V11 Order and Result Dictionary Build and Synchronization
This page is designed to walk someone through the build process for the TouchWorks v11 Order and Results dictionary build. In TouchWorks v11 you have to synchronize your orderable items with the Touchworks Order Concept Dictionary (OCD) in order for things such as care plans 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 Compendium 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, which will most likely be the current paper process. 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. This is much better than manually working one error at a time.
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.
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.
The compendium should also contain Additional Information Questions as well as reflex codes.
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 loaded as 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 OID dictionary for the primary vendor
To begin building the OID dictionary for TouchWorks you should begin by getting the unique list of Order codes from your primary Lab vendors compendium. This does not include any of the resultables that are tied to the Orderable, just the actual test name and it's underlying information.
Once you have the unique list of Orderables, you must insert the data into the corresponding SSMT spreadsheet. For this dictionary, you want the SSMT spreadsheet named "OID - Orderable Item". To get the Headers for this spreadsheet, I would recommend extracting the spreadsheet from the TouchWorks 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 RID Dictionary for the primary vendor
The Results Item Dictionary (RID) is the dictionary that houses the actual dictionary items for the returned result data. These are the place holders for the numeric or text values that are returned by the vendor. For example if you order a CBC that would include resultable such as White Blood Count (WBC), Red Blood count (RBC), or Hemoglobin counts.
This exercise requires you to link the resultables to the parent order for the primary results only.
Step 5: 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 sync the Orders, the user would have two CBC's to choose from and it would be confusing. When the two have been linked, the user will simply choose 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.
In this exercise you need to tell the system which secondary labs are equivalent to the primary labs. Start by choosing a primary lab (whichever one best describes the lab) and map the primary lab to itself. In some cases, the primary vendor may have multiple codes for the same Orderable as well. In that case, you would treat the duplicate orderable as if it were a secondary lab also. The primary value should be the active Order code. As each secondary lab item is mapped to the the primary, inactivate the secondary. This is done in the order Performing Facility Identifiers spreadsheet.
If you are unfamiliar with this spreadsheet, please refer to SSMT: Order Performing Facility Identifiers
If your secondary lab has orders that do not match your primary vendors entries, you would enter that order as if it were the primary lab and complete Steps 3 and 4 for that Order.
Step 6: Link your secondary lab results to the primary
This step is optional, but recommended. This step is recommended if you wish to have results from multiple vendors appear on the same line item in a Flowsheet. This wasn't available in v10, but the advantage of synchronizing resultables for multiple vendors is that it allows the user to flow common results from multiple vendors on one line. This is a huge benefit to the providers if they want to track the trend of a results ordered from multiple places.
This step is very similar to the Order synchronization process. You will fill out the Results Where Performed Identifiers spreadsheet to complete this process.
If you are unfamiliar with this spreadsheet, please refer to SSMT: Results Where Performed Identifiers
If your secondary vendor has items that can't be matched to the primary vendor, you should load the item into the RID dictionary by following step 4. This is a little trickier than the first pass because you may have to place the secondary labs result items under the primary labs order code. If the secondary labs order is tied to a primary lab in the Order Performing Facility Identifier spreadsheet, you must load the unlink-able secondary resultables under the primary labs order code in the RID.
Let's continue the example using LabCorp as your primary and Quest as your secondary. Imagine that the LabCorp CBC included only WBC and RBC, but the Quest CBC had WBC, RBC, and MCH. You wouldn't be able to synchronize MCH because it doesn't exist in the Primary lab, but the result is under an Order Code (CBC) that is synchronized. In that case you would need to load the Quest MCH resultable code into the RID spreadsheet tied to the LabCorp CBC Order code.
Step 7: Optional - Highly recommended: Link the OID dictionary to the TouchWorks 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 TouchWorks 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 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.