OM/EMR Training

1. OM/EMR Training

2. Agenda • Introduction to the EMR • Non-Med Order and Order Set Entry • Consults • Acknowledgment and Incomplete Orders • Post-Filing Edits to Orders • Entering Requisitions

3. Intro to EMR • Electronic Medical Record • Integrated system so same information is viewable regardless of point of entry or desktop • Central access point for all results, patient demographic information, reports, clinical documentation, and clinical data.

4. Intro to EMR • Selected tabs represent the EMR, viewable from all desktops with shared information • Patient header includes name, age, DOB, ht, wt, MRN, Acct number, Reg status, location/room/bed, and allergies • Items that have information “new to you” will be highlighted in red.

5. “i”: More Information • Small “i” next to patient name provides additional information such as allergies, height, weight, admit date and time, BMI, and Code Status.

6. Select Visits Panel • This panel allows you to select the visits for which you wish to view patient data. Choose a time period and visit type, or manually check off the visits you wish to view. Current visit is the default.

7. Summary Panel • The summary panel holds clinical, demographic, and legal information regarding the patient. Allergies, home medications and problems (diagnoses) can be edited via the blue edit button. Allergies and home medications are usually edited on the Clinical Data screen which will be covered later.

8. Summary Panel (cont) • The legal indicators page of the summary panel includes important patient information such as patient rights information, language, immunization, readmission data, blood type, precautions, fall risk, and Braden score. This information is also viewable for all visits by selecting the “all visits” tab.

9. Review Visit • Review visit contains pertinent admission information including reason for visit and physicians associated to this patient visit. • The “More detail” footer button provides additional demographic and administrative information. • The patient abstract can be viewed and printed using the “Abstract” footer.

10. Notices • The notices panel displays those notifications that have been sent to the physician desktop for acknowledgement. These include critical lab results, consultations, and certain nursing events such as patient falls. • The Send Notice button will allow users to manually queue this notice to another physicians desktop that may need to be aware of the result/event.

11. New Results • The New Results panel shows new labs and reports that are new to you. They can be sorted to include data from the last 24 or 48 hours. Tests with multiple results will be listed in a separate date/time column. • All critical results in Meditech are shown highlighted in red/pink and abnormal results will always show in yellow. Clicking on the result will show additional information including the reference range for the test.

12. Clinical Panels • Clinical panels are constructed to provide a comprehensive view of the patient by pulling various types of patient data onto one panel. Additional clinical panels can be found by selecting the “Panels” footer button. Displayed is the M/S Handoff panel. • Information is trended by date/time, but different time increments can be selected using the footer buttons. • You can also choose to pull in data from previous visits by selecting the Visits footer button.

13. Vital Signs • Documented Vital Signs from the nursing assessment appear here. Additional documentations will be trended in an adjacent column by date/time. For patients with large amounts of documentation, the arrows at the top of the screen allow for scrolling through older documentation.

14. I&O Documented intake and output will be listed here. Again data will be trended by date and time and can be adjusted to display increments of 1, 4, 8, 12, and 24 hours.

15. Medications The default on the Medications tab, is the medication list which is a simple list of all medications during this patient’s visit, but can be expanded to include medications from all visits. Clicking the header of each column allows the list to be sorted accordingly. Additional filters can be applied using the footer buttons at the button.

16. Medications cont The second tab on the Medications panel provides a view only display of the MAR. All information on the MAR can be viewed, but no documentation can take place here. You must visit the true MAR for this. The detail footer button allows for viewing of additional medication information, such as the flowsheet, monograph, medication detail, protocol/taper schedules, and any associated data.

17. Laboratory The Laboratory Panel displays all lab data separated out by category. This defaults to the visits selected, but all visit data can be displayed by choosing that tab. Clicking the name of the test will launch you to a list of all results for that test. Clicking the result itself will launch you to a screen to view additional test data, such as the reference range.

18. Laboratory cont Lab reports can be printed by clicking on the date and time header of the lab panel. The user will be launched to a collection data screen, where he/she can select lab report and print the data.

19. Microbiology The Microbiology panel displays all microbiology tests that have been received into the lab. The status and results will be displayed with the procedure. Clicking on the notepad will launch the user out to the final report.

20. Blood Bank The Blood Bank Panel allows for Blood related information to be tracked on the patients. The LAB/BBK department will update information in this panel along with the Blood Product Infusion Record/Reaction documentation done in nursing.

21. Reports The reports panel shows all reports that have been entered on the patient, including radiology report, cardiology reports, dictated physician reports, physician documentation reports, as well as Allscripts reports once they are live in the system. *Initially Allscripts reports will be housed in the patient paper chart. Clicking the notepad will launch you to the report for viewing and printing.

22. Patient Care The Patient Care tab provides a view only overview of all assessments and interventions documented on the patient. The plan of care is also viewable from here. The information can be sorted out by date, name, recorded by, and provider type.

23. Patient Care cont Clicking onto the name of an assessment or intervention will launch you into a view only display of the documentation. No edits can be made from this panel.

24. Notes The notes panel displays all notes entered on the patient by nursing, physicians, and other staff. Dictations and Physician Documentation reports (such as Progess Notes, H&P, Discharge Summary, etc) are not found here. They are on the reports panel. To view, either check off the box next to the desired note and click “View Selected” or clicking directly on the note.

25. Orders Orders will be discussed in detail later in the training. For purposes of the EMR, however, the orders panel is accessible to all users on any desktop. All active orders will be displayed on the current orders table and the history panel contains these as well as cancelled, completed, and discontinued orders.

26. EMR Hands-on • Where are two places in the EMR that I can find documented allergies on a patient (Hint: Clinical data is NOT part of the EMR)? • Where can I view the last medication administration in the EMR (Hint: your nursing MAR is not part of the EMR) • How can I easily tell whether a lab is of abnormal or critical value? • If I want to see a trend in a patients vital signs, how would I accomplish this?

27. EMR Hands-On • What is the easiest and most succinct way to locate a patients all of the assessments and interventions that have been documented? • It is the end of your shift and you are preparing to hand off your patient, where would be the best place to find a comprehensive overview of that patient for that shift? • Where do you go to find physician reports and can you print these reports?

28. Code Status Code status can only be entered on the patient data screen of the Clinical Data Screen. Code status can be selected from a list of options and limits can be entered below if appropriate. This information can be viewed here as well as in the Kardex, the small “i” next to the patient’s name in the header, and in certain clinical panels.

29. Hands on Exercises • Enter Code status on your patient and observe the status in the EMR. Edit this status and note the update in the EMR.

30. Open the Select Visits tab of the patient’s electronic medical record (EMR)If the patient has PCI data available, the “View PCI” footer button will be illuminated.Clicking this button will launch you to a view only display of their PCI information in Magic. Accessing Magic From 6.0

31. Accessing Magic from 6.0 The patient’s PCI chart will display and can be navigated through.

32. Order Entry- Procedures Full orders functionality will be shown in the CBT coming up. To provide an overview, all nonordering providers will select an ordering provider and source upon selecting “New Orders”. This will launch you to your selection screen where you can order off of favorites, by category group, or by typing ahead in the name tab. With the type ahead, select the desired order. Multiple orders can be queued up by clearing the search field after selection and typing ahead again.

33. Orders continued Clicking next will launch into the Edit Order list where all new orders and any potential duplicate orders will display. Any orders that have fields requiring edits will have an asterisk. Clicking that order will display the edit screen and fields with asterisks must be completed. Once these requirements are satisfied clicking next will take you to the Manage Orders screen where additional edits can be made if necessary.

34. Orders cont Once you have reviewed on Manage Orders and click next you will be taken to the Current Orders table where new orders will be displayed with a green “New” status until filed. Clicking submit files the orders. Physicians require pin entry before filing.

35. Order Sets Order sets are available for use by nursing should it be appropriate. They are especially useful in the ED where the Med Approved Protocols are available for use. The sets group orders together to support evidence based medicine and can be ordered by category or by searching by name. Multiple sets can be selected at one time.

36. Order Sets cont Once the sets are selected, the manage orders list allows you to select the orders that are needed. Edits can be made by clicking the blue edit button on an individual order or by selecting edit all which will queue up orders for editing. The functionality here is identical to orders and they will be filed in the same way.

37. Orders Hands-on • Enter orders from different categories • Imaging, Card, US, Lab, Mic, Bloodbank, Nursing, Consults • Make edits both individually and using “edit all” • Make note of the different screens on different types of orders. • Enter the ED RN Protocol Abdominal Pain set • Select any orders relevant to your patient • Use appropriate order sources (MECC Approved Protocol for ED RN Protocol sets).

38. Consult Orders The edit screen of a consult order differs for ordering versus non-ordering providers. Physicians are not require to enter consulting provider, so their consults file as incomplete to be completed by the nurse or secretary. Once the consulting provider information is entered additional information regarding communication to the consulting provider should be entered. A notification is sent to the physicians desktop when this information is entered. Incomplete orders will display on the statusboard as such and on the current orders table.

39. Hands on exercise • Practice entering various consult orders and note the required fields.

40. Acknowledgement of Orders All orders and order edits must be acknowledged by nursing. The Ack column on the statusboard allows for this to be done efficiently. Stat orders will be flagged as Stat and highlighted in pink. Routine orders will display with “Ack” in the column. Click into the column to acknowledge.

41. Acknowledgement cont Each order must be selected and reviewed individually to acknowledge. Once you have reviewed each order, click the Acknowledge button. To restore them to unacknowledged before filing hit Undo. Otherwise click save to file the acknowledgment. You will then be brought to the manage orders screen.

42. Hands on Exercise • Click into the Ack queue on the statusboard for your patient. Review and check off each order individually. File.

43. Editing after Filing To edit an existing order, click on the order in current orders, and make any edits on the edit order list page that you are brought to. Editing a connecting order (lab, pha, mic, rad, card) will place a stop request on the original order and file your edits as a new order.

44. Editing after Filing cont Orders can also be edited from the Edit Multiple Button located on the Current Orders table. Multiple orders can be checked off here and edited using the available footer buttons. Again for connecting orders, edits made to the connecting orders (outside of the specimen collection field) will place a stop request on the order and file the edits as a new order.

45. Editing Orders Hands on • Make edits to both connecting (labs, mic, rad) and non-connecting (nursing, consults, diets) orders to observe the change in statuses. Make note of those orders that stop request when edited.

46. Requisitions Requisitions are a means of communication for information that is not patient specific. Requisitions can serve as requests for supplies or communications to other departments.

47. Requisitions On the edit screen simply enter in your message/communication. Once filed the order will print to the receiving party.

48. Requisitions Hands-on • Enter the Requisition desktop and observe the different requisitions for the Quincy facility. Practice entering requisitions.