Changes for the week of 4/13

Several Changes went into Production this week. Here is a brief synopsis of what went in and why.

Defaulting a Blank for Order Mode: When you enter orders for imaging, lab or contrast you will notice that the order mode field is now blank. This is by design. A pattern emerged that had users confused about what to do with the pop up, and the default of "Standard" was often selected in error. This lead to many orders, for OR cases as an example, that never made their way back for co signatures. You will now need to pick from the list of order modes depending on whether or not you need to send a co sign message to the ordering MD.

No more "Change Order" Icon in Ancillary Orders: Due to the complex nature of parent/child orders in EPIC, a pattern developed where users were checking in orders (which releases the child), then accessing and changing the parent order from Ancillary orders. This lead to some funky things in the system, such as revised orders defaulting to 99,999 occurences. The recommended change order process, using Verify orders, should still be used and this does not change that. What changes is that if you attempt to change an order in Ancillary orders, you will not see the change order icon and therefore will not be able to make the change in that manner.

Until Specified Orders: Since "go live" we have struggled with what to do with the problem with "until specified" orders. The problem was that the Order Composer which is used by MD's to detail and tailor their orders for imaging had a section in it called Frequency. In that section were some things that we depend on for things like your Schedule Orders report, but it also contained that nasty "until specified" button. We could not remove the button without removing things that our build relied on in RADIANT. There was a domino effect for making this change, and it was fairly complex. The starting point was removing the entire frequency section, so that the providers would no longer have the "until specified" button available. In order to replace what we needed from that section, a question was built and plugged into all of the imaging procedures that asked the MD to validate the Date the exam was to be performed. This essentially blew up how our Schedule Orders Report was designed to function. So we had to restructure how the Orders report figured out when an order was supposed to be performed. New filters were created to show only those orders that were meant to be performed "today". However, as in any transition of workflow, we had some orders entered before the change and some ordered after. This caused an initial hiccup, as the new filter created by EPIC filtered out a few orders that we did not want filtered. The problem was quickly fixed and the report is working as intended. Keep in mind that not all modalities have chosen to even use a date filter on their Schedule Order Reports. Some modalities at SMH including CT, see all of their orders regardless of the expected exam date. They instead manually filter these on a daily basis.

thank you

Updated Medical Imaging Order Set in Prod

The enhanced version of the Medical Imaging Order Set is now live in production. Its ID is still 1512 but it has been modified. The main change is that selecting various routes is now done by choosing the version of the medication or contrast by display name. For instance, there will be several versions of Omnipaque 300 listed. In order to document that you gave it via "IV", you would click the arrow next to the Omnipaque 300 line. This opens up a list of all the route options for Omnipaque 300. Choose the appropriate version.

Also notice that you are given a "range" of possible dose for the items on the list. This gives you the ability to document on the MAR the exact number of ML's administered.

General Radiant Update 3/20

Spring is officially here. With that comes Bob Schmook's irrational belief that Cardinals stand a chance in the NL Central. Here are some more rational things Radiant has been looking at and planning for.

• Our work with EPIC to try and get "order modes" to default to nothing has led to new plan. What we are going to be launching soon, is a default message that indicates that the user must select an appropriate mode from the list provided. This will prevent users from selecting the default, which is not selectable, and use discretion when picking order mode. This is especially important in getting appropriate co sign messages sent to ordering MD's.
• We are investigating a plan to decrease the number of errors in the "change" order workflow. As you know, when the wrong path is taken, it leads to odd system reactions such as ending up with 99,999 occurences of an order. We have a plan in mind which will ultimatly require all "change" orders to be done ONE way and the possibility of doing it incorrectly wouldn't exist. After some testing we will launch this plan ASAP.
• We have been working hand in hand to revamp the medical imaging order set. The changes are being reviewed currently and will be released to you as soon as we get the approval from management and super users. The change will allow for easier selection of the appropriate routes of administration.
• We are going to investigate removing the MD's ability to ever enter "until specified" as a choice for IMG orders. What sounds like a simple idea has several associated ramifications both to the MD and how our current Schedule Orders Report is set up. This will not likely be fully tested until after the St Clare "go live", but is a known area for pitfalls and is being looked at
• We are looking into a request by the MD's to be able to cancel scheduled imaging orders. This of course would have far reaching consequences and we are working with the MD representive as well as the Cadence (scheduling) team to map out an appropriate compremise.
• Based on a change in corporate policy we are going to give techs access to document allergies while in the end exam navigator. We will be sending out more information on this ASAP. This will, of course, be controlled by department policy, but we will provide the tools for you to make these edits on the fly.
• We are activly researching solutions for the highly problematic issue of pre procedure orders linked to IR appointments be lost. We think we have a workable plan which will bring this to an end. There some more testing that needs to be done, but the current proposal will be painless for the tech as well as the person who originally entered the orders. We have been give the ok by the ADT team to pilot our idea in the IR department so there will be more to come on this issue.
• We have been conspiring with our EPIC technical support team to address the issue of the Nuc Med staff being painted in a corner when a cardiologist dictates on their orders prior to the order being ended in EPIC. This means the tech can no longer change/revise the exam because the status has been changed to 'preliminary'. Often the techs need to change the exam at this point but are unable to do so for this reason. EPIC has just sent a few proposals which will be discussed fully and a plan will be presented ASAP.
• We recently got back our historical time out information that was 'lost'. The information was technically there, but it took some EPIC geekery to extract it. It was an error on my part when the "time out" form was edited. The information is now available once again.
• We are also actively testing SMH workflows in test environments to ensure that non of your current functionality becomes corrupted when St Clare goes live in April.

Happy Spring!

ED Trackboard

The legend that was temporarily lost from the ED Trackboard toolbar has been "found"! There was a security setting that needed to be changed and an unitended consequence was our disapearing toolbar. It is now back, along with an icon for "comments". The was added in response to a recomendation by the ASAP (ED software) team. Any comment you, as a tech, add here will be viewable on the trackboard to the entire ER. This differs from putting a "tech to tech" comment in your tech work list. It is another communication tool and is, of course, optional.

Why do I get 99999/99999 Occurances?

It appears that some users are still running into the issue of 99,999 occurances of an order being generated when "changing" from one img to another.

The cause is still being investigated, but one important bit of information is that it appears to be happening during the following (incorrect) workflow....

1. Order checked in
2. appt canceled
3. Ancillary orders used to change the order

Remember, when an order has been checked in (an you'll know it has been, if it has an acc#) you can no longer change the order using "ancillary orders". Keep the order on your tech worklist and use the "verify" button to make the change.

Important Note about revising exams

Revising exams correctly has proven to be one of the bigger challenges we have seen since implementing EPIC. This was especially true when attempting to revise an order across modality.

The key to making a successful revision is to use the "verify" tool. This is true whether or not you have checked in your appt. Very often, users were checking in appointments then cancelling them, then using ancillary orders to change the order. The problem with this workflow is that ancillary orders changes only the parent order. When the order gets checked in, the parent order releases a child order which is the order holding on to the accession number. PACS then shows the child order with the accession number, as well as the newly created order (from the change order process) with a brand new accession number. That is all bad news!

The good news is that you can avoid this by following these steps.....

1. Determine whether you need to change/revise the order
2. Determine if you need to change across modality
3. Use the "Verify" tool from your toolbar
4. Change the order from the old IMG to the new IMG
5. If you are changing across modality you will need to now reschedule the appt to the correct resource
6. If you need to reschedule, use the cancel/undo button to cancel the original appt
7. If the patient is an inpatient, the order will now be available on the Schedule Orders Report (of the correct modality). Schedule it from there
8. If the patient is and OP, you will need to access the order on the orders tab of the patients Appt Desk. Schedule it from there.
9. Once you change the order, cancel the original appt, reschedule it and check it in, the order should populate your Modality Worklist

This process keeps EPIC/Pacs/Powerscribe all in synch.

The important things to remember are ....

• use the Verify Tool to revise your orders (not Ancillary orders).
• If you are crossing modalities it is not enough to simply revise the order. You must also reschedule it to the correct resource for it to appear on your Modality Worklist.
• One note: If you need to revise an order that has not been scheduled yet, you can do so from Ancillary orders.

Thanks

Ancillary Orders hitch

A few users recently reported a hitch in the Ancillary Orders module. The tool would essentially lock down if the user attempted to locate the ordering MD by clicking the "spyglass" and listing every provider in the system. When the user then selected the MD, Ancillary Orders locked down and the user was unable to proceed.

This issue has been reported to EPIC but no fix has been created as of yet. In the meantime, users should simply enter (most of all of) the ordering MD's last name manually and let the system populate the field. Using the spyglass is prone to causing this error and it is a less efficient workflow since it would force the user to scroll through hundreds of MD's alphabetical names to locate the correct one.

If this or any other issue persists, let a super user or your manager know. If there is an emergent issue, call 5354.

Unscheduled Orders now available

As you may have noticed it is now possible to view all of the patients outstanding orders that have not been scheduled to an appointment. This can be done from either the Schedule Orders Report or the Tech Work List. Just highlight the patient you are interested in, scroll down to the bottom of the HTML field and view the results.

The unscheduled orders also are designed to print on the control sheet under the section that displays current appointments in medical imaging.

Thanks-