Getting your orders online reduces risk in the practice

You’re using an EHR. You’re e-prescribing. You’ve eliminated pulling the old paper chart (most of the time!). That’s good.

But how about those orders?

Are you still writing on the bottom of your fee slip or encounter ticket that you want the patient to be scheduled for a test or with another physician? That’s not good.

Get the order in your EHR.

Instead of taking the time to write on paper, keep your hand on the mouse or the keyboard and check a box on the screen, or type a special request in the “other” field.

Getting your orders online reduces risk in the practice.

Let’s look at an example.

You see a patient and determine that he has a significant problem and requires an appointment with a specialist or subspecialist ASAP. You write that order, “schedule with Dr. Smith ASAP” on the bottom of the fee slip. The patient carries the fee slip to the check-out station (you hope he doesn’t just leave with it!) and hands it to your cashier/scheduler.

The scheduler tries to get Dr. Smith’s office on the phone but the patient can’t wait any longer, so the ASAP order gets set aside. Maybe it is scheduled within the hour, maybe not.

Is that a risk you want to take knowing society has become very litigious?

Good practice, good risk management, good sense all tell us that creating protocols is not enough; we need to monitor the implementation of those protocols.

Monitoring paper orders for scheduling patients with external referrals is cumbersome at best, and absolutely impossible at worst. Electronic orders in the EHR can be easily and quickly monitored.

How do you create orders in the EHR? Of course every software system is different, but the basics are similar.

As you did with e-prescribing, you can create an orders template that allows you to select pre-built orders. Like having a list of “favorite” medications that you prescribe frequently, your EHR will support a list of external orders or a referral dictionary that allows you to quickly and easily check a box or pick a consulting physician from a list. You may need help from your EHR administrator or project manager to create a new template or checkout screen, so find time to sit down and articulate your needs.

Once you have your templates created, the first step during a patient encounter is creating the order electronically. Remember, if you don’t want to click another box, you can “dictate” your order to your assistant in the room with you and your assistant can document the order electronically and you can sign it.

The next step is the payoff.

When orders are entered electronically, the advantage of using technology kicks in. The EHR will allow you to view all open orders and often filter those orders by special flags, like the “ASAP” request.

At any point you can monitor the status of orders. If you are concerned about a particular patient, you can view the orders for just that patient. Good practice says that monitoring all orders on a daily basis is one method to keep an important request from falling through the cracks, so once you’ve implemented electronic orders, implement a daily process for status review on all orders.

A practice manager or nurse manager can determine within minutes if an order has not been completed or has been processed incorrectly. In our example, that “ASAP” order would be flagged in the EHR, and if the scheduler had not completed it, the manager would know at a glance. Or, if the scheduler had completed the order but scheduled the patient too far into the future, the manager could readily determine that as well.

Electronic ordering is good use of the EHR, good practice, and good risk management.

Rosemarie Nelson is a principal with the MGMA Health Care Consulting Group.

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  • kjindal

    what about when your electronic order for labs/radiology/meds/etc. gets printed out, faxed, interpreted by a human somewhere else, then re-entered into another system before being carried out? That actually INCREASES the possibility for human error by increasing the number of steps, like a game of “telephone”. Only this isn’t a game. It’s what happens when crappy EHR systems blossom due to uncoordinated freely flowing grant money given out by our misguided (and lobbyist-laden) government, trying to force all us luddite doctors to adopting the savior miracle of electronic records.