NEXTGEN LAB ORDER AND RESULT DEMONSTRATION

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NEXTGENLAB ORDER AND RESULTDEMONSTRATION

• This demonstration reviews ways in which you can
  order lab tests, then view and respond to the
  results. Details of the workflow will likely
  vary somewhat, depending on specialty and clinic
  policy, though this should give you a good idea
  of NextGen functionality.
• This has been prepared with EHR 5.6.5.63 and KBM
  7.9.2. Subsequent updates may display cosmetic
  and functional changes.
• Use the keyboard or mouse to pause, review, and
  resume as necessary.
• There is no audio with this exercise.

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Ordering Outside Lab Tests

• There are a few different ways to place outside
  lab orders, depending upon specialty, preference,
  or the nature of the tests youre ordering.
• Note to those who have previously received
  training on this topic
• This lesson updates the user to the new
  alternatives and recommendations in place as of
  October 2012.

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Specialties using the Advanced Template Set would
most commonly begin by clicking My Plan/Orders.
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Other specialties that dont currently use the
Advanced Template Set usually have a similar link
or button, such as the Custom Plan link on the
GYN template.
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A simple way to order lab tests is to use the My
Plan tab. Here weve selected the Diabetes
diagnosis, and picked several tests by clicking
their checkboxes.
When youve picked all the tests you need, click
Place Order.
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If necessary, select another diagnosis and add
more tests.
You can save the tests you commonly order for
specific diagnoses as Order Sets, and you can
continuously modify these on an ongoing basis.
(Info on the setup of Order Sets is covered in
the User Personalization lesson.)
If you havent set up an Order Set for a
particular diagnosis, you can also use the
built-in Quick assessments to order tests.
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You can also use disease management protocols to
order tests here.
As of this writing, we havent emphasized
Protocols due to some technical problems. We
hope to introduce the use of Protocols when these
issues have been addressed.
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After placing orders in any of these manners,
note that the Lab/Diagnostics/Radiology Order
Module Processing link changes color and has a
solid diamond. Click on this link to open this
popup. (The popup will usually appear
automatically as well if you click Save and
Close.)
Note Depending upon clinic-specific policies
and workflow, these next steps may be performed
by the nursing or front office staff.
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If necessary, select the Labs bullet. The tests
youve ordered will display.
You may note that diagnostic studies youve
ordered on the encounter will display if you
select the Radiology bullet. At present we
cannot submit such studies to the Radiology
Department using NextGen, so you can disregard
these.
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Click in the Vendor box and select LabCorp.
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From here you have a couple of ways to proceed.
You can select each test one at a time and click
the Include selected order button.
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The test will move to the bottom list.
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Alternately, you can select the Automatically
perform checkbox. If you do this, just clicking
on the tests will move them to the bottom list.
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To avoid sending invalid orders to LabCorp,
please dont click the Process/Submit button on
sample or practice encounters.
When all of the tests are on the bottom list,
click Process/Submit. Your lab requisition has
been sent to LabCorp, and the patient may go to
have the studies done. Click Save and Close.
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For common tests and common diagnoses, this is
the easiest way to order lab studies. But
sometimes youll need to order an
infrequently-used test, or request a test related
to a less common diagnosis. For this, click on
the Labs tab.
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To order labs from here, first select the
diagnosis at the top, then select the test.
Here, well order a Uric acid level for the
diagnosis of gout.
Then click Place Order. Repeat this process for
all tests needed, matching them up to the
corresponding diagnosis.
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You can click on any of the categories at the top
to launch a popup with more studies within that
category. Here the Chemistry popup has been
launched.
When youve selected all the tests you need,
click Save and Close.
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If you still havent been able to find the test
you need, click the Other Tests link, launching
the Other Labs popup.
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Select the diagnosis, then click in the 1st
Description box.
A pick list appears. Say we want to order thyroid
antibodies. Click anywhere in the pick list and
begin to type thyr.
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The list scrolls down. Double-click on Thyroid
Antibodies.
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Select other tests as needed. When done, click
Place Order, then Save and Close.
A tasking popup may appear you can use it if
necessary, or just dismiss it.
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When youve placed all the orders you need, you
would use the Order Module Processing popup as
demonstrated above.
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Notes about this method of lab ordering When
possible, the easiest thing for the provider to
do is to place orders via My Plan. The next best
bet is to place them through the Labs tab. This
also provides another behind-the-scenes
advantage Your orders are posted to the Order
Management template, so that they can be followed
to completion, just like all other diagnostic and
referrals orders. However, sometimes using the
Labs tab can be a little frustrating, since you
may have trouble finding the exact test you want
on the pick lists youre given. When this
happens, the user may wish to use the Order
Module.
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Begin by clicking the Order Module at the bottom
of the History Bar.
Most users will find it helpful to add the Order
Module to the Menu Bar as well.
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The Orders Module opens with the Results tab
displaying. Change to the Orders tab.
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Click New.
You may notice that if you click the dropdown
arrow, youll have the choice of Lab Order or
Radiology Order. Well only be placing Lab
Orders via this method.
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The New Lab Order popup appears.
Note these 3 tabs. The popup opens on the Select
Tests tab, which is where you will do most of
your work. However, there are times when you
might want to go to the General tab, so lets
look at that.
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Routine will be selected as the default Order
Priority, but you can change that to STAT as
necessary.
Billing type will be Third Party by default, with
insurance information displaying spontaneously.
The provider usually wont have to do anything
here, though it would be best to change Billing
type to Patient if the patient has no insurance
at all, to avoid an error message/task upon
sending the order.
Now lets go back to the Select Tests tab.
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Select the Performing Entity. For most of our
lab work, this will be LabCorp. (This may
display by default).
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Next select the diagnoses that are to be
associated with the order. Youll see the
patients chronic problems and any assessments
youve added today. You can also search for
additional diagnoses.
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Now select the tests you would like done. You
will initially see your Favorites List.
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You can use the Show Favorites button to toggle
back and forth from your Favorites List and the
pre-populated Practice Favorites List.
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An alphabetical list of Practice Favorites tests
will display.
If you dont see the test you need, click Search
All.
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Enter some search criteria then click Find.
Click the Checkbox for the desired test, then
click OK.
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If you click This Order, you will also see all
the tests youve ordered here.
Your test will be added to the bottom list.
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However you have selected tests, you can click
Add to Favorites to add them to your personal
Favorites List.
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Whichever way you pick the test, when you click
the checkbox, it will appear on the list at the
bottom.
If desired, you can fine-tune which diagnoses are
assigned to which test.
When selections are complete click Save Send,
and your orders will be sent to LabCorp.
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When your tests have been successfully submitted,
they disappear from the list at the bottom. You
can add more tests if desired.
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Occasionally you may need to generate an ABN
(Advance Beneficiary Notice) this can be done by
clicking ABN Options. Most of the time, however,
LabCorp will deal with this.
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Occasionally you may see this ! symbol. It
means there are Ask At Order Entry questions that
you need to answer. Clicking it takes you to the
Test Details tab.
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Respond to these questions by clicking in the
Answer box and selecting from the dropdown list.
(You dont have to worry about any of this middle
section.)
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If you try to Save without addressing the Ask At
Order Entry questions, youll get this popup.
After clicking OK youll have the chance to
answer the questions again.
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Note that you can check the STAT box if you wish
a test to be completed stat. (This gives you a
way to make an order STAT without having to go to
the General tab at the bottom.)
Unfortunately, in the past there was a flaw that
resulted in such orders not getting flagged as
STAT when transmitted to the lab. While this is
supposedly corrected now, there have been ongoing
sporadic reports of this problem persisting. To
be on the safe side, the user may wish to click
Save Print, giving the patient a paper copy of
the test requisition to take to the lab,
highlighting in writing that it is STAT.
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Note that you can use the Schedule Date/Time
dropdown on the Test Details tab to indicate a
test you wish to have done in the future.
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You can also type in the Test Comment field,
adding any other details you wish.
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More notes about lab ordering It can be
confusing to the user that NextGen has two
totally different ways to order labs
Template-based (via My Plan or Labs tabs) and
Module-based (via the Order Module). You will be
even more frustrated to learn that these two
methods dont communicate with each other under
all circumstances. NextGen is aware of this
problem, and is working to merge the two systems
into one. In the meantime, here are some tips to
help you choose the best/easiest method.
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More notes about lab ordering Whenever possible,
place orders via My Plan for over 90 of your
common orders this is fast and easy. If you
cant figure out how to order your lab via My
Plan, try to do so via the Labs tab. Either of
these methods posts the order to the Order
Management template, which makes it easier to
track the fact that we get results back. If you
cant figure out how to place an order via either
My Plan or the Labs tab, use the Order Module.
It can be an easier way to search for uncommon
tests.
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More notes about lab ordering Another
consideration is tests that require AOE Ask at
Order Entry questions. We have tried to turn off
the AOE requirement for most tests, since they
are actually questions that would be better
completed by the phlebotomist than the
provider. However, a few AOE questions must
still be answered by the provider. Prenatal Quad
Screening is an example, since the questions
include data about gestational age that the lab
tech would not be privy to. Currently, AOE
questions can only be easily addressed via the
Order Module. Whether you place the order via
templates or the Order Module, you will still
need to go to the Order Module to answer the AOE
questions.
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Reviewing Lab Results

• You will be notified about test results through
  your Task List.
• After reviewing results, youll use the Provider
  Test Action template to address them.
• You review test results through the Order Module,
  regardless how you placed the order.

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The primary way in which you will be notified
about test results is through your Task List.
Select the task and click the Go To Chart button
(you will accept the task along the way).
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Click on the Order Module button alternately,
you can select the Order Module from the
Encounter History.
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You can select a particular test and click Graph
to see a graph of that test over time.
The Order Module will open on the Results tab
test results will display in a grid.
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Results in RED are high. Results in BLUE are low.
You can click on any result to display full
details, such as the normal range.
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Results that are underlined have additional
comments. Click on the result to display them.
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To sign off on a result, go to the Orders Tab.
Alternately, you can click the Go to Order button
to go directly to that one test on the Orders Tab.
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Note that you can select a test then click the
Results dropdown arrow to see the results here,
too.
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Select the test and click the Sign-off button.
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Provide your User Name and Password, then click
Sign-off.
Check the Sign-off All Assigned Orders box if you
want to sign off on all the results at once.
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Sign-off details will display, though you may
have to scroll all way to the right to see them.
Signing off your lab orders here has the
additional effect of marking this lab result
notification as Completed in your Task List.
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Note there is an area here to enter sign-off
comments. If you use this, these comments can be
viewed later by clicking the Sign-off Comments
dropdown arrow.
While this is usable, we recommend another
method, which is somewhat more versatile, and can
also be used with other types of test results
(X-ray reports, outside paper reports, etc).
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To document plans, patient instructions, etc.,
open the Provider Test Action template, which
should be one of your preferred templates. (This
has since been replaced by the USA Provider Test
Action template.)
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With the Lab results bullet selected, lab results
are also visible here.
Using the Action details/Notes box and/or the
checkboxes below, acknowledge the test results
and indicate plans.
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Also document how these plans were communicated
to the patient (phone call, mail, patient portal,
etc.), or send a task to other staff if they are
to be the ones contacting the patient.
Finally, click the Test Action button to generate
a document that includes these plans.
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There are a few ways to print lab results, e.g.,
if you need to give a copy to the patient. If
you just want to print one lab order, on the
Order Module Orders tab, click the Results button
to display results at the bottom.
The Print Results button will allow you to print
that report.
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You have other options through the Document
Module.
Selecting LabResults.NGN will generate a report
with all tests done in the last 30 days.
(LabResults_ALL.NGN will generate a report with
all tests done on the patient since LabCorp
ordering went live circa June 2011.)
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Click the Printer icon to select a printer and
print the report.
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As mentioned previously, signing off the lab
order should automatically mark the task as
Completed. If necessary, however, click the
Completed checkbox.
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• This concludes the
• NextGen Lab Orders and Results demonstration.

How is it that we put man on the moon before we
figured out it would be a good idea to put wheels
on luggage?
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• This concludes the
• NextGen Lab Orders and Results demonstration.

How is it that we put man on the moon before we
figured out it would be a good idea to put wheels
on luggage?