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Outpatient Lab Workflows

Various OP Lab Ordering, Registration, Collection workflows

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Placing an order

The test will default with an Order Status, Resulting Agency, Expected date and Order Class
Status: This marks if the lab will be released today, in the future or repeatedly
Resulting agency is NYP unless sending to an outside lab such as Quest
Class: Labs drawn at your clinic are Clinic Collect. Labs drawn elsewhere such as Lower level are Lab Collect

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Order Status

Order status behavior:

Most lab orders which you want to be drawn today should default to a status of Future +Today
Normal – the order is signed AND released simultaneously.

Typically this isn’t needed for lab orders (see Future).
You can not close the visit until order completed
The lab cancels released clinic collect orders after 4 days.

Future – the order is signed, released automatically or manually depending on expected date.

If expected date “Today” is chosen it will be auto-released. Can close visit prior to completion
If you want the patient to return in the future change the expected date to some time in the future
The lab cancels released clinic collect orders after 4 days.

Standing - each instance released manually.

Typically used for something like an INR, to be performed on a regular basis.
Order will NOT release automatically upon signing. Requires manual release.

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Bringing it all together - conditions

Future + Clinic Collect + Expected Date Today = auto-released**, drawn onsite day of visit
Future + Lab Collect + NYP Hospitals = manual release, done in future, not drawn onsite
Standing + Lab Collect = manual release, Same order used repeatedly, not drawn onsite
Normal + Clinic Collect = auto-released Can’t close visit till completed, drawn onsite
Future + Clinic Collect + Expected Date (not Today/Null) = manual release, drawn onsite in future
Standing + Clinic Collect = manual release, Same order used repeatedly, drawn onsite
Normal + Lab Collect = not allowed

**this is important, as it is most efficient, but might cause confusion.

The lab cancels released clinic collect orders after 4 days.

WHY:

Normal + Lab Collect = Not Allowed: we don’t want to allow the order to release from the Office Visit so when the patient presents to the Draw Station the labs are available to release into the Lab encounter.

Future + Lab Collect + NYP Hospital = Manual Release: this is ideal so that when the patient presents to a Draw Station the labs are available for release into the Lab encounter.

Future + Lab Collect + LabCorp/Quest = Auto Release: this is to get an order into the LabCorp/Quest LIS. We use Future so that we’re not asking providers to change to Normal for this case (consistency with the Hospital Lab ordering process)

Normal + Clinic Collect = Auto Release: this is really not necessary to use at all, as the orders will default to Future (for consistency in all ordering). However, normal orders always release immediately.

Future + Clinic Collect + Expected Date Null/Today = Auto Release: this is assuming the collection is imminent and it defaults to Future (for everything). The provider should populate the Expected Date to Today to aid in clarity.

Future + Clinic Collect + Expected Date (not Null/Today) = Manual Release: this is to prevent releasing an order too early, it is meant to guide the patient and staff as to when the lab should be collected. Since Expected Date is not required, I do not expect this to be populated often.

How do we automatically release?

In LPR 50 (item 8260) we have an LPP defined (LPP 210396001). This is called an After-Sign LPP, it executes when an order is actually signed.

In LPP 210396001, there is another extension, LPP 2105761401 – this LPP holds a CER rule. When evaluated to TRUE, it will effectively release the Future Orders. If False, it doesn’t release Future orders.

CER 2105761401 is the rule that is evaluated. The rule logic is like this:

If LabCorp/Quest and Order Class = Lab Collect or Third Party -> Release

If NYP Lab and Order Class = Clinic Collect and Expected Date = T or Null -> Release

Note: LPP 2103947001 –plugged into LPR 50 (item 8250) will default Expected date = Today for lab orders.

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Specimen Collection in Clinic Same Day

The specimen collector will click Collect Specimen and document the time.
This should be completed immediately prior to physically collecting as it causes a label to print.
Completing the task means the collection is imminent.
The label will print upon task completion. The label should be placed on the appropriate container and the specimen physically collected.
At this point, the collection is done and specimens should be sent to the lab.

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Specimen Collection in Clinic Future Date

If the patient returns for a specimen draw on a different day, use the Appointment Desk to walk-in the patient.
Look up the patient.
Select One-Click > Lab Walk In
Perform the quick registration steps.
Now the patient will be present on the schedule.
MA will double click on the patient to open visit and open Order Review tab

Release the Orders for which the patient is going to be drawn.

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Specimen Collection in Clinic Future Date

Once released, you can use the Visit Orders report in the Sidebar to Complete the Task to generate your labels.