Viewing Lab Results For A Patient

Use the Lab Results option to view the results of lab tests that have been administered for a specific patient. The Commure Pro system organizes lab results into panels and components. A panel can consist of a single component, or a group of components that are performed together. For example, a Prothrombin Time (PT) panel might consist of that single component, while a Complete Blood Count (CBC) panel might consist of a variety of components such as a hematocrit, a hemoglobin, a white blood count, and a platelet count. To view lab results, follow these steps:

1. Select a patient on the Patient List tab, or click on the Details icon from another option.
2. Click on Lab Results from the display list. The patient data display area shows the Lab Results summary window. The initial list that is displayed includes the most recent panel results for the selected patient. If you are looking for a result that you do not see in the list, click the Load More Data button at the bottom of the list. If additional results exist, they are added to the bottom of the existing list. For more information on loading more data, see Displaying More Lab Results Data.

This summary window lists the patient’s most recent lab results. You can view this list of lab results in any of the four summary view formats below, each of which is described in detail in later sections of this chapter. You can easily switch between the four summary views by selecting the view you want from the drop-down list at the top left of the lab results summary window.

• Panel Summary View
• Expanded Panels View
• Component List View
• Component Table View
  You can also opt to display information and generate reports that meet the College of American Pathologists (CAP) reporting requirements. For more information, see Using the College of American Pathologists (CAP) Reporting Option.

Lab results that fall outside of the normal range are highlighted in either yellow or red. Yellow highlighting indicates that the lab results are abnormal, while red highlighting indicates that lab results are critically abnormal. A blue asterisk next to a lab component indicates that the component has either a comment posted by a lab personnel, or an annotation that you have entered (see Annotating a Component). Holding your mouse pointer over the asterisk displays the comment or annotation. You may print the Summary or Detail window by clicking Print . For details on printing in the display area, see the text describing Print icon in Understanding the Patient Data Display.

​

Displaying More Lab Results Data

The Lab Results summary window displays the most recent panel results for the selected patient. If there are more results to display, you can load them into the summary window until you see what you are looking for or until all of the available results are displayed. The number of panel results displayed at a time is based on the setting Number of Elements retrieved for “Load More” (Portal). This settings affects the number of results that are initially displayed, and the number of additional results displayed each time more data is loaded. You can refresh the list to reset it to the most recent results by clicking Refresh . The most recent data is loaded when the list is refreshed. Consult your Commure Pro representative if you would like to adjust the default number of elements that are displayed. To display more data, follow these steps:

1. Scroll to the bottom of the Summary list of lab results so that the Load More Data button is visible.
2. Click the Load More Data button to display more results. If additional results are available, they are loaded and added to the bottom of the list. If there are still more results to display, the Load More Data button remains available at the bottom of the current list. Continue to click the Load More Data button until you find the data you are looking for or until all of the data is loaded. When all of the available data is available the Load More Data button is no longer available.
   If a filter is applied, the Load More Data button is only visible when there are more results to display that meet the filter criteria; if all of the results meeting the filter criteria are displayed the button is not visible.

​

Sorting Lab Results

The results in all four summary views are sorted in descending order by date, as a default setting. This means that the most recent results are shown first. However, you may change the order in which the results are sorted in any of the first three summary views by clicking on a column heading. For example, if you were looking at Expanded Panels and you wanted to sort the results by normalcy status, so that the critical or abnormal results were grouped together, you could click the Norm column heading. Please note that you cannot change the sort order of the Component Table view. Sorting applies to the data that is currently displayed. If more data is loaded, it is inserted into the list and it affects the sort order. The list must be sorted again after more data is loaded.

​

Filtering Lab Results

You may filter the list of lab results, based on several different types of criteria. To do so, click the drop-down filter located in the upper right corner of the summary view window. When you select an item from the filter list, the current summary view (Panel Summary, Expanded Panels, Component List, or Component Table) shows only those lab results that meet the filter criteria. The count of the filtered lab results and the total number of lab results available is displayed in the Panel or Component heading, shown as (# of #). The various types of filter criteria are described here:

• All: Shows all of the patient’s lab results based on the current “Load More” setting (for more information on loading more data, see Displaying More Lab Results Data.
• Out of Range: Select this filter to view only those lab results which fall outside of the “normal” range for the lab test in question.
• Snapshots: Select a snapshot item to view a custom grouping of lab components. For example, you might want to see all components related to coagulation together (such as an INR, PTT, and PT), even though they might not have been administered in a group as a panel, or given on the same date. Your system administrator can set up departmental snapshots of the lab components that most physician’s like to view together, or you can also create your own personal snapshots of favorite groupings. Use the Lab Results Settings option on the Preferences tab to create personal snapshots. For detailed instructions describing how to create snapshots, please refer to Defining Your Lab Results Settings.
• Categories: Select a category to see all the results that fall within that category. If your institution uses them, categories are broad groupings of lab results that are defined by the institution. Categories are different from snapshots, as they are usually a more generalized grouping of lab component types, while snapshots contain a very specific set of related components. For example, you might see categories such as Cardiac, Chemistry, or Endocrine. Since each institution defines their own categories, the ones you see on your filter list may not be the same as those described here. Or if your institution does not use categories, none will be listed.
• Unfiled: Select this item to see the results that are not included in any of the categories defined by your institution. If your institution does not use categories, Unfiled does not appear on the filter list.

Items on the filter list are always listed in the same order as they are in the description above. Specifically, the filter items are listed in this order: All, Out of Range, departmental snapshots, personal snapshots (preceded by an underscore), categories, and then Unfiled.

​

Searching for a Specific Panel or Component

The top of the summary view contains a search field and a contains/does not contain toggle that you can use to include or exclude specific panels or components from the summary view. To search for one specific type of panel or component follow the steps below. For example, you might want to see just the CBC panels.

1. Select the desired summary view. Use Expanded Panels or Panel Summary to see panels, or use Component List or Component Table to see components.
2. Select contains as your parameter (click contains or does not contain toggle between the two choices).
3. Type the name of the panel (for example, CBC) or component (for example, PT) in the search field and then click Search .Only those panels or components whose name contains the text you entered are displayed.

In some cases, you might want to exclude a specific type of panel or component from the summary list. For example, you might want to see all lab panels except the CBC panels.

1. Select the desired summary view.
2. Select does not contain as your parameter.
3. In the search field, type the name of the panel or component that you want to exclude and then click Search .All panels or components whose name does not contain the text you entered are displayed.

To return to viewing all panels or components again, clear the text in the search field and press the Enter key.

​

Panel Summary View

Select Panel Summary from the drop-down list to see the most highly summarized view. This view contains a row for each panel of components that the patient has had performed. For each panel it shows the date/time of the lab panel, the panel name, the normalcy status of the panel as a whole (normal if all results were normal, abnormal if any component in the panel was abnormal, or critical if any component in the panel was critically abnormal), and the completion status. You can click on any row in the Panel Summary to display the details of that panel. Two small detail windows open: Panel Table on the left and Panel Details on the right.

​

Expanded Panels View

Select Expanded Panels from the drop-down list to see a slightly more detailed listing of the patient’s panels. This view displays a row for each panel of components that the patient has had performed. In each panel’s row it shows the date/time of the lab panel, the panel name, the individual components included in the panel and their numeric results, the normalcy status of the panel as a whole (normal, abnormal, or critical), and the completion status. For Complete blood count (CBC), basic metabolic panels (BMP), and Chem 7 panels, the panel detail view also contains a diagram of the results. You can click on any row in the Expanded Panels view to display the details of that panel. Two small detail windows open: Panel Table on the left and Panel Details on the right.

​

Component List View

Select Component List from the drop-down list to display the most granular view of lab results. This view displays a row for each component that the patient has had performed. So if, for example, the patient had a particular component performed three times, there would be three rows—once for each occurrence. For each component row it shows the date/time of the component, the panel name to which the component belongs, the individual component name, the numeric lab result value for the component (in either the Low, Normal/Unknown, or High column), the normal range for the component, and the completion status. You can click on any row in the Component List to display the details of that component. Two small detail windows open: Panel Table on the left and Component Details on the right.

​

Component Table View

Select Component Table from the drop-down list to see a slightly different detailed display of component lab results. The Component Table is similar to the Component List, in that it is a very granular view, which displays components rather than panels. However, the Component Table uses a table format, while the Component List uses a list format. The Component Table displays the type of component on the vertical axis, with each occurrence of that component type listed on the horizontal axis. The cells of the table contain the numeric lab results for each occurrence of the component on a specific date. There is only one row for each type of component. (The Component List, on the other hand, lists each occurrence of a component in its own row. If a particular component is performed multiple times, there are multiple rows in the list.) Please note that this is the only view of the four summary views that does not allow you to change the sort order by clicking on a column heading. Each component is sorted by its associated category if available. A header row for each category will display and then the associated components are grouped by panels which are listed in alphabetical order. Within each grouping of panels, the components will be listed in the clinically relevant order sent by the backend system. For example, if the “CBC” panel contained eight components, and “Chem 7” panel contained seven components, the components would be sorted as follows: all eight of the CBC’s components first in the sequence as sent by the backend system (since “CBC” falls before “Chem 7” alphabetically), and then all seven of the Chem 7’s components. If components do not have an associated category, the Unified header row displays and the components are grouped by panel which are sorted in alphabetic order. All of a panel’s components will be listed in the order sent over by the backend system. Regardless of the value you enter in the Limit to field, all of the components within a panel are always shown; panels are never truncated. For example, if you entered “6” in the scenario described above, all eight of the CBC’s components would be shown (because it will not truncate a panel), but none of the Chem 7’s components would be shown (because the first component of that panel would be the ninth result, which would exceed the number you entered in the Limit to field). You can click on a table cell containing a numeric result to display the details of that particular lab result. Two small detail windows appear below the Component Table: Component Details on the left and a Component Graph on the right (see Graphing Lab Results). You can also click on a component name on the vertical axis of the table to graph all of the results for that type of component. The Component Graph is displayed below the Component Table.

​

Viewing the Details of a Panel or Component

If you would like to see the details of a specific panel or component, simply click on that row or cell in any of the four summary views (Panel Summary, Expanded Panels, Component List, or Component Table). Depending on what you have selected, any combination of the following detail screens may appear below the summary view:

• Panel Table
• Panel Details
• Component Details
  If you have CPOE enabled, you have the ability to reorder any of the labs using the Order Again button from any of these details screens. See Repeating an Order for more information.

​

Panel Table

If you click on a panel in either the Panel Summary or the Expanded Panels view, the Panel Table screen appears at the bottom left of the summary view. This detail screen displays a table containing a history of all instances when that same panel was performed for the selected patient. The panels are displayed in a table format with all of the components within the panel listed on the vertical axis, and the dates and times of each occurrence along the horizontal axis. The table cells contain the numeric results for each component. The date/time heading of the particular instance of the panel that you originally selected in the summary list is highlighted in orange. The ability to view the other occurrences of the same panel, along with the specific occurrence in which you were originally interested, allows you to identify any trends in the clinical data. If you click on any cell containing a component’s numeric result, the Component Details screen appears, where you can see further information about that specific lab result. If you click on a component name that is listed on the vertical axis, all of the lab result values for that type of component are graphed on the Component Graph screen (see Graphing Lab Results).

​

Panel Details

If you click on a panel in either the Panel Summary or the Expanded Panels view, the Panel Details screen appears at the bottom right of the summary view. This detail screen displays the details of the specific panel that you selected in the summary view. It shows you the date and time of the panel, the components in the panel, the numeric results, and both the normalcy status and normal range for each component. If you click on any component row in this detail screen, the display changes to the Component Details screen, where you can see further information about that specific lab result.

​

Component Details

If you click on a row in the Component List, a cell in the Component Table, or on a component’s result in the Panel Table or Panel Details (either of the two detail screens described above), the Component Details screen is displayed. This detail screen shows you information about that one specific component lab result. You can see the date and time it was performed, the numeric result, the normalcy status, the normal range for the component, the completion status, and any comments or annotations. In some cases, the lab component contains formatted results, such as columns or tables. In this case, it is automatically displayed in a fixed-width font to preserve the column/table layout. In addition, a Change Font icon appears, allowing you to toggle between a fixed-width font that does not wrap (useful for formatted results) and a variable-width font that does wrap (useful for viewing long comments).You can click Graph to graph this lab result along with other occurrences of the same type of component, over time (see Graphing Lab Results).

​

Using the College of American Pathologists (CAP) Reporting Option

Physician Portal can also be configured to display lab results and reports that meet the College of American Pathologists (CAP) reporting guidelines. To activate this option, contact your Commure Pro representative. When activated, both the panel and component details panes (and associated CAP reports) display the following new information:

• Collected Date/Time: Date and time the panel was completed.
• Normalcy Flags: Flags (H, HH, L, and LL) for components.
• Units: Units of measure (for example, mmol/L or mg/dL) for components.
• Resulted Date/Time: Date and time the lab results were posted.
• Ordering Physician: Name of physician who ordered the lab work.
• Performing Lab Abbreviation/Name/Address: Abbreviation, name, and address of the lab that performed the lab work.
• Medical Director: Name of Medical Director for the facility.

You can also print CAP reports for both panel and component details that show the additional information for components.

​

Graphing Lab Results

Lab results can be graphed so that you can see a pictorial representation of the results over time. There are two ways you can graph lab results:

• You can click Graph in the top right corner of any of the four summary windows (Panel Summary, Expanded Panels, Component List, or Component Table) to access the multi-graphing feature. Multi-graphing allows you to graph multiple clinical items together, such as lab results, medications, I/Os, and vital signs. Please refer to Multi-Graphing Clinical Data for a detailed explanation of multi-graphing.
• While viewing some of the summary or detail lab displays, you can graph the results of an individual component. You can graph just the selected component, or you can graph the selected component against one additional component. This section describes how to do this.

There are several screens from which you can graph an individual component’s results:

• Component Table: This is one of the summary views. It displays all component types, with the results of each occurrence of the component listed in columns from left to right. Simply click on a component name in the left-most column to display a graphical representation of that component’s results (see Component Table View).
• Panel Table: This is one of the detail views. It displays all of the components of a particular panel, along with the results of other occurrences of the same panel listed in columns from left to right. Again, simply click on a component name in the left-most column to display a graph (see Panel Table).
• Component Details: This is one of the detail views. It shows you the details of one specific occurrence of a component result in a textual format. A Graph button is located in the upper right corner of the Component Details window. Click on it to graph the results of this particular occurrence of the component’s results along with any other occurrences of the same type of component (see Component Details).

Regardless of which method you use to display the graph, the format of the graph itself is the same. The normal bounds for the component are shaded green. The high and low values appear outside the normal bounds, and are shaded red. To display the exact numeric value for a specific data point on the graph, hold your mouse pointer over that point (you do not have to click on the point). Most lab results are numeric. However, if a lab result contains any non-numeric characters (for example, “straw” or “+2” or “<.5”), then it is not included on the graph, and message to that effect is displayed. The graph shows the data for each component based on the overall time range displayed in the panel table for that component (30 days maximum.) To view the details of a component in the Component Details window, select the specific date and time in the panel table. The data is updated in the Component Details window. While viewing the graph of a single component, you can graph it against one additional component. Just select the second component from the drop-down list in the upper right corner, and it is added to the graph.

​

Annotating a Component

You can add annotations to a component result at any time. These are your personal remarks, or reminders to yourself, about the patient’s lab results. Annotations are visible to only you—other physicians cannot see them. You can enter an annotation from either the Component List in the summary window, or from the Component Detail window. Note that an annotation is associated with a specific component in a panel. You cannot post an annotation to the panel as a whole. To enter an annotation, follow these steps:

1. Display the specific component lab result that you wish to annotate, using any of the methods described in the Viewing Lab Results for a Patient section.
2. Click Annotate , located in the top right corner of either the Component List in the summary window, or the Component Detail window. The Annotate Component window appears.
3. Type your free text annotation in the Annotation field.
4. Click OK to save your annotation, or click Cancel to close the window without saving the annotation. The annotation is now associated with the component lab result.

Once a component is annotated, the annotation itself, or a blue asterisk indicating that an annotation exists, appears in a variety of displays below. You can hover your mouse cursor over the blue asterisk to read the annotation.

• In the Panel Summary, an asterisk appears next to the panel name, if one or more of the components in the panel have an annotation.
• In the Expanded Panels view, an asterisk appears next to the names of any components containing annotations.
• In the Component List, an asterisk appears next to the names of any components containing annotations.
• In the Component Table, an asterisk appears in the table cell for any component results that have an annotation.
• In the Panel Table detail window, an asterisk appears in the table cell for any component results in the panel that have an annotation.
• In the Panel Detail window, an asterisk appears next to the lab result value, if any component in the panel has an annotation.
• In the Component Detail window, the full text of the annotation appears at the bottom of the textual lab result.

​

Marking All Lab Results as Viewed

Any lab results which you have not yet viewed on the Commure Pro Physician Portal are displayed in the New Results option display or the Patient Summary tab, while those that you have viewed are not displayed in the areas. You can also mark all of a patient’s lab results as viewed without having to individually select and display each one. See Marking Clinical Data as Viewed for more information and instructions on this topic.