Resource and patient management system



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8.4Order Check Configuration (OCX)


Select the Order Check Configuration (OCX) option on the Order Entry Configuration menu to display the following:

Order Check Configuration


ACT Activate/Inactivate Rules

COM Compile Rules

ENA Enable/Disable Order Checking System

INQ Expert System Inquiry

PAR Order Check Parameters ...

Select Order Check Configuration Option:

Order Checking is based on a system of rules that review orders to see if they meet defined criteria. If they do not 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.

The Order Checking system lets users determine when order checks and notifications are sent. To accomplish this, EHR includes several prepackaged order checks as well as three menus for setting Order Checking parameters such as enabling and disabling specific order checks. Order Checks can also be configured to be mandatory by the CAC or the IT Department. If this feature is enabled, individual order checks cannot be edited by the end users. Non-mandatory order checks can be enabled or disabled by selecting Tools | Options.

Order checks exported with EHR

ALLERGY-CONTRAST MEDIA INTERACTION

ALLERGY-DRUG INTERACTION

AMINOGLYCOSIDE ORDERED

BIOCHEM ABNORMALITY FOR CONTRAST MEDIA

CLOZAPINE APPROPRIATENESS

CT & MRI PHYSICAL LIMITATIONS

DRUG-DRUG INTERACTION

DUPLICATE DRUG CLASS ORDER

DUPLICATE DRUG ORDER

DUPLICATE ORDER

ESTIMATED CREATININE CLEARANCE

GLUCOPHAGE-CONTRAST MEDIA

LAB ORDER FREQ RESTRICTIONS

MISSING LAB TESTS FOR ANGIOGRAM PROCEDURE

ORDER CHECKING NOT AVAILABLE

RECENT BARIUM STUDY

RECENT ORAL CHOLECYSTOGRAM

RENAL FUNCTIONS OVER AGE 65

NOTE: All of these order checks are exported in the disabled state at the system level. Sites can then turn them on for individuals or teams, as determined by the site. Clinical Application Coordinators, individuals, or services can also disable individual order checks, if they so choose.

8.4.1Activate/Inactivate Rules (ACT)


Should not be here

8.4.2Compile Rules (COM)


Should not be here

8.4.3Enable/Disable Order Checking System (ENA)


Select the Activate/Inactivate Rules (ACT) option on the Order Check Configuration Menu to display the following:

Enable/Disable Order Checking System


Enable or disable order checking system. may be set for the following:
1 Division DIV [DEMO INDIAN HOSPITAL]

2 System SYS [DEMO.OKLAHOMA.IHS.GOV]


Enter selection: 2 System DEMO.OKLAHOMA.IHS.GOV
Setting Enable or disable order checking system. for System: DEMO.OKLAHOMA.IHS

.GOV


Value: Enable// ?
Enter 'Enable/E' for order checking, 'Disable/D' to stop order checking.
Select one of the following:
E Enable

D Disable


Value: Enable//

Use this option to enable or disable the Order Checking System.


8.4.4Expert System Inquiry (INQ)


Should not be here

8.4.5Order Check Parameters (PAR)


Select the Order Check Parameters (PAR) option on the Order Check Configuration Menu to display the following:

Order Check Parameters

CON Creatinine Date Range for Contrast Media Orders

CTH CT Scanner Height Limit

CTW CT Scanner Weight Limit

DAN Set Clinical Danger Level

DBG Enable/Disable Debug Message Logging

DPL Lab Duplicate Order Range

DPO Orderable Item Duplicate Order Range

DPR Radiology Duplicate Order Range

EDT Mark Order Checks Editable by User

ENA Enable/Disable an Order Check

GLU Creatinine Date Range for Glucophage-Lab Results

LCL Edit Local Terms

MRH MRI Scanner Height Limit

MRW MRI Scanner Weight Limit

PLY Number of Medications for Polypharmacy

USR Order Checks a User Can Receive


Select Order Check Parameters Option:

8.4.5.1Creatinine Date Range for Contrast Media Orders (CON)


Select the Creatinine Date Range for Contrast Media Orders (CON) on the Order Check Parameters menu to display the following:

Creatinine Date Range for Contrast Media Orders


Creatinine Results for Contrast Media may be set for the following:
1 Location LOC (choose from HOSPITAL LOCATION)

2 Division DIV (DEMO HOSPITAL)

3 System SYS (DEMO.MEDSHERE.COM)
Enter selection:

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. This value is used in the Biochem Abnormality for Contract Media Order check.


8.4.5.2CT Scanner Height Limit (CTH)


Select the CT Scanner Height Limit (CTH) on the Order Check Parameters menu to display the following:

CT Scanner Height Limit


CT SCANNER HEIGHT LIMIT may be set for the following:
1 Division DIV [DEMO INDIAN HOSPITAL]

2 System SYS [DEMO.OKLAHOMA.IHS.GOV]


Enter selection: 2 System DEMO.OKLAHOMA.IHS.GOV
----- Setting CT SCANNER HEIGHT LIMIT for System: DEMO.OKLAHOMA.IHS.GOV -----

Value: ??


This parameter is used by order checking to determine if

a patient is too tall to be examined by the CAT scanner.


Value:

This can be ignored if the site does not have a CT scanner. The height needs to be in whole inches and is the maximum height of the patient.


8.4.5.3CT Scanner Weight Limit (CTW)


Select the CT Scanner Weight Limit (CTW) on the Order Check Parameters menu to display the following:

CT Scanner Weight Limit


CT SCANNER WEIGHT LIMIT may be set for the following:
1 Division DIV [DEMO INDIAN HOSPITAL]

2 System SYS [DEMO.OKLAHOMA.IHS.GOV]


Enter selection: 2 System DEMO.OKLAHOMA.IHS.GOV
----- Setting CT SCANNER WEIGHT LIMIT for System: DEMO.OKLAHOMA.IHS.GOV -----

Value: ??


This parameter is used by order checking to determine if a patient weighs too much to be safely examined by the CAT Scanner.
Value:

This can be ignored if the site does not have a CT scanner. The weight needs to be in whole pounds and is the maximum weight of the patient.


8.4.5.4Set Clinical Danger Level (DAN)


Select the Set Clinical Danger Level (DAN) on the Order Check Parameters menu to display the following:

Set Clinical Danger Level


Order Check Clinical Danger Level may be set for the following:
1 Division DIV [DEMO INDIAN HOSPITAL]

2 System SYS [DEMO.OKLAHOMA.IHS.GOV]


Enter selection: 2 System DEMO.OKLAHOMA.IHS.GOV
Setting Order Check Clinical Danger Level for System: DEMO.OKLAHOMA.IHS.GOV

Select Order Check: no allergy ASSESSMENT

Are you adding NO ALLERGY ASSESSMENT as a new Order Check? Yes// YES
Order Check: NO ALLERGY ASSESSMENT// NO ALLERGY ASSESSMENT NO ALLERGY ASSESS

MENT


Value: ?
Enter the code indicating the clinical danger level of the order check.
Select one of the following:
1 High

2 Moderate

3 Low
Value:

Order checks come with a pre-set danger level for Parameter ORK CLINICAL DANGER LEVEL and Entity ORDER ENTRY/RESUTLS REPORTING, as given in the following table:



Order Check

Value

ALLERGY-CONTRAST MEDIA INTERAC

High

ALLERGY-DRUG INTERACTION

High

AMINOGLYCOSIDE ORDERED

High

BIOCHEM ABNORMALITY FOR CONTRA

High

CLOZAPINE APPROPRIATENESS

High

CRITICAL DRUG INTERACTION

High

CT & MRI PHYSICAL LIMITATIONS

High

DISPENSE DRUG NOT SELECTED

High

DUPLICATE DRUG CLASS ORDER

High

DUPLICATE DRUG ORDER

High

DUPLICATE ORDER

Moderate

ERROR MESSAGE

Low

ESTIMATED CREATININE CLEARANCE

Moderate

GLUCOPHAGE-CONTRAST MEDIA

High

LAB ORDER FREQ RESTRICTIONS

Moderate

MISSING LAB TESTS FOR ANGIOGRA

High

ORDER CHECKING NOT AVAILABLE

Low

POLYPHARMCY

Moderate

RECENT BARIUM STUDY

High

RECENT ORAL CHOLECYSTOGRAM

High

RENAL FUNCTIONS OVER AGE 65

Moderate

SIGNIFICANT DRUG INTERACTION

Moderate

These danger levels are based on rules supplied by a panel of physicians.

NOTE: High danger level order checks require entry of a reason if they are overridden. Moderate and low order checks can be overridden without entry of a reason.

8.4.5.5Enable/Disable Debug Message Logging (DBG)


Select the Enable/Disable Debug Message Logging (DBG) on the Order Check Parameters menu to display the following:

Enable/Disable Debug Message Logging


Enable or disable debug log. may be set for the following:
1 Division DIV [DEMO INDIAN HOSPITAL]

2 System SYS [DEMO.OKLAHOMA.IHS.GOV]


Enter selection: 2 System DEMO.OKLAHOMA.IHS.GOV
-- Setting Enable or disable debug log. for System: DEMO.OKLAHOMA.IHS.GOV --

Value: ??


Parameter determines if order checking will log debug messages into

^XTMP("ORKLOG". 'Enabled' indicates logging will occur. 'Disabled' will

prevent logging of messages and delete log file (^XTMP("ORKLOG")).

The data for zero node entries is the information passed to order checking

from OE/RR. The zero node is in the format:

^XTMP("ORKLOG",,


,,,

,0)=

||local sys>|||

The data for non-zero node entries is the information passed from order

checking back to OE/RR. It is the order check messages plus other info to

enhance OE/RR processing. It is in the format:

^XTMP("ORKLOG",,


,,,

,)=

^^^

Value:

8.4.5.6Lab Duplicate Order Range (DPL)


Select the Lab Duplicate Order Range (DPL) on the Order Check Parameters menu to display the following:

Lab Duplicate Order Range


Duplicate lab orders date range may be set for the following:
1 Location LOC [choose from HOSPITAL LOCATION]

2 Service SRV [choose from SERVICE/SECTION]

3 Division DIV [DEMO INDIAN HOSPITAL]

4 System SYS [DEMO.OKLAHOMA.IHS.GOV]


Enter selection: 4 System DEMO.OKLAHOMA.IHS.GOV
- Setting Duplicate lab orders date range for System: DEMO.OKLAHOMA.IHS.GOV -

Value: ?
Enter the number of hours back in time you wish to check for duplicate

orders.
Value:

Use this option to set the number of hours backwards in time to look for duplicate lab orders. For example, a value of “24” indicates a lab procedure intended to be collected within 24 hours of the collection of the same lab procedure will trigger an order check indicating duplicate lab order. The range can be set up differently for various locations. For example, a lab could be a duplicate in outpatient areas if ordered within 30 days, but a lab in ICU would not be a duplicate if ordered in 24 hours.

The package default is 48 hours and covers all labs except those specifically mentioned in the orderable item duplicate range.

8.4.5.7Orderable Item Duplicate Order Range (DPO)


Select the Orderable Item Duplicate Order Range (DPO) on the Order Check Parameters menu to display the following:

Orderable Item Duplicate Order Range

Orderable item duplicate date range may be set for the following:
1 Location LOC (choose from HOSPITAL LOCATION)

2 Service SRV (choose from SERVICE/SECTION)

3 Division DIV (DEMO HOSPITAL)

4 System SYS (DEMO.MEDSHERE.COM)


Enter selection: 4 System DEMO.MEDSHERE.COM
Setting Orderable item duplicate date range for System: DEMO.MEDSHERE.COM

Select Orderable Item:

Use this option to set the number of hours backwards in time to look for duplicate orders related to specific orderable items. The duplicate order range for lab and radiology procedures in general is set by the Lab Duplicate Order Range and Radiology Duplicate Order Range options.

This is for SPECIFIC orderable items (not all text orders), and it takes precedence over the lab and radiology duplicates. So, you could set the duplicate radiology order to 48 hours but come into this option and set the duplicate chest x-ray order to 8 hours.


8.4.5.8Radiology Duplicate Order Range (DPR)


Select the Radiology Duplicate Order Range (DPR) on the Order Check Parameters menu to display the following:

Radiology Duplicate Order Range


Duplicate radiology order date range may be set for the following:
1 Location LOC [choose from HOSPITAL LOCATION]

2 Service SRV [choose from SERVICE/SECTION]

3 Division DIV [DEMO INDIAN HOSPITAL]

4 System SYS [DEMO.OKLAHOMA.IHS.GOV]


Enter selection: 4 System DEMO.OKLAHOMA.IHS.GOV
Setting Duplicate radiology order date range for System: DEMO.OKLAHOMA.IHS.GOV

Value: ?
Enter the number of hours back in time you wish to check for duplicate

orders.
Value:

Use this option to set the number of hours backwards in time to look for duplicate radiology orders. For example, a value of “48” indicates a radiology procedure intended to be performed within 48 hours of the completion of the same radiology procedure will trigger an order check indicating duplicate radiology order. This range can be setup differently for various locations.

The package default is 48 hours and includes all items except those covered in the orderable item duplicate range.

8.4.5.9Mark Order Checks Editable by User (EDT)


Select the Mark Order Checks Editable by User (EDT) on the Order Check Parameters menu to display the following:

Mark Order Checks Editable by User


Order Check On/Off Editable by User may be set for the following:
1 Division DIV [DEMO INDIAN HOSPITAL]

2 System SYS [DEMO.OKLAHOMA.IHS.GOV]


Enter selection: 2 System DEMO.OKLAHOMA.IHS.GOV
Setting Order Check On/Off Editable by User for System: DEMO.OKLAHOMA.IHS.GOV

Select Order Check: NO ALLERGY ASSESSMENT

Are you adding NO ALLERGY ASSESSMENT as a new Order Check? Yes// YES
Order Check: NO ALLERGY ASSESSMENT// NO ALLERGY ASSESSMENT NO ALLERGY ASSESS

MENT


Editable by User?: ?
Enter 'yes' if the order check can be "Enabled" or "Disabled" by users.
Editable by User?:

For System and Division, indicate if the order check can be edited by a user. Valid values include YES and NO.

If the value is YES, the order check can be “Enabled” or “Disabled” by a user. Users do have access to change the order check's ORK PROCESSING FLAG parameter value.

If the value is NO, the order check CANNOT be “Enabled” or “Disabled” by a user. Users do NOT have access to change the order check's ORK PROCESSING FLAG parameter value. An order check with a NO value does not prevent CACs from setting or changing the order check’s enabled/disabled values.


8.4.5.10Enable/Disable an Order Check (ENA)


Select the Enable/Disable an Order Check (ENA) on the Order Check Parameters menu to display the following:

Enable/Disable an Order Check


Order Check Processing Flag may be set for the following
1 User USR (choose from NEW PERSON

2 Location LOC (choose from HOSPITAL LOCATION)

3 Service SRV (choose from SERVICE/SECTION)

4 Division DIV (DEMO HOSPITAL)

5 System SYS (DEMO.MEDSHERE.COM)
Enter selection: 5 System DEMO.MEDSHERE.COM
---- Setting Order Check Processing Flag for System: DEMO.MEDSHERE.COM ----

Select Order Check: NO ALLERGY ASSESSMENT

Are you adding NO ALLERGY ASSESSMENT as a new Order Check? YES// YES
Order Check: NO ALLERGY ASSESSMENT// NO ALLERGY ASSESSMENT NO ALLERGY ASSESSMENT

Value: ?
Code indicating the processing flag for the entity and order check.


Select one of the following:

E Enable


D Disable
Value:

Use this option to turn specific order checks on or off for a user or for a location. This option works by entering a processing flag for an entity and order check. The entity can be a user, location, service, division, system, or package.



Processing flags

E (Enabled): Order check is enabled for the entity unless an entity of higher precedence has order check disabled (e.g., if Enabled at System level and Disabled at User level, order check is not processed).

D (Disabled): Order check is disabled for the entity unless an entity of higher precedence has the order check Enabled (e.g., if Disabled at System level and Enabled at User level, order check is processed).

8.4.5.11Creatinine Date Range for Glucophage-Lab Results (GLU)


Select the Creatinine Order Range for Glucophage Lab Results (GLU) on the Order Check Parameters menu to display the following:



Figure 8- : 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. This value is used in the Glucophage - Lab Results order check.


8.4.5.12Edit Local Terms (LCL)


Select the Edit Local Terms (LCL) on the Order Check Parameters menu to display the following:



Figure 8- : Edit Local Terms

There is a set of national terms that are used by Order Checking. In order for them to work properly, a site’s local terms must be mapped to the national terms (you can map more than one of your local terms to one national term).

The CAC picks the national term and matches it to the local term. Often the names are identical.

8.4.5.13MRI Scanner Height Limit (MRH)


Select the MRI Scanner Height Limit (MRH) on the Order Check Parameters menu to display the following:

MRI Scanner Height Limit


MRI SCANNER HEIGHT LIMIT may be set for the following:
1 Division DIV (DEMO.HOSPITAL)

2 System SYS (DEMO.MEDSPHERE.COM]


Enter selection: 2 System DEMO.MEDSPHERE.COM
------ Setting MRI SCANNER HEIGHT LIMIT for System: DEMO.MEDSPHERE.COM ------

Value: ?
Enter the maximum height (in inches) of a patient.


Value:

Can be ignored if the site does not have a CT scanner. This order check should also be disabled at the system level. The height needs to be in whole inches. This parameter determines if the patient is too tall to be safely examined by the MRI scanner.


8.4.5.14MRI Scanner Weight Limit (MRW)


Select the MRI Scanner Weight Limit (MRW) on the Order Check Parameters menu to display the following:

MRI Scanner Weight Limit


MRI SCANNER WEIGHT LIMIT may be set for the following:
1 Division DIV (DEMO.HOSPITAL)

2 System SYS (DEMO.MEDSPHERE.COM]


Enter selection: 2 System DEMO.MEDSPHERE.COM
------ Setting MRI SCANNER WEIGHT LIMIT for System: DEMO.MEDSPHERE.COM ------

Value: ?
Enter the maximum weight (in inches) of a patient.


Value:

Can be ignored if the site does not have a CT scanner. This order check should also be disabled at the system level. The weight needs to be in whole pounds. This parameter determines if the patient is too heavy to be safely examined by the MRI scanner.


8.4.5.15Number of Medications for Polypharmacy (PLY)


Select the Number of Medications for Polypharmacy (PLY) on the Order Check Parameters menu to display the following:

Number of Medications for Polypharmacy


Number of Polypharmacy Medications may be set for the following:
1 Location LOC [choose from HOSPITAL LOCATION]

2 Division DIV [DEMO INDIAN HOSPITAL]

3 System SYS [DEMO.OKLAHOMA.IHS.GOV]
Enter selection: 3 System DEMO.OKLAHOMA.IHS.GOV
Setting Number of Polypharmacy Medications for System: DEMO.OKLAHOMA.IHS.GOV

Number of meds more than: ?


Enter the number of medications for polypharmacy.
Number of meds more than:

Enter the number of meds that will trigger this check if it has been enabled. The package number is 7.

This parameter accepts values from 0 to 100. It is used by the Polypharmacy order check.

8.4.5.16Order Checks a User Can Receive (USR)


Select the Order Checks a User Can Receive (USR) on the Order Check Parameters menu to display the following:

Order Checks a User Can Receive

Enter user’s name: USER,DEMO// DU
Would you like help understanding the list of order checks? No// (No)
This will take a moment or two, please stand by ....................

DEVICE: HOME// CONSOLE

The delivery of order checks is determined from values set for Users, Inpatient Locations, Service/Sections, Hospital Divisions, Computer System, and OERR. Possible values include ‘Enabled’ and ‘Disabled’. These values indicate a User’s, Location’s, Service/Section’s, Division’s, System’s and OERR’s desire for the order check to be ‘Enabled’ (displayed under most circumstances) or ‘Disabled’ (normally not displayed.)

All values, except the OERR (Order Entry) value, can be set by the CAC. Individual users can set their ‘Enabled/Disabled’ values for each specific order check via the ‘Enable/Disable My Order Checks’ option under the Personal Preferences and Order Check Management for Users.

The value ON indicates the user will receive the order check under normal conditions.

The value OFF indicates the user normally will not receive the order check.

Order check recipient determination can also be influenced by patient location (inpatients only.) This list does not consider patient location when calculating the ON/OFF value for an order check because a patient is not known when the option is selected.

Order Check List for DEMO,USER Page: 1

Order Check ON/OFF For This User and Why

-------------------------------- ---------------------------------------------

ALLERGY-CONTRAST MEDIA INTERAC ON OERR value is Enabled

ALLERGY-DRUG INTERACTION ON OERR value is Enabled

AMINOGLYCOSIDE ORDERED ON OERR value is Enabled

BIOCHEM ABNORMALITY FOR CONTRA ON OERR value is Enabled

CLOZAPINE APPROPRIATENESS ON OERR value is Enabled

CRITICAL DRUG INTERACTION ON OERR value is Enabled

CT & MRI PHYSICAL LIMITATIONS ON OERR value is Enabled

DANGEROUS MEDS FOR PT > 64 ON No value found

DISPENSE DRUG NOT SELECTED ON OERR value is Enabled

DUPLICATE DRUG CLASS ORDER ON OERR value is Enabled

DUPLICATE DRUG ORDER ON OERR value is Enabled

DUPLICATE OPIOID MEDICATIONS OFF OERR value is Disabled

DUPLICATE ORDER ON OERR value is Enabled

ERROR MESSAGE ON OERR value is Enabled

ESTIMATED CREATININE CLEARANCE ON OERR value is Enabled

GENERIC RESULTS ON No value found

Press RETURN to continue or '^' to exit:

This option displays a list of all Order Checks annotated with the status of each processing flag. The right-hand column has an explanation for the processing flag status.


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