Download 23_Order checks

Order Checks
Cornelius Dial, RPh
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Learning Objectives
• Become familiar with the Order Checking
feature and how it is triggered
• Examine the Order Check Parameters where
system values are set
• Identify the various Order Checks that may be
activated by the EHR Team and CAC and
determine the values that will be set for the
facility
• The EHR Team and CAC will customize the
Order Check system for the facility by
completing the Order Checking script
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Order Checks & Notifications
Order Checks
Notifications
•
Review existing data and current
events to produce a relevant
message that is presented to
patient care-givers.
•
Review existing data and current
events to produce a relevant
message that is presented to
patient care-givers.
•
A real-time process that occurs
during the ordering session and
driven by responses entered by the
ordering provider.
•
Notifications occur behind the
scenes, monitoring data as it flows
through RPMS and when certain
trigger events occur.
•
Messages are displayed
interactively during the ordering
session.
Order Checks
• NOTE: All order checks are exported enabled
at the system level. When turned on at the
system level, they are turned on for everyone.
• IT, Clinical Coordinators, Individuals, or
Services can disable individual order checks if
they choose.
Order Checking
•
Component of order entry
•
Based on a system of rules to see if orders meet defined criteria
•
If orders meet the criteria, an electronic message is sent to the ordering
provider before the order is completed (such as duplicate order, drug-lab
interaction, etc.)
•
The provider can then choose to cancel the order or override the order
check and place the order
Order Checks Exported with EHR
•
ALLERGY-CONTRAST MEDIA INTERACTION
•
ESTIMATED CREATININE CLEARANCE
•
ALLERGY-DRUG INTERACTION
•
GLUCOPHAGE-CONTRAST MEDIA
•
AMINOGLYCOSIDE ORDERED
•
LAB ORDER FREQ RESTRICTIONS
•
BIOCHEM ABNORMALITY FOR CONTRAST
•
MISSING LAB TESTS FOR ANGIOGRAM
MEDIA
PROCEDURE
•
CLOZAPINE APPROPRIATENESS
•
ORDER CHECKING NOT AVAILABLE
•
CT & MRI PHYSICAL LIMITATIONS
•
RECENT BARIUM STUDY
•
DRUG-DRUG INTERACTION
•
RECENT ORAL CHOLECYSTOGRAM
•
DUPLICATE DRUG CLASS ORDER
•
RENAL FUNCTIONS OVER AGE 65
•
DUPLICATE DRUG ORDER
•
DUPLICATE ORDER
Order Checks
•
Order checks are displayed
to the clinician when an
order is written and signed
•
Order checks with a danger
level of high require the
clinician to enter a reason
for continuing with the
order
Enable/Disable Order Checking System
•
•
This option lets the user determine if any order checking processing
occurs in the entire Order Checking system.
•
E (Enabled). Indicates the Order Checking system is enabled and
running.
•
D (Disabled). Indicates the Order Checking system is disabled and not
running.
This parameter is set to Disabled in the exported version of Order
Checking. This must be set to Enabled as part of the implementation
process before order checking can occur.
Enable/Disable Order Checking System
Order Checking Parameters
Set Creatinine Date Range for
Contrast Media Orders
• This order check searches to see when the
last creatinine was done for patients when a
radiology exam is ordered with contrast
media.
• The package value is 30 days
Set Creatinine Date Range
for Contrast Media Orders
CT Scanner Height & Weight Limit
Can be ignored if the site does not have a CT scanner.
These order checks should also be disabled at the
system level.
Set Clinical Danger Level
Lab Duplicate Order Range
• Set the number of hours backwards in time
to look for duplicate lab orders
• Can set different values for locations such as
wards and clinics
Radiology Duplicate Order Range
• Use this option to set the number of hours
backwards in time to look for duplicate
radiology orders. This range can be setup
differently for different locations.
Orderable Item Duplicate Order Range
Mark Order Checks Editable By User
• If there are certain order checks that the user
wishes to remain either on or off for
everyone, this option will allow them to be
uneditable by users.
(uneditable = mandatory)
• Users will not be able to change the settings
in their personal preferences.
Order Checks Made Mandatory
Enable/Disable an Order Check
• Processing Flags
• E (Enabled)
• D (Disabled)
Enable/Disable an Order Check
Set Creatinine Date Range for Glucophage-Lab
Results
• This parameter sets how far back to look for a
creatinine result for a patient taking
glucophage. The package value is 60 days.
Edit Site Local Terms
• Map local orderable items or laboratory test
names to national standard terms used by
the Order Checking system.
• The user picks the national term and matches
it to the local test.
Edit Site Local Terms
• Each item must be mapped to ALL of the
sites terms which meet this requirement
• Most are lab tests which can vary at each site
Local Terms
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ALLERGY-DRUG INTERACTION
Order Check
Dependent on:
 Accurate information in Adverse Reaction Package
 Drug File entries matched to the National Drug File
 Entries unable to be matched to the National Drug File
should have a VA class manually assigned:
– This is a “last resort” type of option.
– Matching provides additional information beyond the class
code.
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MRI Scanner Height & Weight Limit
•Can be ignored if the site does not have an MRI
machine or for open MRI and the order check
should be disabled at the system level
Set Number of Medications
for Polypharmacy
• The number of medications used to
determine polypharmacy. If the patient is
taking more than the number of meds
indicated by this parameter’s value,
polypharmacy exists. This parameter is used
by the order check Polypharmacy.
Display the Order Checks
a User Can Receive
•
•
This option displays a list of all Order Checks annotated with
the status of each processing flag.
The processing flag can be set on one or more of five levels.
The flag that is in effect is the one with the lowest entity
precedence as given in the following list:
•
•
•
•
•
ENTITY PRECEDENCE: 1
ENTITY PRECEDENCE: 2
ENTITY PRECEDENCE: 3
ENTITY PRECEDENCE: 4
ENTITY PRECEDENCE: 5
ENTITY TYPE: User
ENTITY TYPE: Location
ENTITY TYPE: Service
ENTITY TYPE: Division
ENTITY TYPE: System
Order Checks a User Can Receive
Personal Preferences
• Order checks that have
not been set to not
editable may be
changed from the GUI
Personal Preferences
from the Tools menu
Requirements for Order Checks
These 10 order checks were set to Mandatory
 ESTIMATED CREATININE CLEARANCE
 ALLERGY-DRUG INTERACTION
 ALLERGY-CONTRAST MEDIA INTERACTION
 CRITICAL DRUG INTERACTION
 RENAL FUNCTIONS OVER AGE 65
 GLUCOPHAGE-CONTRAST MEDIA
 GLUCOPHAGE-LAB RESULTS
 DANGEROUS MEDS FOR PT > 64
 NO ALLERGY ASSESSMENT
 ALLERGY UNASSESSIBLE
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Questions and Discussion