Nov 15

The Antibiogram Report

In its basic form, an antibiogram is the set of sensitivity results for each organism that’s been isolated from a given culture.  SchuyLab’s Microbiology feature routinely produces antibiograms for each Culture and Sensitivity performed in your lab.  These are, of course, reported as part of the patient’s results.

SchuyLab also permits the creation of specific, targeted microbiology reports, such as a tally of public health reportable organisms (e.g., MRSA).  On occasion, however, your lab may have to provide a detailed overview of the antibiograms for all the Cultures run in a given time period:  how many of each organism were isolated, what antibiotics were tested on each organism, the number of times the organism responded favorably, and so forth.  This is the sort of report needed for Public Health or your Infection Committee.  To do this, SchuyLab allows you to create its Antibiogram Report.

To do this, go into F8: Setup > Set-Up > Report Setup > Reports.  Click the New Report button, and SchuyLab will display the Create New Report box.

Give the report a Name (max 8 characters) and a Description (max 20 characters), for ease of reference.  Under “Type”, pull down the list and select Micro Summary.  Then click OK.  Since this a new report, and has not yet been set up, SchuyLab will remind you to do so by displaying the Microbiology Summary Setup box.

The Queue, Font, &c, are selected as with any other report.  What’s important here is “Print Options”:  check the box labeled “Include Antibacteriogram”.  (Do not also select the box labeled “Summary Only”!  It sounds reasonable, but it will result in a blank report.  Trust me for this.)  Select OK, and then Done to complete the setup.

The Antibiogram Report is accessed through F6: Print > Miscellaneous Reports.  Selecting that icon brings up a list of the reports that have been customized for your lab; the Antibiogram report we just defined will be on that list.  Select it, and SchuyLab displays the Antibiogram Report box.

As with other statistical or demographic reports in SchuyLab, we enter either a range of Accession numbers or a range of dates for the Antibiogram Report we wish to generate.  We select the printer queue (which we can set to “screen” if we want to see the report on screen before committing it to paper), and click OK.  And voilà, SchuyLab generates our Antibiogram Report.

It’s arranged in columns, with the headers on each column describing its contents:  the names of the organisms, how many times they’d been isolated in our range of Accessions or dates, and the antibiotics used in the Sensitivity testing.  For these, the numbers reflect the percentage of cases where the organism was sensitive to that antibiotic – followed in parentheses by the actual number of cases.

So to take a line from our example report above, the organism Escherichia coli was isolated in 127 cases, and was sensitive to AMC 69% of the time (82 instances, out of the 127 cases).

The Antibiogram Report is one of the many customizable reports you can create for your lab through SchuyLab:  demographic reports, result summary reports, turnaround time reports, and much more.  If you have any questions on the Antibiogram Report, or anything else really, don’t hesitate to contact us at Schuyler House.

 

Permanent link to this article: http://www.schuylerhouse.com/the-antibiogram-report/

Oct 11

Medication Module

Introduction

The Medication module enables SchuyLab to automatically correlate the pharmaceutical prescribed by the doctor with the results of the tests performed by the laboratory, and produce a text comment describing that relationship.  For example, if a patient has been prescribed Oxycodone, a test for that drug is expected to show its presence – if the test is negative, then the patient is non-compliant with the prescription.

The Medication module has five parts to it:

  • Drugs and Formulary
  • Prescriptions
  • Auto Remarks
  • Printing Reports annotated by Auto Remarks
  • Security for Pharmaceuticals

Drugs and Formulary

In F7 Features, there is now an “Rx” module.  (This module is loaded into SchuyLab in the usual manner.)

As a foundation list of pharmaceuticals and their ingredients, SchuyLab now imports the RXNorm subset of National Institute of Medicine drug database.  All of the drugs imported from this database are available for prescription purposes.

Once the drug list has been imported, a Formulary is created using the Update Formulary icon.  The Formulary is a subset of the comprehensive drug list that contains the pharmaceutical preparations that the doctor routinely uses; the entire drug list is also available to the doctor for orders that are atypical for his practice.  The items in the Formulary can be a combination of generic and brand name drugs.

For example, in the above image, all of the drugs listed are present as ‘generic’ drugs, except the Morphine Sulfate which is a brand name.  (While the above list only shows examples of oral medications, all delivery forms are presented in the comprehensive drug list.)

Prescriptions

Prescriptions are ongoing documentation of what’s been prescribed to a patient over the course of time.  They are a permanent record and cannot be deleted; if a prescription is entered in error. it can be annotated and closed, but it remains part of the record.

The Prescriptions icon appears on the Patient Processing Screen when the Medication module is loaded into SchuyLab.

Select this icon and SchuyLab displays the Manage Prescriptions screen, showing the prescriptions that apply to this patient.

The Manage Prescriptions screen is divided into two windows: the Current Prescriptions window lists the active items; the Previous Prescriptions window shows the history of prescriptions that are no longer active.

At the moment, this patient has no Prescriptions – so let’s add some.  Select the Prescribe button.  SchuyLab displays the Prescription box.

Enter a word or part of a word in the pulldown box (i.e., enter “Codeine”), or leave it empty to access all of the drugs in the Formulary.

Select an entry and SchuyLab considers that pharmaceutical as being prescribed on that patient.  If you check the box “Include non formulary drugs”, SchuyLab accesses the entire drug database.  The ability to select this option is controlled by a specific security clearance.Enter the appropriate end date of the Prescription:  SchuyLab uses this date to control the automatic closing of this Prescription and move it to the “Previous Prescription” window of the Manage Prescriptions screen.  This date, and the move, is overridden by checking the “Renewable” checkbox.  This checkbox keeps the Prescription active until both the check is removed and the End date is past.

SchuyLab now displays this pharmaceutical in the list of Current Prescriptions.The Prescription we’ve just added is marked with the status of “NEW”.  At this point, we can still delete the Prescription if we’ve added it in error.  The new Prescription isn’t finalized until we click on the Done button in the upper left corner.

If we did want to delete this new Prescription, we’d just select it from the list and get the Prescription box again – but this time, with the Delete button activated.Selecting Delete will remove the Prescription from the “Current Prescriptions” window.  SchuyLab will open a dialog box, asking if we’re sure:Selecting Yes will remove the Prescription.

When you’re satisfied with the status of the patient’s Current Prescriptions, select Done.  Once Done is selected, a prescribed drug cannot be removed from the list.  This is a deliberate mechanism to ensure the integrity of the Prescription information in SchuyLab.Now the Codeine prescription can no longer be deleted.

Once the drug becomes part of the record, if its Prescription is discovered to be in error, we can still deactivate the Prescription:  by moving it from Current Prescriptions to Previous Prescriptions.  This can be done by selecting the drug, then altering its End date, advancing it to match the Begin date.  A Note or Remark Code should be added to the entry, to annotate what you’ve done, explaining the circumstances.

I have changed its prescribed dates (and placed an explanatory note) to remove it from the Current Prescriptions list.

Auto Remarks

SchuyLab now generates user-defined text phrases under certain conditions.  In the case of the Medication module, the conditions would be a specific Ingredient (i.e., Amphetamine) and the result of a particular test (i.e., AMPH).  SchuyLab would be instructed that:

  • if ‘Amphetamine’ is Prescribed AND
  • if the result of AMPH is Positive,

THEN the Remark “Expected” is automatically generated.

The conditions I’ve just described are all configured in your SchuyLab system:  that is, the Ingredients is defined in the Formulary, the text phrase is chosen by you (defined as a Remark Code), and the tests are those performed in the laboratory, as defined in Test Definition.

In F8 Tools > Setup > Test & Panel Definition, next to the Reflex icon, SchuyLab now has an Auto Remark icon.

Auto Remark works in a manner similar to Reflex; it has similar tools… but with the addition of an “Rx” button.Select the Rx button and SchuyLab presents a listbox with an option to select either an Ingredient or a brand name drug as a Condition.

The brand name Drug option for the radio button will probably be used only in exceptional instances (e.g., Clinical Trials) – for the majority of setup requirements, choose the Ingredient option.

Why choose an Ingredient rather than the same drugs as the Formulary?  Because, in order to provide the doctor with the selection he needs for dosage, delivery method (oral/topical/mouthwash), and generic or brand name versions of the chemical compound, the drug list in SchuyLab, of necessity, may contain many line items.

For example:

(This is NOT a complete list of all of the potential entries that contain Amphetamine… less than half of them, actually.)

If you had to set up an Auto Remark for each of those entries, it would be a tedious task, to say the least. Instead, SchuyLab ‘knows’ (via the RXNorm list) that these entries all contain the Ingredient ‘Amphetamine’ and by selecting that Ingredient…

…you can define a single linkage that applies to all of the compounds that contain Amphetamine in any form or combination.

So let’s do that now.  Go into the Auto Remark icon…

… and select the Standard Table.  (This is the only table that is functional at this moment…the ability to add different tables will be added later.)

SchuyLab displays the (now blank) Auto Remark table.  Select the Add button to see the Create Auto Remark Test box.

Start by selecting the AMPH test in the Test/Panel list box, as shown above.

I want to create a comment that is triggered when the result of the AMPH test is greater than its normal range.  I therefore go into the Value button and set the condition of the value of the result to being greater than the normal range of AMPH.If the result of AMPH is greater than 1,000 (the upper limit of the normal range for the AMPH test)… AND… (I select the Rx button)…

(SchuyLab displays the Drug Condition box.)

The patient has been prescribed some pharmaceutical that contains the ingredient Amphetamine… THEN…

SchuyLab outputs the Auto Remark code of “Consistent”.

The “Consistent” option, provides the greatest saving in effort (and this is the format that should be used for our default Toxicology databases from now on).  This format allows for up to 4 Remark codes to be generated from a single entry, depending on the interaction between ‘whether or not the drug was prescribed’ and ‘whether the result is normal or abnormal.

The logic is as follows:

  • If the result is NORM and the Condition (Rx Amph) is True, the Remark Code 1 (Not Consistent) is printed.  The patient was prescribed Amph but does not show any in his urine.
  • If the result is ABN and the Condition (Rx Amph) is True, the Remark Code 2 (Consistent) is printed.  The patient was prescribed Amph and does show it present in his urine.
  • If the result is ABN and the Condition (Rx Amph) is False, the Remark Code 3 (Not Prescribed) is printed.  The patient is taking Amph from some other source.

NOTE:

Let me add a comment here that may prevent some confusion.  There are now two Remark buttons on the Auto Remark screen.  One of those buttons (circled above) controls the OUTPUT of this box.  The whole purpose of Auto Remark is to, well, generate a remark, right?  The Remark Code button circled above shows what is going to be generated by the conditions setup in this box.  There’s another Remark button in the box, however:

This button, like all of its companions to the right of the red line, sets the conditions for generating an Output.  Yes, you can have a Remark generate a Remark…not likely to be needed, but it can be done.

This is what this rule for Auto Remark looks like for the overall setup:

This Auto Remark now makes the statement:

“For the test AMPH, if the patient has been prescribed a drug that contains the Ingredient Amphetamine and the result of the AMPH test is > 1,000, then the result is annotated as being “Consistent”.

Click OK to save this Auto Remark rule.  You may have as many Auto Remark rules as you want in the Standard Table:  one for each drug test performed by your lab.

Printing Reports annotated with Auto Remarks

What is the purpose of the new Medication module?  In its current form, the Medication module correlates the result of the test with a pharmaceutical and annotates the outcome according to rules established by the user.

There are two new sets of information that need to be printed on the lab report to give the physician the information he needs:

  • A list of the pharmaceuticals prescribed
  • The contents of the Auto Remarks conditionally generated by SchuyLab

In F8 Tools > Setup > Report Setup > Patient Report, we select the Accession Report setup button.  SchuyLab displays the Configure Accession Report box.

A list of prescribed pharmaceuticals.

SchuyLab now prints out all of the Current Prescriptions in the Header of the report if the “Print Prescriptions” box is checked.

We add a column, Result Note, to the line on the report.  We set the Inline Remarks option when we do this.

The selection of Inline Remarks allows only the Remarks you want to have print out on the report be qualified by the existing Remark Code options:

Now when this report prints out of SchuyLab, it’ll look like this:

The Prescriptions are not a Note that needs to be manually typed into the Accession – they now represent a list of the Current Prescriptions on that patient.

Similarly, the Comment “Consistent” is not manually placed on the result, but is generated by SchuyLab in accordance with the rules that the user has set up.

Pharmaceutical Related Security

When dealing with drugs it is important to make sure that only the proper employees have access to the ability to alter and change the prescription information. Laboratory managers should review who will have access to the proper drug information.

In F8 Tools > Security Levels > Class, there are now three new security clearances pertaining to drug prescription:

  • Prescribe Drugs.  This security option allows access to the Prescriptions icon on the Patient Processing Screen.
  • Outside formulary.  This option allows the user to access the entire drug list.  Without this clearance, the user is limited to drugs that are already listed in the Formulary.
  • Manage Drugs.  This option allows the user to access the Rx icon in F7 Features.  Without this clearance, the user cannot Import a drug list or modify the Formulary.

 

 

 

 

 

 

 

Permanent link to this article: http://www.schuylerhouse.com/medication-module/

Oct 04

Multiple Language

Introduction

Multiple Language Module is not a translation program.  It will not automatically translate information from one language to another.  What the Multiple Language Module does is it allows each test in Test Definitions to have synonyms for its Name and Description in a set of non-English languages.  (The screen name for the test will still be in English).  Once the synonyms have been defined, each Client in SL can be set to report in any one of those languages.  The language set is limited to languages that read left-to-right but can include other alphabetic systems (eg Cyrillic).

Setup the Multiple Language Module

Setting up the Multiple Language Module is a three step process.

  • Step one to assign the new language to the test definitions.
  • Step two to assign which client will see which language.
  • Step three to setup the reports to print the new language.

Step One

After the module installed a new options button will appear on all test definitions.

F8 > Tools > Test & Panel Definition > Test Definition

The option button appears above the test “Name” and “Full Description”.  The option button is rectangular and has three little dots.

 

 

 

Type in the English name for the test and then press the option language button.  If there is not a language in place click the add button.

A new window will open and from the top drop down menu select the language.  Then type in the translation of the drug.

Add as many languages as needed.

Step Two

After the tests have been setup, setup which clients are going to see which language.

F8 > Doctor’s records > Update Clients

From the clients screen use the Language drop down menu to choose which language this client will see on the reports.

Step Three

The final step is to insure that the information will appear on the report.

F8 > Setup > Report Setup > Patient Report

Set the accession Report and Send Home report to the SPECIMEN type format in the pulldown list.

Properly the reports will print out the language which the client wants to see on the test names. In this example you can see Japanese.

 

 

 

Permanent link to this article: http://www.schuylerhouse.com/multiple-language/

Oct 04

Remote Printing

Introduction

Your system is set up with its required printers, reports and invoices are printing nicely to the correct locations, and all is right with the world. Now, you need to print something from your computer station to the lab next door, the boss’s office across the street, or a client across town. That’s where Remote Printing comes in.

Remote printing requires the purchase of specialized printers or printer hardware.  The use of this hardware, once common, has become rare since the turn of the milleneum and is now difficult to find.  Schuyler House no longer has any contacts in the remote printer industry and this module has been largely supplanted by use of Auto Faxing or by SchuyNet internet module.

Hardware Requirements

  1. Make sure the receiving printer is able to receive the transmission. Make sure the power is on, the printer is online, and that it has paper.
  2. Make sure the receiving printer is plugged in to a dedicated phone line, one reserved for that printer alone. This enables you to send the receiving printer data over a modem.
  3. The SchuyLab station with the modem in it must have a line (cord) between the modem and a dedicated phone line.
  4. The SchuyLab station with the modem in it must be on and logged in to SchuyLab.

Setting Up Remote Printing

  1. Set up the printer queue, the area in the computer where documents go to be printed, for the remote printer.  Make sure there’s a separate queue for each remote printer (REMOTE1, REMOTE2, or the name of the client), as there is for each printer in the lab (test results going to the LAB queue, for example, invoices going to the BILLING queue, etc.).
  2. Attach the remote printer queue to the client’s record.  Once that’s done, all patients belonging to that client will automatically print on that remote printer queue.
  3. Set up the Remote Printer feature to connect the remote printer queue for a client to their telephone number.

A) To setup a new queue for your  remote printer:

  1. Select F8. Tools.
  2. Select Set-Up.
  3. Select Report Setup.
  4. Select Report Queues.

SchuyLab displays the current list of the Queues available.

5.  Select New Queue. SchuyLab displays the Input Report Queue box.

6.  Fill in the Name and Description entry fields. We’ve used “REMOTE1” and “1st remote queue” for this example. Select Ok.

7.  Select Done.

B) To attach the new queue 

  1. Select F8. Tools.
  2. Select Doctor Records.
  3. Select Update Clients.
  4. Click the mouse on the name or number of the client with the remote printer. Select Ok. Select SchuyLab displays the Update Client Record box.
  5. In the Queue pull-down list box, select the new queue you defined for this remote printer site.
  6. Select Ok.

C) To setup the remote printer feature on SchuyLab:

  1. Select F7. Features.
  2. Select Remote Print.

SchuyLab displays the Update Remote Printers box, listing all the remote printer connections currently defined in your system.  Select New.  SchuyLab displays the Define Remote Printer box.

  1. Enter an 8 character name for the client’s site in the Code field.
  2. Select the correct remote printer queue (the one you just set up) from the Queue pull-down list.
  3. Select the model of remote printer from the Printer Model pull-down list. The Printer Model will generally be Remotrix, but there are others available.
  4. In the Printer Telephone field, enter the telephone number for the remote printer’s line. Do not use any dashes or spaces.  Include all prefixes and area codes, and if the number is long distance for you, also include the “1” you need (basically, enter the number as you would dial it).
  5. The Site Name and Voice Telephone fields are optional. They allow you to enter a more complete description of the client’s site, so it will be easily available for future reference.
  6. If you want each transmission to this printer to end with a separator page (to distinguish it from tomorrow’s transmission, for instance), select the “Generate Separator Page” button. The final separator page acts as a mini-log and contains the date, time, and number of total reports printed at the bottom of the page.
  7. Select Ok.
  8. Select Done.

Once all this is accomplished, it should be a simple matter to access a patient record (through F2. Patient or F3. Specimen) or other document you wish to remote print.

When a prompt window pops up with the Printer Queue choice, just select the new remote printer queue.  In the case of Batch Printing, SchuyLab will automatically pick out the reports in the remote printing queues attached to clients and remote print them.  Everything should work without a hitch.  In the case of possible hitches, see below.

General Problems and Possible Solutions

The “Suspend Transmission” button will be checked if SchuyLab has attempted to connect to the remote printer and the connection has failed.  To make SchuyLab try the connection again, click on the button to remove the check mark and select OK.  SchuyLab will try to make the connection again.  If it succeeds, it will send all of the reports that were waiting to be printed.  If it fails, a check mark will appear again in the Suspend Transmission box.

To tell if there’s a problem

The Waiting button displays a list of all the reports which are in the queue for that client, waiting to print as soon as the printer becomes available.

The Reprint button displays a log of all the reports which have been successfully transmitted to the remote site; this is a way to double-check on the progress of your printing.  This will appear in a box with the title of the 8 character code you entered for that client’s remote printer (the printer queue in this example is REMOTE1, but the title is RAINBOW).  To view a log from a previous day, select the Change Date button, and enter the date you want.

Modern Problems

Sometimes the problem can be with the modem.  If the station with the modem in it is not making proper “modem noises” (dialing, connecting, etc.), a few things may be amiss.  First, the modem may be in the computer, but the computer doesn’t know that yet.  To tell it there’s a modem there:

  1. Select F8. Tools.
  2. Select Set-Up.
  3. Select Station Setup.   SchuyLab displays the Configuration screen for a single station.
  4. Select Setup C SchuyLab displays the SchuyLab Communications Setup screen. If your screen looks like the one displayed, the computer doesn’t think it has a modem, when it actually does (it’ll almost always be in COM4).

To correct this, click on the COM4 button.

SchuyLab displays the Setup Port [number] screen.  Click on the pull-down Device: list and select MODEM.

Click on the Setup… button.  SchuyLab displays the Setup [device] screen.

Select the right numbers for your particular modem from the pull-down screen.  Once done, click Remote Printing.  Then select OK.  The SchuyLab Communications Setup screen should have MODEM: Modem in COM4.

Other Problems

Other modem problems could stem from the internal buffers filling up.  If this happens, just get out of SchuyLab and turn the computer off for about 10 seconds.  Then go back in.

Static and other bad “noise” on a modem line, especially a low quality one, can be checked by unplugging the modem line and plugging in a phone.  If there is static on the phone line, call the phone company.

Other things that can lead to problems with the transmission include problems in the phone lines outside the building, problems with the remote printer (not turned on, paper jammed or absent, etc.), or even something as simple as someone picking up a phone on the other end, which is why the receiving printer should always have a line of its own.  If this happens, the “Suspend Further Print” box will be checked.

 

 

Permanent link to this article: http://www.schuylerhouse.com/remote-printing/

Oct 02

Export

Introduction

SchuyLab’s patient database is kept in a proprietary format, which generally can’t be interpreted by other LIS or MIS systems.  The SchuyLab Export function was devised to translate patient records (demographics and test results) into other formats, and write those records to a file.  The file can be on a memory stick, on your computer’s hard drive, or (if your station is networked) on the network server’s drive.  If you save to a memory stick, the memory stick can then be taken to another computer, and the results read in.

There’s a bit of setup involved in using the Export function, which need only be done once.  Thereafter, you can translate and write patient records to memory stick effortlessly and quickly.

NOTE: Remember that some exports the data generated might contain patient’s data.  These exports the laboratory will need to follow all HIPPA security rules to insure that they to protect individuals’ electronic personal health information.

To Setup the SchuyLab Export Function

Select F7 Features, Export. On the Export screen, select Setup Exports.

SchuyLab displays the Update Export list box.  This box contains a list of the existing formats; you can delete an existing format by selecting it from the list.  To configure a new Export format – select New.

SchuyLab displays the Create Export box.  Name your Export format (this will be the label for the icon on the screen) and select the Type of export that this is.  The contents of the Type list approximately correspond to the tabs in the ‘old’ Export screen (plus a few): Result, Charge, Demographics, Test, Insurance, Doctor, Pricing, Invoices, QC. The Export tool can now export Audits too.

Select OK and the new Export format appears in the list.

Close out of SchuyLab and restart it – now SchuyLab generates an icon for the new format.

To set or modify the parameters of one of your Export formats, select the icon.

SchuyLab displays the screen showing (or, in the case of a new format (as above), allowing you to configure) the parameters of your Export.  To set the basic format of the Export, use the Format pull-down list. This displays the formats already set up on your system.

SchuyLab displays the box showing the basic Output Types.  Select an Output Type and use the other buttons on this and prior screens per previous documentation to set the parameters for your Export.

The doctor/client button is designed to limit export of results and charges. Select a list of doctors and/or clients to make the data exported exclusive to those entities.  If no clients/doctors are selected, all results are exported.

Export Format

The Export Format List box shows the formats that have been defined on your system’s Export feature.  To edit or delete any of these formats, you would select it from the list and click the EDIT button.  For the moment, however, we’ll concentrate on creating a new format to suit your lab’s needs.

To create a new format for your Export feature, select New Format.  SchuyLab displays the Create Export Format box.

Complete the fields as described below:

 

Name Enter a name (up to eight characters long) for the new Export format.

 

Description

 

Enter a more complete description for your own records.

 

Peer System Type

 

This is used when one of the pre-programmed standard formats (HL7 or ASTM) requires special handling to interface to another system. The peer system can be selected to trigger this. If the system being sent to is one of the peer systems, then it should be selected.

 

Output Type Select one of the output types:

ASTM-1238 / 1394, a standardized format;

HL7,

Fixed length ASCII, where all fields are the same size;

Delimited ASCII, where the fields can be of variable size and are separated by so-called “delimiters”;

dBase IV format, for use with dBase spreadsheets.

 

Spreadsheet

 

 

 

Select this box if you want the fields to be arranged in the form of a spreadsheet, with the same fields repeated on every line.  This is only available for Fixed length ASCII, Delimited ASCII or dBase outputs, where the tests to be exported are specified (see below).
Pending The Pending field works for all result export methods. The text entered in the box is what will be sent in the result field if the result is pending. If SUPPRESS is specified, then no pending results will be sent at all.

 

Reportable Only When this box is checked, only reportable (or printable) tests will be exported.  Any test created as a “bill only test” will not be reported (See Sec. 4 – Tests and Panels for more about non printing tests).

 

Restricted When this box is checked, restricted test (such as HIV) will be allowed to be exported.

 

By default, the Export function exports all tests in the SchuyLab system (results, codes, prices, etc, as determined by the setup of the format).  If you wish Export to only look at specific tests, select the Tests? button.  SchuyLab displays the Include Tests box.

The Include Tests box will list all tests currently designated for this Export format.  (If none are listed, then all the tests are available.)  To add to the list, select the Add Tests button.  SchuyLab displays the Add Test(s) box.

Select the tests you want included in the Export format, then select Done.  SchuyLab returns to the Include Tests box.

When you’re finished designating tests for the Export format, select OK.  SchuyLab returns to the Create Export Format box.

SchuyLab has four output types to offer you,  ASCII, ASTM, HL7, DBASE.  Following is the setup for each of these formats.  The most common format used is the Fixed or Delimited ASCII format.

ASCII – Fixed Length and Delimited

The ASCII Export format is defined by the number, order, and content of the fields it generates in each record of the report.  To set these, select the Layout button.  SchuyLab displays the Layout Records box.  The box show below is set for the Delimited ASCII Format.  Fixed ASCII does not contain the Separate or Quote boxes.

If you are using the Delimited ASCII type, complete the fields as described below:

 

Separate Enter the character to be used to separate fields.  The

comma (,) is the default, as it’s the most common, but the vertical stroke ( | ) is used by some software programs.

 

Quote

 

 

 

 

Enter the character to be used to mark the beginning and end of a field.  The double quote (“) is the default, as it’s the most common, but the single quote (‘) is used by some software programs.
No Empty Checking the No Empty box will force the program to put a “” field rather than leaving it blank. This should only be used if the receiving system requires it.

 

The definition of the generated records is the heart of the Export function.  Think of each record as a line in a spreadsheet.  A typical record might look something like this:

 

“Smith”, “John”, “550-12-2222”, “1-1-58”, “WBC”, “3.8”, “L”

 

Each of the items in quotes is a field.  Defining a record is simply telling SchuyLab which field — that is, what information — do you want on the line, in what order?  How do you want it sorted?

 

SchuyLab will search through all the test results being Exported, one at a time, and sort them by type of record, as described below:

 

Beginning This type of record is generated once per Export, and is the first record in the file.

 

Ending This type of record is generated once per Export, and is the last record in the file.

 

Patient This type of record sorts the file by patient ID.  It’s useful for applications requiring patient information to be on a separate line.

 

Accession This type of record sorts the file by accession ID.  It’s useful for applications requiring specimen information to be on a separate line.

 

Result This type of record sorts the file by test.  It’s useful for applications where each patient or accession is listed once, followed by test information.  (It’s the most commonly used record type.)

 

Charges This type of record sorts the file by charges.

It’s useful for billing applications and financial

reports.

Note that we can have several types of records in a single export format.  For instance, we can start with a Beginning record, which might simply be a line of text with the name of the lab.  That might be followed with a Patient record, then a Result record.

Also note that the Patient and Accession records will be separate from any other records.  That being the case, they will also repeat as often as necessary.  (Remember, SchuyLab Export will search through its database in order, grabbing first the patient information, then the specimen information, then the tests.)  The software application that’s intended to read the Export file must be able to parse the file correctly; if it’s not capable of distinguishing separate lines of information, you may want to only use the Result record type.  It can be configured to include patient and accession information.

Let’s take a typical example, and have the Export function generate a Result-type record.  (The procedures described here are applicable to any of the record types.)  Select the Result? button from the Layout Records box.  SchuyLab displays the Define Result box.

Remember that each record is made up of fields:  in our example above, the line of data had each field in quotes.  We must define the fields that we want included in this record.  To do this, select Add Field.  SchuyLab displays the Field Type box.

Different types of records will be able to access different fields (i.e., different information), but the fields for the Result record are typical:

 

Skip Inserts a blank field.

 

Text Inserts a line of text.  Length of the line, and its contents, are defined by the user.

 

Patient… Inserts information from the patient file: patient name, patient ID, date of birth, etc.

 

Accession… Inserts information from the specimen record:  type of specimen, draw date & time, received date & time, etc.

 

Test… Inserts information about the tests ordered on the specimen:  test code, full test name, normal range, etc.

 

Result… Inserts information about the results of the tests ordered on the specimen.

 

Doctor… Inserts information about the patient’s doctor:  name, ID, etc.

 

Client… Inserts information about the patient’s client, which may be the doctor, his clinic, or other:  name, ID, etc

 

Current… Inserts information about the record you are exporting:  date, time, etc.

 

Let’s say, for the sake of our example, that we’re exporting test results for data analysis in a spreadsheet.  So one of our fields should be the name of the tests.  We select the line “Test…” from the Field Type box.  SchuyLab displays the Test… box, listing the fields that are associated with test definition.

We select the “Test Name” line from the Test… box.  SchuyLab displays the Test Name box, which defines the parameters of this field.

The Width window determines how many characters long this field will be.  (For Test Name, the Width is set to 16 by default:  this is the length permitted when the test was defined.)  The next two buttons determine whether the data in this field will be left-justified or right-justified:  that is, whether the sixteen characters would read “WBC_____________” or “_____________WBC”.

If you wish the text to be entirely in capital letters, select the CAPS check box.

Finally, there may be further choices in the definition of field.  For instance, when defining a test name, SchuyLab requires a test code (8 characters) as well as a test name (16 characters — the part that’s printed on the patient’s report).  It also permits a “full description”, which is intended for internal use.  For the Test Name field, we have our choice of these three items.  If we select the pull-down list at the upper right of the Test Name box, we get a list of these choices:

We select the form we want, then select OK.  SchuyLab returns to the Define Result box, listing the field we’ve just inserted.

On the line displaying the field, the first number is the space in the line where the field begins (in this case, since it’s the first field, it starts in space #1).  The next number is the length of the field (in this case, 16 spaces).  The next character is L or R, showing whether the field is left-justified or right-justified; then comes the field type (Test Name) and the exact means of display (in this case, the test code).

To add further fields to the record, we select the Add Field button, and repeat the above steps until we have all the fields we need.  When we’re done, the record will look something like this:

Once the fields have been added to the record, you may need to arrange them in the correct order.  To do this, select the Re-arrange Fields button.  SchuyLab displays the Re-arrange Fields box, listing all the fields currently defined in the record.

Re-sequencing the fields is done by clicking the mouse on the item you want to move, then clicking at the spot on the list where you want it to be.  Say, for instance, that in the above example, we want the accession ID number to be the first field on the line.  We click on the “Accession ID” line, highlighting it.  Then we move the mouse to the top of the list and click again.  The accession ID moves to the top of the list.

When the fields are correctly arranged, select Done.  SchuyLab returns to the Define Result box, with the fields in their new order.

When the record is satisfactory, select OK.  SchuyLab returns to the Layout Records box.  Select OK again to return to the Create Export Format box.  Select OK once again to return to the Export Format List box, with the new format present.  Select Done to return to the Export Patient box.  We are now ready to export data to a memory stick.  Below is an example of what you may see.

ASTM – 1238/1394

ASTM 1238 and ASTM 1394 are programmed into SchuyLab, with very little setup on your part.  We have a number of HIS types available.  To choose one, click on the arrow to the right of the box below Peer System Type.

 

To finish any setup, select the Layout button.  SchuyLab will display the Layout Data box.

You will need to contact the software people for the Peer System you are using to complete the information needed in this box.

When the record is satisfactory, select OK.  SchuyLab returns to the Create Export Format box.  Select OK again to return to the Export Format List box, with the new format present.  Select Done to return to the Export Patient box.  We are now ready to export data to a memory stick.

HL7

HL7 is a generated generic output that can be used as a default program, with or without a specified Peer System Type.

To finish any setup, select the Layout button.   SchuyLab will display the Layout Data box.

You will need to contact the software people for the Peer System you are using to complete the information needed in this box.

 When the record is satisfactory, select OK.  SchuyLab returns to the Create Export Format box.  Select OK again to return to the Export Format List box, with the new format present.  Select Done to return to the Export Patient box.  We are now ready to export data to a memory stick.

DBASE IV

The DBASE IV Output type is specifically for use with the dBase IV database engine software from Ashton-Tate.

Panel/Test Translation

In some cases, the program you are exporting information to may use test codes that are different from what you are using in SchuyLab.  By setting up this translation table, SchuyLab will translate the correct tests.  Select the “Update” button.

Match Test by: Code: Use test code

Name: Use test name

Description: Use test description

 

No Match, Use Input If the exported test name doesn’t match the one we expect, it brings it in without translation.  Otherwise no export takes place.

 

Translate results as well as request In some cases you will need to send back the test number instead of the code or name.  This box will need to be checked for that to work properly.

Just like the Test Translation Table in F8, Tools, Device Setup, you need to put in the test code or name as it comes across (I.e. 001, 010, etc).  Under the SchuyLab side match which test this will translate to (i.e. 001 = K, 010 = NA).

Doctor Translation

In some case, the program you are exporting information to may use codes for each doctor.  By setting up this translation table, SchuyLab will translate these codes for you.  When you select the “New…” button,

Systems use the Same IDs IDs match between both systems

 

 

Automatically Build Table Automatically build a translation table

 

 

Automatically Change Name If the doctor’s name changes, trust that the other system has the correct name.

 

Automatically Add Doctors If the other system sends over a new doctor, add them to the list.

 

Automatically Assign IDs If you choose to automatically add doctors, the system will auto automatically assign ID numbers.

 

If the doctor you enter is not in SchuyLab, the Add Doctor box will open.

Insurance Translation

In some case, the program you are exporting information to may use codes for each insurance carrier.  By setting up this translation table, SchuyLab will translate these codes for you.

Systems use the Same IDs  IDs match between the systems

 

 

Automatically Build Tables Automatically build a translation table

 

 

Automatically Change Name / Address If the company name or address changes, update the SchuyLab list.

 

 

Automatically Add Companies If the other system sends over a new company, add it to the SchuyLab list

 

Automatically Assign IDs Assign IDs to any new company.

 

If the company name you enter is not in SchuyLab, the Add Company box will open.

Test List

Export of Test List.  The Export feature now has a test export tab as well as a patient export.  This is currently only able to export some specific formats.  More will be added.

Including Non-charge Transactions

The export of Invoices now includes the ability to generate lines pertaining to Payments, Adjustments and Write-offs.  These new abilities, combined with the Notes export mentioned below, substantially replicate all of the information contained on an Invoice and make that information available to export from SchuyLab.  An important point to remember with respect to this is that SchuyLab does not Export the Invoice per se, this is not a piece of paper that we are parsing; SchuyLab is re-generating the information that would be contained on that Invoice, were it generated now.  That is to say, if a Payment on Invoice #1234 were changed from $100 to $200 after Invoice #1234 had been originally generated, SchuyLab would Export that invoice as if $200 were the original Payment.  This occurs because SchuyLab does not ‘close’ its financial data on a timed-basis (e.g. ‘the end of the month’); that data remains active, and therefore mutable.

Setup the Format

Go into F7, Features and select Export.  Select the Setup Exports and select New.  Create a new Export of type INV (Invoice).  (See documentation for new Export for details.)

When you re-start SchuyLab a new icon (INVOICE) will appear on the Exports screen. Click the INVOICE icon and you will see this screen:

Click on the NEW button to the right of the Format field and you will see this screen:

Make sure the Delimited ASCII button is selected and click on the Layout button. You will see the following screen:

Select Begin Invoice.

The example above shows all of the Invoice fields, and their Text labels.  It produces a comma-delim Export that looks like this:

Inv #:,21509,Inv Account:,#8,Inv Date:, 1/08/20,Inv Due:,,Inv Balance:,0.00,Inv Amount:,0.00,Inv Note:,

,,?,Payment,100.00,Transaction Note:,

,,?,Writeoff,50.42,Transaction Note:,This write-off if because I am a nice person.

The Claim Line needs also to be set up. Click on the Claim Line? Button.

The example below sets the pattern for the generation of both the Claim Line on an Accession and for the output of the Payment and/or Write-off.

It will produce an Exported file that looks like this:

,,?,Payment,100.00,Transaction Note:,

,,?,Writeoff,50.42,Transaction Note:,This write-off if because I am a nice person.

1410838,”Shortstuff, Kay”,954,”EX.CHEM,CBC”,90.00

1410838,”Shortstuff, Kay”,80092,80092 HYPOTHYROID#1 ,61.00

1410838,”Shortstuff, Kay”,83001,83001 FSH ,53.00

When you put both of these configurations together, your comma-delim Export looks like this:

Inv #:,21509,Inv Account:,#8,Inv Date:, 1/08/20,Inv Due:,,Inv Balance:,0.00,Inv Amount:,0.00,Inv Note:,

,,?,Payment,100.00,Transaction Note:,

,,?,Writeoff,50.42,Transaction Note:,This write-off if because I am a nice person.

1410838,”Shortstuff, Kay”,954,”EX.CHEM,CBC”,90.00

1410838,”Shortstuff, Kay”,80092,80092 HYPOTHYROID#1 ,61.00

1410838,”Shortstuff, Kay”,83001,83001 FSH ,53.00

When the actual Export is done, the checkbox “Include non-charge transactions” to allow the export of Payments and Write-offs must be checked.

Export Now Includes Notes

Notes can now be exported on Patient, Accession, Result, Invoice, Claim and Transaction entries.  The setup for the various Exports contains an explicit field for the applicable Note. Select that field.

Remember to set the Note to the length of “999”.  This is the maximum length for a Note in an Export…if the Note is longer than that, the exported text of the Note will end with an ellipsis (“…”)

This Note Exports as below:

Inv #:,28,Inv Account:,#8,Inv Date:, 1/08/20,Inv Due:,,Inv Balance:,0.00,Inv Amount:,382.00,Inv Note:,I have now added a Note on the Invoice per se.

NB (so to speak): Note fields will also appear in the setup list when doing Report Setup, but they do not function in that context; they only work in Export.

QC Export

In the new Export module, you can select an Export Type of QC (see above).  When you do this, the Export screen looks like this:

You will note the similarities between this screen and the QC Detail Report screen.  This Export should electronically duplicate the report produced by that icon.

To set up a particular QC transmission, you will need to find out what the format needs to be in order to be acceptable to the receiving party.  This is likely to be quite specific, but – in general – the setup will involve choosing a format (probably ASCII delimited or Fixed Length ASCII).

Select the Layout button,

SchuyLab displays a somewhat familiar box, with the buttons relabeled such that they apply more specifically to QC.  You may want to set up a Begin File message…but most of your formatting will probably be done in the Result button.

I have selected all of the QC fields and placed them on this Export as a single data line.  After I configure the format, I Export a file to the path I designated earlier.

As you can see, SchuyLab has Exported each line of QC in the manner that I specified.  In the above example, SchuyLab created all of the lines for Level 1, then went on to Level 2 (and 3…but that is not visible above).

 

 

 

Permanent link to this article: http://www.schuylerhouse.com/export/

Sep 29

Check-In

Introduction

When tests are ordered outside of the SchuyLab system, for example via an EMR interface or on SchuyNet, there are two ways that SchuyLab can handle this:  Either SchuyLab issues Accession numbers directly when the orders are made, or it uses a temporary number (order number or requisition number) as a place-holder for the order, and issues the Accession number when the samples actually arrive in the lab.

Logically, speaking, an outside system that was closely associated with the lab (e.g. in the next room) should have Accession numbers directly issued; a system that was physically removed (e.g. across the city) should utilize check-in procedures.  This distinction would be based on the probability that the patient would wander in from the next room to have his blood drawn immediately, but the patient across town only might come in – and it could be tomorrow or the next day.  You do not want Accession numbers issued until the work is imminent.

The problem with this scenario is that the ability to issue an Accession number is often not distinguished by logical need, but by the capabilities and requirements of the other system – EMR or HIS –  to which we are interfacing to receive the orders.  These technical interfacing requirements often obscure the situation:  Thus an Accession number may be issued for a site across town while an order placed in a room just down the hall could require a Check-in process.

SchuyNet was intended to be a remote-ordering system; therefore it always uses Requisition numbers when orders are placed:  It requires a Check-in to issue the Accession numbers when the samples arrive in the lab.  Other HIS, EMR, and Billing systems each have their specific manner of operation – some of them will require Check-in, others will have SchuyLab issue an Accession number and no Check-In is necessary.

The Check-in screen alerts user if requested requisition has been deleted.

Purpose of Check-In

The purpose of the Check-In module is to

  1. Assign an Accession number to incoming specimens
  2. Validate that the samples submitted to the lab are adequate in quantity and quality for the tests ordered (i.e. If a Urinalysis is ordered, there is a urine sample submitted; if a PT is ordered a citrate tube correctly filled to capacity is present.).  If the samples are not adequate for the ordered tests, the orders can be modified at this point to keep the lab from accepting the responsibility of performing orders for which it does not have correct samples.  Additionally, if there are tests that have been called in (or manually written on the requisition, perhaps) that are not reflected in the SchuyNet or other system orders, these tests can be added at this time.
  3. Add or modify information pertaining to the patient:  doctor and insurance information.

The Check-In Process

Specimens arriving in the lab are accompanied by a printed requisition.  Enter the number from that requisition in the Requisition field in the Check-In screen and select the Lookup button, or select List to display all of the specimens that are awaiting Check-in and click an entry on that list.

SchuyLab displays all of the information we have been sent on the selected specimen, and issues an Accession number (based on the lab’s internal format).

Let us take a look at the fields on this screen, and the information it contains.  At the top of the screen is the ‘nameplate’ area, which contains information on the patient.  Since this area is well described in the User Manual, and is familiar to most users, we will not dwell on this box.  Please do note, however, that at the bottom of this area the Accession number (“Accsn#”) is set to zero (“000000000”).  Remember that the purpose of Check-in is to issue SchuyLab Accession numbers; this number will always be set to zero when you bring up a new entry in Check-in.

 

Below the nameplate area, in the upper left of the screen, is the Requisition number field.  This field contains the number that is sent from SchuyNet or from a Other System Interface (eg your EMR or HIS).  You can not change the Requisition number on an entry, but this box doubles as a lookup field so in addition to ‘seeing’ the Requisition number for the entry you have already selected, it is used to Search for a specific Requisition number and retrieve it on the screen.  If you have a specific paper Requisition in your hand, type the number into this field and select the little search icon at the end of the field – SchuyLab will retrieve that entry for you and display it on the screen.  Alternately, select the List box and SchuyLab displays a list of all of the Requisitions that it has available for confirmation.

 

Below the Requisition field four boxes that have Accession, date, time, and initials in them.  These boxes automatically default to the ‘next Accession number’, ‘current date, time’, and ‘person signed onto the system’.  That is to say, they show the time and date it is now, and they show ‘your’ initials – as the person who is logged onto this station.  These fields can be manually modified by the user:  it is possible that the sample was actually received earlier, for example.  Retype the information as necessary.  (NB.  SchuyLab has internal automatic date/time stamps that indicate when the Accession was created, so even if these data are changed, the computer date/time of the creation of the Accession is present in the Full Report.  That data cannot be changed by the user.)

 

Below Accession fields, there is a grey box that displays information on the sample that has been entered at the remote system (SchuyNet or Other System Interface).  This information can include information that has been electronically transmitted in that order:

  • Date and time the specimen was drawn.
  • The location or clinic that sent the order
  • The ordering doctor
  • Insurance

The information in the grey box can be modified by the user by selecting one of the small icons shown below.

SchuyLab displays the Patient Demographics or Change Accession box, and allows you to enter additional information or correct existing information.  (Please see the User Manual for further description of the Patient Demographics and Change Accession boxes.)  When you select F10 Done or OK in the Patient or Accession boxes, SchuyLab automatically returns you to this Check-in screen.

On the right hand side of the screen, you see a box displaying the tests that have been ordered.  These tests can also be altered – deleted or augmented – and they can have a status set on them.  To enter a new order, type into Order/Delete Tests box.

Select the Order button.  SchuyLab displays all of the Tests and Panels that qualify for the text you typed.

Select one of the entries from that list box.  SchuyLab adds that Order to the list of Tests and Panels in the box.

To use the text box to delete a test or panel from the list, type the Code of that Test or Panel, preceded by a minus sign “-“.  (It does not have to be in all capital letters, you note.)

Select Order and SchuyLab indicates that the Thyroid has been removed from the list by turning it green.  (SchuyLab leaves a visible indication that this entry was at one time ordered to minimize confusion in case the Test or Panel needs to be re-ordered.)

Left click with your mouse on an individual line item and SL displays the Update Test/Panel box, showing you what your options are for this item.  Since the entire Order has been placed with a Status of ASAP, the status of this order cannot be decreased to less than ASAP.  That is to say, you may raise the status of a test or panel but you may not decrease the status of a test or panel.

Since the status in the above example is already set to ASAP, SL offers you the chance to upgrade the status to STAT.

Select OK.

SL alters the status of the CBC in the list to STAT.

Alternately, you can right click on an item in the list (ie PT)…

SL displays a small box allowing you to alter the status of the test or panel, Delete it, or Edit it.  If you select ‘Edit’, SL displays the small Update Panel/Test box shown above.

The Unresolved Issues field is a large white box below the grey Accession information box.

The purpose of this field is to display information that has been transmitted by SchuyNet or the Other System to which SchuyLab is interfaced, but which information does not fit in a known category.  That is to say: this field contains information that requires the judgment of a human being.  In most cases the data in this field will be the name of an unknown doctor or an insurance company that is not already present in SchuyLab.  (Since billing needs insurance companies to be associated with their particular fee schedules, we do not want the creation of spurious insurances.)

Click on the text in the Unresolved Issues field.

SchuyLab displays a box that is specific to the nature of the text in the Unresolved Issues box.  In the above example, the pop-up box is the Identify Insurance Carrier box.  The information in this box can be deleted or modified depending on your security clearances.  If you have the security clearance for Billing Setup, selecting OK on this pop-up box creates a new Insurance entry in SchuyLab.

When you are satisfied with the content of the information on the Check-in screen, select the Assign ID button.

At that moment, SchuyLab will assign the number in the Accession box to the sample that is on the screen and present a blank Check-in screen to await your next selection of a Requisition for scrutiny.

Permanent link to this article: http://www.schuylerhouse.com/check-in/

Sep 28

Batch Requisitions

Introduction

Batch Requisitions is designed for large volume labs with multi-station network where specimens tend to arrive in large batches, one or two times a day, and there are numerous techs entering the requisitions simultaneously.

Batch Requisitions is integrated with barcode module and the standard SchuyLab tube type. This combination allows the proper number of barcodes labels to be printed out.

Setup

The Batch Requisition screen is divided into three parts.  The first part is specimen information which is occasionally changed.  The second portion is information which defines the identity of the patient, and the third division is information which is filled in after the patient’s identity has already been established.

Let’s go over the sections individually:

The Top Section

Accession It shows the number which will be given to the specimen you are currently entering. The number in this field will automatically advance to the next specimen number until you reach the end of the batch of numbers you are entering.

 

STAT Select the STAT button if the specimen you are entering is a STAT.  This will move this specimen to the top of any worksheet it may be on and print “STAT” in bold on a bar code label.

 

Note The Note icon in this section of the screen is used to write comments on this particular specimen.

 

Remarks Are frequently used “canned” comments that should refer to this specimen.  Each code consists of a message which is associated with a number.

 

Labels  If your lab has a label or bar code printer, there will be a field marked “Labels” in the first section of the screen.  The number in that space indicates the number of labels that the label/bar code printer will produce for this specimen.  The labels are printed either when the OK button is pushed on the Batch Entry screen or when F10. Done is pushed after the tests are ordered on the specimen, depending on the configuration of your system.

 

Draw Date, Time, By In Tools, SOP, the Draw Date/Time format is set by the Lab Supervisor to default to the “Current” Date/Time, a “(blank)” Date/Time or the “Prior” Date/Time.  Depending on this setting, the Draw Date/Time filed will either containg the current time, a blank, or the same time that you set for the previous Accession.

 

Recv Date, Time, By In Tools, SOP, the Received Date/Time format is set by the Lab Supervisor to default to the “Current” Date/Time, a “(blank)” Date/Time or the “Prior” Date/Time.  Depending on this setting, the Draw Date/Time filed will either containg the current time, a blank, or the same time that you set for the previous Accession.

 

Other Accession ID Not all labs make use of the “Other Specimen ID” field.  Use this space to record the number given to a specimen by its source facility.  It’s OK to leave this field blank.

 

Specimen Received The box marked “Specimen Rec’d” is both a list box and an entry field.  Select the arrow to choose from among the contents of the list box, or type directly into the field.

 

The Middle Section

This is important:  The information you enter in this section is what the computer uses to establish the identity of the patient.  In this section, enter all of the information that you are sure of; do not enter any information you are not sure of.

Let me give you an example- If you have a patient, Peter Wachowski, and you aren’t really sure of his birth date, but you think it says “12/26/52” and you put in both of those pieces of information, the computer will search for a patient that matches both criteria.  If it fails to find an exact match, it will assume that this is a new patient.  If you just put in the name “Wachowski, Peter”, then it will search for all of the people by that name.  Maybe it will find a Peter Wachowski who was born 12/26/57!  Then you use ancillary information in Patient Demographics to confirm that this is indeed the same person.

Age, Birth Date.  SchuyLab calculates the age from the date of birth.  Enter the age only if the date of birth is not available.

The middle section also contains a field: Patient’s ID.  The ID of the Patient is guaranteed to be unique in SchuyLab.  If you wish to use a single entry to search for the Patient, use this field.  If you know that the patient is a new patient and you want to define the entry as such, entering a new Patient ID with the name/date of birth/age of the patient will do that.  As above, you need to be aware that this is a powerful field:  If you enter Peter Wachowski and Patient ID 1234 and Peter Wachowski actually has an ID of 1235, you will be creating a new patient.

Client field is not required to be filled in but it helps narrow down a search for a patient by entering the Client that this specimen came from.

When you push the Search button, SchuyLab searches its memory for an exact match to that patient.  If SchuyLab finds a matching patient, it will fill in the nameplate at the top of the screen.  (There is more information visible in the nameplate than you have put in the middle section of the batch entry screen.)  Use this information to confirm the identity of the patient.  If you need more information, use the Patient Demographics icon in the bottom section to look further.  What do you do if you decide that the patient SchuyLab finds isn’t the one on the requisition?  Push the Cancel button on the bottom section.  This will clear the screen of what you have typed in, without advancing the specimen number.  Now you can type in a new set of patient information and Search again.  If you aren’t certain that the patient that SchuyLab ‘finds’ is the same as the one on the requisition form in front of you, make a new patient.  Get it?

If you are sure, use the patient the system finds.

If you aren’t sure, make a new patient.

Enter as many fields as you are certain of, depending on the procedures set down by your lab.  When you have entered all of the appropriate fields, push the button labeled Search.  SchuyLab will look through all of the patients in its database for a match.  At this point, the middle section will ‘grey out’.  This keeps you from accidentally changing significant patient data after the ID has been established.

The Bottom Section

The bottom section contains two icons, nine text fields and two buttons.  All of these icons and buttons are grayed out until a patient ID is established. When the middle section becomes grey, the bottom section is activated.

The Text fields are Ordering Doctor, Client and areas for up to eight ICD-9 codes.

Ordering Doctor: This is the doctor that is on the Accession – the doctor who ordered this specific set of tests.

Client:  This is the Client that is on the Accession – the Client that this specimen came from. Client input can be greyed out by F8: Tools > Set-Up > Parameters > Optional Processing, unchecking Use Clients and then selecting OK.

ICD9 Codes:  These codes can be entered directly or you may search for the ICD9 code by typing in the name of the diagnosis (or part of the name) in the “Search by codes or phrase” box , SchuyLab will list all the diagnosis’s in it’s library for you to choose from.

The icons are: Order Tests and Patient Demographics.  These icons behave just like the do on the Patient Processing screen.

The buttons are:

Cancel– This button clears the screen of all the information on it.

OK– This button accepts the patient and tests, advances the specimen number, and displays an empty screen for you to enter the next specimen.

Permanent link to this article: http://www.schuylerhouse.com/batch-requisitions/

Sep 26

Barcodes and Labels

Introduction

Positive patient identification is necessary if the results obtained by the laboratory are relevant to a patient’s prognosis.  Each time a sample is relabeled, aliquoted, or manually identified there is a chance for error.  Primary tube analysis of bar-coded samples provides the best system for achieving an unbroken linkage between the test results and the patient who actually provided the specimen.

In addition to patient care, using barcodes in a laboratory can save personnel time measured in FTE’s.  Also, many instruments of modern design do not function well without bar-coded tubes; laborious ‘work-arounds’ are necessary if technologist attempt to run these instruments without barcodes.

What is a Barcode?

The standard UPC barcode that you are accustomed to seeing pasted to the apple you are buying at the grocery store is made up of black and white parallel lines.  These lines encode digits in blocks of seven units; adjacent lines (and white spaces) of the same color merge to form 4 different widths of line (or space) thickness.  These lines of varying width comprise the barcode that you routinely see.  (There are other barcode systems using dots and concentric circles, but the discussion of these is beyond our scope here.)

All that is contained in these barcodes are the numbers and letters of an identification sequence.  In laboratory work, this sequence is usually the Accession number, though it can also be the Patient ID.  The barcode does not contain the patient name, the list of tests ordered, or any other information.  That information can be transmitted as a result of a query based on a barcode, but it is not in the barcode itself.  The information content of the human-readable portion of the barcode label changes from format to format; the content of the barcode itself stays the same (checksums aside – more on that later).

(NB: There is a reason for using this method:  If the barcode itself contains testing information, this information cannot be easily changed.  For instance, if the barcode were to contain the test ‘Glucose’, then you would be in trouble when the doctor added on the rest of the CMP.  By just using the barcode to contain the Accession number, “42”, then the information linked to that number can be altered at will:  “42” could mean just a Glucose one minute, and a whole CMP the next.  This allows for the dynamic flexibility needed in a laboratory environment.)

 

Barcode labels and Tube types

 Many changes have been made to our Barcode module, including the ability to print on different types of barcode printers on the same system (until now, all barcode printers had to use the same communications format), the ability to print as many different size labels as you would like, the ability to prefix a subset of labels with a letter (or three) and have those labels print using a separate format, and the ability of each station to specify where its labels (of various sizes) will print. Also, when the tubes are checked in, the accessioner can mark if additional tubes have been drawn, if expected tubes are missing, and can create aliquots of existing tubes. If the accessioner marks a tube as ‘missing’ the tests associated with that tube are greyed out. If a test is greyed out, (ie is on a tube that has not been checked in) it will not appear on the worksheets,

What is more, the printing of barcode labels is now related to the tubes that you have drawn, and the other types of samples you have.  When you set up your samples correctly, SL now ‘figures out’ how many labels, and of what kinds and sizes, it needs to print.  SL ‘wants’ to print out one label per container or tube…but you can override this manually.

While it is not necessary to have Barcoding in order to use tube types, the reverse is not true:  you need to have tube type set up properly in order for barcodes to work.  If you have not set up your tube types, please do so before proceeding to work with barcodes.Laboratory use of barcodes and labels

The automatic generation of labels, with or without barcodes, is typically used by a laboratory in one of three ways, depending on their individual needs and workflow.

 

Labels only, no barcodes

In this instance, the laboratory has chosen labels for the sake of positive patient identification and legibility.  The lab has no instruments that can make use of barcodes, or perhaps they are a specialty lab that performs exotic manual tests.  Nonetheless, they have had experience with trying to read hand-written labels, and the lab has decided to have SchuyLab print human-readable labels.

 

Barcodes for Unidirectional Instruments 

Many instruments, archetypically hematology instruments, can read a barcode and transmit it with the test results.  These instruments generally perform a single test or panel, so there is no selection of test options.  In this case, barcodes substitute for the tech standing next to the instrument, typing in accession numbers:  the tubes are placed in a rack, and the test(s) are performed as the barcodes are scanned by the instrument.

 

Barcodes for Host-query instruments 

Barcodes come ‘into their own’ with a host-query instrument, because in these cases the barcode substitutes not only for the time the technologist stands by the instrument, typing in numbers, it also makes it unnecessary for the tech to send a worksheet to the instrument, or otherwise program it with orders.  Instead, the instrument reads the barcode and ‘asks’ SchuyLab what tests should be performed on that specimen.  SchuyLab answers with a list of tests; the instrument performs those specific tests and transmits the results back.

General Information on Using Barcodes

The placement and orientation of the barcode label on the tube has some specific requirements.  Unfortunately, CLIA and your facility may have additional requirements, which can make it difficult to make everyone happy.  If labels are printed subsequent to the patient being drawn, slightly offsetting the barcode label, so that the hand-written label partially shows beneath it, can satisfy all parties.  If the labels are printed prior to the phlebotomy, then the phlebotomists are usually asked to initial the label.  Please check the regulations of your facility and licensing agency before setting a policy for the placement of the label.

In order for an instrument to read the barcode, you need to orient the barcode longitudinally on the tube.  Hold the tube such that the open end points left.  Hold the label so that you can read the printed name and information in a normal fashion.  Maintaining the relative positions of label and tube, adhere the label to the tube.  (Don’t laugh: we have had instances where the barcode didn’t work because the techs were applying the labels 90 degrees off the proper alignment.)

If your instrument has trouble reading the barcode, look to see where the barcode reader is positioned in the instrument.  Watch it as it reads, or tries to read, a barcode.  Often you can see a red line where the laser is scanning the tube.  Do you have the barcode placed too high on the tube?  Too low?  If the barcode reader on that instrument has not been used before, it may need cleaning or adjustment.

Some instruments are very particular about the amount of ‘white space’ they need around a barcode.  ‘White space’ is the blank space immediately before and after the barcode.  If you have selected a long SchuyLab Accession number format, and you notice that the barcode fills the entire label, from edge to edge, you may have a problem with some instruments being able to read the barcode.  Test for this by under-lapping a label before and after a test label that has a barcode on it.  Make sure you have about a quarter of an inch white space before and after the label.  (You can always put some white-out where the labels overlap, to make sure the edges are not read as a ‘bar’.)  If the instrument can now read the label, you can switch to a barcode format that provides more white space, get bigger labels or select a smaller, more concise, format for your Accession number.  (Fortunately, SchuyLab has a variety of formats, and it is easy to change.  Please contact Technical Support before you do this, since changing the format of your Accession number could have consequences to other aspects of your laboratory work.)

Changing your Accession format or buying bigger labels could be an inconvenience to your work or finances.  What else could you do?  You could switch your barcode format from ‘checksum’ to ‘non-checksum’.

Nearly all formats come in two “flavors”: checksum and non-checksum.  What does that mean?  Checksumming is a method of verifying the digits in an accession number.  A simple example of checksumming might go like this:  Let’s say that your accession number is “123456”.  Summing the digits of that number yields 1+2+3+4+5+6= 21.  But “21” has two digits… so we add them together: 2+1 = 3.  The checksum for the accession number “123456” is “3”; a checksummed barcode label for “123456” would actually encode “1234563”, with the checksum suffixed to the end.  If the instrument and SchuyLab are both set to ‘checksum’ the accession numbers, then they will both look for that “3” at the end of the accession number.  If they don’t find the correct number, then they know that something is wrong and that the number has been mis-scanned.

Obviously, both the instrument and the LIS must ‘agree’ on whether or not checksumming is being used.  Otherwise, there is a legitimate question as to whether the Accession number is “1234563” or “123456 with a checksum of 3”.  Some instruments can only read non-checksummed numbers; others always assume checksums are in use; most can be configured either way in the instrument setup.  You must configure all of the instruments in your lab to read the same format – obviously, if one instrument can only read (for example) checksummed barcodes, that will be the controlling factor in your decision of what format to use.

If your instruments can handle checksumming, and your Accession number format isn’t too long, you should opt for a checksummed barcode format – it provides greater accuracy.  If your barcode is perilously near the edge of the label, though, consider going to the non-checksummed version of your barcode format.

Setting Up the Barcoding Module

NOTE: Tube Types must be set up prior to setting up the Barcoding Module. (F8 Tools > Setup > Test & Panel Definition > Tube Types) If you wish to use the default setup for both Tube Types and Barcoding, skip this section.

SchuyLab’s use of Barcodes

To set up the barcodes for SchuyLab:

 

 

  • Select F7 Features.
  • Select the Barcoding icon (this will be present only if your lab has opted for this feature.)

SchuyLab displays the Barcoding screen with the following icons:

 

 

 

This screen shows the different sections for setting up your SchuyLab’s barcoding feature.  Note that these settings are system-wide throughout your SchuyLab system – except for Staion Setup, which will display the queue set up for this particular station, as defined in Connect.

Setting Up Barcode Media

The first step is to set the size of the labels your lab will be using. Select the Barcode Media button and the Update Label Sizes window will open.

Input the size of your labels in decipoints (720dpt/inch). If you have multiple barcode printers all using the same size labels, you only need to define one type. To add a new sized label, select the New button.

Give the new label size a name and enter its dimentions in decipoints.

Once you have all the media sizes your barcode printers will be using, you should assign which printers will be using which sizes.

Setting Up Individual Barcode Printers

On the station connected to the barcode printer you wish to set up:

 

  • Select F8 Tools.
  • Select Set Up.
  • Select Station Setup.
  • Select Setup Comm.
  • Select the COM button of the port to which the barcode printer connected.
  • If the correct printer is not yet assigned to the port, select it fron the “Device:” pulldown menu. If the printer does not appear in the list, select “*define new device*” and select “BARCODE” as the devce. At this point, you can change the code and name. Below the code has been changed to “ZEBRA” and the name has been changed to “Zebra Barcoding.” It is good practice to assign codes like “MICRO1”, “CYTO2” or “LABMAIN” to make the printer’s location and function clear at a glance.

Select the Setup button.

Select the model of printer and the size of lable it uses. Repeatedly Click OK until you’ve backed up to the Station Setup screen.

Define Barcodes

  • Select F7 Features.
  • Select Barcoding.
  • Select Define Barcodes.

 

 

Select the label you wish to update or create.

Make sure the correct media size is selected from the “Media” pulldown menu, then select the “Custom” button.

This is where you will add each piece of information you wish to appear on your barcode lable. Because SchuyLab’s Barcoding Module is capable of a huge degree of customization, it would be impractical to cover each type of information here. Instead three lines will be added that will be common to nearly every barcode label and will illustrate the process of adding new lines and columns to a label. Select “Add Line.”

Enter the “Point size” of the line in decipoints (100 is equivalent to 10 point type) and select “Add Column.”

The first item that will be set up to appear on the label is the Specimen Label Number. Select the “Specimen…” item to bring up the Specimen sub-menu.

Select “Spec Label.”

This screen provides controls to customize the appearance of the information. (The various buttons should be familiar to users of word proccessing programs. In almost all cases the defaults will be used.) Since a simple text ID is desired here, and the width is appropriate for the accession number and sufix alreaqdy set up in SchuyLab, select “OK.”

You will notice that an entry appears on the Define Line screen for the column you just defined. Select “OK” again.

 Now, we want to create a line that also places the Specimen number on the label but in barcode format. Select “Add Line”. On the next screen set the point size to 120, set the advance after printing to 240, and select “Add Column”. On the next screen select “Specimen…”. On the next screen select “Spec Label”.

Clicking the barcode button will change the options available on the “Spec Label” screen:

The “Code:” field sets the format of barcode that is printed, and the sufix “C” indicates that a checksum will be added to the specimen number. “Height” should be set to 240.

 The next field, a pull-down menu, controls the size of the barcode. The options are “Normal”, “Compress”, and “Smallest.” The smaller sizes are used when smaller labels are needed for plates or slides, or when the numbering scheme for accessions produces a barcode longer than will fit on the label at “Normal” size.

NOTE: When you first print labels at the compress and smallest sizes, be sure to test them on the instruments intended to read them: Some instruments will not read the smaller sizes.

 For now, simply repetedly select “OK” until you return to the “Define Custom” screen. At “Normal” size, a blank line will need to be added to make room for the barcode, so select “Add Line”, set point size to 120 and select “Add Column”, and select “Skip”. Now, repeatedly select “OK” until you return to the “Define Custom” screen.

 The final line we add to the label will be the patient’s name and date of birth. Select “Add Line” and set the point size to 120, select “Add Column”, and select “Patient…”, select “Patient Name.”

The default settings are fine, but there are many options for the format of the patient’s name, and are available via the pull-down menu in the upper right corner of the screen. Select “OK” to return to the “Update LINE” screen.

Because we want to add more information to the same line, select the “Add Column” button. Select “Patient…” and then, “Patient DOB” on the following screens.

There are several formats for the date of birth information available from the pull-down menu in the upper right corner of the “Patient DOB” screen. Whatever format is selected, make sure the “Width” field is long enough to accomidate all the characters or the date of birth information may be truncated when it is printed. Select “OK.”

On the “Update LINE” screen, you will see both columns displayed. Select “OK” again.

The “Update Custom” screen displays each of the lines you have entered. Select “OK” twice more and then “Done” to complete the creation of your label definition.

 Your finished label, when printed, should look like this:

Notice that there is a “W” suffix after the accession number. This label is intended for a tube of whole blood. If a tube of serum is also required for the tests ordered on this accession, an additional label with an “S” suffix would be printed. In situations where microbiology or cytology labels are used, decimals or prefixes may be printed. For example, 120814003.2 or M00301.

There are some situations in which printing the accession ID without a sufix is desireable:

  • If the instrument can’t handle letter suffixes or the ‘.’ character when reading a barcode.
  • If the barcode won’t fit on the label for some instruments (though you might also try a more compact format like Code 128).
  • For requisition labels, where the top-level accession ID is what is desired on the label.
  • For labels where you want the accession ID and the current sample ID to both appear on the label (especially if the sample ID is a microbiology or cytology label.)

Generation Setup

If, in addition to the normal labels for specimens, you wish to print Accession Document Barcode labels and/or Patient Barcode labels, select “Generation Setup” on the Barcoding screen.

The Generation Options screen will allow you to enter the number of labels of each type that you wish to print along with the specimen labels for each accession:

 

The pull-down menus select which media size you want and the “Edit” button alows you to edit each line and column of the label in the same manner as described under “Define Barcodes” above. Also see “Printing Extra Labels” below.

Station Setup

The final step in setting up the Barcoding module is to direct which type of label goes to which barcode printer. Selecting the “Station Setup” icon will bring up a window which will display the barcode printers attached to the current station only. This means that you will only be able to use this window to set up barcode printers that are physically attached to the computer you are currently using to sign in to SchuyLab. To set up barcode printers that are attached to other stations, you must sign in to SchuyLab on those computers.

 

Use the pull-down menus to select which barcode queue each label type will be sent to. The “Waiting…” button will bring up the Bar Code Control screen for that queue.

The Bar Code Control screen allows you to view any label printing jobs that are waiting to be printed. The pull-down menu allows you to change the view to any other barcode queues. As SchuyLab usually prints labels very shortly after tests have been orderer, you will not usually see anything in this list.

 A common exception is when a barcode printer has been disconnected, turned off, or is malfunctioning. In that case, you can select the print job by clicking on it and use one of the activated buttons above the list to move or copy the job to another queue, or delete the printing job altogether. If the printer error is easily fixed, you need do nothing: When the printer comes back on line, all the jobs in its queue will automatically be printed.

Printed Extra Labels

If, for whatever reason, you need to print extra labels, go to the accession by selecting “F3 Accession” and entering the accession number. On the accession screen select “Change Accession.”

 

 

Select the “Labels…” button.

This screen displays all the labels available for this accession. The checkboxes to the right of each label indicate which ones will print when the “Print” button is selected. You can manually check or uncheck them, or you can check all or none using the “All” or “None” buttons.

 In addition, labels can be printed that are not intended to be attached to specimens. For labels to be attached to documents (or other purposes) check the box to the left of “Accession Document Labels” and enter the number of labels you require. When the correct labels have been checked, select the “Print” button.

Patient Barcodes

So far, we have been describing barcodes that print when a new Accession is entered.  SchuyLab also has the ability to print our Patient based barcodes – which is to say, barcodes that reflect the Patient ID number rather than the Accession number.

These barcodes can only be printed through the Print Labels icon in F6 Print.  Select the “Patient” option using the radio button, and the range of Patient ID’s.  The print output can be limited to Undischarged Patients by selecting that checkbox.  The sequence in which the labels print can be modified by the Sort list (Patient ID; Name; Sex, Name).

Other Labels

There may be times when you may wish to print labels that have no bar codes.  Or, perhaps, your SchuyLab system doesn’t include the Bar Code feature.  (Yet.)  You can still print labels with Accession information, in the amount you want.  This takes a bit more setup than the standard Bar Code feature.

  • Select F6 Print.
  • Select Print Labels.

SchuyLab displays the Print Labels box.  Depending on whether your SchuyLab system has the Bar Code feature, the Print Labels box will look like one of the following:

Without Bar Codes Feature:

With Bar Codes Feature:

If you have the Bar Code Feature, unclick the Barcode Printer checkbox, and the Print Labels box will look like this:

Select the Setup… button.  SchuyLab displays the Setup Labels box.

Complete the following fields:

Queue Sets the printer queue on which the labels will print.  Note that this is not the barcode printing queue, set up in the Bar Code feature; this is a standard laser or inkjet printer.

 

Font Choose a font for the labels:  either the default font (or the font already in use for your reports), or select from the list available (e.g., Courier, Sans Serif, Roman, and more).  Scroll down the pull-down list to choose the font you wish.

 

Accession If the labels are to print by Accession range, click this radio button.  Doing so opens the Existing Accessions Only option (it is no longer grayed out).

 

Patient If the labels are to print by Patient ID range, click this radio button.  Doing so opens the Sort option (it is no longer grayed out).  If you are printing by Patient ID, please note that the Accession number will not print on the label.

 

Existing Accessions Only This option enables you to print labels for all open Accessions – i.e., any Accession with tests ordered but not accepted.  This way, you can enter a wide range of numbers and SchuyLab will ignore any accession number in that range that doesn’t have a test on it.

 

Undischarged Patients Only This option enables you to print labels for all in-house patients – i.e., any Accession for a patient who’s not been discharged, but still in one of the hospital beds.  This way, you can enter a wide range of numbers and SchuyLab will ignore any patient in that range that has gone home (this works especially well for hospitals).

 

Sort If you are using the Patient ID as the range, you can sort the labels by a variety of ways: Patient ID, Name or Sex/Name.

 

Type Point Size By changing the type size, you can get more (or less) information on each line of the label.  Simply type in the number you want.  The default is 120 (which is about a font size 12).

 

Copies of each label Type in the number of labels you want printed for each Accession number or Patient ID.

 

Format Choose the label layout of the label sheets used in your printer.  You can select one of the several Avery (or equivalent) layouts already programmed, or you can custom design your own.

 

Labels in each row If you choose to design your own labels, set the number of labels that will be printed across the page.

 

Rows on each page If you choose to design your own labels, set the number of rows of labels that will be printed down the page.

 

Top Margin If you choose to design your own labels, type a number here to move the start of the printing down from the top of the label (NOT the top of the paper).

 

Left Margin If you choose to design your own labels, you can specify how indented the printing starts for each label.

 

Width of each label If you choose to design your own labels, this will determine the maximum characters you print on each line of the label.

NOTE:  SchuyLab will not give you an error message if the amount of information you want on that line is too much for your label size (i.e. if you have set 25 characters as the width, but your doctor’s name is 30 characters, the doctor’s name will run over into the next label).

 

Length of each label If you choose to design your own labels, this will determine the maximum lines you print on each label. The scale for the length of each label is 720 = 1 inch.

NOTE:  SchuyLab will not give you an error message if the amount of lines you want is too much for your label size (so if you have  360 in this box, that gives you a label about ½ inch long, which would be about 3 lines of information.  Any more than that and you will print on the next label below).

 

 

Label Design? Depending on whether you want patient information on the label, or just print a series of accession numbers for the day, you can determine what is printed and where.  When you click on the Label Design? Button, SchuyLab displays the Define Define Label box, which may look familiar:

 

You can then set up your labels, much like setting up a result form (See Sec. 7 – Reports and Printing for more information).  Your limitations are the size of the labels you are using.

After you have set everything up it’s very simple to print out the labels you need.  The number range will either be the range of accessions or range of Patient ID (depending on how you set it up).

If you have chosen to print by Patient ID (and marked Undischarged Patients Only), your labels may look something like the following:

Whereas the accession label (with Existing Accessions Only marked) may look like;

Permanent link to this article: http://www.schuylerhouse.com/barcodes-and-labels/

Sep 26

Autoverification

Introduction

The Autoverification feature of SchuyLab is intended for those laboratories where the test results don’t necessarily require human approval.  SchuyLab can be set, using Autoverification, to accept for final release all test results which fall within a normal range, or which follow certain user-defined rules.

SchuyLab’s Autoverify feature is frequently used in conjunction with another feature offered for SchuyLab, the Review Results feature (also called 2nd Level Review).

Autoverification Terminology

Accept The Accept button is found in test result screen for each analyzer, under F4: Devices.  When the analyzer transmits the results for an accession, those results appear in F4: Devices as a “holding area”.  The human user selects the Accept button to move those results from F4: Devices to the patient’s record.  Each result is tagged with a date-time stamp and the User ID of the user logged on that SchuyLab station.

 

For SchuyLab systems without the Review Results feature (separate from Autoverification), to Accept a test result is to also release it (see below).

Autoverify The Autoverify feature will automatically Accept results that would normally appear in F4: Devices for a human to look over.  Each result is tagged with a date-time stamp and the word “AUTO”.  Whether a given result is Autoverified will depend on the user-defined criteria for Autoverification, as described below.  Test results that don’t meet these criteria will need to be Accepted by the user, via F4: Devices.

 

As with the manual Accept procedure described above, once a result is Accepted via Autoverify, that result is immediately released.

Review At some point in the result process, a human user must review the test results, and Approve them if it’s decided the results are reasonable, consonant with the patient’s prior results, &c.  For SchuyLab systems with the Review Results feature, this Approval is a separate step from Accepting or Autoverifying the results.  For SchuyLab systems without Review Results, the review process is done through F4: Devices before the Accept button is selected.  Autoverified results are not reviewed.
Release To release a result, either through Accepting it, Autoverifying it, or (for SchuyLab systems with the Review Results feature) Reviewing it, is to make it available for general use.  The released result can be printed or faxed, may be viewed via SchuyNet or SchuyMed, transmitted to an interfaced HIS or EMR, and so on.

Autoverification Functions

To access the functions of the Autoverify feature, go to F7: Features.  Select the Auto Verification icon.  SchuyLab displays the Auto Verification screen.

The Auto Verification screen has two icons, the Verification Log and Verification Rules.  The Verification Rules can be used to set up your SchuyLab Autoverify feature, but people generally find it more convenient to do that through the Device Setup screen.  See the section on Verification Setup, below, for more details.

 

 

The Verification Log prints a list of verified results.  Selecting the Verification Log icon causes SchuyLab to display the Auto Verification Log box.

Enter a range of Accession numbers, or dates, and select OK.  SchuyLab will then print a report showing all of the results in that interval which were Autoverified.

 

 

The Verification Rules icon shows a list of all of the instruments upon which Autoverification is active.  Selecting this icon causes SchuyLab to display the Update Auto Verification box, listing the Verification Rules currently defined in your SchuyLab system.

Click on an entry to see or edit the Verification Rules for a particular instrument.

Instrument Level Autoverification

Before Auto Verification (or on a SchuyLab system without Auto Verification installed), results from analyzers are accepted through the F4: Devices screen.  The user selects the analyzer icon to see the test results transmitted through Connect to SchuyLab.  These results are “on hold”, neither accepted nor rejected until they’re reviewed.  If the results seem acceptable, the user clicks the Accept button.  At that point, the results disappear from the F4: Devices screen and are copied into that Accession’s result record, with the status of “Accepted” on each test.  Each test result is further tagged with the date and time (as registered on that SchuyLab station) and the User ID of the person logged onto that SchuyLab station.

For Autoverification to take place, an Autoverification module is installed in SchuyLab and Autoverification rules are selected on each instrument. Once that module is present, Connect ‘looks’ at the rules for Autoverification and, if the test does not fail those rules, stamps the results with the “auto” label (visible on the Full Report) and with the time and date stamp. Those results are copied into the result record of the Accession.

Please note that Autoverified results never appear in F4: Devices.

Autoverification Setup

Instrument level Autoverification is set up, logically enough, at the instrument level: in Device Setup.

F8: Tools > Setup > Device Setup > Choose the device off the list

Select the instrument on which you wish to set up Autoverification.  SchuyLab displays the Test Translate Table with the new field and button for Autoverification.

Select “New…”.  SchuyLab shows you the option box.  The Description field is just a text field that allows more detailed labeling.  (It does not, for instance, create a generic rules set…though this might occur in the future.)

The Autoverification Rules:

When Autoverification is implemented with no options set, it accepts all results unless:

  • The test has not been ordered on that accession
  • The accession number is not recognized by SchuyLab
  • The result is a repeat, and has an Accepted or Unaccepted (Hold) result already entered.

 

When Autoverification is set only to “verification are stored, but not accepted”:

  • The results are accepted but stay in F4: Devices and require a human to accept them.

 

When Autoverification is set only to “Results must not be abnormal”:

  • It does accept results that are normal.
  • It does not accept results that are abnormal.
  • It does accept normal results that fail delta check.

 

When Autoverification is set only to “Results must pass delta check”:

  • It does accept results that pass delta check.
  • It does not accept results that fail delta check.
  • It does accept results that are abnormal.

 

If Autoverification is set to both “Results must not be abnormal” and “Results must pass delta check”:

  • It does not accept results that are abnormal.
  • It does not accept results that fail delta check.

 

When Autoverification is set only to “Results must not be abnormal” and “Unless affirmative delta check”:

  • It does not accept a result that is abnormal that fails delta check.
  • It does accept a result that is abnormal that passes the affirmative delta check.

 

When Autoverification is set to “All accepted or none”:

  • It obeys the other rules that are described above, but if any single test in a transmission does not pass the selected rules, it will not Autoverify any of the tests on that accession in that transmission.
  • A ‘transmission’ is a set of test results that are sent by the instrument at a single time for a single accession. This rule operates only on instruments that transmit in this manner – instruments that send results intermittently (some of the older Chemistry analyzers do this) cannot use this rule.

 

To be clear on this – Autoverification with no options set will pass ‘almost everything’ into the result record of the patient.  It Autoverifies normal, abnormal, and critical results, irrespective of whether or not they pass delta check.  This is a hazardous setting, if it is used without a subsequent level of scrutiny, but it maximizes the throughput of the instrument results into patient data.

 

Any result that is not Autoverified is sent by Connect into the F4: Devices screen, where it awaits the judgment of a real live technologist.  You still must look at F4: Devices when you have Autoverification configured for an instrument.  There will be results there that are repeats, or that have incorrect accession numbers, or which have unordered tests on them.

 

The concept of the affirmative delta check is a new one in SchuyLab.  Many patients have particular test results that are characteristically abnormal (e.g., they are sick).  It is important to maximize the efficiency with which these results are released without increasing the chance that an incorrect abnormal value will be released (e.g., they are really sick).  If the lab opts for the Autoverification of abnormal results, it can also select to verify only those abnormal results that have a prior abnormal result that ‘matches’ it.  SchuyLab then uses the delta check parameters to decide if the prior result ‘matches’ the current result.  If it does, then it Autoverifies it; if not, then the result stays in F4: Devices, awaiting human judgment.

 

Each instrument must have Autoverification set up independently on it, since each instrument performs different tests with different parameters.  The options shown above are the ‘most liberal’ setting (i.e., no options have been selected).

Autoverification Interaction with Instrument Flags

Autoverification is cognizant of instrument flags.  To quickly recap:  Instrument Flags are set up in the Test Translation Table.  They can be set up either on the instrument as a whole (“For any test on the MD16, any “H” or “L” flag should be ‘ignored’.”) or for a particular test (“For just the HGB on the MD16, put Remark Code 5 on any “L” flag”).

Flag options are:

  • Green flag means that you have told SchuyLab to ‘ignore’ this flag. The green flag will show up in the list in the TTT, but it will not be visible on the F4: Devices screen
  • Red flag means that the result is probably invalid – this flag will show on the F4: Devices screen and is meant to alert the tech not to Accept this result without careful scrutiny. Examples of the use of this flag are instrument messages that indicate a malfunction of the instrument (“Aperture clogged”) or QC failure.
  • Yellow flag means that there is a Remark Code that has been placed on this instrument message. This flag is visible in F4: Devices and indicates that this Remark will be automatically appended to the result when it is Accepted.
  • Blue flag represents a new flag option: It means “Do not Autoverify this result”.  It is present only if you have Autoverification available for this instrument.

Autoverification in the Device Log

Since the inception of SchuyLab, there has been an icon on the F4: Devices screen that has a picture of a logbook on it:

This icon shows you what has been transmitted from that particular instrument.  This log includes everything that has been Accepted or Autoverified, and everything that has been Deleted.  It also shows you the results currently waiting in F4: Devices for that instrument.  Did you accidentally Delete that pediatric sample?  Now you can find the results again.  Push the button, Max.

SchuyLab displays all of the results that have been sent from the instrument.  The “X” shows results that have been Deleted.  The checkmark shows results that have been manually Accepted.  The little blank squares (below) show results that are still waiting in F4: Devices.  The big blue “A” shows results that have been Autoverified.

 

 

Permanent link to this article: http://www.schuylerhouse.com/autoverification/

Sep 25

Archiving

Introduction

The ultimate purpose of Archiving is to allow you to better manage your active patients by placing your long-term inactive patients in another section of your SchuyLab database.  It is important to realize that all of the test results and demographic information of the archived patients are still retained in SchuyLab…they are just located in a ‘different place’.  These patients can still be viewed, printed and re-activated by someone who has the right security privileges.

 

Archiving will alter your daily backup process:  It will make it faster, and you will be able to use smaller media for the backup, since you are only backing up the active patients.  It will also shorten any other diagnostic functions that have to be run on the database as a whole.  You will need to backup your Archived databases occasionally:  We recommend doing this once a month.  Your daily backups of the active database should still be done every day.

 

Archiving is available as an optional Feature in SchuyLab, and is located in the F7 Features section of your SchuyLab system.  (NB If you have a version 3.0 SchuyLab, only a portion of the Archive module is available:  You will be able to archive patients, but not view or retrieve any results until after you upgrade to a 3.1 or later version.)

 

Set up and Run Archiving

Archiving is located in F7 Features of SchuyLab.  Archiving does not have any ‘persistent’ setup feature:  You set it up each time you use it.  When you click OK, then Archiving begins running, using the settings you have just entered.

 

Archiving may be run as a background task on the server or on a separate workstation, whilst your lab is still doing production work.  For major archiving tasks, we recommend using the server to run this task.  The disk speed is the most important aspect for efficiency of archiving.

 

Archiving may be done episodically.  If you have to stop the archive process at some point, when you begin it again, enter the same parameters in the box and it will take up where it left off.

Select the Archive Patients icon.

SchuyLab displays the Archive Patients screen.

Select [Archive Patients].

SchuyLab displays the {Archive Patients] box.  In the Before Date field, enter the cutoff date for archiving patients.  For example, if you enter, 9/1/2012, then all of the patients before that date will be archived.

Note that there is also a checkbox labeled “Archive Patients with no accession”.  Occasionally, there will be a case where a patient is entered into SchuyLab but no Accession is created and no tests are ordered.  In such cases, you can choose to have these miscellaneous patients archived as well, just to remove them from your active database.

When you select the OK button Archiving will begin.

Access Archived Patients

Results may be accessed on a patient that has been archived, and reports may be printed.  This access does not un-archive the patient; the patient remains in the archive database.

To access data on an archived patient, go into the Archive Feature in F7 and select the Select Patient icon.

SchuyLab displays the Archived Patient lookup box.

Enter the name of the patient you wish to access.  SchuyLab displays its traditional confirmatory box.

Select the correct patient from the list (or select Cancel)

SchuyLab displays the Archived version of the Patient Processing Screen for the patient you entered, in this case, “Test Patient’.  Using this screen you may view and print patient demographic, cumulative, and result information.  The Archive database is a permanent database – SchuyLab will not let you do anything on this screen that will alter any of the information that has been archived.

SchuyLab will, however, let you Retrieve a patient into the active database.

Retrieving an Archived Patient

To Retrieve a patient from the Archived database into active status in SchuyLab, follow the above instructions for accessing the patient and then select the Retrieve Patient icon.

SchuyLab will close the Archived Patient screen and return you to the Archive main screen.

At this point, you may select F2 – SchuyLab already has the retrieved patient already waiting for you on a button in the F2 list.

From this point, the patient is like any patient active in SchuyLab.

Permanent link to this article: http://www.schuylerhouse.com/archiving/

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