taking each of the medications on their list.  Remember the clinic policy is to D/C any medication the patient is no longer taking EXCEPT medications prescribed by Spine & Pain or Hematology.  Verify any unverified medications with the patient, and add them to either the current or past medication lists.  When you’ve finished with the medication list, click one time on any medication so that it is selected.  Then right click and scroll to the bottom of the menu by hovering over the black arrow at the base of the menu.

Click on List Reconciled.   When you do, a date will appear in the upper corner of the Meds box.  If you cannot see the date, click on the small down arrow on the far right edge of the box.  Whether or not you can see the date depends on your resolution settings (how big the font is on your display). 

For Allergies, confirm with the patient that they are allergic to all items listed and that each item has a reaction associated with the allergy.  If the patient has any additional allergies, add them.  If the patient has no allergies, be sure that you indicate that by listed either No Known Allergies or No Known Drug Allergies.  When you have confirmed all allergies, select any one from the list by clicking it one time.  Right click on the allergy and click List Reconciled.

As with the medication list, the date will appear at the top of the Allergies box indicating that the list has been reconciled.  You only need to do this for one medication or allergy in the list because the list reconciliation applies to all medications or allergies in the list.



“Hold For” Order Tracking Report

Whenever I’ve had to “hold for a representative”, I usually have to recount the information I’ve already given to that representative.  It is as if “holding for” is really a state of being in limbo, a sub-waiting room of sorts.  I’m still waiting, just in a different place.  Sometimes active orders have the status of Hold For instead of Active, as below, and like the example, are in limbo.

The reason that the order status is not Active is because the To Be Done Date is what is called a “fuzzy” date.  A fuzzy date is any date that is not exact.  Instead of November 30, 2010, a fuzzy date would be Before November 30, 2010.  When an order is entered with a To Be Done Date set for a fuzzy date, the system classifies the status as Hold For because it is holding for the exact date. 

Sometimes a fuzzy date is used in the instance of ordering a lab test to be done before the patient’s next appointment, or after a particular date due to insurance billing guidelines.  The problem is that the patient presents to the lab when they are instructed, regardless of how that is input into the system.  If you don’t want a patient to have a lab drawn until after November 1, 2010, then put that as the To Be Done Date, just November 1, 2010, and the lab will know not to draw that lab until that day or after.  If you want a test done before a certain day, tell the patient. 

When an order is entered with a fuzzy date and has the status of Hold For, it will not show up in the order tracking reports run by each office.  These reports are run to ensure that results are received and patients are having all the tests ordered for them by the provider.  If orders are missing from this report, they can’t be tracked which does not allow for the best patient care possible. 

To track orders with a status of Hold For, use the Order Tracking Report with the status of Hold For only, removing Active and In Progress, and remove the dates in the To Be Done Date field and the Expiration Date field.  Once you’ve run this report and found those orders with a status of Hold For, you can edit the order to adjust the status to Active.

To edit the order, right click on the order and choose Edit.

In the To Be Done Date field, you will see that there is a fuzzy date.  Click on the calendar next to that field.

At the top, there are circular buttons for On, Before, After and Approximately.  A fuzzy date means that Before, After or Approximately is checked.

Click the On button and set the date as appropriate.  Click Ok, Commit, Save & Continue.

NDC Numbers & Med Admin Injections

We have received several calls regarding a Task that is being sent to the Provider after recording an injection. The NDC (National Drug Code) is now required to be entered in the Administration Details of any Injection; if you do not enter the NDC, the system will send a Med Admin task to the provider as below.

If you double click on the task, you will be directed to the Record Administration screen so that the NDC# can be entered. That will remove the task from your list.

Where do you put the NDC#? See below, right underneath the Site and above the Expiration date.

So where do I find that pesky NDC#?

In most cases, the NDC# will be on the container and labeled as NDC#. It is an 11 digit number in 5-4-2 format. For example: NDC# 12345-6789-01. However, some companies will only list nine numbers as the NDC therefore requiring the provider to “fill in the blanks”. For example, the container reads “NDC 1234-123-01”. The provider has to place a zero in the first spot of the 5-4-2 format. In this example, the actual NDC# would be 01234-0123-01. Also, some manufacturers will not spell out the NDC on the container. They will include it as part of the bar code on the container. The bar code is listed with a series of numbers underneath it, and this would then generally be considered as the NDC#, keeping in mind that zero’s may have to be added if absent.

If there is a question as to what the NDC# is (maybe only partial information is on the container—9 numbers, etc.), then generally at the end of the patient package insert, the NDC#’s are listed in the “How Supplied” section. The NDC#’s for all product forms supplied are listed, and it would then be a matter of matching up the information to what is actually on hand.

Scheduled Orders - Recurring

The workflow for recurring orders is changing.  Many of you have used Order Reminders to set up recurring orders.  We have learned that this workflow is not optimal for recurring orders.  When you have a patient that will need the same test, for the same diagnosis, on a regular basis (i.e. an A1C every 3 months for Diabetes), use the Scheduled Orders function. 

When you Schedule an order, that order shows in the patient's clinical desktop in the Orders tab with all scheduled dates.  Six days before a due date, the system will automatically generate the next order instance.  What that means for you is that you put the order in one time, and after that, the system creates them for you.  They are also visible on the HMP with a Q in the second "Schedule" column, just like the reminders.

To schedule an order, click on the new order icon (the beaker) to get into the ACI.  Click on the name of the active problem that is linked to the order in the upper left corner.  Be sure that you have selected the correct provider name (if you aren't the provider), then click on the Schedule button at the top of the ACI.

When you click on the Schedule button, a Schedule Dialog box will appear. 

Check the circle next to Recurring and fill out the recurrence pattern.  If the day you order a test is the 31st, you will get a message that on any month without 31 days, your order will fall due on the last day of the month, as below.

Set your start date, if any day other than the day you enter the scheduled order.  Then, choose the end date.  If you choose "End By", it will select one year by default.  You can change this date as needed.  There is no need to click Generate, as the dates will automatically generate.  Just click OK.

Search for the test you are ordering and check the box beside the test name.  It is important that you set the schedule BEFORE selecting the test.  This schedule of recurrence will apply to all tests you select until you click OK in the ACI.  If you would like to order a test that does NOT have this schedule, click the circle beside Schedule so that it is not marked.  If you want to CHANGE the schedule for another test, click Schedule and follow the above steps again.  You will see in the ACI there is a message that says Recurring beside the Schedule button at the top. 

When you have finished selecting your orders, click OK at the bottom of the ACI.  Click Commit.  Your scheduled order will appear in the Orders tab with the first active order as below.

When the patient presents to the lab for that order, the lab will mark as Complete ONLY the order with the Status: Active, not the one marked In Progress with all scheduled dates.  The system will automatically generate the next instance of the order six days before it is due.

Filtering Your Chart View

You have the ability to filter your chart view to find a specific item (i.e. any EKG's done for a patient), only things done by a specific specialty or a particular provider, within the last year, etc.  This can be a helpful way to find what you are searching for quickly.  To filter your chartview, click on the icon that looks like a funnel in the chartviewer box, the Quick Filter. 

When you've clicked on the Quick Filter (funnel icon), you will see that there are several options for filtering the chart.  There are drop down boxes where you can specify Provider, Specialty, Section, Encounter, etc. as well as a Search field at the top.  Use the Search field to search for an item type, such as EKG. 

As you type the item name into the search box, the chart will filter to that item.  Keep in mind that the search field searches the item name.  So, if you are searching for EKGs, you will only find those chart items that have EKG in the item name.  See below.

If the EKG has been scanned into a Correspondence folder or saved as "Result", it will not be found in this search. 

You can also use the Date dropdown to select Any Encounter Date, Last Month, Last 3 Months, Last Year or a Date Range. 

You can use the Date filter alone, or in combination with any of the other dropdown selections, such as Specialty.  If you want to see any items done in Cardiology in the last year, set your Specialty first by clicking on the dropdown arrow beside Specialty and checking the box beside Cardiology. 

Then click on your Date dropdown and select Last Year.  Your Specialty box is red to indicate that there is a selection made in that category.  You will see that the chart filters down to items done by Cardiologists in the last year for that patient. 

The chart filter will hold as long as you stay in that patient's chart.  When you go to another patient's chart, the filter will reset and only show the filtering options.  To remove the filter options, simply click again on the Quick Filter (funnel) icon, and the chart will return to your default view.

Don't Forget the qChart!

One of the most useful, and often overlooked, icons in the EMR is the qChart, or, the quick chart.  The qChart is a quick way to look at the chart without going out of the screen you are in to get back to the patient's clinical desktop.  It is available on every screen in the EMR except the chart (since you are already there). 

The qChart icon is the first icon on the Clinical Toolbar and looks like three boxes.

When you click the qChart icon, another window will open up and show the Clinical Desktop on top of the window in which you are working. See below, qChart opened while in the Task List.

The qChart can save you time as a quick reference of the patient's chart, allowing you to look up information or perform regular tasks while not leaving your current window.  For instance, if you are in the Task List and need to renew a patient's medication, use the qChart to get to the patient's medication list.  Because it is a smaller window, you may not see all of the buttons you are used to seeing at the bottom of each box.  On each box, in the bottom right corner, is a small downward arrow that says Toolbar Options when you hover over it.  Click that arrow to make the other buttons available. 

You can also use the qChart from the Schedule to print a requisition, from a Note to D/C or renew medications, to view a previous note or from Charge Entry.  To save time & clicks, don't forget the qChart!

Result Verification Worklist - New View

There is a new option for Providers and Result Verification.  A new Worklist view has been created that more closely resembles v10.  To see this new view, click on Tasks on the vertical tool bar, then the Worklist tab is the last tab across the top.

Note that the patients with results to be verified are all listed down the left hand side so that you can choose which one to view.  When you verify from this list, the patient's name will appear in italics until you navigate away from the Worklist and back again, at which time it will not be in the list.  The results to be verified are visible on the right.

You will see options along the bottom to Update Provider (if you have received results that do not belong to you), to Print Results, Annotate and Verify.  Depending on the size of your monitor and screen resolution, you may be limited in how many options are visible at the bottom of the screen. 

If you click on the small arrow in the bottom toolbar at the far right (Toolbar Options), the other items will show for selection.

Click on Verify to see all options for verification.

When you click any of the options there, you will have the same Result Verification Dialog box allowing you to choose the action to take and annotate that is accessible when verifying through the other Worklist view.  You still have the Worklist view that incorporates the chart viewer, medications, etc., and you will still be directed to that Worklist if you double click a Verify Patient Results task from the Task List.  This is simply another option.

Standard Patient Worklist View

What are Unverified Medications?

What are unverified medications?  What do we do with them?

"Unverified" medications come into our system from RxHub for the previous 6 months.  It is a form of medication history that comes from the patient's insurance in addition to information provided by the patient.  They show up in the medication list under the heading Unverified like this:

While you are reviewing medications the patient is taking with the patient, these unverified medications need to be verified as appropriate.  Treat them like medication history.  To verify the medication, right click on the medication and click on Verify and Add.  Your options at that point are:

Choose either Active, D/C or Complete as clinically appropriate to add the medication to the patient's Active Medications or Past Medications.  If the patient reports that they have never taken this medication, they will need to contact their insurance company for this to be completely removed from their record.

Once you have verified all medications, you will be able to reconcile the medication list by right clicking on any medication and choosing List Reconciled.  You will not be able to reconcile the list until all Unverified Medications are verified.