Orders and Results: The Engine of Clinical Care

Purpose: To trace the complete data trail of all non-medication clinical orders—from provider request through fulfillment and results—covering labs, imaging, procedures, and referrals.

The Order Ecosystem: Beyond Medications

While medication orders are handled by ORDER_MED, nearly every other clinical action is initiated through the ORDER_PROC table. This powerful table orchestrates a vast range of clinical activities.

View SQL Query

SELECT 
    ORDER_TYPE_C_NAME as Order_Type,
    COUNT(*) as Count
FROM ORDER_PROC
WHERE PAT_ID = 'Z7004242'
GROUP BY ORDER_TYPE_C_NAME
ORDER BY Count DESC;

Order_Type	Count
Lab	12
Outpatient Referral	5
Imaging	5
Microbiology	2
Immunization/Injection	1

This single table manages labs, imaging studies, referrals, procedures, and more, each with its own specific workflow and data model.

Deep Dive: Lab Orders and Results

Laboratory testing is one of the most common workflows. It begins with an order in ORDER_PROC and is fulfilled with results in ORDER_RESULTS.

View SQL Query

SELECT 
    ORDER_PROC_ID,
    DESCRIPTION as Test_Name,
    SUBSTR(ORDERING_DATE, 1, 10) as Order_Date,
    ORDER_STATUS_C_NAME as Status,
    ABNORMAL_YN as Has_Abnormal_Results
FROM ORDER_PROC
WHERE PAT_ID = 'Z7004242'
  AND ORDER_TYPE_C_NAME = 'Lab'
ORDER BY ORDERING_DATE DESC
LIMIT 5;

ORDER_PROC_ID	Test_Name	Order_Date	Status
945468372	HEPATITIS C ANTIBODY	9/28/2023	Completed
945468371	LIPID PANEL	9/28/2023	Completed
945468370	HEMOGLOBIN A1C	9/28/2023	Completed
945468368	LIPID PANEL	9/28/2023	Completed
945468369	HEMOGLOBIN A1C	9/28/2023	Completed

Once the lab is completed, the results are stored in ORDER_RESULTS. A single lab order (like a metabolic panel) can generate many result components.

View SQL Query

SELECT 
    o.DESCRIPTION as panel_name,
    r.LINE,
    r.COMPONENT_ID_NAME,
    r.ORD_VALUE,
    r.REFERENCE_LOW || '-' || r.REFERENCE_HIGH as reference_range,
    r.REFERENCE_UNIT,
    r.RESULT_FLAG_C_NAME
FROM ORDER_PROC o
JOIN ORDER_RESULTS r ON o.ORDER_PROC_ID = r.ORDER_PROC_ID
WHERE o.ORDER_PROC_ID = 772179262
ORDER BY r.LINE;

panel_name	LINE	COMPONENT_ID_NAME	ORD_VALUE	reference_range	REFERENCE_UNIT	RESULT_FLAG_C_NAME
BASIC METABOLIC PANEL	1	SODIUM	142	136-145	mmol/L
BASIC METABOLIC PANEL	2	POTASSIUM	5.0	3.5-5.1	mmol/L
BASIC METABOLIC PANEL	3	CHLORIDE	102	98-107	mmol/L
BASIC METABOLIC PANEL	4	CO2	30	22-29	mmol/L	High
BASIC METABOLIC PANEL	5	GLUCOSE	97	74-100	mg/dL
BASIC METABOLIC PANEL	6	BUN BLOOD	14	7-20	mg/dL
BASIC METABOLIC PANEL	7	CREATININE	0.94	0.70-1.20	mg/dL
BASIC METABOLIC PANEL	8	CALCIUM	10.3	8.5-10.4	mg/dL
BASIC METABOLIC PANEL	9	ANION GAP	10	5-14	mmol/L
BASIC METABOLIC PANEL	10	BUN / CREAT RATIO	14.9	8.0-26.0
BASIC METABOLIC PANEL	11	OSMOLALITY CALCULATED	294	275-295	mosm/kg
BASIC METABOLIC PANEL	12	EGFR NON-AFR/AMER	>90	-	mL/min/[1.73_m2]

Key aspects of lab results:

ORD_VALUE: The result, stored as text to accommodate values like “Positive” or “Not Detected”.
ORD_NUM_VALUE: A numeric version for calculations.
RESULT_FLAG_C_NAME: Flags results as ‘High’, ‘Low’, ‘Abnormal’, etc.
ABNORMAL_YN: A summary flag on the main ORDER_PROC record indicating if any component was abnormal.

Imaging Orders

Imaging studies like X-rays and MRIs are also managed as procedures.

View SQL Query

SELECT 
    ORDER_PROC_ID,
    DESCRIPTION as Study,
    SUBSTR(ORDERING_DATE, 1, 10) as Order_Date,
    ORDER_STATUS_C_NAME as Status,
    ORDER_PRIORITY_C_NAME as Priority
FROM ORDER_PROC
WHERE PAT_ID = 'Z7004242'
  AND ORDER_TYPE_C_NAME = 'Imaging'
ORDER BY ORDERING_DATE DESC
LIMIT 10;

ORDER_PROC_ID	Study	Order_Date	Status	Priority
439060613	MRI BRAIN WO CONTRAST	7/31/2020	Completed	Routine
439060612	MRI BRAIN WO CONTRAST	7/21/2020	Completed	Routine
439060610	CT HEAD OR BRAIN W WO CONTRAST	7/15/2020	Canceled	Routine
439060609	MRI BRAIN WO CONTRAST	7/14/2020	Canceled	Routine
772179259	XR ANKLE MIN 3 VIEWS	2/8/2019 1	Completed	Routine

Referrals and Consults

Orders are also used to manage referrals to specialists.

View SQL Query

SELECT 
    DESCRIPTION as Referral_To,
    SUBSTR(ORDERING_DATE, 1, 10) as Referred_Date,
    ORDER_STATUS_C_NAME as Status,
    REFERRING_PROV_ID_REFERRING_PROV_NAM as Referred_By
FROM ORDER_PROC
WHERE PAT_ID = 'Z7004242'
  AND ORDER_TYPE_C_NAME = 'Outpatient Referral'
ORDER BY ORDERING_DATE DESC;

Referral_To	Referred_Date	Status
AMB REFERRAL TO OCCUPATIONAL THERAPY EVAL AND TREAT	2/9/2022 1	Sent
AMB REFERRAL TO NEUROLOGY	12/22/2022	Sent
AMB REFERRAL TO NEUROLOGY	12/22/2022	Sent
AMB REFERRAL TO NEUROLOGY	12/1/2022	Sent
AMB REFERRAL TO GASTROENTEROLOGY	1/9/2020 1	Sent

The Order Lifecycle: Status and Timing

All orders progress through a series of statuses, from creation to completion.

View SQL Query

SELECT 
    ORDER_STATUS_C_NAME,
    COUNT(*) as orders,
    SUM(CASE WHEN ORDER_PROC_ID IN (SELECT DISTINCT ORDER_PROC_ID FROM ORDER_RESULTS) 
             THEN 1 ELSE 0 END) as has_results
FROM ORDER_PROC
GROUP BY ORDER_STATUS_C_NAME
ORDER BY orders DESC;

ORDER_STATUS_C_NAME	orders	has_results
Completed	17	7
Sent	5	0
Canceled	3	0

Linking Orders to Encounters

Orders are always linked to the encounter where they were placed, providing critical context. An order record is linked to its encounter via the PAT_ENC_CSN_ID column.

Key Takeaways

ORDER_PROC is the central table for all non-medication orders, identified by ORDER_PROC_ID.
Order Types: The ORDER_TYPE_C_NAME field differentiates labs, imaging, referrals, and other procedures.
Lab Results: Lab results are stored in ORDER_RESULTS, with one row per component, linked back to ORDER_PROC.
Abnormality Flags: Epic uses a two-tier system: RESULT_FLAG_C_NAME at the component level and ABNORMAL_YN as an order-level summary.
Result Values: Results are stored as text (ORD_VALUE) for flexibility and as numbers (ORD_NUM_VALUE) for computation.
Context is Key: Orders are always linked to an encounter (PAT_ENC_CSN_ID).