MedCom MC-S239 July 2007 WebReq

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 thehistory behind WebReq. In time WebReq has

been updated in co-operation between the WebRequsers and the WebReq architects. Today we are proud

of the usability of the system, which has shown to bevery timesaving and both costs and error reducing.

2 WebReq

WebReq is dynamic

At the Clinical BiochemicalDepartment, we are a team ofthree; two consultants and a dataprocessing consultant from theRegion of Central Denmark whoassist general practitioners ininstalling and using WebReq.

When a general practitionerchooses to switch to this form ofelectronic communication, it isimportant that somebody followsup, to give help where needed.During the course of the firstweek that WebReq is installed,

my colleagues and I monitor howthings are going. We give the ge-neral practitioner our telephonenumber, he or she is always ableto call one of us. It is relativelyrare that anyone takes up thisoffer, because WebReq is veryeasy to use once it has become apart of the everyday routine.

Why would I recommend thesystem? First and foremost, forsafety reasons.

In the ”olden” days, it was notuncommon for a social securitynumber and a name not tomatch. Occasionally, somebodywould forget to note a date andsometimes the date of a samplewould be incorrect. And when wehad to redo a procedure and hadto send out new forms, it was notalways the most recent forms thatwere used. WebReq is dynamic. If we change something in thesystem, it is automatically trans-ferred to the sampling forms, andnobody has to spend time check-ing forms and colour codes andthat sort of things. So, it alsosaves users a lot of time.

Technical Laboratory Consultant Uffe LystbækÅrhus University HospitalClinical Biochemical Department ,,...Why would I recommend the system? First and foremost,for safety reasons...”

3– off to a good start

Get off to a good start! 4WebReq – in brief 5WebReq – how we use it! 6Examples of requisition

scenarios 10Benefits and drawbacks 13Useful side benefits 14Help is available 16Hotline 16Price 16WebReq’s further

development 18

Interviews:

Uffe Lystbæk 2Jeanette Madsen 5Henning Orsholt 9Kurt Rasmussen 12Margit Kristensen 15Thomas Rasmussen 17Jens 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 kommunikationGraphics: Christen Tofte Grafisk TegnestuePrint: Oberthur GrafiskEdition: 2000Translation into English in 2014: Kirsten RavnChristiansen & Mie H. Matthiesen

Table of Contents

4 WebReq

Off to a good start!

Everyone who knows how to useWebReq agrees that there aremany benefits to be gained fromusing it. It is easy to becomefamiliar with WebReq, eventhough it might seem compli-cated at first glance.

The benefits of using WebReqare obvious. Of course it shouldbe possible to fill in and transmitelectronic requisitions for clinicalbiochemistry, clinical immuno-logy, clinical microbiology andpathology examinations via elec-tronic pathways. The system hasnot been implemented until nowdue 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 onelocation on one central server.Internet technology and broad-band connections are used forcommunication between thegeneral practitioner and the central server.

Consequently, any generalpractitioner across the countryhas 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 apatient’s basic data is automati-cally retrieved from the journal.And labels for test tubes etc. areof course printed directly fromthe programme.

In other words, there are amultitude of reasons for gettingoff to a good start with WebReq.


WebReq – in brief

WebReq makes it possible for ageneral practitioner to submitelectronic requests for all types oflaboratory tests.

The three modules in WebReqcover:

● 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 apage with forms for printing barcodes.

WebReq contains a completeanalysis register from all bio-chemical and microbiologicallaboratories and pathology de-partments, including relevantsupplemental information, comments and questions relatedto individual tests.

No information is lost When we use WebReq, there isnever any doubt about the accura-cy of the patient information, thesample’s identity and the name ofthe physician taking the sample.Information from the electronicrequest is transferred automatical-ly to the laboratory system. There-fore any risk of erroneous inter-pretation of information on thehandwritten requisitions is elimi-nated. This also removes the needto send samples back to the re-questers due to missing informa-tion; a process which is time con-suming for both the requester andfor us, and it delays the diagnosis.We value the benefits that Web-Req provides in improving the Pathology Department’s dailywork and we look forward to the

day when all of our referrers have implemented it.

Data Processing Biotech Analyst Jeanette MadsenHvidovre Hospital, Pathology Department

The general practitioner hasaccess to WebReq directly fromhis or her computer. This is ini-tiated via a double-click on theWebReq icon.

The vast majority of the gene-ral practitioners’ (GP) systemsallow users to transfer a patient’sbasic data and their own logindata directly to WebReq by usinga simple command on their com-puter.

When you login to WebReq,you select which of the threeWebReq modules you wish to use– Clinical biochemistry and clini-cal immunology, Clinical micro-biology or Clinical pathology.This allows automatic access tothe registry of services for thepreferred laboratory but it alsolets you choose a different labora-tory if you wish to do so.

WebReq – how we use it!

Order slip

The first page in the WebReqmodule is an order page. Hereyou order the required tests. If itinvolves Clinical biochemistryand clinical immunology or Clinical microbiology, you candecide whether the order listshould be displayed as a ”normaldisplay” or as a ”list view/quicklist”. The latter resembles thefamiliar checkbox list. In the”normal display”, the order slip is divided into main groups, with their own samples and ownsample profiles.

When ordering samples forClinical biochemistry, it is doneby ordering groups of samples,called profiles.

Supplementary analysis can beordered if needed. The same goesfor samples for analysis done bythe general practitioner.

The first pageof a WebReqmodule is theorder page –in this case forClinical Bio-chemistry.

6 WebReq


Display ofordered analyses

The same procedure is followedfor pathology and microbiologyand the on-screen displays arebuilt over the same template.

Ordering

An order is initiated by one clickor simple keyboard command forthe profiles and set of analysesrequired. Analyses not on displaycan easily be found by using thesearch function.

Useful information – and questions

Along with the order slip, theindividual laboratories provideinformation that is relevant forthe tests, for example that thepatient must show up fastingbefore the appointment, or thatspecific samples must not be sub-mitted just before a weekend.The laboratory also requestsinformation that is important for

the test, for example whether thepatient has been abroad, whatweek of a pregnancy the patientis in, etc.

When there is a need to sup-plement the request with clinicalinformation, you select ”Next”(Ctrl+Shift+N) and page 2 of themodule is displayed. WebReq will also stop automatically hereif there are questions with man-datory answers that have notbeen completed.

It is also indicated on thispage whether the sample must betaken at the laboratory or at thepatient’s home.

8 WebReq

Print of the sample extraction form

When the requisition has beenfilled in, the bar code labels ofthe sampling form, (PTB), areprinted. This is done by selecting”Send and print” (Ctrl+Shift+S).You will now see the completedsampling form appear on screenand select the printer.

The system will automaticallyonly print the required labels.Printing is done with a laser prin-ter. Most types of laser printerscan be used.

The PTB form contains in-formation about which and howmany 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 wasextracted, etc. The form also haslabels for the pipette extractiontest tube, name labels and addresslabels for the laboratory that willperform the tests.

Finally, the form contains information concerning the preliminary processing of the

samples, and information aboutthe sampling; for example, aboutthe specific analyses that aremade in the same test tube. Thelaboratory updates this informa-tion automatically – if necessaryon a daily basis.

One form

In a general practice, only thePTB form is needed for requisi-tion of tests, and all laboratoriesuse 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 andprint” being pressed, WebReqautomatically sends the requisi-tion’s information to the labora-tory.

The sampleextractionform, (the”PTB”) in- cludes labelsfor pipetteextraction, testtubes, namelabels andaddress labelsfor the labora-tory.


Free from loose slips of paper We are six physicians, a graduatephysician and two laboratorytechnicians who normally relieveeach other. Here, it is primarilythe physicians who request bloodsamples via WebReq. Sometimesit will be a week before the patient has an appointment.

When I am setting an appoint-ment for a blood test, by phonewith a patient, I enter the datainto WebReq at the same time. I save it in the system, and thelaboratory technician calls it upwhen the patient arrives.

The same applies when I see apatient and we agree to have ablood sample taken in, for exam-ple, three months hence. In thisway, we are all free of loose slipsof paper that we used to havebefore WebReq.

We have placed a network printerin the laboratory which all thephysicians use for printing. Thepatients are then called into thelaboratory in the sequence inwhich the requisitions come outof the printer.

We have benefited greatlyfrom using the profiles in theWebReq system, which we findrelatively easy to edit ourselves.

The profiles make it manageablefor us to see which samples shouldbe extracted and how they shouldbe handled.

It is also easy to click on a singlesample in order to receive detailedinformation. We also use WebReqfor pathology and smear taking,however, not nearly to the samedegree as for blood samples.

In the beginning, we wantedthe program to run faster. Withconstant improvements to theWebReq programme that problemhas now been solved.

General practitioner Henning OrsholtJyderup

,,...the profiles make it manage-able for us to see which sam-ples should be extracted andhow they should be handled...

When ordering tests for clinical biochemistry

1. From the GP system, selectgeneral practice WebReq andthe clinical biochemistrymodule.

2. Select list view.3. Select for example: potassium,

sodium, haemoglobin and ablood type.

4. Select Send + Print. The screen will now display thecompleted PTB form.

5. Reply to any questionprompts, for example the dateof the last menstruation.

6. Print the PTB form.

Examples of test request scenarios

10

Clinical biochemistry

WebReq

With respect to requests forclinical biochemistry, a lotof time is saved if the individual general practicecreates its own profiles for,for example, Lipid status –which contains the analysesof cholesterol, HDL, LDLand triglyceride.With respect to microbio-logy, it is a good idea tocreate a quick list of thetests that are ordered mostfrequently.This allows the generalpractitioner to order theanalyses with a single click.

Ordering smear tests

1. From within the GP system,select the WebReq pathologymodule.

2. Select cervical cytology.3. Answer the relevant questions,

for example information onthe hormone treatment pre-paration.


5. Print the PTB form.

11

Smear

– off to a good start

For Ordering tests concerning Chlamydia

1. From the GP system, selectgeneral practice WebReq andthe Microbiology module.

2. Select normal display. 3. Select test: Chlamydia as well

as the material and localisa-tion.


5. Print the PTB Form.

Chlamydia

12 WebReq

On-line help is one click away

In my opinion, one of WebReq’sstrengths is the fact that we asgeneral practitioners, are able touse profiles to standardise diag-nostic and treatment controls.Additionally, the profiles enableus to take the only relevant sam-ples, no more, no less.

We also value the fact thatthere is updated on-line help forevery single sample, informationabout sample extraction andinterpretation is always availablewith one click. Overall, WebReq isan example of how electronicscan simplify work procedures. It isnot exactly time-saving, becausenaturally it also takes time to fillin the form electronically. How-ever, it gives us only one form tojuggle.

WebReq could also be impro-ved. Among other things, if wehad one common page where wecould order all samples. I believethat the developers are currentlyworking on this. I would also liketo see a central collection point –one location where we can sendall samples, where they will beforwarded to the proper reci-pients.

Since we started using thesystem there have been on-goingimprovements, and we havealways received the support weneeded.

General practitioner Kurt RasmussenSkødstrup Medical Practice

,,...Overall,WebReq isan exampleof how electronicscan simplifywork 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.

14 WebReq

Informative links

When you request laboratorytests, it is possible to link directlyto analysis guides and laboratoryinformation, directly from Web-Req. Hence it is unnecessary tosearch in handbooks and on theInternet.

Laboratories can use WebReqto provide new information totheir users. Unread news itemsfrom the laboratory are markedwith a special icon, a green flag.

Note to the journal

In particular, in the GP system it is possible to select whether aline should be inserted in thepatient’s journal stating that samples have been taken.

Save function

It is possible to save a request inWebReq for later use, for exam-

ple; if the physician agrees withthe patient during a telephoneconversation, precisely whichtests will be performed. Whenthe patient comes in for the visit,the order is brought up. A re-quest that has been sent to thelaboratory at an earlier point intime can also be retrieved andreused with a new order number.

Introducing the ‘Hotel’ function

The hotel function is used if aphysician requests some tests andthe patient later visits a differentdoctor in order to have the sam-ples taken, for example; if a specialist or a hospital outpatientdepartment places the order andthen the patient’s own physiciantakes the samples.

Another example of the hotelfunction’s use would be the patient’s own physician orderingthe tests, and the patient havingthe samples taken during a holiday somewhere else in thecountry.

If the party ordering the testsuses a different laboratory thanthe party taking the samples,then the latter can be notifiedautomatically if there are samplesthat should be extracted diffe-rently.

The program will automati-cally send results to both thephysician who has taken thesamples and the physician whohas ordered the samples.

Useful side benefits

Specialist and hotel functionsWhen a patient has been referred to a spe-cialist, the specialist may order tests directlyduring the visit and, at the same time, notifythe patient that the samples will be taken bytheir own general practitioner. In order todo this, The order is placed in the WebReqhotel, and when the patient goes to his/herown general practitioner the order is calledup 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 statementsabout WebReq, because our practice was a pilot practice andwe have participated from thevery beginning.

Today, we are by and large run-ning everything, apart from bloodand a few microbiology tests viathe requisitioning system. One ofthe greatest benefits is thesystem’s absolutely reliability.

Errors that were consequencesof mistakes made during manualprocedures have been eliminatednow. And as a bonus, the labora-tories have been freed from doinga lot of repetitive clerical work.It is also my experience that thesystem 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 touse. You just need to sit downand learn how to use it. UsingWebReq is at least as fast as usingpaper. We send core patientdemographic and clinical datafrom the GPs’ computer systemsand this saves a lot of time. Oncethe demographic data has beencaptured from the GP’s system,select from the following topicchoices; clinical chemistry, micro-biology and pathology. As thesystem opens and we select therelevant profiles; cholesterol,fluids etc. which we want to use,we have everything we need available to us.

15

WebReq is always updated withthe latest information and rules(in relation to the tests), for example types of test tubes, quantity and handling.

We are also able to prepare arequest and then ”park” it if wewish to extract a sample for apatient at a later point in time. Ifthe sample is to be taken fromthe patient at a different location,then the message is placed in the”hotel”.

I must stress the importance ofhaving relevant profiles, other-wise it becomes unmanageable. Itis exactly like placing your electro-nic documents in named folders.

Bioanalyst Margit KristensenLøgstrup General Practice Løgstrup

,,...you justneed to sitdown andlearn howto use it...

– off to a good start

Typically the only expense that ageneral practice has when usingWebReq is the operation of thelaser printer that will be used forprinting out the sample extrac-tion forms. WebReq is operatedby a private company, namedDMDD Aps. The company has

entered into agreements with theregions and the national labora-tories concerning payment fordevelopment and operation ofthe system. The regions’ labora-tories pay a monthly fee for eachgeneral practice that uses Web-Req.

Price

16 WebReq

Help is available

Before the general practice canuse WebReq it must be ‘set up’on the server. At the same time,the general practice also sets upits own profiles for laboratorytests.

The laboratories can help with this. They offer to come outand provide instruction in theuse of the system and connect upprinters.

Procedures differ from labora-tory to laboratory, but most ofthem have a WebReq contactperson who stands by for assist-ance. The contact person can befound at www.medcom.dk underthe menu item ”Names andaddresses” > The ”WebReq sup-port team”.

National eHealth agency”MedCom” assists the labora-tories with information, adviceand guidance concerningWebReq. MedCom offers, forexample, WebReq courses as wellas guidance, suggestions and con-sultancy.

Hotline

A special Hotline is set upfor issues concerning Web-Req (but not for generalinternet-related problems).

The Hotline number is(+45) 7572 0177, and thereis no charge for using it.

It is available during busi-ness hours: Monday to friday from 8:30 am to 3:30pm.

WebReq manuals can bedownloaded fromhttp://service.webreq.dk/

It is also possible to sub-scribe to a free e-mail advisory service for servicemessages of differenttypes.


20 minutes – and it’s up and running!

I have participated as a projectmember since the beginning and I am currently using WebReq forclinical chemistry, pathology andmicrobiology. It works fine allaround – just as I expected it to.From my point of view, the greatest benefits are within clinical chemistry, where we cancreate profiles that define sets ofanalyses that are required forspecific purposes. In addition, it isfast and simple to request tests.

It is great to say goodbye tousing various paper forms.

Now there is only one: thesample extraction form, called the”PTB”.

In the early days the first ver-sions of WebReq were difficultand time-consuming to workwith. But continuous improve-ment by the DMDD team has streamlined it and improved all

aspects. WebReq’s electronic pathology request form looksmore or less like the familiarpaper-based request form requisi-tion, and it is quite simple to startusing it. I believe that new userswill need about 20 uninterruptedminutes per category to familia-rise themselves with WebReq –and then they are good to go.

In my practice, I experience thesystem being a bit slow in themorning, when the physicians are”waking up”, and I miss receivinga copy of the requisition in my GP system. Apart from that, I amcompletely satisfied with Web-Req.

General practitioner Thomas RasmussenCopenhagen South

,,...it is greatto say goodbye to usingvariouspaperforms...

18 WebReq

WebReq’s further development 10% of WebReq’s revenues arereinvested in further developmentof the system. All prioritisation of future development has beenplaced in the hands of the usergroup. The group is organised byDanish government agency Med-Com and has representativesfrom general practices, includingan ÆSKULAP user, laboratoriesand PLO (the Danish MedicalAssociation). The representativefrom MedCom is the chairmanof the user group. The user groupmeets every six months andmakes decisions concerning thedevelopment of new functio-nality.

Full integration of WebReqinto the electronic medicalrecords systems used by generalpractices has a very high priority.

Soon, it will probably be pos-sible to bring the list of servicesfrom WebReq into the individualGP systems and to store this datain the general practitioner’s owncomputer system.

In the same manner, it will bepossible to retrieve informationfrom WebReq in order to con-firm precisely which tests havebeen ordered and to place theinformation on a separate labora-tory card.

The user group is also givinghigh priority to development of acommon requisition view with allthe laboratory specialisations inone overview.

Additionally, this will makeWebReq faster and easier to use.


,,... clearimprove-ments thatimprove ourdaily work-flow...

Rational use of laboratory services

Electronic communication is anatural development for thehealth sector. There are a numberof highly effective medical ITsystems, most of which add a lotof value. WebReq is certainly sucha system. Each laboratory definesits own forms of course. Previous-ly, we had a range of differentforms for all types of testing pro-cedures. Today, we have a printerwith blank paper and just usestandardised labels.

The system is highly automa-ted. For example, with a simplepress of a button, we can performan annual check for diabetes patients.

We no longer need to remem-ber precisely which measurementsand samples we have to take forevery patient. Once we have created a profile for a particularpanel of tests, it remains availablein the system.

We are able to create profilesthat are suitable for the clinic andat the same time make use of theprofiles the laboratories makeavailable to us. I believe that weare making more intelligent useof laboratory services.

For many years, I have claimedthat nothing can compete withpaper. And in terms of timewasted or saved, WebReq is pro-bably neutral – I can still place Xsjust as quickly manually as on ascreen. In contrast though, theelectronic system does provide uswith some clear improvementsthat ease our daily work, reducethe opportunity for errors andgenerally improve the care thatwe can give to our patients.

General practitioner Jens ParkerCopenhagen East

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WebReq contacts

WebReq contact people assistgeneral practices in the settingup the WebReq system and provide training.

Find the contact person in yourareas at www.medcom.dk. Select the menu item: ”Nameand addresses” and then select”WebReq contact people”.

Forskerparken 10DK-5230 Odense MPhone (+45) 6543 2030www.medcom.dk

WebReq

Documents

MedCom MC-S239 July 2007 WebReq