Reconciliation

What Works: Effective Practices for Office-based CareTracking of Test Results
Lab Test Reconciliation

Recommendation: A system to reconcile ordered lab tests with outstanding requests.

Source: CRICO/RMF Office Practice Handbook


 Exemplary Practice

Distribution of guaiac cards are documented in EPIC. If not completed by the patient a “pop up” notification is sent to the ordering provider. The clinical staff will perform patient outreach until the result is reconciled.

Benefits:
  • Automated system for identifying outstanding lab results.
  • Uses existing EMR functionality.
  • Provides follow up for those patients who might only receive episodic care.
In practice at: HVMA Somerville


 Exemplary Practice

  • All providers order pre-visit labs for comprehensive examinations.
  • Patients receive notification via a letter of labs to be drawn onsite.
  • If the patient is a “no show” for the requested labs the provider receives a message in their “In Basket.” The physician forwards the information to the MAs who will perform patient outreach and re-schedule the testing.

Benefits:
  • Ability to identify outstanding lab results.
  • Practice based.
In practice at: HVMA Cambridge, Lynnfield, Peabody


 Exemplary Practice

Computer-based system lists all pending tests (generated every 2-4 weeks) and acts as a double check for the practice.

Benefits:
  • Decreases workload, manpower needs.
  • Practice-based.
In practice at: MacroMedical Management System Company (MGH)


 Effective Practice
Laboratory test tracking system
  • A future order for laboratory tests is entered in EPIC.
  • Labs are drawn on site, the laboratory staff will notify the providers if a patient is a no show and they will contact the patient to reschedule.
  • The provider will make a note in the medical record.
Benefit: Ability to identify outstanding lab results.
In practice at: CHA Internal Medicine Associates


 Effective Practice
The LMR tickler, To Do, and the clincical messaging systems can be used to track furture and outstanding concerns and tests.
Benefit: Electronic system to identify outstanding test results.
In practice at: BWH (all sites)


 Effective Practice
  • Laboratory tests are entered into the electronic system when ordered.
  • Patients make an appointment for future lab tests.
  • Patients who fail to keep the appointment are identified through the missed appointment system.
Benefit: Leverages functionality of the EMR to identify outstanding lab test results.
In practice at: BWH Hyde Park Medical Center


 Effective Practice
Test reconciliation:
  • Laboratory and imaging orders are made electronically.
  • Labs are drawn on site and most are processed through LabDAC. Labs that are not processed on site are sent to Quest laboratories. LabDAC and Quest both interface with the EMR; labs are resulted electronically.
  • Laboratory/imaging orders are pended forwarded and alarmed. Providers are able to reconcile outstanding test requests with incoming results.
  • Lab and imaging results are forwarded to the provider's clinical Inbox: they are reviewed, acted upon, and a note is placed in the patient record. The results cannot be transferred to the patient's medical record until they are reviewed and signed electronically.
Benefit: Processes ensures reconciliation with laboratory as well as provider review.
In practice at: PPOC Office of Dr. Peter Masucci


 Effective Practice
Venapuncture is completed onsite by the physician. Tests are entered under “pending labs” section of EMR.
  • A log book is managed by the LPN and reconciled daily. The practice receives a hardcopy from Quest, the LPN documents in the log book before forwarding to the physician.
  • The physician enters the data into the EMR which includes an additional provider step, under “reviewed labs.” The physician initials and dates the paper results copies then they are filed in the paper medical record.
  • All results and labs test results are followed by the physician and reviewed with the patient/parents via phone or office visit.
Benefits:
  • Demonstrates that the provider reviewed and the patient is aware of the follow up plan.
  • Defensibility.
In practice at: PPOC Community Pediatrics


 Effective Practice
A log book is used to document testing ordered, dates, and results received. The log book is reconciled by the medical assistants and nursing staff.
Benefits:
  • Ability to identify outstanding lab tests.
  • Paper-based, low cost.
  • Easy to implement.
In practice at: PPOC Swansea Pediatrics, Mark Vonnegut Pediatrics, MAH Primary Care Center, MAH Waverly Primary Care


 Effective Practice
A tickler system is used to determine that tests have been done as ordered and results have been obtained.
Benefits:
  • Ability to identify outstanding lab test results.
  • Paper-based, low cost.
  • Easy to implement.
In practice at: Office of Dr. Shelley Kramer (CRMA), Waverly Primary Care (MAPS), Urban Medical Group, The Doctors Group Brookline (BIDMC), Mount Auburn Health Care at Arlington (MAH), Cambridge Medical Associates (MAH), Office of Dr. Bassaly (BWH), Office of Dr. Stubbert (BWH), BWH Brigham and Women's Newton Corner, Brookside Community Health Center, Hyde Park Medical Care, Southern Jamaica Plain Health Center, West Roxbury Medical Group, MAH Office of Dr. Christopher Peckins


 Effective Practice
  • Designated checkout person who enters all ordered laboratory tests electronically (or the laboratory requisition is used).
  • Medical assistants track ordered laboratory test results to ensure completion and receipt of results.
  • Results Manager is used to receive and acknowledge receipt of test results and patient notification letters.
Benefits:
  • Ability to reconcile lab results.
  • Ability to identify outstanding lab results.
  • Patient notification letters are automated.
In practice at: Harbor Medical Group Salem (NSMC), Office of Dr. Chaoui (NSMC)


 Effective Practice
Nurses use laboratory requisition slips to reconcile and track outstanding test results. Patient notification letters are generated by nurses and reviewed by physician.
Benefit: Ability to identify outstanding lab results.
In practice at: Harbor Medical Group Marblehead (NSMC), Office of Drs. Kaufman and Moynihan (NSMC)


 Effective Practice
Laboratory tests are reconciled with log books and rosters with daily runs for compliance. Any tests not completed are noted and flagged in Epic.
Benefit: Ability to identify outstanding lab test results.
In practice at: HVMA Quincy


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