Creating Single Tests, Test Groups and Test Profiles in the MEDITECH LAB Dictionary
By Paul Asbury

As clinical laboratories grow with their MEDITECH installation and the range of procedures they offer increases in kind, operational needs will necessitate the creation of customized test profiles and/or test groups to ensure that healthcare providers have the diagnostic tools available to assist in patient care. For the purpose of this article, test profiles are defined as a LAB Dictionary entry containing two or more reportable results, including: numeric values, informational prompts, interpretive fields or comment fields. Test groups are defined as a collection of previously-created or specifically-related test profiles that are combined into one orderable procedure in the MEDITECH Lab Dictionary. This article will focus solely on Dictionary edits related to the LAB module in MEDITECH for test profiles and test groups. Dictionary Edits for single test entries are similar to those of test profiles and groups in the information necessary to populate fields, but the entry screen on Pg 3 is substantially different. Guidelines specific to single test entries will be covered in a separate, subsequent article in the VCS newsletter. Additionally, BBK, MIC and PTH Dictionary entries have their own specific format for test profile and group creation and will also be addressed in subsequent issues of this newsletter. These guidelines assume the reader is familiar with the Enter/Edit LAB Test Dictionary screen in MEDITECH.

For Test Profiles:

The first task to complete before entering any information in MEDITECH related to the test profile or test group creation is to organize all relevant information into a logical diagram or list. Performing this step beforehand allows the individual performing the Dictionary edits to ensure they've included all of the data necessary to populate required fields of the Dictionary entry screens.

The following checklist is an example of how to organize information related to LAB Dictionary Edits.

1. Choose a unique naming convention for each specific profile, such as: print numbers, test mnemonic and abbreviation
2. Determine whether the profile is performed onsite (corresponding to MEDITECH LAB Site ML) or referenced to another LAB site, such as a third-party partner laboratory. Ref Codes and Res Codes usually determined and provided by the performing reference laboratory, become relevant if the outgoing orders and incoming results are interfaced
3. Have a list of the component test mnemonics available. It is possible to search the LAB Dictionary to populate the fields on Pg. 3 of the dictionary when creating the profile, but it saves time to have this information ready when you reach that stage of the profile build
4. Ensure that the following information is available for each profile you intend to build: Print Number, Mnemonic, Name, Abbreviation, Type, Department, Container (Pg. 1), Lab Sites, Ref Code, Res Code, Temp State, EMR ID, Collect Instructions, Pending Message, Numeric (Pg. 2), Profile, Default Profile and Mnemonics of included tests (Pg. 3), Method (Pg. 4)

Some elaboration on fields to be populated when creating profiles and groups:

Print Number: The print number is a unique identifier for each result field that determines the manner with which each are displayed on a report screen or printed copy of a laboratory report. The print numbers are usually in the format xxx.xxxx or xxx.xxxxx and their corresponding tests appear on reports in descending order from lowest to highest. For example, Test profile CBC has a print number of 100.0000. Included test hemoglobin (HGB) has a print number of 100.0001 and hematocrit (HCT) has a print number of 100.0005. A report display or print-out would list the analyzed results of the HGB ahead of the HCT due to a lower print number. Print numbers are unique to each test in the MEDITECH LAB dictionary no matter the test type. For example, ANA has a print number of 101.0000 and ANA-SLE, an anti-nuclear antibody screen meant for a lupus profile has a print number of 101.0001, even though they are in practice the same assay.
Mnemonic: The test mnemonic is a maximum ten-character descriptive term for the test, profile or group being created. It must match exactly with any corresponding information in the OE Procedure Dictionary. (Example: CBC for complete blood count)
Name: A description of the test being performed. It must match exactly with any corresponding information in the OE Procedure Dictionary. (Example: Complete Blood Count for mnemonic CBC)
Abbreviation: Another brief description of the test being performed. In many instances, it is the same value populating the Mnemonic field.
Type: Details whether an entry is a Test (T), Profile (P), Group (G) or Charge (C).
Department: A mnemonic that describes to which department an entry is assigned.
Example: BMP in department CHEM, CBC in department HEMO, etc.
Container: A mnemonic describing the tube, transport container or preparation material needed for the test. Example: LAV (EDTA tube for CBC).
Lab Site: A mnemonic describing where the testing is performed.
Ref Code: A numeric or alphanumeric, value usually provided by a third-party laboratory, to enable referenced tests to be interfaced with vendor LIS systems and enable outgoing orders transmission.
Temp State: A mnemonic describing the temperature state of specimen handling, usually used for third-party reference testing. Example: F (Frozen), T (Room Temperature) and (Refrigerated) R.
EMR ID: A description of the assays being performed that is recognizable to clinicians ordering procedures in the Electronic Medical Record (EMR). Example: Anti-Nuclear Antibody for ANA.
Collect Instruct: A field to enter collection instructions for clinical staff. Example: Collect in SST, Refrigerate Immediately.
Pending Message: A field that indicates a specimen’s processing status for uncompleted tests. Example: Test referenced to third-party provider.
Numeric: Result responses are allowed to be numeric if the value for this field is set to Y.
Profile: A mnemonic that determines which component tests are included in the profile. For test groups, this may include: previously-created profiles, single tests, charges, or some combination of the three. Mnemonics of tests included in profiles are taken from their mnemonic entry in Pg 1 of the LAB Test Dictionary.
Default Profile: Determines which component tests are set as the default components to be ordered when the profile is selected by clinicians. Example: "A" profile is set as default.
Method: Which testing methodology is used for a given test or profile. Example: RXL for Siemens RXL Chemistry Analyzer to perform BMP.

Some important points to keep in mind before proceeding with Dictionary edits:

• Component tests of profiles must be built and active before the profile itself is created in MEDITECH. One common example of a test profile is a basic metabolic panel (BMP), which usually consists of the following analytes (with example mnemonics include for illustrative purposes): sodium (NA), potassium(K), chloride(CL), carbon dioxide (CO2), glucose (GLU), blood urea nitrogen (BUN), creatinine (CREAT) and calcium (CA). Each of these analytes, existing as single test entries in the Dictionary, would be included in the BMP in the following manner:
  BMP:
  

  NA
  K
  CL
  CO2
  GLU
  BUN
  CREAT
  CA

• Creating these single test entries ensures that they are available when the profile is built.
• Single tests can be included in more than one profile, however care should be taken to determine whether an existing test is used or a parallel test is created specific to that profile. An example of this decision logic would be a hemoglobin included with a CBC (usually performed onsite) and another hemoglobin used with an RBC Folate assay (commonly a test referenced to third-party laboratories). Given that the profiles for each are performed at different testing sites, it would be wise to create a second hemoglobin test in the dictionary customized for the RBC Folate panel with a descriptive Name field to distinguish each test.
• Profiles included in test groups must be active in the LAB Dictionary to be included in test groups.
• For single tests referenced to third-party laboratories, information on the reference code and result code should be populated in their corresponding fields on Pg 2 of the Enter/Edit LAB Test Dictionary screen.
• Required information that should be compiled includes the following: Print Number, Mnemonic, Name, Abbreviation, Type, Department, Container (Pg 1), Lab Sites, Ref Code, Res Code, Temp State, EMR ID, Collect Instructions, Pending Message, Numeric (Pg 2), Profile, Default Profile and Mnemonics of included tests (Pg 3), Method (Pg 4).
• Print numbers for individual result fields in a profile should be close together to ensure that the order in which they are displayed is logical. However, the print numbers should not be so close together that a subsequent test (and print number) cannot be inserted between two extant print numbers should an existing profile have tests added to it. One helpful method is to increment the latter fields of print numbers by five. Example: Profile CBC (100.0000) has HGB (100.0000) and HCT (100.0005). If a test for mean corpuscular hemoglobin concentration (MCHC) were needed later and should be displayed between HGB and HCT, the gap between the two print number's sequences would allow it to be assigned print number 100.0002 to satisfy this requirement.

For Test Groups:

The information listed above is relevant to the creation of either profiles or groups in the MEDITECH Lab Dictionary. In general usage, test profiles are meant to contain a collection of related single tests or charges (such as CBC as mentioned above). A test group is meant to contain a collection of related test profiles. An example of this usage would be a test group created for a Preventive Health Assessment that includes the test profiles BMP and CBC. It is possible to build a test group in the LAB Dictionary composed solely of single tests (as you would build a test profile) or with a combination of included test profiles, single tests and charges as needed. Our recommendation is that a standard be established to determine how test groups are built and what parameters are allowed when constructing them. For example, determining whether they be permitted to include single tests, charges, and test profiles, or only test profiles. Individual site operational needs determine best practice in each case.

For more information about our MEDITECH practice and how VCS can help your organization, please call us at 610-444-1233 or visit our website at www.getvitalized.com. You may also email us at vcs@getvitalized.com.