V11 Order and Result Dictionary Build and Synchronization
This page is designed to walk someone through the build process for the Allscripts v11 Order and Results dictionary build. In Allscripts v11 you have to synchronize your orderable items with the Allscripts Order Concept Dictionary (OCD) in order for things such as careguides and AHS defined specialty favorites to work correctly with orders. If you are using multiple vendors, you also must go through the process of synchronizing the multiple vendors together. Once you have the order side complete, you can go through the process of synchronizing results to the Results Concept Dictionary (RCD). RCD is used to flow or graph equivalent results from multiple sources.
Step 1: Request the Order/Result Compendiums from the various vendors
The first step is to gather the order/result compendiums from the various lab vendors. In most cases people will ask for a utilization report and only focus their effort on the top 80% of labs ordered for their locations. There are a bunch of possible orders that aren't used often or at all, so it can cut down on the effort and future maintenance if you focus your efforts. If you do use this approach, you will need to have a process for ordering labs not found in the system; many utilize a miscellaneous orderable, and type in the actual order and order code into the information field. When the results are returned through the interface the dictionary values may need to be entered for the results to file. There is also a dictionary loader interface that can be utilized with results interfaces. This can be requested from your AHS interface analyst. It will file missing items on the fly.
When requesting the compendium from the vendor, be sure to ask for CPT4 and LOINC codes as well. This helps dramatically when going through the synchronization process. This will allow you to group the various vendors by CPT4 and/or LOINC and help determine which orders and results are indeed the same. It is not always one for one, but it usually narrows it quite a bit.
The compendium should also contain Additional Information Questions (along with the answer and answer type, such as picklists, free text, numeric), reflex codes and CPT/charge codes.
Supplies are typically ordered by specialties such as Orthopedics, Podiatry, and Family Practice among others. Supply lists should be collected by specialty. Coding & billing departments can provide the HCPCS codes. Additional info questions can be supplied by both the specialty department and the coding/billing department if applicable. Encounter forms or paper routers can also be good sources of supply descriptions and HCPCS/charge code mappings.
Step 2: Pick a Master Vendor
The next step is probably the easiest, pick your master vendor. In most cases a medical group has a lab that they utilize the most and that is typically the best choice. Overall you want to choose the lab vendor that has the most codes and preferably the cleanest compendium. This vendor that you choose will be the primary lab vendor and will be the vendor that gets loaded into the Order Item Dictionary OID. It is ok if the primary vendor doesn't have every single item that your other vendors will need, but it should be more than 50% of the distinct tests.
Step 3: Build the Orderable Item and Resultable Item Dictionaries for the primary vendor
Once you have the primary compendium data, you must insert the data into the corresponding SSMT spreadsheet. For this, you want the SSMT spreadsheet named "OrderResults-v11". To get the headers for this spreadsheet, extract the spreadsheet from the Allscripts Database using SSMT and ensuring that the "Show Headers in Extracted Data" option is selected. There have been many times where the headers at the bottom of the screen have differed from the actual needed headers. Returning them during the extraction seems to be more reliable.
Step 4: Build the Orderable Item and Resultable Item Dictionaries for the secondary vendor
Once you have the secondary compendium data, you must insert the data into the corresponding SSMT spreadsheet. For this, you want the SSMT spreadsheet named "OrderResults-v11". Again, extract the spreadsheet from the Allscripts Database using SSMT and ensuring that the "Show Headers in Extracted Data" option is selected.
Step 5: Scrub the OR-v11 spreadsheets
You should utilize the Allscripts V11 Scrub Tool Spreadsheet to ensure codes and mnemonics do not exceed the 10 character limit and there aren't duplicates in naming. You can also add a prefix or suffix Lab Identifier Code from within the Scrub Tool. You need to scrub the OR-v11 spreadsheets from both vendors individually. (Even if you only have one lab vendor and don't need to synchronize labs, this is a good tool to ensure you're data is clean and ready to be loaded into the database.
The scrub tool will walk you through step by step how to load the OR-v11 spreadsheet, add prefixes and scrub the compendium data for issues that will prevent a clean load into the database.
Step 6: Link the secondary vendor to the primary
This step is the first part of the synchronization process. This will allow you to enter identical labs from multiple vendors but only presents the user with one option. For example if you are loading LabCorp and Quest Orders, they would both have a CBC. If you don't synch the Orders, the user would have two CBCs to choose from and it would be confusing. When the two have been linked, the users will have one order to choose, they would select the requested performing location and it would then be routed appropriately with the correct codes. The requested performing location can be defaulted in many ways in v11. You can set them based on site, insurance, or a combination of the two. This allows you to define the most likely choice, but also allows the user to change it if they have feel it needs to go elsewhere.
You should utilize the Allscripts V11 Synch Tool Spreadsheet to synchronize the primary and secondary labs together. You will need the 2 separate scrubbed OR-v11 files from Step 5. The synch tool will walk you through step by step how to load the spreadsheets, specify the master compendium, process the unique codes and matching/synching by CPT4 code. You can then manually match any remaining orders by name (those that don't have CPT4 matches).
Several spreadsheets are generated within the tool by the synching process. Once all synchronization is complete, you will need to take the data from the "UniqueCodes" tabs and combine it with the data from the "SSMT OrderResult-ResultSynching" tab to have a complete OR-v11 spreadsheet. This can be loaded into the database via SSMT category OrderResults-v11. You will also need to load the "Order Performing Location" data into the database via SSMT category Order Performing Facility Identifiers.
If you are unfamiliar with this spreadsheet, please refer to SSMT: Order Performing Facility Identifiers
Step 7: Optional - Highly recommended: Link the OID dictionary to the Allscripts OCD Dictionary
Once you have completed loading the OID and RID entries into the system it is time to synchronize the OID dictionary to the Order Concept Dictionary (OCD) dictionary. The main purpose of this is for users to have the ability to use CareGuides. This is for the most part a manual process that a lab expert would need to complete for the client. This is completed within TWAdmin. Please see OID OCD Mapping for further details regarding this process.
Step 8: Optional - Optional: Link the RID dictionary to the Allscripts RCD Dictionary
Once the RID dictionary has been built you can synchronize those items to the Allscripts Results Concept Dictionary (RCD). Used to flow or graph equivalent results from multiple sources. Please see RCD Mapping and Results Synchronization for further details.
Step 9: Optional - Highly Recommended: Define your Requested Performing Location Picklists
When a user is ordering a test or any non-medication item, they have the ability to select the Requested Performing Location. This enables them to determine where the order will be sent whether it is electronic or on a printed requisition. In most cases a particular order should only have a few viable choices. For example, you wouldn't want a user to be able to select a radiology center for a laboratory test. In order to set this up properly you must use the SSMT spreadsheet named SSMT: OID - Order Defaults - Insurance/PatientLocation/Site.
Step 10: Optional - Highly Recommended: Define your Communication Method Picklists
Step 11: Optional: Define Orderable Behavior on the Site or Req Perf Loc level
In many circumstances it is necessary for a separate site or Requested Performing Location to have differing defaults for orderable item behaviors. This is especially true if some location bill for certain procedures while others do not. This can't be set in the OID dictionary because it would set the behavior on a global level. In that case, you would need to use the SSMT: OID - Order Defaults - Req Perf Location / Site to define these defaults. This spreadsheet can also set patient instruction behavior, order instruction behavior, order detail behavior, hold for reason behavior, needs info behavior and overdue requirement behavior.
Step 12: Determine the organization's .NET Preferences for both Orders and Results
Step 13: Build Flowsheets which will display time-based data
Step 14: Result Reference Ranges
v11.2 has introduced new result reference ranges and can be viewed at 11.x to 11.2 Result Reference Ranges
Step 15: Build Order Reason Dictionary
Order Reasons are used for follow up and referral orders.
Step 16: Update the Requested Performing Location Communication Method and interface settings
This will tell the system that an order interface is being used and to transmit the orders electronically. See Order Interface, Req Perform Location, Communication Picklists.
Step 17: Plan for future compendium updates
Whether the compendium consists of only a data set from an internal LIS, an external reference lab, or a synchronized version of both, it is always a best practice to keep the OID and RID dictionary as in sync as possible with the upstream system. After the initial build or bulk load of the compendium prior to go-live, look to establish a process where weekly, monthly, or quarterly updates are communicated so that update, addition, and inactivation entries can be made. In some cases when codes or mnemonics remain the same, but descriptions change, the provider or user can develop the impression that the systems are out of sync.
Sometimes this level of diligence is not directly required, such as circumstances where the site may be utilizing the dictionary interfaces in CxR that have the ability to "auto-build" these dictionaries on the fly or real time.
Order Synchronization Webcast Materials: *Allscripts Enterprise EHR - Order Synchronization