Lab Tracking. e-MDs Solution Series 8.0

window, listing all chosen items. Additional searches can be performed at this time. When all desired items are in the Select List, click Accept.

ƒ

To select multiple codes at one time,

click the first code to be linked, hold down the Shift key, and then click another code to select a contiguous series of codes. Or, if the codes are not in a series, click the first code to be linked. Then, while holding down the Ctrl key, click the other codes. When the group of codes is properly highlighted, right-click and choose

Add Code(s) to Select List.

3. To copy a subset of links: links, click Select All located below the blue bar labeled CPTs.

Copy Selected, and choose the correct menu item indicating to where the links will be copied.

c. Continue as outlined above.

Lab Tracking

Lab Tracking is a module that works with e-MDs Chart, DocMan and TaskMan to track labs, radiology tests, and procedures, and to notify the ordering provider when results for these items are overdue. It works like a tickler file to help providers keep track of outstanding items by their respective CPT and

HCPCS codes. A pre-defined rule within Rule Manager determines if these items are overdue and automatically sends a message, using TaskMan, to the ordering physician and/or designated medical assistant. All CPT and HCPCS codes can now be set to “trackable” status, so that once they are selected within a Visit or Order Note in e-MDs Chart, a pre-defined “clock” is started.

To prepopulate the database, due dates for a select subset of codes were determined and loaded into the system based on the TYPE OF SERVICE parameter the code belongs to such as Diagnostic Labs,

Diagnostic X-rays, and Medical Care (includes procedures). These due dates may or may not represent the actual expected due dates for individual users and are completely customizable.

Lab Tracking Interface - Overview of Lab Tab

The Lab Tracking Window provides a patient specific view of pending labs/tests/procedures and allows those items to be marked as complete. At the top of the window, identifying information including the patient’s name, date of birth, gender and age are displayed. On the Lab tab, a split screen displays due dates, codes and descriptions for CPTs in the upper part and due dates, codes and descriptions for

HCPCS in the lower part. The codes listed here represent items that were ordered for this particular patient and are currently being tracked. This list can include items that are both coming due and that are already overdue. A total of three messages identifying overdue items will be sent to the ordering provider

(as well as the assistant designated in the Visit Details of the note) when items are determined to be overdue. Even after all messages have been sent the item will remain in this list until it is marked as done.

Pending items can be marked as complete (the results for these items have come in) by selecting the check box that appears next to each item in the list and then clicking the Save button. This marks the items as done and prevents overdue messages from being sent for those items.

To select all items in the list, click the check box located at the very top of the list (next to the column titles). Clicking that check box automatically checks all the remaining check boxes.

At the top of the window is a button labeled Groups. The Groups button opens a User Group window that allows the provider to identify additional people to be notified of overdue items. By default the provider and assistant specified in the visit details of a note are the only people notified unless otherwise indicated in the User Group window. e-MDs Solution Series Chart User Guide 8.0 R01

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Accessing the Lab Tracking Window

The Lab Tracking window shows patient specific pending labs/tests/procedures and allows those items to be marked as complete. It can be accessed from within both Chart and DocMan.

To access the Lab Tracking window from Chart:

1. Open a patient chart and click the Lab Tracking icon which can be found on the gray patient specific tool bar that runs across the top of the patient’s chart just below the blue demographic bar.

2. To access the Lab Tracking window from DocMan:

3. Open a patient chart and click the DocMan icon to open DocMan. Then within the DocMan module, click the Lab Tracking icon on the main toolbar.

OR

Open a patient record in the DocMan stand alone module. Then within the DocMan module click the Lab Tracking icon on the main toolbar.

OR

Open a patient record and click TOOLS then LAB TRACKING on the main DocMan toolbar.

OR

Open a patient record, select a specific category that is marked for tracking such as LABS,

RADIOLOGY, etc… and click NEW DOCUMENT prior to scanning.

OR

Select a specific category that is marked for tracking such as LABS, RADIOLOGY, etc. and click

TOOLS then IMPORT DOCUMENT from the main DocMan menu.

Mark Tracked Labs as Complete

CPT and HCPCS items that are ordered in a Visit or Order Note will be designated as pending and overdue messages will be sent, via TaskMan, unless the items are marked as complete (results are in).

The Lab Tracking Window provides a patient specific view of pending labs/tests/procedures and allows those items to be marked as complete. At the top of the window identifying information including the patient’s name, date of birth, gender and age are displayed. At the bottom of the window a split screen displays due dates, codes and descriptions for CPTs in the upper part and due dates, codes and descriptions for HCPCS in the lower part. Next to each CPT and HCPCS code is a check box.

To mark items as complete in Chart:

1. Open the Lab Tracking window from within Chart by clicking the Lab Tracking icon

2. Click the check box next to the item or items for which results have been obtained.

3. Click the Save button to activate the changes.

4. This marks the items as done and prevents overdue messages from being sent for those items.

To mark items as complete in DocMan:

1. Open the Lab Tracking window from within DocMan by clicking the Lab Tracking icon click Tools then Lab Tracking on the main DocMan menu toolbar.

2. Click the check box next to the item or items for which results have been obtained.

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3. Click the Save button to activate the changes.

4. This marks the items as done and prevents overdue messages from being sent for those items.

OR

1. Open a patient record.

2. Scan an item into a Category in DocMan that is set up for tracking in DocMan such as Labs or

Radiology (see Lab Tracking in DocMan for details on setting up tracking categories).

4. This will launch the Lab Tracking screen so pending items can be marked as complete (this will prevent overdue messages from being sent).

5. Click the check box next to the item or items for which results have been obtained.

6. Click the Save button to activate the changes.

7. This marks the items as done and prevents overdue messages from being sent for those items.

8. To finish the scan, select a document type along with the option to send or not send a message

(with the scanned image attached) to the ordering provider as notification that the results have arrived.

OR

1. Open a patient record

2. Import an item into a Category in DocMan that is set up for tracking in DocMan such as Labs or

Radiology (see Lab Tracking in DocMan for details on setting up tracking categories).

4. This will launch the Lab Tracking screen so pending items can be marked as complete (this will prevent overdue messages from being sent).

5. Click the check box next to the item or items for which results have been obtained.

7. This marks the items as done and prevents overdue messages from being sent for those items.

8. In the next window pick the document to be imported and click Open.

9. In the Document Info window click the … button and select a provider to be messaged.

10. This will send a message to notify the provider that the results are available.

Tracking Radiology Results

When a user imports a radiology result (narrative report or image), the result is listed on the Radiology tab in the Lab Tracking window. The user can then take various actions by clicking the drop-down button in the Document Type field, selecting an option, and then clicking Save. e-MDs Solution Series Chart User Guide 8.0 R01

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Remove From Tracking Options

The Remove From Tracking options allow the user to document that no further result is expected and to indicate whether the result received is a narrative report or image or combination of both. When a user selects one of these options and then clicks Save, several things happen:

• The result is removed from the Lab Tracking window.

• The result is linked to the CPT code in the chart.

• The result is flagged as an image or narrative report. (This information is used for certain

Meaningful Use reports.)

• A note indicating the type of result received is appended to the Orders Descriptions column in the

Order Tracking window.

Leave On Tracking Options

The Leave On Tracking options allow the user to leave the result in the Lab Tracking window and to document that a narrative result has been received and the image is expected (or vice versa). Selecting one of these options and clicking Save also links the result to the CPT, flags the result as an image or narrative, and appends a note to the Orders Descriptions column in the Order Tracking window.

Notification of Overdue Labs

The Lab Tracking module tracks labs, radiology tests, and procedures, and notifies the ordering provider when results for these items are calculated to be overdue. These notifications are sent in the form of a

TaskMan message that contains information about the patient that includes the patient name and date of birth, as well as information about the overdue item that includes the calculated due date and the CPT or

HCPCS code and description.

A total of three messages identifying overdue items will be sent to the provider, as well as to the medical assistant designated in the Visit Details of the note, when items are determined to be overdue. These messages will be sent on 3 consecutive days as reminders to investigate the overdue item. After the third and final message is received no more messages will be sent. These messages will be stored in a message category in TaskMan labeled Lab Tracking and any messages marked as URGENT will be designated as such by a red ‘P’ flag.

Notifying Additional Staff

By default only the Provider and Assistant listed in the Visit Details window of a note are notified of an overdue item. The Provider is a required field in the Visit Details but the Assistant is not, so be sure to list an ASSISTANT if you would like someone other than the PROVIDER of the Visit or Order Note to be e-MDs Solution Series Chart User Guide 8.0 R01

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notified of overdue labs, tests, procedures. Additionally, other staff members can be chosen to be notified by using the Groups button at the top of the Lab Tracking window.

Note:

Additional staff can be added either permanently or temporarily. Adding names temporarily can be useful for coverage of absences such as vacation schedules.

To select additional staff for notification:

2. A window labeled User Group will open displaying a list of users for the facility.

3. Select the desired staff member by clicking their name in the left column.

4. Click the right-pointing arrow in the middle column to add the selected name to the Group list

(multiple names can be added to the list).

5. Once the desired name or names have been added to the Group list click the OK button to save the changes.

Note:

To remove a name from the list highlight the name and click the left pointing arrow in the middle column and then click the OK button to save the changes.

Setup Tracked Items

The Lab Tracking module tracks labs, radiology tests and procedures based on their CPT and HCPCS codes and a number of days value associated with the codes. This number of day’s value represents the number of days that an item will be considered pending before it becomes overdue. For example, if a

CBC has a number of days value of 7 associated with it and it is ordered in a Visit or Order Note, it will be considered pending for 7 days and will become overdue as of day 8 if no results are available within that time.

As part of the content included in the database that ships with Solution Series products, e-MDs provides default values for most labs, radiology tests, and procedures. These values are set based on the specific

TYPE OF SERVICE (TOS) under which the code is categorized. The following table denotes the default values set in the database.

CPT (TOS)

Diagnostic Labs

HCPCS (TOS)

Diagnostic Labs

Due Date

2 weeks

Diagnostic X-Rays* Diagnostic X-Rays* 3 weeks

Medical Care Medical Care

*Mammograms are set to 6 weeks.

8 weeks

The tracking values set for these codes can be left at the default setting or if they do not meet the user’s requirements they can be edited to reflect values based on an individual clinic’s preferences.

Permanent changes to tracking must be made in the Billing Details of either the CPT or HCPCS reference menu.

Lab Tracking Rule

Lab Tracking works in conjunction with Rule Manager to track overdue rules. A default rule named Lab

Tracking is installed with Rule Manager to accomplish this. As with any other rule in Rule Manager this rule can be set to run daily, weekly or monthly. As part of the default setup the Lab Tracking rule is set to run on a daily basis although to have rules run automatically the Windows Scheduler needs to be set up work with the Rule Manager. To set up the Windows Scheduler to work with Rules Manager see Set Up the Rule Schedule for details. e-MDs Solution Series Chart User Guide 8.0 R01

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Note:

When setting up Lab Tracking to run automatically, it is recommended that this rule be run at night since it may need to query a large number of records in the database depending on the size of the practice.

To disable this rule so that Lab Tracking does not occur:

To turn off Lab Tracking:

1. Login in to Rule Manager using the same login and password used for Chart.

2. Select the Lab Tracking rule by clicking it.

4. In the Edit Rule, clear the Rule Active check box.

Note:

There is a Reset Lab Tracking button in the Lab Tracking rule window. This button will set all labs to a status of NOT being tracked and will also delete any automated Overdue Lab TaskMan messages that were sent notify users of overdue labs. This feature allows users to reset the system to start lab tracking over. It is especially useful in cases where Lab Tracking is not turned on immediately after the Chart product is installed. In those cases a large number of Overdue lab messages can accumulate.

Tracked items (CPT and HCPCS codes) can be edited to change their expected due dates or to turn them off completely. Tracked items can only be changed permanently in the Billing Details section of either the CPT or HCPCS Search module.

To edit tracked items permanently:

1. Log into e-MDs Chart and click the Reference menu item on the main Chart menu toolbar then select CPT Search (or HCPCS Search) from the popup menu.

2. Once the Search module opens, select a code and then click the Details button on the main toolbar.

3. The Lab Tracking setup is found below the Code Valid section of the Details section.

4. Check the ON box to track this code and set day(s) time line for overdue notices.

Edit of a Tracked Item on the fly can only occur within an open Visit or Order Note. It is anticipated that this will most likely occur at the time the order is created but can occur at a later time as long as the note has not been permanently signed.

To edit tracked items on the fly:

the done by clicking a lab or test item in a PLAN template that has Extended Attributes linked to it.

click here for details

OR

By adding a CPT or HCPCS code under the Orders header in the PLAN Section of an open note

click here for details

2. Once a code (CPT or HCPCS) has been added to the Orders section, click the code and select

Properties from the popup menu

OR

Click the (In-House) or (Send-Out) text at the end of the CPT code description (this is for CPT codes ONLY).

3. The Order Properties window will open. e-MDs Solution Series Chart User Guide 8.0 R01

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4. There is a tracking section in the bottom of this screen consisting of 4 fields: a Track check box, an Urgent check box, a Due Days field and a Date Due date field.

○ If the Track box is checked the code is set to be tracked.

○ Check the Urgent box to change the priority of the Overdue Message generated and sent by

TaskMan. Once received in TaskMan, a RED “P” flag is added to this message if the Urgent box is checked.

○ If the Track box is checked a default value will appear in the Due After days field section. This default value can be changed for this instance only by typing a different number into the field.

Note: To receive an Overdue Message the very next time the Lab Tracking rule is run, set this value to 0 days.

○ The Due Date is calculated from the Visit or Order Note date by adding the Due After day’s value.

○ If the Track box is NOT checked the item is not set to be tracked. To set it to be tracked for this instance only, simply check the box and complete the Due After days field as well. The program will automatically calculate the Due Date based on the Visit or Order Note date by adding the Due After day’s value entered.

Note:

The Stat check box is for the Printed orders form only. It is NOT currently being used in Lab

Tracking.

Setting Up Tracking Categories in DocMan

Categories can be set up in DocMan so that when a document is scanned or imported into that category the Lab Tracking window will automatically open to allow pending items to be marked as completed.

To set up tracking categories:

Privileges Required: Immunization: DocMan Control Panel

1. Log in to DocMan.

3. Click a specialty in the left column and then select a category such as Labs in the middle column.

This will launch the Lab Tracking screen any time an item is scanned or imported into that category.

View Graphed Lab Results in Chart

e-MDs provides a Graphing module that can be accessed from within both DocMan and Chart. When lab results are scanned into a patient’s record, an image of the lab report is saved and the numeric results are not recorded in a structured way. In response, e-MDs has added the ability to graph lab results.

Manual data entry is required, but is very easy to accomplish and can be performed while viewing the scanned lab report on screen. We do not expect that the user will want to graph every lab, but may have a few key data types (such as cholesterol or HgbA1c) that are worth the effort. More information about graphing lab values is available in the Graphing Lab Results in DocMan section of the help and User

Guide.

See the following sections for more information:

• Create Data Types to Graph

• Add Data Points to a Graph e-MDs Solution Series Chart User Guide 8.0 R01

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• Edit or Delete Data Points from a Graph

• View All Graphed Labs for a Given Patient

To access graphing from within Chart:

1. Open Chart and open the appropriate patient’s record. blue bar with the patient’s name and demographic information.

This opens the Image Data/Graph window. All Data Types that have previously recorded values for the given patient are listed in the Patient Results window.

3. Highlight the desired Data Type in the Patient Results window.

When a Data Type is selected, the upper right window displays all prior values for this Data Type as a graph, and the lower right window displays the results in a grid.

The graph is titled with the Data Type and Patient Name, and represents numerical results over time. Red and blue horizontal bars represent expected maximum and minimum normal values, respectively. Plotted values are identified by black squares with yellow labels that display the individual numerical results. Successive values are connected with a black line. The horizontal axis, representing time, will lengthen or narrow depending on the number of plotted points.

Referral Authorization Window

The Referrals/Authorizations window provides the user with the ability to track multiple referrals per patient. It is designed to be an on-screen processing tool although a hard copy printout of data can also be generated.

Note:

The Referrals/Authorizations window is a Practice Management module. Access to this module is dependent on the clinic having the billing component of the Solution Series. If e-MDs Bill is not

present, this module will not be accessible.

Referral Authorization Window Options

Referral Authorization

Retrieve

New

Edit

Retrieves a list of referrals based on filter settings.

Click this to create a new referral.

Opens the highlighted referral in edit mode.

Select

Print

Used when selecting a referral from other parts of the system, such as when browsing from an invoice to link a referral to a claim.

Prints the referral report.

Edit Patient

Print Form

Reset Filter and Filter

Opens the patient demographics form for the patient whose referral is currently highlighted.

Opens the Word forms module. The system automatically selects the patient in the referral/authorization highlighted at the time the button is clicked.

These are the buttons at the bottom left . If a work list has already been retrieved, the Reset Filter button can be used to return filter settings to their defaults. The

Filter button is used to update the list if any filter criteria have been changed with a list already loaded.

The following filters are available for work list creation.

Authorization Start Date

Range and Authorization

End Date Range

Facility

By default the system will use the start date as the search range so the box for this is checked. To use the end date range, check the box above that filter. You can use both at the same time. Enter date ranges.

Shows referrals for this facility, or all facilities to which the user has access rights. e-MDs Solution Series Chart User Guide 8.0 R01

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Patient

PCP/Referring Physician

Specialty

Specialist

Insurance

Provider

Show Default Referral

# Days Until Expiration

# of Remaining Visits

Type

Status

Shows referrals for a specific patient.

On the referral.

The list can be filtered by the specialty of the PCP/Referring Physician on the referral.

The first specialist on a referral.

Patient primary insurance.

Patient’s primary provider .

Default referrals are entered in the patient demographics file but are still stored in the authorizations tables. They are displayed in red in the referrals module but are excluded from the search list unless this box is checked.

Tracks against the authorized date range of a referral. This can be filtered for any number of days, referrals with at least or less than a number of days, and a specific count. This filter is useful for finding referrals that are expiring, but may have a high count of visits authorized remaining.

Tracks against the authorized visit count. This can also be filtered by any number of remaining visits, referrals with at least or less than a number of visits, or a specific visit count remaining.

Filters by the inbound and outbound classifications.

Filters by the Active, Inactive or Pending classifications.

Referral Workflow

This section is a brief explanation of how you might use the referral/authorization tool in your office.

• Create a Referral “Order”: The office needs to get a referral for a patient (inbound, or on behalf of a patient being sent to another specialist). Nurse or other staff member goes to the referral tool and creates a pending referral.

• Convert Pending Referrals by Getting Authorization: The staff member assigned to this functional task creates a work list in the referrals window and calls the insurance companies listed for each pending referral. Information required by the insurance is looked up from within the window by opening the patient or the pending referral order. When the authorization is received, the number and other data is added to the referral, and the referral is changed to Active.

• Notify Patient and Specialist: When the authorization is received (or denied), the staff member can contact the patient and schedule an appointment, or tell them to contact a recommended specialist in their network. A referral authorization information sheet can be printed for the patient to take with him/her. It includes information about the patient, insurance and referral and is useful for staff members in other offices.

• File Claims: The active referral is linked to invoices and tracked automatically.

• Ensure Compliance: If necessary, someone can generate a referral work list to find referrals that are expiring but where there are still authorized visits remaining.

Adding a Referral/Authorization

An unlimited number of referrals can be added to a patient. Referrals are either inbound (applicable to this organization for tracking purposes), or outbound. They can also be tracked as pending, active or inactive. These classifications affect whether the referral is a work list for a user, tracked by the system, or historical. e-MDs Solution Series Chart User Guide 8.0 R01

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To create a Referral Authorization:

to module which may be more convenient depending on work flow are:

○ Click the Referrals button in the Schedule Check In module. This saves having to search for a patient when creating the new referral since the person is already known.

○ Double-click the A column in the Bill daily work list. This also filters for the patient, saving keystrokes.

○ From within an invoice, click the Find button next to the Referral field.

2. Click first.

3. In the Patient Referral window, fill out fields as required. See Referral/Authorization Window

Options for a description of available options.

Save to store the referral. The system will ask if this is the Active referral. If so, click Yes.

Subsequent invoices for the patient will be tracked against it. If the referral status is Not Active, another pop-up asks for verification.

Referral/Authorization Window Options

Referral/Authorization

Medical Facility

Inbound/Internal,

Outbound/External

Referrals are facility specific for tracking purposes. The default is the facility in which you are working, but another can be selected if necessary.

Set this based upon whether the referral will be tracked for billing purposes in this office (internal) or by another clinic to which the patient is being referred (external).

Only inbound referrals are tracked for warnings.

Status

Authorization Number

Referral Number

PCP/Referring Physician

Specialist, Second

Specialist

Approved Visit Count

Start and End Date

Allowed Amount

Out Patient

Comment

Pending indicates a referral that needs to be authorized by insurance. Users can run a report of all pending referrals and use it as a work list. Active referrals are ones that can be used for billing and scheduling tracking. Inactive referrals are retained for historical tracking. The status type is summarized in the referral view with codes of A, I and P.

The number issued by the insurance company for the treatment.

Additional referral identifier that may be assigned by the insurance company.

The person that will be identified on claims as the referring physician.

Up to two physicians authorized to perform treatment can be entered, e.g. a surgeon and an anesthesiologist.

Set to the number of visits authorized for the treatment. Based on the Setup Options to track authorizations by appointment or invoice, the Remaining field decrements by 1 for each invoice tagged to this referral. When the number remaining has expired, users get warnings when scheduling or invoicing patients.

Enter the date range within which treatment must be rendered.

Enter the maximum allowed amount. If an invoice allowed balance exceeds the

Remaining amount, a warning appears upon saving. If the remaining amount is <=

0.00, a warning will also be issued when trying to schedule an appointment.

Check the box. This is for information only.

Type a comment into the field to give more information about the referral, or click

Find to select a standardized comment from the comment reference table. A combination of a standard comment and free text is permitted. e-MDs Solution Series Chart User Guide 8.0 R01

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ICDs

CPTs

Type ICD codes into the field then press Enter or click Add for the codes to appear in the list. When an invoice is created with codes that are not part of a referral linked to the invoice, the system warns users upon saving. To remove an ICD, click

Remove.

Enter CPT code ranges for the procedures authorized. For a single code, enter the same code in both the start and end fields, then click add. Custom sets of authorized codes can be created in a Referral Types support table (see Referral

Types on page 48). Click Find to browse and select a type. To remove a CPT, click

Remove.

The referral authorization sheet can be used by staff as a checklist for working a referral, or can be given to a patient to take to a specialist, etc. It prints all the patient, physician and insurance demographics, as well as details about the referral.

To print a referral/authorization:

1. Select the referral in the Referral/Authorization window and click Edit.

3. Select a printer and click OK.

Note:

A custom referral form can also be generated using Word forms and then printed by clicking the Print Form button in the Patient Referral window.

This feature allows users with the Chart: Secure Chart privilege to determine who can and cannot access a specific patient chart. Chart Security allows users access to charts in general, but can be set to block certain users from accessing particular patient charts. This feature is useful when there is a need to lock access to charts of staff members (who also happen to be patients), charts of a celebrity or other VIP patients, patients with privacy issues such as HIV, mental health, or other patient charts where there is a need to limit access.

To set security for specific patient charts:

Privileges Required: Chart: Secure Chart

1. Within a Patient chart, click the Padlock icon .

Users can be moved to the “Excluded Users” window on the right by highlighting the user’s name and using the middle arrows to move them. Multiple users can be selected by holding down

CTRL on the keyboard or select all users by clicking the double black arrows. e-MDs Solution Series Chart User Guide 8.0 R01

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4

Prescribing and Refilling

Medications

This section provides instructions on how to use the Solution Series script tools to prepare and submit new prescriptions, approve and submit refills, check for drug-drug and drug-disease interactions, and work with a patient's formulary to ensure proper insurance coverage. The features covered are:

ƒ

Using Script Writer to search for drugs and their descriptions; write new prescriptions; and refill current and past prescriptions.

ƒ

Processing new prescriptions and refills through print, fax, phone and electronic transmission (using SureScripts).

ƒ

Using prescription tools to effectively support these requirements. Those tools include:

ƒ Prescription Tracker to follow and report the status of prescriptions

(especially the processing of electronically submitted prescriptions).

ƒ Dose Calculator to compute the appropriate therapeutic dose range for a selected drug based on the patient's age, weight and diagnosis.

ƒ Quick Picks to list the most commonly prescribed drugs used in a particular practice.

ƒ Phone-In Script module to manage prescriptions to be called in to a pharmacy.

ƒ Medication Reconciliation to reconcile a list of medications from an external source with the medications previously or currently prescribed in the current facility.

ƒ

Refill Request module to manage requests for refills received from pharmacies.

Continued on the next page ....

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