Satisfies Element 5A-1 and 2

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1 Satisfies Element 5A-1 and 2 Outstanding Lab/Diagnostic Imaging (DI) Protocol Initiated 6/18/14 JL Updated 12/16/14 JL eclinicalworks automates tracking and tasking of lab or diagnostic imaging orders that are generated by the ordering provider within the EMR. When the lab order is generated, it automatically defaults to the phlebotomist. The DI orders automatically default to the ordering provider s designated Medical Office Assistant (MOA). When the lab specimen is obtained or the test is scheduled with the radiological facility, the phlebotomist sends the order to the holding queue. This is done by assigning the order to z- Pending,Orders. When the order is resulted, the lab interface populates the results directly into the electronic order with the EMR (indicated by the pink paperclip) and sends that order back to the ordering provider. Once the results are reviewed by the provider, an electronic message is sent to a staff member to contact the patient. Each staff member and provider has their own individualized order/result inbox. Below is a workflow algorithm indicating how lab and DI results are followed. Staff continuously monitors the holding queue and reconciles outstanding orders Staff contacts patient or testing facility to reschedule test or obtain results Lab order generated in EMR DI order generated in EMR Lab order defaults to phlebotomist DI order defaults to MOA Order sent to holding queue z- Pending, Orders Result received by interface or fax and sent to the ordering provider Results sent to staff member to contact patient with necessary follow up Below is the descriptive step-by-step process. 1. To view Outstanding Labs/DI, click on the individualized lab/di orders and results inbox (L jelly bean). At the next screen, click on All on the Labs/DI/Procedures line. On the next line, click on the down arrow next to provider and click on the provider you want to work on Outstanding Labs/DI for. Click on the down arrow next to Colleen Bingham, M.D. Jeffrey K. Brummer, D.O. Michael G. Brummer, M.D. Jeffrey Crowell, M.D. Amanda Bierman, M.D. Thomas Heischmidt, M.D.

2 Assigned to and click on all. Two lines down click on order date to change date from oldest to newest or newest to oldest. 2. Outstanding Labs/DI should be no older than 3 months. (Example: if labs are ordered on January 5th, they should be followed up in Feb, Mar and Apr.) 3. Each lab is going to have different circumstances; please check over each one thoroughly. Things to consider before sending a letter: Has the order just not been attached to the result? (Check patient documents) Colleen Bingham, M.D. Jeffrey K. Brummer, D.O. Did the patient have the labs order in the future? (Check patient lab tab) Is this order a duplicate? (Check the patient lab tab) Does the patient have an upcoming appointment? (Check telephone encounters) 4. Initial letter can be mailed out as early as one week before lab is due. Letter should be mailed no later than 30 days after lab is due. Additional letters or phone calls should be sent or made 30 days later. All letters must be tracked when running. You need to put date and your name in the internal notes section when printing letter. 5. Each time a patient is contacted about an Outstanding Lab/DI, the date should be entered in the Result Field on the Lab/DI screen. If there are previous dates from previous attempts, those dates should be left in the Results Field so the number of times the patient has been contacted can be seen without going into the Lab/DI screen. 6. Tracking dates in the results field should look like this: z 6/12/11, 5/12/11, 4/12/11. By putting the most recent date directly behind the z you can sort labs by the results and it will show you which labs are due for a letter. 7. A letter will be mailed or phone call made monthly to remind patient of lab orders every 30 days. If we get no response from the patient within 2 weeks of 3rd letter, open a TE to document non-compliance. 8. In the telephone encounter the following should be documented: Names of labs, date labs were originally due, how many times and what methods used to contact patient. In the action taken, go to browse and select L then choose Lab Non- Complaint. This will automatically insert We have made 3 attempts to contact patient to schedule overdue lab tests with no response from patient. Lab order closed due to non-compliance. into the TE. Then review the TE. Under the DI tab, take out the z in front of the dates (leave the dates) and put Non-compliant where the z was. You may review the lab at this time as well. Make sure the Don t publish to Web Portal is checked if you are reviewing for noncompliance. 9. Results and Outstanding Orders for Protime/INRs will be taken care of by the nurses. 10. Any time we are scheduling appointments we need to check to see if patient has outstanding orders. This needs to be done by front office, MOAs and nurses. 11. The Lab Technician will remove these dates and any remarks in the results field when the patient comes in for the labs. If the results are being attached to orders by the front office, these dates and any remarks should be removed from the results area when attaching the results to the order. If results come across the interface these dates and any remarks will also need to be deleted before reviewing the lab. Michael G. Brummer, M.D. Jeffrey Crowell, M.D. Amanda Bierman, M.D. Thomas Heischmidt, M.D.

3 12. Nurse MOA float will count the number of Outstanding Labs/DI and send an to everyone in the office on the first of every month. 13. Everyone in the office who is trained on Outstanding Labs/DI should work on these as they have time. 14. Each month when the count is ed, each provider s MOA is responsible for making sure the Outstanding Labs/DIs is followed up on monthly. If the MOA does not have time to work on them, they should send out an to the office asking for help. 15. Provider lab protocols must be followed for ongoing medication to be refilled. **Also see outstanding lab, XR and DI test instructions** Colleen Bingham, M.D. Jeffrey K. Brummer, D.O. Michael G. Brummer, M.D. Jeffrey Crowell, M.D. Amanda Bierman, M.D. Thomas Heischmidt, M.D.

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5 Satisfies 5A-3 and 4 Flagging Abnormal Lab and DI results Initiated 7/10/14 JL Any lab or diagnostic imaging results that are abnormal will be flagged as high priority to alert the provider there is a need for immediate review. When labs or DI come across the interface that are abnormal the lab/di will electronically get marked as high priority, causing any lab values that are electronically entered in the EMR to become red in color. (There are not any DI values placed in the DI order) Also by marking them as high priority, a red exclamation point will electronically be placed in the far left column of the lab/di screen. The lab/di then gets electronically placed in the ordering provider s lab/di box for review. If there are any abnormal labs/di in the ordering provider s lab/di box, it will turn their lab/di icon, or Jelly bean, red alerting them there is an abnormal lab/di to review. If labs/di comes through the fax box as abnormal, the fax box operator will input all necessary lab values in the corresponding lab/di order and attach the documented lab/di results to the corresponding order. They will mark the lab as high priority; this will make the lab values entered, red in color. They will then send the lab/di to the ordering provider s lab/di box. As above, once an abnormal lab/di result is placed in the ordering provider s lab/di box, it will turn their Jelly bean red; alerting them there is an abnormal lab/di to review The Jelly bean is a term used to describe the icons located in the upper right section of eclinicalworks screens. These icons alert users to new documents, results, messages, etc. for review. Additionally, they act as short cuts to additional screens. See example below: erx/ Refill prescriptions Office Visits/ Schedule Documents/ Fax In- and Outbox Referrals Telephone/Web Encounters Labs/DI High Priority/ Emergent Message Colleen Bingham, M.D. Michael G. Brummer, M.D. Amanda Bierman, M.D. Jeffrey K. Brummer, D.O. Jeffrey Crowell, M.D. Thomas Heischmidt, M.D.

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8 Satisfies Element 5A-5 Notifying Patient/Families of Normal or Abnormal Test Results Initiated 7/10/14 JL Updated 12/17/14 JLB All lab and/or diagnostic imaging (DI) results are automatically populated into the provider s lab/diagnostic imaging inbox (L-jellybean). The process below explains how patients are notified of their normal and abnormal lab or DI results: 1. Once a provider reviews a normal or abnormal lab/di result, they will either create an electronic message (Telephone Encounter or TE ) giving the results along with their recommendations, or they will ask that a normal lab letter be mailed to the patient. At times, the provider may document to send a normal lab/di letter under the lab/di order itself. They will then assign the Telephone Encounter or the lab/di order to a medical office assistant (MOA) or a nurse. 2. Once the MOA or nurse receives the Telephone Encounter or the lab order (as assigned by the provider), an phone call will be made to the patient or family member within 1 business day of the provider review for abnormal results, and within 2 business days of the provider review for normal results. 3. If the MOA or nurse is unable to contact the patient or family member by phone within the designated time constraints, he or she will refer to the Telephone Triage Protocol for further instructions.

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