Healthcare

Accessioning – HCP

Accessioning

Registration and accessioning of assay requests or orders is an important part of the POL LIS, as that is where EHR – or paper – meets LIS. There are many aspects of this point in the workflow that are vital to the correct, successful handling of patient testing. Patient information or PHI must be accurate and secure to HIPAA standards and correctly linked with requested assays/panels and results. The requests themselves must be accurately reflected in the system and applicable regulations must be complied with regarding the information entered and stored in the LIS. On top of all of this, it must be a quick and easy process, suited to the level of qualifications and training of POL staff (often MAs or MTs who are more patient care oriented).

The User Requirement Specifications here address the registration and accession process in a physician office laboratory LIS.

[Template fetch failed for https://www.limspec.com/index.php/Template:Specification_POL_P0011_Easy_registration_and_accession?action=render: HTTP 500]HealthCloudPOL General User-Friendliness

The LabLynx physician office LIS, HealthCloudPOL, was designed especially for ease of use, while retaining the powerful professional-level functionality of its parent application, the industry-leading ELab LIMS. ELab was trimmed so that it only includes the features wanted/needed by the physician office laboratory, with a menu that is short and to the point, arranged in the order of the standard workflow most POLs use.

Standard Menu

Screens are logically laid out, with fields and buttons clearly labeled. Each screen deliberately contains as few mandatory fields as possible (displayed in bold for easy recognition) so that work can be accomplished even if all details are not immediately available.

The use of functions like “Copy” help to speed up repetitive processes, so users can quickly duplicate entire sets of assay requests, inventory items etc. that are similar, and just make the minor changes necessary.

Users are aided by drop-down picklists, with selection choices edited by the lab, helping to eliminate faulty data and speed up workflow. The handy filter tool makes looking up an order, specimen, report or other item quick and painless.

Assignment of assays to specimens is also simple. The appropriate available assays are pre-filtered based on the specimen type, and assigned with a single click of a button. They can also be easily unassigned, changed, etc.

Specimen status, as well as complete order status is displayed both by a tag and by color code, for at-a-glance updating.

Additionally, the menu and available screens/functions displayed are filtered according to the user’s role, so that, for instance, a medical assistant who typically enters assay requests doesn’t have to navigate through administrative menu items like setting passwords, test setup etc.

The bottom line is that LabLynx has taken the experience of nearly two decades of development, usage and user feedback, plus the latest physician office lab experience and real-world clients and fashioned a dedicated, useful and simple LIS that provides all the functionality needed.

Specimen Detail Screen

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HealthCloudPOL Easy Registration/Accession

As part of HealthCloudPOL’s intentional design for POLs, the most frequently used screens, and the ones that kick off the laboratory processes, i.e. the Registration or Order accessioning screen and the Specimen detail screen, are set up with one thing in mind: to provide all of the fields and features you need while enabling the quickest and easiest use possible. One of the chief reasons for an LIS in the first place is to save time while simultaneously increasing accuracy and easy retrieval of records. And that’s what ours does.

HealthCloudPOL is cloud-hosted, so it is available all the time, from anywhere. That means anyone given a login access to do so can submit test requests, including patients or outside facilities (as long as a physician approves or orders the tests). Unique accession numbers are automatically generated by the LIS for each order and specimen. These are linked to all related information (per CLSI NCCLS LIS3-A 6.3) and can be used – as can any other main identifiers like DOB, name, test/panel, date, etc. – to retrieve that information quickly and easily. HealthCloudPOL meets all of the standards cited in the Laboratory Informatics Institute’s Limspec Specification POL P0011 Easy registration/accession POL LIS specification for this item.

New Order screen

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The initial screen for new registrations/orders, while containing a comprehensive set of data fields, only requires ONE: the submitter name (in BOLD) selected from an existing user-defined picklist. Once filled out (even with just the required submitter field), additional fields are displayed for more information to be entered if/when desired.

Saved New Order with ID and Additional Info Frames

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Thus the screen allows for specimens to be added to the order within seconds of order entry (see Specification POL P0114 Specimen information), as well as any relationships to other entities like agencies, facilities or individuals, and any files or scanned paperwork can be uploaded and associated with the order.

The specimens themselves are also quick and easy to register. The user clicks the New button in the specimens frame and a short, simple entry screen opens:

New Specimen Initial Screen

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Again, note that only a couple of fields are in Bold as required, so the specimen can be saved quickly without fuss. After it is entered and saved, the test assignment frame displays. Users simply select from the available tests for that specimen type and click the Assign button Add Selected Tests Button.png.

New Specimen 2 Assign test.png

The specimen is immediately ready for testing and simple registration is complete. Additional information, files, etc., as discussed before, can be added any time before the results are completed and report issued.

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[Template fetch failed for https://www.limspec.com/index.php/Template:Specification_POL_P0110_Unique_accession_and_specimen_IDs?action=render: HTTP 500]HealthCloudPOL supports this standard fully. First, every entity in the system has a unique system ID, which ensures it is recognized and treated appropriately within the system. Second, unique user-friendly IDs are also automatically generated for orders and specimens, which can be used to search within the system (any other criteria may also be used for quick searches). The Order IDs incorporate the date created and physician office lab initials, and specimen IDs are simply ordinal for each year. These IDs are by default incorporated into the standard specimen label (which is also barcoded).

Order ID

Order ID.png

Specimen ID

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Specimen Label

Specimen Label.png

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[Template fetch failed for https://www.limspec.com/index.php/Template:Specification_POL_P0111_Multiple_specimens?action=render: HTTP 500]HealthCloudPOL’s Order Management screen allows for any number and types of specimens, and assays or panels are quickly and easily assigned – or unassigned/changed.

Order Management Screen

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Assigning Assays/Panels to Specimens

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The entire process is described in detailed step-by-step fashion in the Order Management section of the HealthCloudPOL manual.

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[Template fetch failed for https://www.limspec.com/index.php/Template:Specification_POL_P0112_Assay_assignment?action=render: HTTP 500]Assigning and unassigning assays or panels in HealthCloudPOL couldn’t be easier, and you can do it any time, as long as testing is not underway.

For any given specimen type, the available tests are listed on the left of the specimen screen Assign Sample Test Run section, and any tests already assigned are shown on the right. The blue buttons between them allow you to move any tests you select back and forth. The orange Add Test Group button displays any available panels for easy one-click selection.

Assigning Assays/Panels

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The entire registration/accessioning process, including assigning and unassigning tests is described in step-by-step detail in the Order Management section of the HealthCloudPOL manual.

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[Template fetch failed for https://www.limspec.com/index.php/Template:Specification_POL_P0113_Order/test_request_information?action=render: HTTP 500]The Order Page is the central spot in HealthCloudPOL for all orders, and its unique ID is referenced by all related pages (e.g. all specimens in that order). Further, each related item is linked by clickable hyperlinks, so that users can quickly and easily view all information related to an order, including that specified in CLSI, CLIA and elsewhere. All PHI (Protected Health Information) is securely stored in accordance with HIPAA.

The required information is included as follows:

 Name or other alpha ID – Order page, Patient Mgt, Specimen label, report

 unique specimen ID or MRN – Patient Mgt, linked to order, both on specimen label, report (these are linked to Order)

 DOB or age – Patient Mgt, Specimen label, report (these are linked to order)

 Gender – Patient page, report

 date/time of order – Order page (linked to specimen page)

 date/time of collection and collection location (these may be on individual specimens instead if the order includes more than one specimen) – Specimen page (linked to order page), collection date/time is also on report

 date/time of login/accession – Order page

 date/time of receipt – Order page, report

 assays/panels ordered – Order page, specimen pages, labels, report

 financial # (if applicable) – Patient page

 ordering physician* – Order, report

 insurance information – Patient page, order detail section

 ICD-9/10 code or diagnosis – Order

 cross-reference between ICD-9/10 code and CPT (if applicable) N/A

 comments/notes – Order page, specimen page (these appear on report by default),

 specimen source – collected by is on specimen page, submitter plus notes on order page

 SSN – Patient page

 Address – Patient page

 user entering the data – all pages

Order Page

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Patient Page

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Specimen Label

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Patient Report

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[Template fetch failed for https://www.limspec.com/index.php/Template:Specification_POL_P0114_Specimen_information?action=render: HTTP 500]Specimen information in HealthCloudPOL meets CLSI and ASTM standards, with all required information on the specimen screen itself (tests are shown there also), order page and/or specimen label. All three are linked so that all necessary information is available to authorized users at the click of a link. Additionally, the order page being essentially the central matrix for any testing requests for the lab, its unique ID is referenced by all other related pages, labels, reports, etc. so that all relevant information is linked and easily accessed by authorized users.

Any paper or electronic requisition forms are easily uploaded to the order:

Requisition Form uploaded to Order Page

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The specimen screen links to the order screen, users simply click on the specimen to view its details:

Specimen frame on the Order

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Specimen Screen showing various features

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Returning to the Order screen, plenty of notes can be entered pertaining to the order or specific specimens, and labels can be printed at any time. When an order is initially marked as “Received” by a user, the LIS automatically presents a popup asking if they would like to print labels at that point (usually that is when they are printed).

Order Detail - Print labels.png

Printing Labels at Receipt

Receive - Print Labels.png

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[Template fetch failed for https://www.limspec.com/index.php/Template:Specification_POL_P0115_Collection_and_container_information?action=render: HTTP 500]HealthCloudPOL is designed to make sure you have all the features and functions you need for your physician office laboratory, and to help you meet CLIA requirements, all in a free, reliable and professional system. But HealthCloudPOL also meets many other industry standards, including collection and container information. The Specimen page in HealthCloudPOL includes fields for collection date, person who collected the specimen, requested tests (this also is automatically printed on the barcoded label), and Tube Type – which is a text field, supporting any type of container, description and notes. The Order page that the Specimen page is linked to also helps you to meet this requirement, with fields specifically for any additional notes, observations, hazard warnings, etc.

Specimen Page (Linked to Order Page)

Specimen Detail.png

Order Page

Order Detail screen.png

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[Template fetch failed for https://www.limspec.com/index.php/Template:Specification_POL_P0116_User-configurable_order_and_specimen_screens?action=render: HTTP 500]HealthCloudPOL comes pre-configured to provide out-of-the-box functionality to suit most physician office laboratories. However, any lab will need to define the users in the system, load their own logo onto the report and many other things. These administrative configurations and more are all supported in HealthCloudPOL.

Areas where authorized users can do their own configuration include:

  • User Management – Administrators can define any number of users, assign login ID and password and enter other details, including password expiration, access profile (Lab Manager, MTA or Office Staff) and more.
  • Settings – The Settings menu item is the first step in initial setup.

    Settings

    It defines your location, including address, phone, etc. and, importantly, it is where your lab’s logo is uploaded so that it displays on the Order Report along with the other information. It also allows for the Lab Director and CLIA number to be displayed, in compliance with regulations.

  • Test, Panel and Parameter Management – There are over 50 common assays and ~1000 parameters included in your HealthCloud Physician Office LIS by default. But any tests that you want to use may need their parameters and/or ranges adjusted, instrument assigned etc. before being activated and published for use. Additional new tests may be created if necessary. Results may include any alphanumeric values, including symbols (e.g. <, >, etc.), and may also be selectable, with user-defined choices (e.g. present, ND, neg/pos etc.), with multi-select also available. Any tests can be grouped into panels, which can then be assigned to specimens in a single click during registration (or any other time).
  • Picklist Management – “Picklists” are the drop-down lists of choices that display on various screens. Many of these sets of choices are editable by you. Those that you can edit are listed in the Picklist Management menu item.

Picklist Management list screen

  • Specimen Types – This is an Administrative function rather than a standard lab operation. Only users with Lab Manager profile have this on their menu and may access it.

The Specimen Types List screen displays Specimen/Sample Types currently defined in the system and provides a means to define additional Specimen, or Sample, Types. A Specimen Type is also called a Matrix. A useful application of Specimen Types is to filter the tests on the Order Management screen to only display those tests that were assigned the same Sample Type as the specimen in question, which HealthCloudPOL does by default.

If it is important to separate your tests by Specimen Type you can create a test for a particular Sample Type, copy that test and change the Sample Type and possibly the Result Units for use on another matrix.

HealthCloudPOL contains several default Sample Types, which should be sufficient for most labs. If, however, you have need to define additional ones or you wish to delete or inactivate existing ones, this can be done here.

Users can make good use of this field in querying data for specimens. On all of the screens where it is used, the Sample Type is a picklist (drop-down list) where the user selects the desired type.

Specimen Types Menu Item

Sample Types 1.png

  • Parameter Groups – HealthCloudPOL enables you to add and edit Parameter Groups. Parameter Groups are simply multiple analytes (parameters) derived from the Master Parameters List, grouped together for reporting purposes.

HCPOL comes with several standard Parameter Groups that serve as group headers for Patient Report results.

Parameter Groups List Screen

Parameter Groups 1.png

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[Template fetch failed for https://www.limspec.com/index.php/Template:Specification_POL_P0012_Registration_before_collection?action=render: HTTP 500]HealthCloudPOL lets you define any order ahead of time, and by default the specimens are not shown as received and available for testing until marked as such by an authorized user. Further, if they have been received and then you find for some reason they aren’t ready to test, there is an “On Hold” function that removes any given specimen from the available list until that box is unchecked. In all cases, the order’s status is displayed. Where more than one specimen exists on the order, the least-processed specimen status displays as the order status. “On Hold” status is displayed on the specimen detail page, with its overall status (i.e. “Assigned”) displayed on the order.

Receiving an Order.png

Order Statuses

Received Statuses.png

On Hold Specimen

On Hold.png

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[Template fetch failed for https://www.limspec.com/index.php/Template:Specification_POL_P0013_Labels?action=render: HTTP 500]The standard specimen label included with HealthCloudPOL includes:

  • Barcoded Specimen ID Number
  • Specimen ID Number
  • Patient Name
  • MRN
  • Order ID Number
  • Tests Requested

Specimen Label

Specimen Label.png

Specimen labels are a standard 1″ x 1.5″, and easily printed on most barcode printers (or regular printers if you do not use a scanner). Notes intended to display on the label may be entered in the “Tests” field. Alternatively, if you wish to customize the label and/or specimen page with another field or add other label sizes/types, etc., an optional Plugin may be ordered at any time (Standard Edition subscription).

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[Template fetch failed for https://www.limspec.com/index.php/Template:Specification_POL_P00014_Manual_and_semi-automated_registration?action=render: HTTP 500]Registration is streamlined in HealthCloudPOL, so you can get your work done as fast as you need to. The only required field is the Submitter (usually the physician). All of the rest can be filled in when it’s most convenient for you. That means you can move on immediately to adding the specimen itself, and the tests requested. The only mandatory fields for creating a specimen in the LIS are Sample Collection Date (important in keeping track of hold time), Specimen Type (whole blood, serum, urine, etc.) and Priority. Saving that information then allows quick and easy assignment of assays/panels, ensuring maximum flexibility. Barcoded specimen labels can be printed at registration or at any time thereafter, helping you to keep track of specimens. If an order is pre-registered, scanning the label will bring it up in the LIS. The manual or transcribed registration process is clearly explained in step-by-step fashion in the Order Management chapter of the HealthCloudPOL manual.

Additionally, Optional Integration Plugins are available to Standard Edition subscribers, to facilitate OCR or mark card reader technology, or to interface with your EHR or other system to automate order receiving, specimen creation and/or results entry and reporting.

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HCH Integration Diagram.png

The HealthCloud Physician Office LIS from LabLynx, Inc. was created using the core design of the LabLynx ELab LIMS, well-known for its industry-leading flexibility and ability to interface with any other kinds of systems, databases, instruments/devices or other entities. This in-built capability means that if you upgrade from Basic to Standard edition, you can request Optional Plugins any time you want to link up with your EHR, PM, instruments or anything else, in full support of MU2 and HITECH.

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Order ID.png

Each order, each patient, submitter and each specimen is automatically given a unique ID in the HealthCloudPOL system, and all are linked to the order, so that records are managed correctly. Additionally, orders and specimens are automatically assigned a user-friendly unique ID that can be used to search and view all associated entities and information. During registration, users do not enter submitter or patient information. Rather, they select them from the existing list held in the LIS’s Patient Management database. If a submitter or patient does not already exist there, they may be quickly and easily added from the registration screen, and additional information (address, insurance info, etc.) can be added when convenient. This method prevents record duplication, while allowing entities with the same names to not present problems.

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[Template fetch failed for https://www.limspec.com/index.php/Template:Specification_POL_P0017_Editable_accessions?action=render: HTTP 500]Registration is streamlined in HealthCloudPOL, so you can get your work done as fast as you need to. The only required field is the Submitter (usually the physician). All of the rest can be filled in when it’s most convenient for you. That means you can move on immediately to adding the specimen itself, and the tests requested. The only mandatory fields for creating a specimen in the LIS are Sample Collection Date (important in keeping track of hold time), Specimen Type (whole blood, serum, urine, etc.) and Priority. Saving that information then allows quick and easy assignment of assays/panels, ensuring maximum flexibility. Barcoded specimen labels can be printed at registration or at any time thereafter, helping you to keep track of specimens. If an order is pre-registered, scanning the label will bring it up in the LIS. The manual or transcribed registration process is clearly explained in step-by-step fashion in the Order Management chapter of the HealthCloudPOL manual.

Additionally, Optional Integration Plugins are available to Standard Edition subscribers, to facilitate OCR or mark card reader technology, or to interface with your EHR or other system to automate order receiving, specimen creation and/or results entry and reporting.

By default, the system captures the user who creates any record in the system (an order, specimen, new patient, etc.) as well as all additional saves. The last user to edit a screen is displayed on that screen, along with the user who created the item and dates/times for both. All edits to results screen are available for administrators to retrieve and review if desired. For Standard Edition subscribers, an Optional Plugin is available to enable full user audits for any desired pages in the system.

User Create/Edit Tracking – Order Screen

User Edit Tracking - Order.png

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[Template fetch failed for https://www.limspec.com/index.php/Template:Specification_POL_P0018_Patient_information?action=render: HTTP 500]Patient information in the HealthCloud Physician Office LIS is stored securely, yet quickly and easily accessed by authorized users in the Patient Management section. Full instructions on its use are available in the HealthCloudPOL manual chapter on Patient Management. These records can also be automatically passed from and referenced to EHR patient records through an Optional Plugin to maintain consistency and coordination. The HL7 secure data transfer protocol is the standard method of transfer for all HIPAA-protected patient PHI (Protected Health Information). Any SNOMED or LOINC communication integrations desired may be added at any time through an Optional Integration Plugin, as long as you have a HealthCloudPOL Standard Edition subscription (not available to free Basic Edition users).

Patient Management Screen

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[Template fetch failed for https://www.limspec.com/index.php/Template:Specification_POL_P0019_Associate_items_and_notes_with_registration?action=render: HTTP 500]The HealthCloudPOL Order Screen has several places for notes of various kinds to be entered as free text, as well as the provision for quick and simple upload of paper requisitions or any other associated files.

Order Detail - Comments and Upload Files.png

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Notes

Individual Specifications were transcluded from limspecwiki

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