What a medical order is

A single consult can end with three lab tests, one imaging study, a follow-up in two months and a course of treatment. Each of those is an order, with its own clinical deadline and its own administrative path. The Medicare hospital conditions of participation require every one of them, verbal orders included, to be dated, timed and authenticated promptly by the practitioner who gave it.

• Lab tests and imaging, which run through scheduling and through prep.
• Follow-ups and later assessments, which depend on one clinician's calendar.
• Procedures, which add theatre time, supplies and consent.
• Treatments and medication, which depend on the patient and the pharmacy.

Who is responsible for making sure an order gets completed?

The physician wrote it and moved on to the next patient. The patient left with a sheet of paper and an instruction to book. The contact centre works whatever lands in its queue. Between those three there is a gap where the order belongs to nobody, and that is where it stays.

What gets measured afterwards is delivered care, so an order that was never booked shows up on no dashboard. Counting them means looking at the other end of the process: how many were written, by when they should have happened, how many did. That is a care gap, and this is how we calculate it.