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Script: Quest Tutorial – Sending Lab Orders and Receiving Results Electronically

In this training video, we will walk through through the process of submitting lab orders to Quest Labs and receiving lab results electronically.  For the sake of thoroughness, we'll use a somewhat complex example – typically the process will be simpler than what is shown in this video.

Here we have two orders for our test patient – a hemoglobin A1C test and a urine culture. These orders were added in an encounter note, but could also have been scheduled outside of an encounter note by clicking on the plus icon here in the Open Orders block and selecting from patient favorites, or common labs or scans, or typing to search.

Once added to a patient's chart, there are a few ways you can send an order to Quest. In the Open Orders block, you can right-click on the order and select Send Order to Quest Labs or you can check the box beside one or more orders and select Send to Quest Labs from the Manage Checked drop down menu. You can send the order from inside the open encounter note where it was added – again, via the right click menu or by selecting Send Orders to Quest from the Plan menu, which will send ALL orders associated with the note.

When you select send, this pop up appears to enter more details, if necessary. At the top, you can indicate whether you are collecting the specimen in the office to send to Quest Labs, or the patient is coming in to Quest to give a specimen. If the latter, this drop down menu appears for you to indicate approximately when the patient will be arriving at Quest. BUT, you should not change the default selection, which is "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 that period even if "today" is selected as the arrival date. 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.

Next, you can indicate who Quest should bill for the labs – the practice, the patient, or the patient's insurance. The insurance option is only available if you have insurance information on file for the patient, which is something that you would handle via the Insurance tab in the Patient Information pop out. Again, which option is selected by default is configurable.

This first notes field is for entering notes about this lab order that the lab will see – for example, "Send an additional copy of results to…" etc. The second notes field is for entering notes that will be returned along with the lab results – so reminders to yourself, for example "Call patient's cell immediately with results." Keep in mind that for any lab results that you opt to show on the Patient Portal, the right hand notes field (notes to you) will be viewable, and there is a possibility that the left hand notes field (notes to the lab) will also be viewable.

Now for the orders themselves. Quest uses a proprietary coding system for lab orders, which our system attempts to match to the labs that you have selected. Likely matches are shown in a drop-down menu. If you do not see the test you are looking for, you can choose to search for it by test name or Quest code, if known. If you manually match the test to its Quest equivalent, either using the drop down menu or by searching, you will be given the option to default to the selected Quest test ID whenever that CPT code is ordered. Check the box below a particular order to include notes – to the lab, or to yourself, as in the general notes fields above – that will be shown alongside this particular test.

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 – in this case, "Source" here below the Urine Sample order. For the sake of our example, we'll enter "Clean Catch," which is the most common source for this test. Then let's go ahead and click Done!

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.

Our order generated an additional document that you probably will not see very often. Here at the top we have an ABN release form because this patient is on Medicare and we selected "bill to insurance," so Medicare in this case and the Hemoglobin A1c test is not covered for the diagnosis entered. In this situation, which should be rare, you need to print up both pages of the ABN release (which are identical) for the patient to read and sign. One copy is for the patient, and one is for your records.

Below the ABN release, we have the requisition form that you would print and give to the patient. Quest automatically has a copy of the requisition on file, and a copy will be saved to the "Sent" tab in the patient's documents block. There may be more than one PDF generated for multiple orders. Here, the term PSC Hold at the top just means that the specimen will be collected by Quest, as we specified in the send order pop out.

Just above the requisition form is a small Print Label button. This is for when you are collecting a specimen in the office to send to Quest. Click to generate a label to print and attach to the specimen.

That takes care of our lab order. Next, we will look at how results are received electronically, matched to the patient's open orders, and filed.
Lab results that are received electronically from Quest will be shown in the Imported Lab Results block on the schedule page. Generally, the lab results will be matched to the patient for whom they were ordered. But if the system cannot match to a patient, you will see this "Could not match to patient message" and will have the option to manually match these results.

Clicking on an entry here opens a PDF lab result form. You can see that this one is matched to our test patient, and has a default document name that is the name of the tests performed. By default, the Document Type is set to labs, but you can change this using the drop down menu. Check the box if the results should be reviewed by any doctor or a specific doctor in your practice. Labs needing review will show up on the applicable doctors' task lists. Let's leave this box checked to review results now, and assign them to our test patient, noticing first that if you don't need the results, you can delete them by clicking on Delete Result here.

OK, here we have our Document Review pop out. This is where you would classify results as normal, uncertain/borderline, or abnormal, set a follow up task if desired, indicate whether the patient has been notified and even handle patient notification via the Patient Portal or email. You can also add notes, flag the document as a Key Document – i.e., something that should be shown prominently in the Documents block – add it to the patient's past medical history, and indicate whether the results should be shared with the patient on the Patient Portal.

Finally, you can match these results to the patient's open orders. Then, save changes to file the document. Now here it is in our labs and, because we checked those boxes, in the patient's Key Documents and past medical history blocks.

That wraps up our Quest lab ordering video tutorial. For more information, visit our help sections at www.md-hq.com/help.