EPIC and physician offices

Hello Deborah- yes we're in the midst of doing this in EPIC and it takes some work, but once you're interfaced you'll be so happy. We have both unsolicited and solicited orders for our POCT at our clinics. A great example of unsolicited is our glucometers. The User scans their own ID badge to get access to the device. They scan the patient's armband then do a fingerstick and voila- the results go into EPIC. We use Telcor as the middleware and our devices are Nova StatStrips. 

Hi Deborah! We use solicited testing in our ambulatory locations for urine, covid and Ha1c testing. The order number is used for patient ID, which allows for the results to go from device to Telcor to Epic, and the second identifier is the patient name, which we use for troubleshooting if the interfacing did not occur. Our unsolicited testing does not require a Provider order and is not utilized in the ambulatory location. But unsolicited is easy, using the armband or visit number from Epic. Testing goes from device to Epic.  

Yes, Deborah, we've used EPIC clinical workflow for manual testing for 20 years; our LIS has been Beaker for quite a few years.
We have a variety of different group practices and physician offices.

The EPIC clinical workflow for manual POC tests starts with providers 'ordering' the test in EPIC. The results are entered by staff (staff 'put in using 'enter/edit''. 
For connected/interfaced tests the workflow is: instrument to RALS to Beaker to EPIC patient chart. 

Even though the connected tests don't technically need orders for providers to select, we still have them built for each (connected) test in case there is a failure in some way in that interface/workflow (eg 'do not upload'/flag on a patient result on a connected test).

100% we do not print labels out of EPIC or Beaker related to POCT.

For manual testing, and for scanning related to connected instruments, the only option we have is to print registration labels 'at patient check-in', which have both the MRN (for manual testing workflow using EPIC enter/edit) and the CSN (required for connect devices workflow). We do not arm band in physician offices.

Both of our connected instruments are able to scan the CSN barcode on the registration label, with of course the challenge for newbies coming in to choose the correct barcode (CSN) when they scan for a connected POC test patient ID. 
Good Luck!
Peggy

Hi Deborah, Methodist has some physician offices that utilize EPIC as their EMR, which is the same as the hospital EMR. The POC glucose meter is connected to the network via an ethernet cable. The office does have an EPIC label printer to print the patient barcode which is scanned, and the patient information automatically populates, and the glucose meter is then docked and an unsolicited order for POC glucose is created based on necessary interface information. 

I have numerous clinics performing unsolicited POCT for fingerstick glucose and POCT urine dipstick. Our outpatients are not armbanded, so the staff have to print generic patient labels from Epic that contain a barcoded CSN that they use to scan as the patient ID in the unsolicited POC devices. Works like a charm! I had my Epic Cadence Team build out this generic label specifically for POC testing so it had a barcoded CSN on it. I also didn't want them using manual entry. I can email you our tip sheet for how they print these labels out of Epic. They print to a zebra printer and they can select the exact # of labels they want to print. These are also the labels they use to label all specimens collected in our outpatient clinics that get sent to the main lab for testing. 

For those of you with clinics that perform unsolicited POC tests, are there order sets that are attached to the patient visits? The issue we run into with unsolicited results is that the diagnosis code isn't attached and then billing has to go add it on the back end which is a ton of work for them. Due to this, we require an order to be placed before an operator runs any test that is interfaced with Epic. Possibly it's just the way our IT has it set up??

I am using unsolicited POC tests in my clinics with RALs and EPIC. It acts kind of like a "solicited" test in that the MA will chose the order in EPIC, release it, and collect it. A Beaker label is printed with the barcode but it is barcoded for a CSN not a CID. We have Beaker printers in each patient room and in the POC lab. The process is pretty smooth, my only issue is with MA's using incorrect labels such as the demographic label or they choose a "Main" Lab test in which it prints the barcode with a CID, this is where the training comes into play and having MA's pay attention to details. I also use the "Enter/Edit" section of EPIC for manual entry of urine HCG's only. 

We will be getting started building Epic Beaker though we have been on Epic since 2012.  I may need to tap into some of you folks so we build it correctly.  We have RALS and have heard conflicting instructions that we may not need RALS because POC analyzers will connect to Beaker.  Is that true?  We don't need RALS for operator, QC lockout and review?  How would that work in Beaker?

Also, how do you interface ambulatory tests vs hospital billed tests in Beaker?  Can the charges go to 2 different insurance claims?