User Guide — In-House Labs for athenaClinicals

When you order an in-house test (one that is set up as an office order type), the order task and the result task are created simultaneously. In this way, you can enter the lab results in the result task at the time of the visit (instead of waiting for the fax or interface from the outside clinical provider).

The in-house order closes automatically when these conditions are met:

• The provider signs off on the order.
• The result task contains actual data — either values or images.

In-house order templates are set up locally for each practice. You create the in-house order templates used to record in-house test results on the Office Order Types page.

Note: Although you may typically do a particular test in house, you can choose to send it to an outside lab. The order task will then move to NOTIFY status, and the result task will not be created until the results are received from the outside lab, as with all outside lab orders.

The Order Routes and Office Order Types pages work together: athenaOne sends out orders according to the order route that is specified for the order type. You can select a different clinical provider for an individual order, and you can choose to perform a specific lab in house.

Note: Use the Results section in the patient encounter to record the in-house results.

Only order types set up as office order types generate an in-house test result template document. For practices with in-house tests that generate paper or electronic results, only tests such as glucose finger sticks or urinalysis dipsticks that will be resulted during the encounter should be set up as office order types.

When you create an in-house order, a result document is created automatically in DATAENTRY status, assigned to the provider staff, and tied to the order. When the result is closed, the order moves to CLOSED status automatically.

When an in-house order has a result, only the result — not the order — appears in the Clinical Inbox. When a test interpretation is configured for the office order type, the interpretation always appears in the Clinical Inbox.

Note: The result and interpretation documents associated with the in-house order represent the work that needs to be done to fulfill the order; these documents appear in the Clinical Inbox, but the order itself is not listed in the Clinical Inbox.

The in-house order does not appear in the Clinical Inbox under these circumstances:

• The clinical encounter is open, and the in-house order and the encounter are both assigned to the same person (amended encounters can also have an OPEN status).
• The in-house order is tied to a result but is not tied to an interpretation document.
• The in-house order is tied to a result and to an interpretation document, and the status of the result is not CLOSED.

Note: When you create task assignment overrides for in-house orders, consider whether the in-house order is configured for the result or the order document to appear in the Clinical Inbox. If you are routing the result documents, please note that all in-house results are classified as "lab results" regardless of the order type.

You can order an in-house lab through the Assessment / Plan section, the same way that you order a lab to be performed outside your office.

Because the order type is set up using the Office Order Types page, athenaOne knows the lab will be resulted in house.

In the Assessment / Plan section, you can access the lab template that you set up in the Results section. From there you can use the lab template to record the results.

Note: If you use an MDP external dictation partner, you can dictate the result note for in-house orders into the MDP partner's mobile application. The partner transcribes the dictated audio file and sends the transcribed text to athenaOne. athenaOne matches the incoming text to the order document's Results Notes text field. For more information about this feature, see the Encounter Dictation Feature page.

To record in-house lab results

1. In the patient chart, click the Results tab.
2. In-Office Result — If the lab order template is not already visible, select it.
3. Enter the result data in the fields provided.
4. Click Save.

When you enter a result manually, the result appears in several places:

Clinical Inbox: You can access a result document in your lab/imaging bucket, where you can view the results outside the encounter.

Assessment / Plan section of the encounter: You can see the results in the Assessment / Plan section of the encounter, as well as in the Assessment / Plan encounter summary section.

When you order an in-house lab, an order document is created. You can create the order without specifying the diagnosis. Because we don't want to close the order until a diagnosis is indicated, you must enter a diagnosis and sign the order before the order is closed.

After a result is entered (and the order has a diagnosis and has been signed off on), the order will close. Note, however, that a separate document for the result is created. This document can be in review status for the provider to look at during the encounter, or afterwards.

When closing the encounter, you are not allowed to have open orders, but you can, of course, still have results in review status.

A document is created when an order is entered and when a result is entered. In other words, two separate documents (tasks) are created: one for the order and one for the result. In most cases, athenaOne attempts to tie the result document to the order document to close the order loop. This occurs with in-house labs by the fact that you enter the result into the encounter section as you enter the order.

How the various document routes work for orders

1. Select a diagnosis > order an in-house lab > leave the order unsigned. This action creates an order task that is assigned to the provider in REVIEW status. You will not see this order in the Clinical Inbox as long as the encounter is open. This workflow might be used by an MA when ordering a lab at intake.
2. Select a diagnosis > order an in-house lab > sign the order. This action closes the order and creates a Result task in DATAENTRY status for the provider's staff. This task appears in the signed orders bucket and should indicate to the staff member that a lab result needs to be recorded. This workflow might be used by a provider when requesting an in-house lab during a patient encounter.
3. Select "No Diagnosis" > order an in-house lab > leave the order unsigned. (Note that you cannot sign an order that does not indicate a diagnosis.) This workflow can be followed when the diagnosis is not determined prior to the lab order.
   An order task is created and assigned to the provider in REVIEW status.

How the various document routes work for results

 

At this point, you can enter the results only through the patient encounter. From the Assessment / Plan section of the encounter, click on the order that you want to result.

1. Enter the result > click Save.  
   This action creates a Result task that is assigned to the provider in REVIEW status. The provider can select one of the standard options for reviewing a result (Notify, Close, Leave in Review, etc.).
2. Enter the result > click Save > Select the "discussed this result/close" option.
   Select this option if you discussed the results of the lab with the patient. This action creates a Result task and sets the task to CLOSED status immediately. The result bypasses NOTIFY status.

The order closes after it is signed off on. If "No Diagnosis" is selected, you can enter the result, but in order to close the patient's encounter, you must sign all orders. To do that, you'll need to select a diagnosis. In this way, we ensure that a diagnosis is selected for all billable services.