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Diagnosis Triggered Order Sets

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mj2718

(@mj2718)

Posts: 54

Trusted Member

Topic starter

We are looking for a way to make Order entry easier. Some of the feedback from our physicians is that the EMR should be able to automatically link diagnosis to their Orders. We know you can use MEL functions to add orders with specific diagnosis, but we don't want to reinvent the wheel.

We've seen other products address this issue using Diagnosis triggered Order Sets. Centricity doesn't have this functionality baked in, but I'm sure there are ways to do it using MEL and custom forms.

Here is an example video showing Diagnosis triggered Order Sets in another product:

Anyone willing to share their solution in Centricity?

Thx -Matt Johnson | Fisher-Titus Medical Center

Posted : December 11, 2012 12:35 am

evanstaden

(@evanstaden)

Posts: 31

Eminent Member

We have built our order sets custom and it works by opening approved medical necessity edits that are added to the order. It took awhile to develop but works well for us. Our forms facilitate easily adding a diagnosis to an order without going to the standard "order form"

We actually only enter "charges" into the system as "orders" and services and other ordering we've built custom forms and workflows.

Also services etc get ordered with a specific CPT code in the system as a future order, once the patient returns for the actucal service, the CPT might be different than the end billing CPT. This now creates a situation where you add another step on the workflow of having to cancel one "order" and create a new one. Also, you now have a bunch of open orders out there that a person has to run reports on, investigate and close out/complete.

Example: ordering a EEG CPT-95819 Awake and Drowsy or CPT-95819 Awake and Asleep, well you dont know that till after the EEG is complete whether it was Drowsy or Asleep, yet at the time of ordering you have to make that decision.

Esthee Van Staden

[email protected]

Posted : December 11, 2012 3:27 am

kaplan32

(@kaplan32)

Posts: 76

Estimable Member

can you elaborate on how you programmed medical necessity edits?

Posted : January 10, 2013 10:56 pm

evanstaden

(@evanstaden)

Posts: 31

Eminent Member

We have lists of diagnosis codes for procedures. I converted these into comma delimited (concatenated) lists and linked them to orders and charges with a function that seperates the ICD from its description and then pulls into the appropriate fields in the MEL_ADD_ORDER expression. They then order with forms built with visibility fields basically based on a process of elimination which ends up displaying the correct set of ICD codes in listboxes for the procedures ordered. These ICD codes can be added to the patients problem list or not.

MEL_ADD_ORDER("S", "SNC In House Services", "Methylpred (Depomedrol) 40 mg/unit",DOCUMENT.MODIFIER, fnProblemCodes(), fnProblemDesc(), "", DOCUMENT.UNITS, "", "", "")

I'd be happy to have a GoTo Meeting and demonstrate if you email me.

Esthee Van Staden

[email protected]

Posted : January 15, 2013 5:02 am

Anonymous

(@Anonymous)

Posts: 0

New Member Guest

you must be very careful with this one. From a compliance standpoint, the provider (with ordering authority or on the basis of eg a verbal order) must specify the medical necessity (tick off the associated problem code). If you "default" something, then you could be in trouble with an audit. Especially if that something was not previously on the problem list. You can use a form with MEL_ADD_ORDERS() to help with this, however, the problem should be chosen by a doc from a pick list. You could build filters for certain CPTs, eg, if service == "CPT-95819" or "CPT-95819" then filter diagnosis entry listbox to show ICD ranges for epilepsy or spells. It'd be a lot of work but do-able.

A caveat; MEL_ADD_ORDERS() will error if you use an obsolete or invalid ICD code.

hint: first check to see if it's valid

ord_result_code=mel_add_order("T",ord_to_add.....

will return a "0" if success. If something else eg:

cond
case ord_result_code== "-5" mel_add_order("T",ord_to_add...

a "-5" means an invalid ICD code. Re-do the whole string and put the ICD code in the "comments" section!

Posted : January 15, 2013 5:48 am

kaplan32

(@kaplan32)

Posts: 76

Estimable Member

evanstaden said:

We have lists of diagnosis codes for procedures. I converted these into comma delimited (concatenated) lists and linked them to orders and charges with a function that seperates the ICD from its description and then pulls into the appropriate fields in the MEL_ADD_ORDER expression. They then order with forms built with visibility fields basically based on a process of elimination which ends up displaying the correct set of ICD codes in listboxes for the procedures ordered. These ICD codes can be added to the patients problem list or not.

MEL_ADD_ORDER("S", "SNC In House Services", "Methylpred (Depomedrol) 40 mg/unit",DOCUMENT.MODIFIER, fnProblemCodes(), fnProblemDesc(), "", DOCUMENT.UNITS, "", "", "")

I'd be happy to have a GoTo Meeting and demonstrate if you email me.

Esthee Van Staden

[email protected]

Posted : January 15, 2013 6:27 am

kaplan32

(@kaplan32)

Posts: 76

Estimable Member

I would like to do a goto meeting at your convenience. my email is [email protected]

Thank you

Nannette

Posted : January 15, 2013 6:29 am

evanstaden

(@evanstaden)

Posts: 31

Eminent Member

We don't default diagnosis at all, we bring up a pick list for providers to chose appropriately. Thank you for the comments, it helps to be reminded and get perspective on issues we all face daily in this industry. Smile

Posted : January 15, 2013 6:35 am

evanstaden

(@evanstaden)

Posts: 31

Eminent Member

nelsendavida said:

you must be very careful with this one. From a compliance standpoint, the provider (with ordering authority or on the basis of eg a verbal order) must specify the medical necessity (tick off the associated problem code). If you "default" something, then you could be in trouble with an audit. Especially if that something was not previously on the problem list. You can use a form with MEL_ADD_ORDERS() to help with this, however, the problem should be chosen by a doc from a pick list. You could build filters for certain CPTs, eg, if service == "CPT-95819" or "CPT-95819" then filter diagnosis entry listbox to show ICD ranges for epilepsy or spells. It'd be a lot of work but do-able.

A caveat; MEL_ADD_ORDERS() will error if you use an obsolete or invalid ICD code.

hint: first check to see if it's valid

ord_result_code=mel_add_order("T",ord_to_add.....

will return a "0" if success. If something else eg:

cond
case ord_result_code== "-5" mel_add_order("T",ord_to_add...

a "-5" means an invalid ICD code. Re-do the whole string and put the ICD code in the "comments" section!

This is how we have designed our forms with filters and visibility fields that bring up certain lists of dignosis codes that providers can pick from, we dont default. Smile

Posted : January 15, 2013 6:37 am

evanstaden

(@evanstaden)

Posts: 31

Eminent Member

Posted : March 5, 2013 3:32 am

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