Managing Held Orders

When an order is placed on hold, the order is kept in a hold list until it is filed or deleted, or until it is purged from the system automatically. (An administrator determines the number of days that held orders are retained in the hold list.)

For example, if you put the order on hold because the specimen had not yet been collected, once it is collected you can retrieve the order from the hold list, add the collection information, and then file it. You can also retrieve an order from the hold list, make changes to it (such as adding or removing tests), and put the order back on hold for completion later. If the patient or the patient’s physician decides not to have the test performed, you can delete the order from the hold list. You can also simply view a list of the tests associated with an order on the hold list, as well as print the hold list or export it to an Excel spreadsheet.

There are several ways to access a held order:

• You can view the hold list for a specific patient or client at your current lab (which you can optionally limit by date range).

• You can view all of the pending orders for a specific patient using the Order Entry page (including those placed at a lab other than your current lab).

• If you have the PSC hold confirmation letter, you can retrieve that order by scanning or typing the bar code number.

Even when viewing the hold list, you can search for any text, which can help you locate orders associated with a particular requisition number, physician, date, or other data.

Notes:

• Contracted phlebotomists cannot access the hold list.

• With the hold list, you can retrieve up to 250 held orders at once.

• For generic orders, the hold list displays the generic client ID in parentheses below the eLabs client number, and the generic lab name below the requisition number. If you do not want to include generic orders in the hold list or on the Patient Search - Advanced Results dialog box, clear the Include Generic (Held, Scheduled, Standing) check box in your user profile.

• For orders that were added to the hold list because the original order was manually split or transferred from the requisition log, the hold list displays the requisition number associated with the original order. For split orders, the date that the order was split also appears. (This information appears below the requisition number of the held order.)

• If a held order was processed by another lab (for example, if the patient went to a Quest Diagnostics PSC while traveling), that order does not appear in the hold list or the Patient Search - Advanced Results dialog box for the original lab. However, it does appear in the requisition log.

• When you open a held order, if the specified collection date is not today’s date, the date and time (if any) are automatically removed from the order. Unless your user profile is configured to automatically use today’s date as the collection date, you must specify the date before you can file the order.

• When you open a held order containing invalid order codes, a message appears at the top of the Order Entry page listing the invalid codes. You will be prompted to reconcile the invalid codes before you can file the order.

• If a held order was placed without a draw fee and a draw fee is required at your facility, you are required to add one, or to select the Draw Fee Not Required check box before you can file the order.

Retrieving Held Orders QuickStart

Retrieving National Pending Orders QuickStart

Third-Party Orders

In addition to the orders placed manually via order entry, eLabs can receive orders from an external system, such as an EMR system. These orders—referred to as third-party orders or third-party holds—are placed on the hold list so that they can be reviewed before they are filed.

If a third-party order contains an error (such as an invalid order code or missing AOE information), the requisition number appears in red in the hold list. If you position the pointer over the requisition number, a pop-up window describes the nature of the error. These indicators do not appear on the Patient Search - Advanced Results dialog box, although a message does appear when the order is opened. If the third-party order included a non-conforming test for a Medicare patient, a message indicates that the order code was removed.

If the specimen for a third-party order should be collected in the future, the projected date appears in red in both the hold list and the Patient Search - Advanced Results dialog box. (If the projected date is today or a date in the past, the date appears in black.)

Notes:

• Third-party orders that contain an invalid client number are not added to the hold list. In these situations, an administrator receives an email advising that the order was not placed on hold due to an error with the client number.

In addition, if a third-party order does not include the patient’s SSN or patient ID, then the MRN is used as the patient ID. If an MRN is not included or not supported by the client, the chart ID is used as the patient ID. If none of that information is included in the order, or if an MRN or chart ID is not supported by the client, the order is not put on the hold list.

• For labs that support this feature, if a third-party order is flagged as STAT, the word *STAT* appears in red in the hold list, on the Patient Search - Advanced Results dialog box, and on the Order Entry page when the order is edited. It also appears on the requisition when the order is filed.

• If the external system sends more than the allowed number of diagnoses, only the allowed number of codes are added to the order, and no message is displayed.

• If a third-party order contains an ICD-9 diagnosis code, that code is automatically translated to an ICD-10 code if a one-to-one match is available. Any ICD-9 codes that do not have a single corresponding ICD-10 code are retained in the order and identified as written diagnoses on the requisition when the order is filed.

• If the external system sends more than the allowed number of order codes, only the allowed number of codes are added to the order. When you edit the order, a message indicates which order codes were ignored. You can manually create a separate order for them.

• In order for AOE information to be added to the order, the corresponding AOE question must have already been defined in eLabs.

Third-Party Order Updates

If the client supports this feature, an external system or the lab can also modify existing third-party orders on hold. For example, tests and AOE information can be added or removed, and diagnoses can be added. In addition, if the patient demographic or physician information has changed, the updated information replaces the previous information. When you edit a held order for which a test has been added or removed by an external system, a message appears on the Order Entry page, advising you of this and listing the order codes. (No such message appears if a test was removed by the lab.)

If the client does not support this feature, or if the existing held order cannot be located (for example, if the lab reference ID was inadvertently deleted from the existing order, or if the external system did not include all of the information needed to identify the existing order), then no action is taken on any requests to modify the order.

Consumer Orders

Consumer orders are a special type of third-party orders that are typically initiated by a patient (via QuestDirect™ consumer-initiated testing) or separate company or organization, such as a personal health record or health management service provider (referred to as consumers). When a patient requests a test via one of these services, the order is automatically put on hold as soon as the patient’s physician or the Physician Wellness Network approves the test. When the patient comes to your facility to have the specimen collected, you can retrieve the order from the hold list, add the appropriate information, and then file the order.

Consumer orders can be easily identified by the consumer symbol that is associated with the order in the hold list and elsewhere. If the patient paid for the test in advance, the symbol is green (); if the patient did not pay in advance, the symbol is yellow ().

Each consumer order has a unique order number, which is the lab reference ID in the order. This number is saved only with that particular order; it is not saved with the patient demographic information. To ensure that this number is associated with only one order in the system, consumer orders cannot be manually split.

When a consumer order is received, if the patient did not previously exist in the system, that patient is added. However, if the patient currently exists, and the demographic or billing information from the consumer order differs from the existing data in the system, the consumer information is used only for that order. The patient demographic and billing data in the system is updated only via patient registration or when an order is placed manually using eLabs (as described in Managing Patient Information and Placing an Order).

After a consumer order has been filed, information about which consumer was used to initiate the order, the payment status, and the order number (that is, the lab reference ID) appears in the requisition log. For more information, see Requisition Log Content.

Blueprint for Wellness Orders

Blueprint for Wellness is a program that provides individuals with test results that can help them identify potential health issues, such as diabetes, high cholesterol, or anemia. When an individual registers for Blueprint for Wellness, an order is put on hold, and a PSC employee or an IOP can retrieve and file the order when the specimen is collected.

Although Blueprint for Wellness is offered by Quest Diagnostics, these orders are handled like other consumer orders, except that they do not require a physician’s approval. The consumer symbol appears in the hold list and elsewhere, the lab reference ID is the order number, and any existing patient demographic and billing information is not changed.

In some cases, the lab closest to the patient might not be the lab that actually performs the tests. For example, the patient might go to a PSC affiliated with the Pittsburgh lab to have the specimen drawn, but if the tests are actually going to be performed by the Horsham lab, the order will be on the hold list for the Horsham lab. When you search for the patient via the Order Entry page, your search automatically encompasses all of the labs that you can access. If appears for a particular patient on the Patient Search - Advanced Results dialog box, clicking the edit icon under the Action column might automatically change the lab and client to the appropriate ones. (If you typically use accessioning, you will not be able to do so if the lab changes. The Request Accession Number check box will not appear when you file the order.) On the other hand, if you search for the patient via the hold list, you might have to change the lab manually (as described in Changing the Lab) so that you can check the hold list for each lab that you can access.

When you print the requisition, it will include the name of the lab that will perform the tests. In addition, if that lab differs from the lab originally specified in the order file, a special message appears about sending the order to the appropriate lab. For example, if the order file specified the Houston lab, but the Dallas lab will be performing the tests, the name of the Dallas lab will appear on the requisition. You would send the specimen and requisition to the Houston lab as you normally do, and the Houston lab will send this material to the Dallas lab.

If you cannot find a Blueprint for Wellness order on hold, you must complete the order using a paper requisition.

Note: Blueprint for Wellness hold orders will not appear if they were placed outside of the start and end dates defined for the particular program, or if they were placed within the date range, but it is currently past the end date of the program.

All results are handled by the performing lab; they will not be available via eLabs.

Insurance Draw Orders

Insurance draw orders are placed for insurance applicants who must complete a paramedical exam in order to qualify for life insurance coverage. Orders are placed by an agency that represents the life insurance company, for example, ExamOne (a Quest Diagnostics subsidiary).

When an insurance draw order is placed, the order is put on hold. A PSC employee, a contracted phlebotomist at an Approved Service Provider (ASP) or Purchased Service Agreement (PSA) facility, or an IOP can retrieve, complete any ask-at-order-entry (AOE) questions, and then file the order after collecting the specimen. The requisition for an insurance draw is unique, and requires the applicant to review their completed AOE questions and then sign to verify them as accurate. If one or more forms print along with the requisition, the applicant must review, sign, and date the forms, which are then submitted along with the requisition.

Specimens are to be collected using a specific draw kit, and are submitted to a specific lab that supports paramedical testing. All results are forwarded directly to the insurance company for assessment; they will not be available via eLabs.

Manage a Held Order via the Hold List

Manage a Held Order via Order Entry