If you haven't already:
Click Write (ALT+W).
Click Diagnostic Studies (ALT+I).
Click Echo (ALT+H).
Complete the form
Click to select Trans-thoracic (TTE), Trans- esophageal (TEE), or Stress (C).
A duplicate order warning is triggered by either of these two circumstances: the patient's record includes echo results for the exam you selected, reported within the previous two (2) weeks, or the patient has an active order for the exam you selected. When prompted:
If the patient has a recent report, click View Report to display results. Click
To stop writing the second order, click Cancel (ALT+C).
To continue the order:
Type the clinical indication for ordering the exam again.
Click OK (ALT+O).
When prompted for indications, check the appropriateness of echocardiography in this situation against MGH policy:
Click Contraindications (ALT+N) to view a list of conditions for which it is inadvisable to perform an echocardiogram. Click Close (ALT+C) to return to the order form.
Click Echo Guidelines (ALT+G) for situations where echocardiography is of limited value. Click Close (ALT+C) to return to the order form.
When prompted, complete the clinical history:
Select indicators from the checkbox lists. TTE allows no more than 5 selections each for Signs and symptoms and Rule out/Assess for.
Click the appropriate tab to display options for clinical history: TTE and TEE = Signs and symptoms (ALT+S) and Rule out/Assess for (ALT+R); Stress test = Indications (ALT+I), Exercise limitations (ALT+E), Risk factors (ALT+R).
Click OK (ALT+O).
Click Clinical History (ALT+H) to change this information.
For Trans-esophageal echo (TEE) or Stress Echo, provide medical information when prompted:
Click Review Contraindications (ALT+S) for more information on the impact of these considerations on echocardiology.
If the procedure you selected is contraindicated, click Cancel (ALT+C).
Answer each question by clicking the corresponding Yes or No option, then click OK (ALT+O).
Select Routine or Urgent from the Priority drop-down list.
As needed, type the following in the conflicts/comments field:
Possible scheduling conflicts
Comments
Request for an agitated saline study (bubble study), including indications for this study
For pediatric patients only, if conscious sedation is needed, click Yes; otherwise, click No.
Click OK (ALT+O).
For pediatric patients needing conscious sedation, click OK (ALT+O) to acknowledge the alert that you must call to coordinate the exam with the PICU CSS (Conscious Sedation Service).
Write additional orders as needed, then sign the session.