The addition of an orders button to the message area in V4 is great, but when I put in orders this way, any other text I've put in the message pane is deleted, and I can't add any text to the order list (why I ordered it, what happened, etc). This problem doesn't occur when prescriptions are added here. I'm sure it must be easy to fix.

I use the message pane for all quick notes, refills, orders, etc. including those I do via e-mail.

Henry

I have sent in a "suggested improvement" via AC and even a bug about the fact that if an order is done within an office visit it is not saved and easily found later (only within the note) - was told that they were working on revamping the ORDERS in general for the upcoming version. I would suggest that everyone who wants this or something similar use the suggested improvements in AC and send it in. I find that they actually do look at these and if enough people put it in that it will make a difference.

I know that some of the support people try to look at the user's board, but they are strapped for time.

I have sent in a "suggested improvement" via AC and even a bug about the fact that if an order is done within an office visit it is not saved and easily found later (only within the note) - was told that they were working on revamping the ORDERS in general for the upcoming version. I would suggest that everyone who wants this or something similar use the suggested improvements in AC and send it in. I find that they actually do look at these and if enough people put it in that it will make a difference.

I know that some of the support people try to look at the user's board, but they are strapped for time.

Not sure if this has anything to do with it, but I find it completely annoying that orders done in the note or done from the patient list does not record the diagosis. This is ridiculous. Many times the lab loses the req and they call for another one, and my staff has no way of knowing the diagnosis.

This, in my opinion, is one of the top ten failings of AC.

I agree - everyone needs to suggest improvement on this one

Steven,

We always agree, do we not? LOL.

So, when one clicks on the order button from within a note there is the option to save or to print. So if we print it, is it also saved? Where is it saved to; only to the plan section of the note? I wish there was a way to send the order to the lab electronically. All in all I am struggling to find a good way to use this feature.

Tim

Tim, you can always print to your fax. Chose to print the orders and then select your fax server as the "printer".

Leslie

Tim, I think you are thinking too much on this one.

It is basically just like the prescription writer except meds don't go into PMH.

With the script writer, you can print from a note, and the script stays in the writer and is documented in the plan. Or you can just save a medication to the plan without printing it. Or you can right click on a patient outside of a note and print a medication.

With the orders, there are a few options:

1. The most likely scenario is you are in an office visit. The visit flow is the you do an H & P, select an assessment/diagnosis and the do a plan. The plan would include medications, labs and other things. So, at that point, you would open the order writer, write an order and print it and give it to the patient. By printing it, the order would be documented in the plan. Just as with paper. With paper, you would fill out a requisition, hand it to the patient, and document in the note the lab.
2. There are not many reasons for doing this, but if you do not wish to print out the lab, you can choose to save and not print. This will save the lab order to the plan.
3. As Leslie suggested, you could open the order writer, print up the order to print, but print to fax and fax it directly from your PC to the lab. This would also save it to your plan. Pretty much anytime you do an order with the chart open IN A VISIT that will be saved, the lab order is saved to the plan.
4. You can right click on a patient in your Patient List and print an order or print to fax. This will save the order to your Visit History. Note that choosing Save Without Printing there does nothing. It just closes your order writer.

Now there are some issues to understand:

If you write an order from outside of an office note, e.g. by right clicking on the patient in the patient list, the order will then appear in your message box. This happens whether you choose Save without printing, Print preview, or print to default. Of course, the nice thing about this is that it is saved to your visit history, and it is easy to find it later. Unfortunately, it is saved with the generic Orders Given. If you wish to specify the lab, you must click on reply in order to allow the subject line and note area to be editable.

The biggest problem with printing or faxing a note from the patient list is that even though it saves to the visit history where it is more easily searched, it does NOT save the diagnosis, only the rule out. The other problem is that for some reason, the order writer does not grab the latest ICD-9 code, it lists the last 30 or so. This is really annoying.

We have found started experimenting with unchecking the box to include ICD-9 code and then typing the diagnosis in all caps. This includes the diagnosis in the saved lab.

It is nice to have the requisition saved to the plan as, after all, that is where it should be, but it is difficult to search through ten visits to see what you ordered. So, I suppose it would be nice if labs would save to the plan and to visit history or some other place.

Now, the absolute worst thing that can happen is and you have to train your staff quickly on this one:

You ask your staff to order a CXR on Patient A. Instead of doing it by right clicking on the patient in the Patient List so it is saved to the chart, they do it by opening up the patient's last note. You can certainly print a lab from there, but it is as if it were never ordered.

Wow, I guess I made it complicated. In summary:

You either print the req out from the note and it is saved or you fax it from the note and it is saved.

Or you send after the fact from the Patient List, and it is saved in the visit history.

Yes, somewhat complicated, but since I like to overthink things anyway, it's appreciated. Now I have a much better understanding of how it works.

Thanks mucho!

Thanks too to Leslie...

Tim

Now you know how my patients feel.

We wish that all orders were saved somewhere in the chart in a format that could be reprinted if the patient loses the order as so often happens (or, faxed to the lab or imaging office). Preferably it would be saved to Imported Items (without sign-off requirement). Then, when the results came in, they would be imported and the order deleted. If the search function in AC would include the Imported Items "Item Subject", we could use it to identify any orders that had not been deleted. I have submitted this search capability as a suggestion in the past: we would like to be able to do a search of Imported Items, for just one example, for 'diabetic eye exam' for all patients with a diabetes diagnosis to see who needs to be reminded/encouraged to get their exam done.

I have been trying to figure out a way to template lab and imaging orders into the letter writer, since once printed all letters are automatically saved to Imported Items. Still have work to do on that, though. In general, this Order function could use some improvement as has been suggested by others here.

We (2 Docs) are 3 1/2 months into AC, and today were trying to figure out how to find orders made via the message box, or reprint orders given to patients, but were lost. I hope this comment keeps this string alive, and I really appreciated Bert's input on 4/8/09.

Yes it could use improvement. I'd like to be able to send the orders as a message to another staff member. If they are in the lab, they can read it on-screen instead of printing it out (for labs anyway).

It should also be saved as part of the chart. The way AC is set up, I'd say in Imported Items, but in a separate folder called "Orders" which is non-signoff. Or as a single long-running "addendum"(probably the wrong word) where each new order is simply added as a new entry to the addendum with a date/time stamp so you can see when it was added. This would make for a nice record of what labs were ordered so that they could be checked when they come in.