Help : Labs and Orders

Help: Open Orders

Open Orders pop upThe Open Orders block shows all orders for the patient (e.g., labs, scans, etc.) for which results have not yet been uploaded. You can right click on any open order to:

  • Mark as complete (removes it from the Open Orders block but does not associate it with a results document)
  • Remove it without marking it as complete (use this option if the patient will not fill the order)
  • Delete the order
  • Create a fax form with the requested order that you may print, fax to the appropriate facility, or save to the patient's file and, if you'd like, share with the patient on the Patient Portal
  • Send the order electronically if you have an HL7 sync with any labs

You can also manage multiple orders by checking the box beside the orders that you would like to manage and selecting from the Manage Checked drop down menu:

  • Faxable Form - creates a form with the checked orders that you may print, fax to the appropriate facility, or save to the patient's file and, if you'd like, share with the patient on the Patient Portal.
  • Send to Lab - sends checked orders electronically to a lab with which you have an HL7 sync.
  • Assign Documents - matches open orders with a results document, either one that you have already uploaded to the patient's documents or you can upload a new document from your hard drive. Note that if you want to match an efax or imported results document to open orders, you can do this from the relevant document in the incoming fax queue or the imported results queue, respectively, both of which are found on the schedule page.

You can also add new orders via the Open Orders block by clicking on the plus icon, though orders are more typically added via an open encounter note.

Help: Add Order

Add an order for a lab or scan by clicking on the plus icon in the upper righthand corner of the Open Orders block or, more commonly, from an open encounter note.

Add/Schedule Orders pop-upWhen the Add/Schedule Orders pop-up first appears, you will see automatically-generated lists of common or favorite orders below the "Run the Following Tests" search bar.
  • Patient's Favorites are the orders that have most commonly been placed for this patient.
  • Common Labs and Common Scans are the labs and scans that have most commonly been used by the whole practice.
  • Note that these automatically-generated lists of common or favorite orders cannot be manually modified.
Click on an order from one of these lists to add it, or type in the search bar to search by order title, subtitle, category, CPT or ICD10 code, nickname, and/or description using whole or partial words. The system will search the database as you type and list results below. By default, the system will return results from your preferred short list, which includes any order you have ever added to a patient's chart, along with orders that you have manually added to the list. If there are no matches on your short list, or if you enter a “+” in the search bar, it will instead return all matching entries from the full code set.
  • How to manually edit your preferred short list: type to search for an order that you would like to manually add (or remove) from the short list. Right-click on the order when it appears in the search results list and select "ADMIN: Add/Remove as preferred CPT". A pop up will appear confirming that you have added or removed that item from the orders short list.
You may add multiple orders at once by continuing to select from the favorites list and/or using the search bar. You must also specify one or more reasons (diagnostic codes) for the order. If you add the order from an encounter note, any diagnosis in the encounter note when the order is added will automatically appear in the order form. Remove a diagnosis from the form using the [x] button to the left of the diagnosis. Add diagnoses using the search box provided. Add notes, if desired, or leave default text.

Adding Orders via Chart Parts

You can add orders into a Chart Part to make it an easy addition to an open SOAP note. When you set up a Chart Part, choose Order/Lab from the Add Action drop down menu at the bottom of the Add New Template pop up. Then, search for the order you are looking for in the smart search bar, and add it to the Chart Part. You can add multiple orders, as well as corresponding diagnoses and text for the SOAP note in this pop up. Save, and add to your open SOAP note as normal. This will show the Order, as well as any diagnoses or other actions associated with the Chart Part to the Suggested Actions block in the SOAP note.

Help: Electronic Ordering: Quest

Note: this help section is only applicable if your build is integrated with Quest. If you are not currently integrated with Quest but would like to become so, please contact support@md-hq.com.

Open Orders Manage Checked MenuOnce labs or scans have been added to a patient's chart, there are a few ways to initiate an electronic lab order to Quest. First, in the Open Orders block, you can right click on an order and select "Send Order to Quest Labs." Or check the box beside one or more labs and select "Send to Quest Labs" from the Manage Checked drop down menu.

Alternately, if the orders were added inside an encounter note, you can send from inside the encounter note, either via the right click menu or by selecting Send Orders to Quest Labs from the Plan menu (sends ALL orders associated with the note).

Completing Your Lab Order Using the Send Orders Pop Out

When you click Send, a pop up appears for you to enter more details. First you can indicate where the specimen will be collected - in your office and then sent to Quest, or at a Quest facility. If the patient will be going to Quest to deliver the specimen, a drop down menu appears for you to indicate approximately when the patient will be arriving. Do not change the default (Today) unless the patient will not be arriving for months. The lab order will be valid for 90 days and the patient can come in anytime during this period even if "Today" is selected as the arrival date. Note that the default selection for where specimens are collected - that is, which option is selected when the pop out window appears - is configurable for your practice.

If you are collecting the specimen to send to Quest, you will have the opportunity to print a label for the specimen when the order is sent and the system returns a requisition form (see below).

Send Orders to Quest Pop UpNext, you can indicate who Quest should bill - your practice, the patient, or the patient's insurance (available only if you have health insurance information on file for the patient). Again, which option is selected by default is configurable.

Then there are two notes fields - one for entering notes to the lab that will accompany the order, and one for entering notes to yourself that will be sent back along with the results. Note that for any results that you opt to show on the Patient Portal, the notes to yourself (righthand notes field) WILL be visible and the notes to the lab (lefthand notes field) MAY be visible.

For the orders themselves, the order and CPT code that you selected are shown on the left, and on the right are possible matches from Quest's proprietary lab coding system. If no matches are found or you do not see the test you're looking for in the suggested matches in the drop down menu, you can type to search by test name or Quest code. You can also look up Quest codes by test name, test code, CPT or keyword on Quest's website. If you manually select something other than the suggested match, you will be given the option to check a box (appears below the CPT code on the left) to default to the selected Quest test whenever that CPT code is ordered. You can also check a box to add notes (to the lab or to yourself, as in the general notes fields) for that particular order.

For a minority of lab orders, Quest asks for additional information. If this is the case for an order that you have selected, you’ll be presented with what are called Ask on Order prompts below the selected Quest test (for example, "SOURCE" below the Quest equivalent for the Urine Culture and Colony Count). Ask on Order prompts may require a valid entry for Quest to process your lab order.

After You Click Send - Lab Requisition Forms and More

When you click "Send," if the order fails to send for whatever reason, you will be returned to the ordering pop out and a message will appear indicating what the error was. Otherwise, the system will generate one or more PDF documents. This means that the order was successfully sent to Quest and you can print out the necessary forms for your patient.

At least one of the forms will be an electronic lab requisition form, and there may be more than one requisition form, depending on the labs ordered. The words "PSC Hold" in the upper right corner mean that you specified that the patient would go to Quest to give the sample. Otherwise, the requisition form will say "EREQ" (for electronic requisition). Quest has a copy on file and a copy of the requisition form is automatically saved in the Sent tab of the patient's documents block.

In rare cases, the system may also return an "Advance Beneficiary Notice of Noncoverage (ABN)" form. This form is only provided where the patient is a Medicare patient and bill to Medicare was selected in the ordering pop out and the selected test is not covered by Medicare for the diagnosis code provided. If an ABN is provided, the patient needs to read it and sign both copies. One is for the patient and one is for your files.

If you are collecting the specimen to send to Quest, you can print a label for the specimen by clicking on the small "Print Label" button just above and to the right of the requisition form. The label should open in a new tab.

Help: Imported Lab Results

Electronic lab results (including Quest) are shown in the Imported Lab Results block on the schedule page. Clicking on an entry brings up the results, which are displayed inside a PDF or HTML document, in an "Assign to Patient" pop out window.

Technical note: imported lab results are displayed inside a PDF (Quest) or HTML document. But the system also stores the lab values themselves and associates these values with the results document. So, for example, MD HQ would store not only the Quest results document shown in the screenshot, but also the fact that the patient named TC4 Test had a measured hemoglobin A1C value of 4.6% on 01/20/2014. This allows for tracking of lab values over time, searching for patients with test results in a specified range, etc.

Assigning Imported Lab Results to a Patient

The Assign to Patient pop out is primarily used to confirm (or occasionally, specify) which patient the results are for, set up a task for one provider or all providers if the lab results require review by a provider, and get rid of documents that are not needed (for example, preliminary results, where the final results have also been received).

Generally the results will be automatically matched to the patient for whom they were ordered. If the system cannot match to a patient (or matches to the wrong patient), you can select the correct patient manually. If the wrong patient is shown, click the [x] beside the patient's name to display an "Assign Patient" search bar.

Assign to Patient Pop Out

 

By default, the document title is the name of the lab tests performed. The default document type is "Labs". Both of these default values can be edited.

The check box for "Needs to be Reviewed by" is used to add the results document to a selected provider's task list or, if "ANY DOCTOR" is selected, to every provider's task list. If ANY DOCTOR is selected, the task will disappear from all task lists as soon as one provider marks it as complete.

Checking "Review Results Now" pulls up a reviewing pop out (described below) when you click "Assign to this Patient."

The DELETE RESULT icon at the bottom right is for discarding results that are not needed, like preliminary or duplicate results.

Reviewing Results

The review results pop out is identical to the pop out that you see when you click on any document that has been uploaded to a patient's file (except that the lab values themselves remain associated with the PDF or HTML document that displays those results - see technical note at the top of this help section).

Document Review Pop Out ScreenshotIn the top left of the Document Review pop out, you can indicate that the document should be reviewed by a provider or ANY DOCTOR, in which case it will go on the task list of all providers until one marks the task as complete. Just above the document viewing pane, there may be other functions you can perform on the document, depending on the document file type, like use as the basis of an outgoing fax, open in a new tab or window without the document review pane, and print.

In the document review pane to the right of the document, the results document's editable default TITLE is simply the name(s) of the test(s) performed. The default document TYPE (Labs) can be changed using the drop down menu provided.

The RESULTS drop down menu lets you specify whether the lab results shown are normal, uncertain/borderline, or abnormal. Create a follow up task that will appear on your own task list after the specified time period using the FOLLOW UP drop down menu.

Document Notify via Portal ScreenshotThe NOTIFY PATIENT functions let you specify whether the patient has been notified and notify the patient via secure message on the patient portal or by email. Clicking "Email Patient" pulls up a new email message in your email client (e.g., Gmail, Yahoo, etc.) in a new tab, with the patient's email address entered in the "to" field. Remember: you should never send secure or private information via email.

Clicking on "Notify by Portal" brings up a text box for you to type in your message or select from preset notification messages that you have created, if applicable. You can also manage your preset messages from by clicking on the "Select from a preset message" drop down menu. When you save the document, any message that you have entered here will automatically be sent to the patient via secure message, and a generic notification will be sent to the patient via email.

Enter any notes you would like in the notes field. These are visible when the document is opened for review and when you hover the mouse cursor over the document. Notes that you enter here are not visible to the patient if the document is shared via the Patient Portal.

Checking "Flag as Key Document" adds the document to the patient's Key Documents, which are shown prominently in the documents block on the patient dashboard.

Checking "Add to Past Med History?" adds the document to the patient's Past Medical History block.

Checking "Show in Pt's Online Portal?" makes the document visible to the patient via the Patient Portal. This option is only available if the patient has Portal access enabled.

Click "Save and re-open in a new SOAP note" to save any changes, open a new encounter note and re-open the document in front. Then, you can toggle between the document and the encounter note as needed (minimize the document view by clicking on the minimize icon in the upper right hand corner of the Review Document pop out).

Click "View patient's dashboard in a new tab" to open the patient's dashboard page in a new tab. This is useful, for example, where you have opened the Document Review pop out from your task list and so do not have the patient's chart in front of you.

Finally, you can match the results to open orders using the MATCH TO OPEN ORDERS check boxes (which initially appear only if there are open orders that have not yet been matched to any results). Once you check the box to assoicate an open order with a results document, that order will continue to appear in the same location beside a now-checked checkbox when the Review Document pop out is opened for that document. You may uncheck the box at any time to disassociate the open order from that document.

Help: Lab Integrations

MD HQ integrates with several labs to enable easier ordering and importing of lab results. Labs integrate with us on one of two tiers: results only or two way. We are working to expand our offerings in this area, so check back to find additional integrations as they arrive.

Two Way Integration

Two way integration allows you to order labs directly from an open SOAP note as well as import lab results directly into the Imported Lab Results block on the schedule page. The following labs have a two-way integration with MD HQ:

  • Quest
  • Direct Labs
  • BioReference
Results Only Integration
Results only integration allows you to receive lab results directly into the Imported Lab Results block on the schedule page. They do not support electronic ordering, so you will continue to order labs as normal (e.g. faxing order forms). The imported results bypass the need to import each lab result as it arrives. The following labs have a results-only integration with MD HQ:
  • Doctor's Data
  • Cleveland HeartLab (two way integration in progress, estimated start 2016)
  • CPL (two way integration in progress, estimated start 2016)
  • Genova
  • LabCorp* (two way integration in progress, estimated start 2016)
  • Inova Reference Laboratory (Mid-Atlantic only)
Other Partners
MD HQ is working to set up partnerships with the following labs, though no integration exists at present time: HDL
How to Set Up an Integration:
Every lab is a little different. For some labs, like Quest or Doctors Data, we're able to request an interface on your behalf if you provide us your lab account numbers. Others require that you contact your lab representative to request the integration. Contact us at support@md-hq.com and we can guide you through the process.
Also keep in mind that labs take different amounts of time to add accounts to our interface - some labs will integrate within a day or two, while others can take weeks or even months for their IT teams to activate an account. Generally labs will respond more quickly if you have large ordering volumes with them, but it's often hard to predict. We can provide a best-estimate on timing if you are curious about a specific lab based on our historical experience.

Help: Lab Integrations

MD HQ integrates with several labs to enable easier ordering and importing of lab results. Labs integrate with us on one of two tiers: results only or two way. We are working to expand our offerings in this area, so check back to find additional integrations as they arrive.

Two Way Integration (Bi-Directional)

Two way integration allows you to order labs directly from an open SOAP note as well as import lab results directly into the Imported Lab Results block on the schedule page. The following labs have a two-way integration with MD HQ:

  • Quest
  • Direct Labs
  • BioReference
  • True Health Diagnostics
  • Boston Heart
  • Innova/Sunrise
  • Singulex
  • Empire Labs
Results Only Integration

Results only integration allows you to receive lab results directly into the Imported Lab Results block on the schedule page. They do not support electronic ordering, so you will continue to order labs as normal (e.g. faxing order forms). The imported results bypass the need to import each lab result as it arrives. The following labs have a results-only integration with MD HQ:
  • Doctor's Data
  • Cleveland HeartLab
  • CPL (two way integration in progress, estimated start 2017)
  • Genova
  • LabCorp* (two way integration in progress, 2017)
  • AccuReference
  • Path Labs
  • NorDx
  • Clearview (*we also have a demographic sync for aiding ordering)
Other Partners
MD HQ is working to set up partnerships with the following labs, though no integration exists at present time:
  • Dutch
  • VCS
  • Spectracell
  • Alletess
How to Set Up an Integration:
Every lab is a little different. For some labs, like Quest or Doctors Data, we're able to request an interface on your behalf if you provide us your lab account numbers. Others require that you contact your lab representative to request the integration. Contact us at support@md-hq.com and we can guide you through the process.
Also keep in mind that labs take different amounts of time to add accounts to our interface - some labs will integrate within a day or two, while others can take weeks or even months for their IT teams to activate an account. Generally labs will respond more quickly if you have large ordering volumes with them, but it's often hard to predict. We can provide a best-estimate on timing if you are curious about a specific lab based on our historical experience.