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.