Unsolicited Blood Gas Interface - Does Anyone?

We run unsolicited blood gases on the iSTAT. However, for Rapidpoint, they must be solicited...

I suspect the vast majority of systems do this for POC testing.

Note: this is not the same thing as "not ordered".  This is in reference to how they are processed.
Solicited: Most lab tests have an actual lab test orded in the lab system by a provider.  This is then collected, received by the lab and finally verified by the lab, all with different documented times.
UnSolicited: In my system, either the provider places a "notification order" (which is not a true lab order) to have the test performed, or a hospital work-flow/policy which the providers have signed off on that prompts the staff on the floor to perform the POC test.  This test is ran and when it uploads into the HIS system it is ordered, collected, received and verified all at the same time.  The basis of this is that it was just completed by the staff on the floor.   

I run unsolicited with the iSTAT to RALs to EPIC.

We run unsolicited blood gasses on the GEM 5000 using the GEM web data management system interfaced to the LIS.

As Jeremy so expertly described above, an unsolicited process for blood gas is largely the model when testing is performed outside of a main/core lab setting, which is mostly how blood gas is done.  We use this model for multiple blood gas device types, including Radiometer, iSTAT and EPOC.  A solicited process is generally more challenging as it requires the POC operators to be able to navigate your LIS, which is just another hurdle to avoid if you can.

We run unsolicited on our i-Stat blood gasses (CG8+) and our GEM 5000's that are located in the OR and Cath Labs.  The rest of our hospital units use solicited orders.  We had originally run everything unsolicited, but we found that the POC operators would often select the wrong panels on the GEM's (didn't match what the provider ordered).  With solicited, they just scan their label and run their sample.  They don't have to do anything with the LIS, they just have to follow the correct collection process in Epic (our EHR) so the order to flows to the GEMs and their label is recognized.

HI Ken, we also run all our blood gases (and all other POC tests) via the unsolicited process, very expertly explained by Jeremy. We have i-STAT, Epoc, GEM 5000, RapidPoint, and ABL 90. I'd guess that most POCT programs run this way, especially if they have POCT middleware. It is possible to have solicited orders on the Big Three middleware solutions, but I think the majority of us use unsolicited. 

We do unsolicited testing as well for our POC moderate testing. We utilize phase of testing order sets, where the orders get placed for a number of individual tests. For example:  If we have a person in our Cath Lab, a phase of care order set would include up to 20 ACT test orders that will get released by the RN and signed by the Provider. It has taken a LONG time to get each Unit to become compliant with placing orders for POC unsolicited testing. I did collaborate with our hospital compliance as this is also a billing compliance item. That team was very influential in getting the other stakeholders involved and listening. IT was super helpful in creating an Epic report that can pull up by sample ID and match if an order was placed prior to testing.  It is a process but can be done. 
Good Luck!

Thank you, all. We had a solicited interface until last year and I have been struggling with our LIS vendor to make the interface work like it did before (Radiometer with Aqure to Werfen with GEMweb). They want us to go to unsolicited, but the issues with unintentionally released results, duplicates, billing issues and lack of doctor order documentation compliance will be huge problems in changing our workflow. Our RTs were used to solicited workflow for... decades. Unsolicited will change so much and will create a lot more mess with orders/results for RT management and myself to clean up.

I suppose I will have to consider what the vendor wants us to do, but it is frustrating to have to completely change workflow for a department without being given a reason that makes sense. 

Thank you all, lots to consider

You should be able to use the workflow that you are used to; the vendor should conform to what you need, not you to them. Good luck in finding a solution.

Many of these responses confirm the concerns I have about changing this interface, but also reassuring that others have figured out ways to make it work. I hope we can figure this out. Thank you again, all. 

I'm not an IT person so I don't know the details of how it works, but we have GEM 5000's that interface via GEMWeb and DI Instrument Manager to Epic for our solicited orders.  So it's definitely possible.  We also have unsolicited orders in our surgical areas so a split system is possible as well.  In the past we've worked with a Werfen IT engineer named John "Jet" Dumont.  He might be able to explain the requirements to make this setup work?

I completely agree with Kathleen's statement, the vendor should conform to the system not the other way around.  With that being said, I also believe that the users would find the unsolicited workflow easier in the long-run once they have adjusted to it.