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Streamlining Eye Care Orders and Workflow in the Clinic

Learn how generic eye care orders and specific physician-generated orders are created, transmitted, and executed within the clinic workflow. Find out how data integrity is maintained and how imaging modalities and instruments are utilized. Discover the benefits of automated order creation, expiration, and charge posting.

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Streamlining Eye Care Orders and Workflow in the Clinic

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  1. IHE & YOU—How Does it Work in the Clinic? Linda Wedemeyer, MD, MS--Ophthalmologist Veterans Health Administration Los Angeles, CA

  2. Mrs. Smith Arrives for Appointment • The clerk checks her in, providing demographic information to the ADT actor • ADT actor: possibly practice management system or hospital information system • ADT actor sends demographic information to the order filler or order placer • Order filler: possibly EMR • Order placer: possibly practice management system

  3. Generic Eye Care Orders Created • Order Filler (possibly EMR) creates automatic orders for lensometry and autorefraction.

  4. Why do we need Generic Eye Care Orders? • Have you ever heard of a physician writing an order every time a pair of glasses gets measured? • Can you guess what he would say if you asked him to?

  5. So Why Do We Need Orders at All? • For Data Integrity • Right patient, right image, right data

  6. How do we solve the dilemma? • Generic eye care orders • Automatic creation of orders when a patient is registered • Some of the orders will be performed, and some won’t • The tech decides which ones, as he would normally

  7. What is different about a generic order? • It may or may not be executed, as decided by the technician or by some other informal process • Generic orders that are not executed will probably expire in a shorter time frame than more specific orders

  8. Generic Eye Care Orders—Mrs. Smith • Again, recall that automatic orders were created for lensometry and auto-refraction for Mrs. Smith • Triggered when Mrs. Smith was registered in the clinic

  9. Information Flows to Modality Worklist • Generic eye care orders cause Mrs. Smith’s demographic information to be listed on the lensometer and auto-refractor • Both instruments are acqusition modalities • This list is the Modality Worklist

  10. The eye tech calls for Mrs. Smith • He brings her to an exam room, takes a history, then measures her glasses. • The tech arrives at the lensometer with Mrs. Smith’s glasses. • On the lensometer, he selects Mrs. Smith’s name on the Modality Worklist • This confirms what procedure was actually done • He measures the glasses • Measurements are uploaded by the image manager to the storage server

  11. Tech decides not to perform auto-refraction • Mrs. Smith’s vision is 20/20 and she is happy with her glasses

  12. What happens to the order for auto-refraction? • It expires • At whatever time the clinic determines • Time for expiration is set in the Order Filler (possibly EMR) • Expiration could be triggered by time of day, or perhaps by an event such as completion of physician documentation

  13. Tech completes appropriate workup • Mrs. Smith is ready for the physician

  14. Physician Sees Mrs. Smith • Takes a history • Performs an exam using multiple instruments--slit lamp, indirect ophthalmoscope, tonometer… • Some of these instruments may produce digital images—generic orders might be used as described above

  15. Physician Elects Further Workup • Decides that a fundus photo and visual field are indicated • Orders these procedures • Uses either the order placer (possibly practice management system or hospital information system) • Or the order filler (possibly eye clinic EMR)

  16. Specific Orders This Time • This is a physician generated order, where a specific procedure is ordered for a patient • The expectation is that these orders will be executed • They may or may not be set to expire automatically

  17. Orders Created by physician

  18. Orders Transmitted to Instruments • The visual field machine and the camera query the order filler (probably EMR) for the patient’s demographic information • This creates the Modality Worklists on those devices (acquisition modalities)

  19. Technician Notified • Yelling down the hall • Or tech looks at orders in EMR

  20. Mrs. Smith is sent to camera--Imager Selects name/demographics

  21. Photos Taken—any IHE Compliant Camera

  22. Images uploaded to storage server

  23. With a couple mouse clicks…

  24. Charge Posting—Procedure Codes • The instrument passes procedure codes to the order filler (optional feature) • The order filler maps to CPT codes • The order filler notifies the billing system (charger processor or charge poster) that a billable procedure has been completed

  25. Charge Posting—Diagnosis Codes • Diagnosis codes added manually using charge processor • By physician or billing personnel • Some day we’ll automate this too!

  26. What happens to studies to be read? • After the modality performed procedure step • The order filler can be configured to notify the physician that there are results to be read

  27. Physician notified

  28. Images now viewable

  29. Image Display Actor • Desktop computer • Retrieves images from a storage server

  30. Physician reviews the photos

  31. And writes a report • In the future, report creation will be standardized in IHE • Once report creation is addressed in IHE eye care, automatic charge posting for the physician’s report can occur

  32. Tech Calls Mrs. Smith • And brings her in to the visual field machine • Selects Mrs. Smith’s name on the visual field machine and then performs the procedure • Data is uploaded to the storage server

  33. Charge Posting—Procedure Codes • The instrument passes procedure codes to the order filler (optional feature) • The order filler maps to CPT codes • The order filler Notifies the billing system (charger processor or charge poster) that a billable procedure has been completed

  34. Charge Posting—Diagnosis Codes • Diagnosis codes added manually using charge processor • By physician or billing personnel • Some day we’ll automate this too!

  35. The physician is notified • He retrieves the visual field from the storage server (image archive) • While sitting at his desktop computer (image display actor) • Reviews the study

  36. And writes a report • Some day this will generate a charge

  37. Diabetic Teleretinal Screening • Perfect example for generic orders • Every patient gets the same thing • Every scheduled patient is automatically on the Modality Worklist of the camera

  38. Integrating the Healthcare Environment (IHE) Eye Care • Patient Data Anytime, Anywhere… • Standards make it happen!

  39. More information…. • IHE Web site: www.ihe.net • Technical Frameworks • ihe_eyecare_tf_TI_vol1_2006_06_01 (Trial Implementation version) • ihe_eyecare_tf_TI_vol2_2006_06_01 (Trial Implementation version) • ihe_tf_rev6.0ft_vol1_2005-05-18-FINAL (Radiology) • ihe_tf_rev6.0ft_vol2_2005-05-18-FINAL (Radiology) • ihe_CARD_tf_vol2_2.1_FT (Cardiology) • Standards used by IHE Eye Care • DICOM Standardwww.nema.medical.org • HL7 Standardwww.hl7.org • IHEConnectathon Oct. 2006 at RSNA HQ • IHEShowcase at Nov. 2006 AAO Conference • Vendor Products Integration Statements

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