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How To Use the Labs Ability

The Labs Ability enables MacPractice to receive lab results from selected laboratories. Lab specimens are sent to a laboratory via paper requisition and results are then transmitted back to the office and imported into MacPractice electronically – where they are associated with the patient’s files.

Lab results can be viewed in the Orders tab of the patient ability. The Labs icon is a special shortcut that will take a user directly to the Orders tab and automatically selecting the Filter by Type – Laboratory. At this time, Lab results are unidirectional. MacPractice is able to receive lab results from lab companies, however it is not able to send out lab requisitions from MacPractice. Check here for information on the setup process

If you'd prefer to watch a video series on how to use labs, check out the Videos section. 

Typical Workflow

A. Send a paper lab order to the laboratory to run specific tests.

Consider printing Notes, paper forms, an EMR form or an EHR form to document this in MacPractice. Here is an example of an EMR lab template. 
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B. Create Orders to keep track of the lab requests sent out. 

Create a new order using the plus button on the top right of the Orders table.
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  1. Change the Order Type to Laboratory & Select the Lab Name.
  2. Enter in a Short Description that can assist in describing what this order is about.
  3. Set a Due Date and Order Status so you can sort them in the Orders table.
  4. Save your newly created Order.
  5. To print the paper lab requisition,  ensure that you have your lab requisition set in Preferences > Forms > Order Form.
    After saving the lab requisition simply hit Command + P or navigate to the File Menu > Print. This will print the lab requisition.
    We recommend you scan this into MacPractice and add the requisition as an attachment for the order.

C. The lab receives the lab order and performs the necessary tests.

D. The lab returns the test results to the office. 

  1. Laboratory Integration: Results are returned in an HL7 message placed in the Incoming folder, imported into MacPractice automatically, and linked to the patient account.
  2. Manual Laboratory with Structured Data: Results are returned to the office; the office must import this into the patient's order and select the correct codes for the tests.
  3. Generic Labs for Tracking: Results are returned to the office; the office must add the attachment to the patient's order and manually type in information for tracking.

E. The lab results are reviewed and managed by the appropriate staff member. 

Checking Lab Orders can be done per patient or all at once. Select the MacPractice Orders tab and use the Filters under the Orders tab to manage the imported lab results. You may also click on the Labs Ability Icon in your toolbar or the Imported Orders button in your shortcuts. To view orders for a single patient, simply choose that patient in the selector, the results for the patient will show on the Orders tab. Open orders also display on the patient's Clinical Tab. 
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Set Filters to View Results
First set your filters to see the results you'd like to view. 
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  • Filter by Office: By default, All Offices will be selected. If you have multiple offices, select separate lab results related to patient from another office location.
  • Filter by Provider: By default, All Providers will be selected and will show all results that are associated to any of the providers in the office. If a Provider is selected, this Provider is the Provider associated to the patient in the Patient tab. If no provider is selected in the Patient tab, the Provider will pull from the Account tab.
  • Filter by User: This commonly used filter will always default to the individual that is currently logged in to MacPractice. To view all lab results despite to whom the results are associated, set the All User filter. Orders are automatically assigned to a user based on the Labs Preferences. 
  • Filter by Type: This filter will reduce the amount of information in the Orders tab. Since the Order tab is used for other importing features in MacPractice, the Filters by Type menu allows you to select which importing feature you wish to look at. In this example, we select Laboratory results.
  • Filter by Status: This menu will always default to Open when you log out of MacPractice and log back in. This filter locates lab results that have been moved to other views by using the central column Status option

Results Table
All orders that fit the filter criteria will display on the table. You may change the order of the columns or click on a header to sort by that item. Each lab order should be assigned to a patient, if one is unassigned, please update it to the correct account. 

Review and Update Lab Orders  
Lab results will display in either the Lab Results or Attachments Tab of the Order. Review the results, then update the information such as the Due Date, Review Status, and Notes. Change the Assigned To person if needed or Sign the Order once everything is complete. For details on all Lab Order window attributes, please click here.

 

Types of Labs 

All three styles of Lab tracking follow the steps above; however there are differences in how the results are returned and imported into MacPractice. 

Laboratory Integration

Results are returned in an HL7 or PDF message placed in the Incoming folder, imported into MacPractice automatically, and linked to the patient account. This style requires a connection with the Laboratory and a MacPractice representative will assist with setting this up in Preferences. Once the HL7 message is imported into MacPractice, the patient's order will be updated.

Importing Results
The result file will be placed in the incoming folder. MacPractice will import the file, and the Lab Status column will be flagged as Received. The Status column will be set to Open by default.
NOTE: You must be logged in to MacPractice for results to be imported. If you are not logged in to MacPractice on the computer where the incoming folders are located, the results will simply sit in the import folder until someone logs in to MacPractice on that computer.
 
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Attachments
Orders from Lab Integrations will display an extra item - attachments. This is only used for HL7 lab results with embedded PDFs or laboratories that sent PDF results. 
 

Manual Laboratory with Structured Data

The Other Labs feature in MacPractice is a fully manual entering system. Results are returned to the office; the office must import this into the patient's order and select the correct codes for the tests. Create Orders for all each lab, using the Other Labs name. 

Import Results and Update Status
By default, all lab results start out as Open orders. As you receive results, import the results into the Attachments and update the status as well as other details. The status options will allow you to keep your Orders area more manageable as new results appear.
 
As you get results back, find the Order for that patient and select the Tests tab. In the Received Date: field you can enter in the date the lab result was received by your office or the date you entered in the lab result or you can leave it blank.
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Click the plus button to the right of the Received Date field this will bring up a drop down window that will allow you select Tests Being Ordered. The Tests Being Ordered is like a subject title for the results you will be entering in, for example Blood panel. Select your desired panel and click the OK button. If you have multiple tests you can repeat this process for all your Tests Being Ordered.
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Now, manually enter in the lab test results. First confirm you are on the right test if you have multiple entered. Then click the plus key next to the Results field to bring up your drop down window to search for your lab results. For example when I search Glucose, MacPractice will bring up all options relating to Glucose. Select the correct code and click OK to add that result to your Results field.

You will need to repeat this process for each lab result entry.
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After all of the lab results have been entered, save your Order. Repeat the process if you have multiple Tests Being Ordered. Save your entries. 

Add any Notes and update the Order Status. 

Generic Labs for Tracking

Results are returned to the office; the office must add the attachment to the patient's order and manually type in information for tracking. This is typically the method selected by offices who send very few labs or dental offices tracking cases.

In References, create a new Order Type for Labs. Offices using manual labs will not have a default "Laboratory" type that is usable. Create an Order for a patient using the new order type. Set Due Dates or reminders as needed. When results are in, update the notes and status information. Attach the results and close the Order when all work is complete. 

 

Lab Results - Other Information

Orders and lab results cannot be deleted. It is vital that each user in the office has the proper user privileges, and proper confirmation steps have been taken before the lab results are created in MacPractice. 
 

Results Without Names

Blank results are properly designed HL7 messages that are simply missing some matching criteria.  If there is no patient associated to the lab result, a manual association will needed. A blank result is normal as your office and the laboratory start to sync and will reduce as you move forward with the interface. This can also be due to human error, but these blank results are easy to maintain. 
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With the lab result selected, select the Lab Results tab. View the patient's name on the lab result. In the central column at the bottom, click the Assign Patient button and a window will appear from which you can search for the patient.

After you have located the correct patient name in the search window, select the name, then click the OK button. Three things will happen: the patient and provider column will populate, the patient demographic line will populate, and an audit trail entry will be made.
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Blank results should be a priority, once all the blank results have been assigned, manage the remaining results with the Orders, Attachment, and Lab Result tabs.

Laboratory Order Attributes

The Orders Tab 
The Short Description explains the lab order, as well as showing on the Subject column of the Orders and showing on the patient's Clinical Tab. The Long Description may also be changed to provide more information.
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On this tab, you may also change the provider, office, incident or ordered date for this result. 

The Attachment Tab 
This is only used for HL7 lab results with embedded PDFs or laboratories that sent PDF results. These results will also display as attachments in the Attachments or Images Ability. When a lab result imports with an embedded PDF, the asterisk indicates that the Attachments tab displays the embedded PDF.
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The Lab Result Tab 
The Lab Result tab is the main tab used to view lab results as text. MacPractice does not edit the lab results. The lab results display exactly as the laboratory sends them to MacPractice.

Assign To
Lab results are automatically assigned to a user based on your preferences. You can send this lab result to another individual in your office with the Assign To menu. When the user logs in, they will see the lab result in the list of orders assigned to them.
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Status
Update the status to help manage orders. You may filter the results table by Order Status; however if the Archived status is selected, the lab result will be removed from the patient's Clinical tab. If you can't find a lab result, select the All Order Status option to see everything. When the lab result is found, you may move it by choosing a new option in the Status menu.
 
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Due Date
The Due Date is an additional date that will appear in your Order tab columns, but it will not impact any of the order's attributes or settings.

Urgent Order
The Urgent Order checkbox is used to display the order in red.
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Unreviewed 
The Unreviewed menu is an additional flag that can be associated to the lab result. This menu has two options: Normal or Abnormal.
  • Normal: The patient's lab result and all tests have returned with standard outcomes.
  • Abnormal: The patient's lab result or a test was returned with a nonstandard outcome and more action will need to be taken for the patients care.
When one of these two options are selected, the other checkbox is activated:
  • Preliminary Review: Indicates that someone other then a provider has reviewed the lab result.
  • Final Review: Usually indicates that the Provider of the office has reviewed the lab result and made a determination on the patient's care. When Final Review is enabled, the above options are grayed out, preventing them from being changed.
  • Locked: This prevents any further changes.

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When any of these options are used, an Audit trail entry is made to indicate who made the change and when it was made. This allows the office to hold everyone accountable for what is done to the lab results. Each of these options have User Group Privileges related to them so your office can allow or prevent anyone access.

Assign/Change Patient
If an imported lab result comes in to MacPractice as a blank result or auto is associated incorrectly to a patient, use the Assign Patient or Change Patient buttons to move the result.

Sign
Click the Sign button, enter the user's password, and click the OK button The Order tab will lock, preventing any further changes. You will never be able to change the Short Description again.

Note
The Note field is used to keep internal information about the order. Notes cannot be edited. Once the Note is saved, you will need to add another Note if the information is incomplete.
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To print the note, first enable the Orders Note Audit Trail from in References > Forms. Select the form, select the box next to the Form Active checkbox and save. In Preferences > Forms, select the Orders Note Audit Trail form in the Default Order Form menu. After printing the Note Audit Trail, you may reset the default form in Preferences to Default Order Form, as the Note Audit Trail is not used that often.
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