CERNER MILLENNIUM Postpartum Visit

1. CERNER MILLENNIUMPostpartum Visit This demonstration reviews a postpartum visit. Details of the workflow will likely vary somewhat, depending on practice policy & clinic layout, though this should give you a good idea of the process. This has been prepared/updated for Millennium code level 2015.01.21 & mPage 6.5. Subsequent updates may display cosmetic & functional changes. All patient names displayed are fictitious. Use the keyboard or mouse to advance.

2. When you see a patient for a postpartum visit, if you look at the Prenatal/Postpartum workflow tab, you won’t see much there. That’s because our general workflow is to close the pregnancy at discharge from the hospital after delivery. While there is an opportunity to Reopen last active pregnancy here, you generally don’t need to do that. (We will, however, demonstrate that process at the end of this lesson.)

3. As you begin the prenatal visit, a good way to review the details of the pregnancy & delivery is to go to Documentation. There you can read the delivery note, discharge summary, & prenatal visit notes.

4. Of particular value is the Pregnancy Summary Document that is generated at discharge after delivery. This is an inclusive summary of the pregnancy, similar to what you would find in a completed ACOG form at the end of a pregnancy.

5. Otherwise, a postpartum visit works like most any other clinic encounter. Review & update aspects of the chart as necessary. You may wish to utilize the Gynecology Amb WorkflowmPage (or perhaps Family Med Clinic Workflow in Family Medicine) for this purpose.

6. If you plan to create your visit note via DynDoc, you can utilize the fields on the mPage to record your HPI, ROS, physical exam, & assessment/plan sections. (If you will be using PowerNote, there is no value in using these fields, since they won’t be pulled into your note.)

7. We’ll search for the Postpartum Visit diagnosis, & add it as a billing diagnosis (indicated via This Visit).

8. We’ll reconcile/update medications by clicking Outpatient under Home Medications.

9. We’ll continue her cetirizine & multivitamin, & stop the ibuprofen. We’ll also add a prescription for Depo-Provera. Click +Add.

10. Search for Depo-Provera & click on the desired option.

11. Complete details such as instructions & refills, then click Reconcile and Sign.

12. The prescription is sent to the pharmacy, & medication reconciliation is complete.

13. Finish any remaining documentation & add appropriate Patient Education.

14. When you’ve completed your work, generate the visit note, using either DynDoc or PowerNote. If you’re using DynDoc, an easy way is to click Gynecology Office Clinic Note at the bottom of the navigation. (Family Medicine Office Visit Note for Family Medicine.)

15. Edit further as necessary, then click Sign/Submit.

16. Residents would search for the supervising attending to submit the note to. Otherwise, when done click Sign.

17. If you want to use the PowerNote approach, click Documents… Click the +Add button, selecting PowerNote from the alternatives if necessary for your specialty.

18. Select an appropriate Note Type, e.g., Gynecology Office Clinic Note. Locate an appropriate note template using the method of your choice. Here we’ve used the Encounter Pathway tab, searching for ob postpartum. Double-click OB Postpartum Visit, Ambulatory.

19. Click through the PowerNote template to add your documentation. When done, click Sign/Submit.

20. Residents would search for the supervising attending to submit the note to. Otherwise, when done click Sign, concluding the visit.

21. Opening & Closing A Pregnancy If you every have to reopen or close a pregnancy, these are the steps.

22. Staff will generally close a pregnancy at hospital discharge after delivery. So when you open the Prenatal/Postpartum tab at the postpartum visit, it will probably look like this. As discussed above, you usually won’t need to reopen a pregnancy. But if you ever need to, click Reopen last active pregnancy.

23. You’ll be asked to confirm that you really want to reopen the last pregnancy. Add a comment like Postpartum visit, then click Yes.

24. All of the prenatal visit details will display to review or update as desired.

25. If you reopen a concluded pregnancy, you need to close it again when you’re done. Return to the L&D/Inpatient tab & go to the Overview section. Click on Close Pregnancy.

26. Fill in details. There are a number of required fields, but if the pregnancy has been previously closed, most of the details will already be here. Just make sure there’s nothing you need to update, then click OK.

27. Maternity mPages will return to the appearance of a non-pregnant woman.