YES! Attaching Documents to Orders as Results

The Allscripts TouchWorks EHR 11.4.1 upgrade for Meaningful Use Stage 2 reporting contains a new feature which allows a document to be attached to an order as a result or as additional information.

This article is going to focus on attaching documents as results. For organizations that have paper results returned for lab and/or imaging orders this new feature will improve the workflow for verifying results, completing the orders, and support compliance with meeting MU2 Core Measure 10 and MU2 Menu Measure 3. Scanned results attached to orders will be documented in the patient’s chart like electronic results and will no longer be hidden in a list of scanned results.

Prior to the introduction of this new functionality, verifying results and completing the orders with scanned results usually followed one of two processes:

1.    The provider verified the result by signing a paper copy of the result, and then the result was scanned into the TouchWorks EHR and tied to the appointment encounter within which the order was placed. The order was then manually completed.

2.    The paper result was scanned into TouchWorks EHR, tied to the appointment encounter within which the order was placed, and a Review Document task was sent to the ordering provider. The order was then manually completed.

Attaching a document to an order as a result solves many inefficiencies in the order completion process. Now, when the provider verifies the result, with the same workflow used for electronic results, the order automatically completes. The order also automatically completes when the document attached as a result does not require provider verification.

Changing your current workflow to include attaching a document to an order as a result requires consideration for scanning processes, who will attach the result document to an order, and when will this work be done during the course of patient care. Not everything needs to be changed; for example, the question of who performs the scanning can remain the same with this new workflow, whether the scanning is done by a central scan center, a medical records team, clinical staff, or whomever else a clinic utilizes.

The following is a suggested workflow with these considerations in mind:

All result documents that are scanned into the system need to generate the same task type from scan. If an organization does not receive tasks from a transcription center, the best option is to use the Review Document task because this particular task is not presently utilized by other defined workflows within the Allscripts TouchWorks EHR. The Review Document task should be set to delegated and then filtered into a task view that is worked by the person or team that will be attaching results to orders.

The biggest challenge for implementing this new workflow is deciding who will be taking on the job of attaching the documents to orders. The process involves not only going into a patient’s chart to find the corresponding order, but also the time to enter at least one discreet result data item to make the result count for the MU2 measures. The time taken to implement this workflow will replace the time taken to manually complete orders and may or may not involve the same people.

There are many benefits and efficiencies to be gained through this new workflow:

·         Scanned result documents, attached to orders, can be viewed in the same Chartviewer locations where electronic results are viewed.

·         Results are no longer separated from the order and buried in a list of scanned documents that are difficult to locate and associate to the correct order.

·         Providers receive a Result Verification task in the same manner as an electronic results.

·         Scanned results can be cited into a note.

·         The orders with attached results are displayed in flowsheets.

·         The orders are included in duplicate checking and are used in order reminder calculations.

Configuration Requirements for Attaching Documents to an Order

Document Type Dictionary
If your organization is able to use the Review Document task from scan, set Workflow for all scanned result document types to “Non Electronic”. This controls scan sending a Review Document task as opposed to a Verify Doc or Sign Note task if “Electronic Verification” or “Electronic Signature” are selected.

Documents may be specified as “Is Result”, but other types of documents may be attached. The only documents that cannot be attached are enforced types: Encounter Form, CED-Automatic Export, CED-Import from External, CED-Manual Export, Result, Audit and invalidated documents.

If the document type is specified as ‘Has Image”, and the orderable item and image are included in Meaningful Use reporting, the attachment is included in Meaningful Use reporting.

User Requirements
Users attaching documents to orders need Chart-Edit and Results-Edit security.

The user role that attaches documents to orders will need the Documents tab on their clinical desktop, with the delegated Review Document task as the default view.

Order Requirements
Orders placed in Allscripts TouchWorks EHR must be in an Active or In Progress status to enable the functionality of attaching a document as a result to an order.

The order must be associated with a resultable item and the ‘Enable Documents as Results’ checked. This option is selected by default after the 11.4.1 upgrade.

All orders can have documents attached as results except Clinical Findings.

Task Requirements
Delegate the Review Document task and define a view that is given to the users that will be attaching the results to an existing order in Allscripts TouchWorks EHR.

Meaningful Use Stage 2 Requirements
Meaningful Use Stage 2, Core Measure 10 – Lab Results, requires at least one result entered as discrete data, in addition to attaching the paper lab result to the order. To meet this requirement an organization needs to decide which discrete value will be entered for each lab order with paper results. If a complete set of discrete results values are entered, than the scanned document can be attached as additional information instead of as a Result.

Meaningful Use Stage 2, Menu Measure 3 – Imaging Results, requires checking “Image Accessible for MU Reporting” in the Orderable Item Dictionary Behavior section for imaging orders that have a resulting image scanned into TouchWorks EHR and attached to the order as a result.


Workflow for Attaching Scanned Results to Orders

There are different ways to attach a scanned result to an existing order in the system. This workflow assumes the result document is scanned into the system before it is verified, and a delegated Review Document task is automatically generated.

In addition, this workflow design requires providing the Documents tab to the users attaching the results to orders, with the default view set to the delegated task view containing the Review Documents task.

1.    Go to the Documents tab and select the document from the task list

2.    Select ‘Attach To Result’

3.    Highlight the correct order on the list

4.    Click the beaker icon next to the order

5.    Click ‘Save”

6.    Click ‘Done’ to complete the Review Document task

If the order is set to require verification, the ordering provider automatically receives a Verify Result task. Once the result is verified, the order will complete.

In the perfect world, providers place orders during the patient visit when it’s decided the order is needed. However, there are times when an order has not been placed in TouchWorks EHR and is not available for attaching the corresponding result. If protocol allows, a retrospective order may be placed by clinical staff during the result attachment process.

1.    In the ‘Order Selection’ dialog box, click ‘New Order’.

The ACI opens with the Lab Orders tab selected by default.

2.    Create and save the new order

3.    Close the ACI, returning to the ‘Order Selection’ dialog box

4.    Attach the document to the new order

5.    Click ‘Commit’ on the Clinical Toolbar

6.    Click ‘Done’ to complete the Review Document task

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