WebReq
– off to a good start
MedCom ●MC-S239 ●July 2007
2014:
This information material is a product of the early WebReq. A retrospect and a part of the history behind WebReq. In time WebReq has been updated in co-operation between the WebReq users and the WebReq architects. Today we are proud of the usability of the system, which has shown to be very timesaving and both costs and error reducing.
WebReq is dynamic
At the Clinical Biochemical Department, we are a team of three; two consultants and a data processing consultant from the Region of Central Denmark who assist general practitioners in installing and using WebReq.
When a general practitioner chooses to switch to this form of electronic communication, it is important that somebody follows up, to give help where needed.
During the course of the first week that WebReq is installed,
my colleagues and I monitor how things are going. We give the ge- neral practitioner our telephone number, he or she is always able to call one of us. It is relatively rare that anyone takes up this offer, because WebReq is very easy to use once it has become a part of the everyday routine.
Why would I recommend the system? First and foremost, for safety reasons.
In the ”olden” days, it was not uncommon for a social security number and a name not to match. Occasionally, somebody would forget to note a date and sometimes the date of a sample would be incorrect. And when we had to redo a procedure and had to send out new forms, it was not always the most recent forms that were used. WebReq is dynamic.
If we change something in the system, it is automatically trans- ferred to the sampling forms, and nobody has to spend time check- ing forms and colour codes and that sort of things. So, it also saves users a lot of time.
Technical Laboratory Consultant Uffe Lystbæk
Århus University Hospital Clinical Biochemical Department
,,
...Why would I recommend the system? First and foremost, for safety reasons...”
Get off to a good start! 4
WebReq – in brief 5
WebReq – how we use it! 6 Examples of requisition
scenarios 10
Benefits and drawbacks 13 Useful side benefits 14 Help is available 16
Hotline 16
Price 16
WebReq’s further
development 18
Interviews:
Uffe Lystbæk 2
Jeanette Madsen 5
Henning Orsholt 9
Kurt Rasmussen 12
Margit Kristensen 15 Thomas Rasmussen 17
Jens Parker 19
ISBN 9788791600357
Editorial staff: Ib Johansen, Margit Rasmussen, Gitte Henriksen
Photos:
Front page (blood sampling: Clinical Photo, OUH.
Page 2 and 12: Sofus Comer. Page 5: Henrik Fryd- kjær. Page 9: Kurt Johansen. Page 15: Lars Holm.
Page 17 and 19: MEW.
Journalistic work: Kim Jørstad / arkitekst kommunikation
Graphics: Christen Tofte Grafisk Tegnestue Print: Oberthur Grafisk
Edition: 2000
Translation into English in 2014: Kirsten Ravn Christiansen & Mie H. Matthiesen
Table of
Contents
Off to a good start!
Everyone who knows how to use WebReq agrees that there are many benefits to be gained from using it. It is easy to become familiar with WebReq, even though it might seem compli- cated at first glance.
The benefits of using WebReq are obvious. Of course it should be possible to fill in and transmit electronic requisitions for clinical biochemistry, clinical immuno- logy, clinical microbiology and pathology examinations via elec- tronic pathways. The system has not been implemented until now due to the fact that the requisi- tion module has required com- prehensive programming.
Furthermore, preparation and, in particular, maintenance of a register of services for each laboratory has been a huge task.
These tasks have been hand- led! Development and main- tenance of the electronic request- ing solution take place at one location on one central server.
Internet technology and broad- band connections are used for communication between the general practitioner and the central server.
Consequently, any general practitioner across the country has direct access to electronic pathology requests from all laboratories.
The system is of course inte- grated into the general practitio- ner’s system, from which point a patient’s basic data is automati- cally retrieved from the journal.
And labels for test tubes etc. are of course printed directly from the programme.
In other words, there are a
multitude of reasons for getting
off to a good start with WebReq.
WebReq – in brief
WebReq makes it possible for a general practitioner to submit electronic requests for all types of laboratory tests.
The three modules in WebReq cover:
● Clinical biochemistry and clinical immunology
● Clinical microbiology
● Clinical pathology
Every module is structured in the same manner, with a request
form as its first page, followed by a page for supplemental in- formation and subsequently a page with forms for printing bar codes.
WebReq contains a complete analysis register from all bio- chemical and microbiological laboratories and pathology de- partments, including relevant supplemental information, comments and questions related to individual tests.
No information is lost
When we use WebReq, there is never any doubt about the accura- cy of the patient information, the sample’s identity and the name of the physician taking the sample.
Information from the electronic request is transferred automatical- ly to the laboratory system. There- fore any risk of erroneous inter- pretation of information on the handwritten requisitions is elimi- nated. This also removes the need to send samples back to the re- questers due to missing informa- tion; a process which is time con- suming for both the requester and for us, and it delays the diagnosis.
We value the benefits that Web- Req provides in improving the Pathology Department’s daily work and we look forward to the
day when all of our referrers have implemented it.
Data Processing Biotech Analyst Jeanette Madsen
Hvidovre Hospital, Pathology Department
The general practitioner has access to WebReq directly from his or her computer. This is ini- tiated via a double-click on the WebReq icon.
The vast majority of the gene- ral practitioners’ (GP) systems allow users to transfer a patient’s basic data and their own login data directly to WebReq by using a simple command on their com- puter.
When you login to WebReq, you select which of the three WebReq modules you wish to use – Clinical biochemistry and clini- cal immunology, Clinical micro- biology or Clinical pathology.
This allows automatic access to the registry of services for the preferred laboratory but it also lets you choose a different labora- tory if you wish to do so.
WebReq
– how we use it!
Order slip
The first page in the WebReq module is an order page. Here you order the required tests. If it involves Clinical biochemistry and clinical immunology or Clinical microbiology, you can decide whether the order list should be displayed as a ”normal display” or as a ”list view/quick list”. The latter resembles the familiar checkbox list. In the
”normal display”, the order slip is divided into main groups, with their own samples and own sample profiles.
When ordering samples for Clinical biochemistry, it is done by ordering groups of samples, called profiles.
Supplementary analysis can be ordered if needed. The same goes for samples for analysis done by the general practitioner.
The first page of a WebReq module is the order page – in this case for Clinical Bio- chemistry.
Display of ordered analyses
The same procedure is followed for pathology and microbiology and the on-screen displays are built over the same template.
Ordering
An order is initiated by one click or simple keyboard command for the profiles and set of analyses required. Analyses not on display can easily be found by using the search function.
Useful information – and questions
Along with the order slip, the individual laboratories provide information that is relevant for the tests, for example that the patient must show up fasting before the appointment, or that specific samples must not be sub- mitted just before a weekend.
The laboratory also requests information that is important for
the test, for example whether the patient has been abroad, what week of a pregnancy the patient is in, etc.
When there is a need to sup- plement the request with clinical information, you select ”Next”
(Ctrl+Shift+N) and page 2 of the module is displayed. WebReq will also stop automatically here if there are questions with man- datory answers that have not been completed.
It is also indicated on this
page whether the sample must be
taken at the laboratory or at the
patient’s home.
Print of the sample extraction form
When the requisition has been filled in, the bar code labels of the sampling form, (PTB), are printed. This is done by selecting
”Send and print” (Ctrl+Shift+S).
You will now see the completed sampling form appear on screen and select the printer.
The system will automatically only print the required labels.
Printing is done with a laser prin- ter. Most types of laser printers can be used.
The PTB form contains in- formation about which and how many test tubes are to be used, for example ”5 PURPLE”,
”5 GEL”, etc., as well as the patient’s patient identifier num- ber, the time the sample was extracted, etc. The form also has labels for the pipette extraction test tube, name labels and address labels for the laboratory that will perform the tests.
Finally, the form contains information concerning the preliminary processing of the
samples, and information about the sampling; for example, about the specific analyses that are made in the same test tube. The laboratory updates this informa- tion automatically – if necessary on a daily basis.
One form
In a general practice, only the PTB form is needed for requisi- tion of tests, and all laboratories use the same form.
The form is paid for and dis- tributed by the laboratories.
The ”request” is sent automa- tically to the laboratory.
Simultaneously with ”Send and print” being pressed, WebReq automatically sends the requisi- tion’s information to the labora- tory.
The sample extraction form, (the
”PTB”) in- cludes labels for pipette extraction, test tubes, name labels and address labels for the labora- tory.
Free from loose slips of paper
We are six physicians, a graduate physician and two laboratory technicians who normally relieve each other. Here, it is primarily the physicians who request blood samples via WebReq. Sometimes it will be a week before the patient has an appointment.
When I am setting an appoint- ment for a blood test, by phone with a patient, I enter the data into WebReq at the same time.
I save it in the system, and the laboratory technician calls it up when the patient arrives.
The same applies when I see a patient and we agree to have a blood sample taken in, for exam- ple, three months hence. In this way, we are all free of loose slips of paper that we used to have before WebReq.
We have placed a network printer in the laboratory which all the physicians use for printing. The patients are then called into the laboratory in the sequence in which the requisitions come out of the printer.
We have benefited greatly from using the profiles in the WebReq system, which we find relatively easy to edit ourselves.
The profiles make it manageable for us to see which samples should be extracted and how they should be handled.
It is also easy to click on a single sample in order to receive detailed information. We also use WebReq for pathology and smear taking, however, not nearly to the same degree as for blood samples.
In the beginning, we wanted the program to run faster. With constant improvements to the WebReq programme that problem has now been solved.
General practitioner Henning Orsholt Jyderup
,,
...the profiles make it manage- able for us to see which sam- ples should be extracted and how they should be handled...
When ordering tests for clinical biochemistry
1.
From the GP system, select general practice WebReq and the clinical biochemistry module.
2.
Select list view.
3.
Select for example: potassium, sodium, haemoglobin and a blood type.
4.
Select Send + Print. The screen will now display the completed PTB form.
5.
Reply to any question
prompts, for example the date of the last menstruation.
6.
Print the PTB form.
Examples of test request scenarios
Clinical
biochemistry With respect to requests for clinical biochemistry, a lot of time is saved if the individual general practice creates its own profiles for, for example, Lipid status – which contains the analyses of cholesterol, HDL, LDL and triglyceride.
With respect to microbio- logy, it is a good idea to create a quick list of the tests that are ordered most frequently.
This allows the general practitioner to order the analyses with a single click.
Ordering smear tests
1.
From within the GP system, select the WebReq pathology module.
2.
Select cervical cytology.
3.
Answer the relevant questions, for example information on the hormone treatment pre- paration.
4.
Select Send + Print. The screen will now display the completed PTB form.
5.
Print the PTB form.
Smear
For Ordering tests concerning Chlamydia 1.
From the GP system, select
general practice WebReq and the Microbiology module.
2.
Select normal display.
3.
Select test: Chlamydia as well as the material and localisa- tion.
4.
Select Send + Print. The screen will now display the completed PTB form.
5.
Print the PTB Form.
Chlamydia
On-line help
is one click away
In my opinion, one of WebReq’s strengths is the fact that we as general practitioners, are able to use profiles to standardise diag- nostic and treatment controls.
Additionally, the profiles enable us to take the only relevant sam- ples, no more, no less.
We also value the fact that there is updated on-line help for every single sample, information about sample extraction and interpretation is always available with one click. Overall, WebReq is an example of how electronics can simplify work procedures. It is not exactly time-saving, because naturally it also takes time to fill in the form electronically. How- ever, it gives us only one form to juggle.
WebReq could also be impro- ved. Among other things, if we had one common page where we could order all samples. I believe that the developers are currently working on this. I would also like to see a central collection point – one location where we can send all samples, where they will be forwarded to the proper reci- pients.
Since we started using the system there have been on-going improvements, and we have always received the support we needed.
General practitioner Kurt Rasmussen
Skødstrup Medical Practice
,,
...Overall, WebReq is an example of how electronics can simplify work pro- cedures...
Benefits
●
WebReq is supplied free to general practices.●
The system is also used internally in general practices.●
WebReq ensures the correct test tube and proper labelling.●
Only one form for the entire country.●
Updates are made centrally.●
Simple programming for GP systems.●
Easy to implement – nearly no costs●
Continued investment allocated for research and continued development.●
It is a simple technology – with no need for new investments.●
Can eliminate future requirements, for example reporting of monitoring of infectious diseases.Informative links
When you request laboratory tests, it is possible to link directly to analysis guides and laboratory information, directly from Web- Req. Hence it is unnecessary to search in handbooks and on the Internet.
Laboratories can use WebReq to provide new information to their users. Unread news items from the laboratory are marked with a special icon, a green flag.
Note to the journal
In particular, in the GP system it is possible to select whether a line should be inserted in the patient’s journal stating that samples have been taken.
Save function
It is possible to save a request in WebReq for later use, for exam-
ple; if the physician agrees with the patient during a telephone conversation, precisely which tests will be performed. When the patient comes in for the visit, the order is brought up. A re- quest that has been sent to the laboratory at an earlier point in time can also be retrieved and reused with a new order number.
Introducing the ‘Hotel’ function
The hotel function is used if a physician requests some tests and the patient later visits a different doctor in order to have the sam- ples taken, for example; if a specialist or a hospital outpatient department places the order and then the patient’s own physician takes the samples.
Another example of the hotel function’s use would be the patient’s own physician ordering the tests, and the patient having the samples taken during a holiday somewhere else in the country.
If the party ordering the tests uses a different laboratory than the party taking the samples, then the latter can be notified automatically if there are samples that should be extracted diffe- rently.
The program will automati- cally send results to both the physician who has taken the samples and the physician who has ordered the samples.
Useful side benefits
Specialist and hotel functions
When a patient has been referred to a spe- cialist, the specialist may order tests directly during the visit and, at the same time, notify the patient that the samples will be taken by their own general practitioner. In order to do this, The order is placed in the WebReq hotel, and when the patient goes to his/her own general practitioner the order is called up and the samples can be extracted pre- cisely as they were ordered by the specialist.
In from the beginning
I am probably disqualified when it comes to making statements about WebReq, because our practice was a pilot practice and we have participated from the very beginning.
Today, we are by and large run- ning everything, apart from blood and a few microbiology tests via the requisitioning system. One of the greatest benefits is the system’s absolutely reliability.
Errors that were consequences of mistakes made during manual procedures have been eliminated now. And as a bonus, the labora- tories have been freed from doing a lot of repetitive clerical work.
It is also my experience that the system is totally reliable in opera- tional terms.
It has not been out of opera- tion one single time since 2004.
The WebReq system is very easy to use. You just need to sit down and learn how to use it. Using WebReq is at least as fast as using paper. We send core patient demographic and clinical data from the GPs’ computer systems and this saves a lot of time. Once the demographic data has been captured from the GP’s system, select from the following topic choices; clinical chemistry, micro- biology and pathology. As the system opens and we select the relevant profiles; cholesterol, fluids etc. which we want to use, we have everything we need available to us.
WebReq is always updated with the latest information and rules (in relation to the tests), for example types of test tubes, quantity and handling.
We are also able to prepare a request and then ”park” it if we wish to extract a sample for a patient at a later point in time. If the sample is to be taken from the patient at a different location, then the message is placed in the
”hotel”.
I must stress the importance of having relevant profiles, other- wise it becomes unmanageable. It is exactly like placing your electro- nic documents in named folders.
Bioanalyst
Margit Kristensen Løgstrup General Practice Løgstrup
,,
...you just need to sit down and learn how to use it...
Typically the only expense that a general practice has when using WebReq is the operation of the laser printer that will be used for printing out the sample extrac- tion forms. WebReq is operated by a private company, named DMDD Aps. The company has
entered into agreements with the regions and the national labora- tories concerning payment for development and operation of the system. The regions’ labora- tories pay a monthly fee for each general practice that uses Web- Req.
Price
Help is available
Before the general practice can use WebReq it must be ‘set up’
on the server. At the same time, the general practice also sets up its own profiles for laboratory tests.
The laboratories can help with this. They offer to come out and provide instruction in the use of the system and connect up printers.
Procedures differ from labora- tory to laboratory, but most of them have a WebReq contact person who stands by for assist- ance. The contact person can be found at www.medcom.dk under the menu item ”Names and addresses” > The ”WebReq sup- port team”.
National eHealth agency
”MedCom” assists the labora- tories with information, advice and guidance concerning WebReq. MedCom offers, for example, WebReq courses as well as guidance, suggestions and con- sultancy.
Hotline
A special Hotline is set up for issues concerning Web- Req (but not for general internet-related problems).
The Hotline number is (+45) 7572 0177, and there is no charge for using it.
It is available during busi- ness hours: Monday to friday from 8:30 am to 3:30 pm.
WebReq manuals can be downloaded from http://service.webreq.dk/
It is also possible to sub- scribe to a free e-mail advisory service for service messages of different types.
20 minutes – and it’s up and running!
I have participated as a project member since the beginning and I am currently using WebReq for clinical chemistry, pathology and microbiology. It works fine all around – just as I expected it to.
From my point of view, the greatest benefits are within clinical chemistry, where we can create profiles that define sets of analyses that are required for specific purposes. In addition, it is fast and simple to request tests.
It is great to say goodbye to using various paper forms.
Now there is only one: the sample extraction form, called the
”PTB”.
In the early days the first ver- sions of WebReq were difficult and time-consuming to work with. But continuous improve- ment by the DMDD team has streamlined it and improved all
aspects. WebReq’s electronic pathology request form looks more or less like the familiar paper-based request form requisi- tion, and it is quite simple to start using it. I believe that new users will need about 20 uninterrupted minutes per category to familia- rise themselves with WebReq – and then they are good to go.
In my practice, I experience the system being a bit slow in the morning, when the physicians are
”waking up”, and I miss receiving a copy of the requisition in my GP system. Apart from that, I am completely satisfied with Web- Req.
General practitioner Thomas Rasmussen Copenhagen South
,,
...it is great to say goodbye to using various paper forms...
WebReq’s further development
10% of WebReq’s revenues are reinvested in further development of the system. All prioritisation of future development has been placed in the hands of the user group. The group is organised by Danish government agency Med- Com and has representatives from general practices, including an ÆSKULAP user, laboratories and PLO (the Danish Medical Association). The representative from MedCom is the chairman of the user group. The user group meets every six months and makes decisions concerning the development of new functio- nality.
Full integration of WebReq into the electronic medical records systems used by general practices has a very high priority.
Soon, it will probably be pos- sible to bring the list of services from WebReq into the individual GP systems and to store this data in the general practitioner’s own computer system.
In the same manner, it will be possible to retrieve information from WebReq in order to con- firm precisely which tests have been ordered and to place the information on a separate labora- tory card.
The user group is also giving high priority to development of a common requisition view with all the laboratory specialisations in one overview.
Additionally, this will make
WebReq faster and easier to use.
,,
... clear improve- ments that improve our daily work- flow...
Rational use of
laboratory services
Electronic communication is a natural development for the health sector. There are a number of highly effective medical IT systems, most of which add a lot of value. WebReq is certainly such a system. Each laboratory defines its own forms of course. Previous- ly, we had a range of different forms for all types of testing pro- cedures. Today, we have a printer with blank paper and just use standardised labels.
The system is highly automa- ted. For example, with a simple press of a button, we can perform an annual check for diabetes patients.
We no longer need to remem- ber precisely which measurements and samples we have to take for every patient. Once we have created a profile for a particular panel of tests, it remains available in the system.
We are able to create profiles that are suitable for the clinic and at the same time make use of the profiles the laboratories make available to us. I believe that we are making more intelligent use of laboratory services.
For many years, I have claimed that nothing can compete with paper. And in terms of time wasted or saved, WebReq is pro- bably neutral – I can still place Xs just as quickly manually as on a screen. In contrast though, the electronic system does provide us with some clear improvements that ease our daily work, reduce the opportunity for errors and generally improve the care that we can give to our patients.
General practitioner Jens Parker
Copenhagen East
WebReq contacts
WebReq contact people assist general practices in the setting up the WebReq system and provide training.
Find the contact person in your areas at www.medcom.dk.
Select the menu item: ”Name and addresses” and then select
”WebReq contact people”.
Forskerparken 10 DK-5230 Odense M Phone (+45) 6543 2030 www.medcom.dk
