Radiology: MRI Breast orders update
To make ordering MRI Breast studies more concise because it is always a bilateral scan, unilateral MRI Breast orders will be removed and the ‘bilateral’ description will be removed. Even if a patient has had a mastectomy, both sides are always scanned to evaluate residual tissue.
MRI Breast orders after changes:
MRI Breast Biopsy
MRI Breast w/wo with CAD
MRI Breast w/o
UMC Imaging Team
PLACING LAB ORDERS FOR A FREQUENCY OF EVERY 2 HOURS OR LESS
What’s the problem? Lab Orders that are entered with a Routine Priority and a Frequency of every 2 hours or less, Cerner will incorrectly combine every other specimen so that labels print with duplicate times and no labels print for missing times due to the specimen netting that occurs within Cerner.
Solution: To avoid the confusion with orders for duplicate times as seen in the above example for the Urine Specific Gravity, place all Lab orders with a frequency of 2qh or 1qh with a Priority as Timed.
Example:
A Random Glucose ordered as Timed q2h for 2 days and a Urine Random Specific Gravity ordered Routine q2h for 2 days. Even though the frequency shows correct on the orders screen in PowerChart, Collections Inquiry shows incorrect times for the Glucose but correct times for the Specific Gravity.
Orders shown in Powerchart with the correct time frequency:
However, Collections Inquiry displays how the labels will print-Note the Urine Specific Gravity times are incorrect:
There are now required fields for home health agency and care service on the Social Services for Home Health order.
This is what the order looks like today, “Placement” is the only required field. All other fields and dropdowns are optional.
These are the changes that will take place. There are 2 required fields now.
The “Placement” field is the same. If “Other Placement Service” is chosen, address the “Other Placement Service” field.
The options of “No Preference” and “Other” were added under “Preferred Facility” in case you have no preference or would like to choose a different facility. The “Other Preferred Facility” field should be addressed if the “Other” option is chosen from the “Preferred Facility” field.
Please note, the addition of “South Plains Rehab Hospital (IPR)” and removal of “The Plaza” in this field.
When
Sunday August 4th, 2019
Why
Impact
NO PATIENT STATUS ORDER (PSO) = LOST HOSPITAL REVENUE
Order Changes
MEMORANDUM
DATE: April 30, 2019
TO: Physicians, Residents, Nursing, and Allied Health Staff
FROM: Alanna Emrick, MLS (ASCP)cm SMCM
Manager, Microbiology
SUBJECT: HSV Culture discontinued – replaced with HSV PCR
In a continued effort to bring faster turnaround times, the laboratory will no longer perform HSV Culture. The 7-day culture has been replaced with HSV PCR with a same day turnaround time.
Beginning May 1, 2019, all HSV Culture will be unavailable and orders will be placed as HSV PCR.
If you have any questions, please feel free to contact me at 775-8361.
LABORATORY: CHANGE IN ORDERING FORMAT
What? Collection Priority and Reporting Priority will be combined into one Priority prompt for Lab tests
Why? This change will result in less confusion of the priority of the test and fewer clicks when ordering Lab tests
There will be no change in Priority selection
Order changes that took place in June, 2019:
Social Services for Home Health Care order changes:
Social Services for Placement order changes:
Current View
New Changes
ALL stress tests are now powerplans instead of caresets for single orders. The “Why” for this is to ensure the correct type of imaging order is placed.
Search for “stress” within the orders window or navigate to the Stress Folder
There is also a folder called “Stress Tests”
When you select the plan, the imaging/type options for stress are available. If you do not choose an order, by clicking in the square, you are NOT placing any order. Complete the needed fields as indicated by the blue circle with the X. This means you need some additional information on the order
Complete the required fields, and sign the plan
If no order is selected, you will receive this message. You will need to click “Cancel” and go back and chose the test you want to be completed on the patient
You cannot order from this screen; you must click cancel and order from the powerplan
ONE order will be REQUIRED
ALL Mammogram orders are now powerplans instead of a single order. The “Why” for this is to ensure the correct mammo order is placed. We have added an option for IMPLANT orders. The radiologist read these in different views and the exam takes longer.
Search for Mammo orders using the “search” or navigate to the Mammo folder within the Radiology folder
When you select the plan, the two mammo options are available. If you do not choose an order, by clicking in the square, you are NOT placing any order. Complete the needed fields as indicated by the blue circle with the X. This indicates you need some additional information on the order
Complete the required fields
If no order is selected, you will receive this message. You will need to click “Cancel” and go back and chose the test you want completed on the patient.
You cannot order from this screen; you must click cancel and order from the powerplan
Cerner Registration & Scheduling: New Radiology Orders Process
When: Past several weeks; addition of new folders (e.g., Stress Tests) and replacement of existing orders/caresets with the new PowerPlans
What: Updates of the existing radiology caresets (e.g., mammo, NM, MRI, etc.) to be usable with the new Cerner Reg/Sched process
*Note: This is the orders process, not the scheduling process that starts August 4th
You will notice right away that orders that were either single orders, or caresets, will now appear with the yellow “pizza.” This indicates they are now PowerPlans.
They will work much more straightforward than the larger PowerPlans.
You will locate and place the order for the desired exam as usual, and then find them in the PLANS section of the orders scratch pad to finish the required fields.
You MUST select an order prior to signing. Skipping the actual order will lead to no order processing through.
When you complete the entire order requirements, you will see the order in the “initiated” state.
NEW STRESS TEST ORDERS
To clarify the ordering of stress tests, new orders have been created in Cerner to designate the type of stress and the type of imaging performed. These orders can be found in a new “Stress Tests” folder and will also be available in the Cardiopulmonary Folder.
UMC Radiology Order Catalog Revamp
New orders, more applicable choices, clean up of unused orders, etc – all to make ordering more streamlined to HRO.
Highlights to note:
Will now will have the ability to order Bilateral procedures for all extremity orders.
Combo order MRI Orbit/Face/Sinus order will now have individual orders to choose from.
“Brain” will replace “Head” for MRI procedures.
MRI Foot & Toes description to reflect more accurately with MRI “Forefoot” and MRI “Hindfoot.”
New SP orders for Pleurix Cath procedures.
Look for the option of Implant orders for Mammo procedures in specific PowerPlan.
When order placed, the option to choose Mammo with Implants:
*Note: Please see attached Excel spreadsheet for more details.
Changes will occur over the next few weeks.
There will be a change to the fields in the Consult MD order and how the Consult is completed.
New Workflow:
The Provider will place a Consult MD order. Required fields are Reason for consult, Medical Service to Consult, and Assistance with Contact Number.
**NEW** If the provider needs a contact number, this will place a task for the HUC to provide you with the phone number.
Provider will call consulting service.
Consulting service will assess patient and place orders if appropriate.
**NEW** Consulting service will Complete the Consult MD order. This will be an indication to nursing and primary providers that the initial consult was completed.
Screenshot of New orders detail:
How to complete order: Find Consults/Referrals section and Right Click on Consult MD order. Click on Complete. Order Status will show as Complete.
VIZIO of Consult MD Orders Workflow
During the CPOE conversion there was a new filter set to “Focus” which will only look at the orders on the current encounter. This was a recommended change by Cerner in order not to confuse providers when going about their day-to day business, for the most part.
We will be making the change back to “All” orders associated with the patient.
This change will take place on February 25,2019.
With this change you might need assistance with your exisiting filters. There are videos and articles on PUTTER that will assist you if needed.
/tutorials/using-filters-and-order-view-customization.html
You can also reach out to the help desk @ 806-743-4357 or emrhelpdesklubbock@ttuhsc.edu
A new lab order, Heparin-Induced Thrombocytopenia Antibody (HIT AB) will be available January 2, 2019. This order will provide decision support for providers: 1) Is HIT AB test necessary for my patient? 2) Results from HIT AB will reflex Serotonin Release Assay (SRA) when needed.
When completed, the HIT Powerform shown below will result with a 4Ts Score of 0-8. This will be the first step to provide probability of HIT diagnosis. When signing the order, a 4Ts score of less than 3 shows a probability of 1.9%. With low probability for HIT, there is the option to Cancel or Override the order for HIT AB. When the 4Ts score is more than 3, the order for HIT AB is placed after signing.
Below are the probabilities of HIT given each HIT AB negative result along with each possible 4Ts score from the PowerForm and each positive result for HIT AB along with the possible 4Ts Score. When HIT AB is detected, the probability of HIT diagnosis increases and Serotonin Release Assay (SRA) will reflex to confirm.
Look for new Radiology orders January 2019 per CMS requirements:
Fecal Microbiota Transplant Orders, Forms and PowerPlans
This process will go-live on January 23, 2019
The current Fecal Microbiota Transplant Plan will be inactivated and unavailable for use.
The 3 new powerplans will be searchable by FMT and Fecal. These plans are route specific.
The provider will place the appropriate FMT plan and the first phase (Fecal Specimen Processing) will be initiated pending, while the other three phases are planned pending. This means that the first phase will be initiated by the provider when they sign the orders. The next three phases will be initiated by the nurse on the day of the FMT. You will note that both orders in the first phase (Fecal Specimen Processing) are prechecked/required and the route is defaulted to the appropriate route.
When the provider clicks on ORDERS FOR SIGNATURE the Fecal Microbiota Transplant Inclusion/Exclusion Criteria form will pop up and must be completed to order the FMT.
The Inclusion/Exclusion Form, three questions
After completion of the Inclusion/Exclusion form the screen will look like this, note the blue orb indicating a missing detail.
You must enter the date of the FMT into the Fecal Specimen Processing order. This will tell the lab when to start preparing the specimen. After completion of this detail the plan will be signed and the first phase initiated.
On the FMT Rectal Plan the Fecal Specimen Processing order has two order sentences and one must be chosen.
On the FMT Colonoscopy Plan the first phase has an additional order, Schedule Endoscopy Procedure.
There are three additional phases that will be initiated by the nurse on the day of the FMT.
The Policy and procedure for Inpatient FMT is available in two places on the powerplan.
Right click on the plan in the Orders View window and click Evidence.
Or click on the sheet of paper icon to the left of the Fecal Specimen Processing Order.
The NPO Diet order will now have 2 additional fields. This is to differentiate and clarify why the patient will be NPO.
The options of GI Dysfunction, Medical Condition, Procedure, and Swallow Dysfunction will now be available under the new field NPO Reason. One of the options will be required to be chosen.
Except for Tube Feedings requiring a yes or no answer has also been added.
