AHLTA Misconceptions: • It will make us more productive. • It is a documentation tool, not a productivity tool. • It can improve healthcare, but at a cost. • It will not fix an inefficient clinic. • We won’t need coders any longer. • Dr. INSERT NAME HERE Designed it. • I did not design it.

AHLTA Truths • I have to uses it to see patients too. • I am not currently a full-time provider. • As a full-time provider and department head at a small hospital I was forced to implement P-GUI and see XXXX patients a day. • When AHLTA is down during my clinic I hate it and my patients receive worse care. • AHLTA is evolving just as CHCS Legacy did.

Benefits: Medical records availability Population Health (macro and micro level) Point of Care Decision Support Costs: Time (implementation, learning curve, documentation) Effort (overcoming organizational and individual inertia) AHLTA:

Objectives: • Provide you with tools to help you use this system as individuals and as a team. • Leave you with the screen shots and links in this presentation for a reference.

Clinic & Command AHLTA Team • Who is your: • Clinic AHLTA champion? • IT support? • Patient administration link? • Coder? • MTF Clinical Champion? • Regional Clinical Champion? • Template manager – clinic and MTF?

Front Desk Procedures • Both systems are needed • CHCS Legacy – Demographics and 3rd Party Insurance Verification, future appointment creation. • AHLTA – Check-in, Telcons, Walk-in appointment creation. • AHLTA Telcons • As AHLTA is implemented telcons will need to be checked in AHLTA and CHCS. • Completed AHLTA Telcons are available in Previous Encounters. • Communication with healthcare team via the Comment field

Completed AHLTA telcons are viewable in previous encounters.

DefaultAppointment Screen

Columns are actionable. Selecting a column will sort by that column.

Columns can be reordered by dragging them to the new position. Comment Field from CHCS Legacy appointment or AHLTA New Appointment window.

View Comments will allow user to view and edit comments.

Provider must Refresh appointment screen to see changes in comments as well as Status.

Patient Flow in Clinic • How to communicate without paper charts (Flags, Flip Cards, Comment Field) • Minimizing trips to waiting room • Vital Sign Area vs. Vitals in the Exam Room • Dictated by physical spaces and support staff. • Exam room provides support staff with the ability to document in AHLTA and privacy for screening questions.

Support Staff • Vitals • S/O documentation • CC/ROS/PMHx/FHx/SHx, Developmental History • HPI must be documented by Provider • AHLTA strategies for documentation

Existing Vital Sign’s Module

AIM form. Support staff should only complete CC:, PMH, Family and Social Hx, and ROS

Support staff note from AIM form

Edit Note – Take over note retaining documentation. The original note is move to the change history section at the bottom of the encounter. New Note – Original note remains in S/O section. New note may duplicate or even contradict information in original note. Unique elements in both notes are considered by E&M calculator. Delete Note – Moves original note to change history section with statement that it was deleted.

Edit Note using same AIM form. If the provider selects a different AIM form, some data documented on the support staff AIM form may not be shown on the Provider AIM form.

New Note. No elements selected by the support staff are displayed in the new note. The provider can use any AIM form, however some elements may duplicated or worse contradict documentation in the support staff note.

New note results in both Support staff and Provider notes being displayed in the S/O segment of the encounter note.

Support Staff Medcin Template with only PMH and ROS elements

Support Staff note from Medcin Template

Edit note using Provider Asthma Medcin Template. (PMH and ROS elements are identical to Support Staff template)

Edit vs. New S/O Note • Coding issues • MHS and AMA coding rules allow support staff to document CC:, PMH, Family Hx, Social Hx, and ROS. • E&M calculator will count elements completed by support staff with is appropriate if limited to these areas. • Note flow • Edit Note results in a better flow of S/O section, but clutters the change history section. • Inconsistencies and Duplications • New Note risks both • Do not use different AIM forms with Edit Note as previous documentation my be masked in the S/O module. • Edit, Delete and New note all retain clear documentation of who documented what.

Efficiency Tips for Provider Documentation • Encounter Templates with order sets • Default template

Select an Encounter Template then right click to set that as your default.

Template details for this Encounter Template. S/O template is an AIM form

Default S/O template will load for all patients. Users other favorites available with drop-down.

Default Diagnosis list.

Default Order Set.

Default Procedure list.

Default Therapy list.

Pre-Positioned Encounter Templates

Pre-positioned Encounter Templates note: you must have an encounter opened to activate the Template Selections tab.

Enterprise Templates Folder: Your MTF Folder Folder contains a subset of AHLTA encounter templates. Many have been reviewed by Specialty Leaders and Coders. Any user can select these templates use them, add them to their favorites or copy them. Only a few people can store templates in this folder.

Army Encounter Templates (about 200) Specialty Specific Subfolders

Add to favorites using tool bar or right click drop down.

Never move a template from the Enterprise Folder!!! You will not be able to move it back.

Do Not Move Encounter Templates out of the Enterprise Folder!!! • Bug in the system allows any user to “move” a template out of the Enterprise Encounter Template folder, making it unavailable to other users. • Only a few people in each of the 3 services can restore the template to the Enterprise Folder after it has been moved.

Template Management Enhancement (to be released summer 2006)

Navy Template Naming Convention: • DESCRIPTION--SPECIALTY--MTF--INITIALS--DATE • Capitalized, double dashes without spaces. • Description limited to 10 characters and may include spaces. • Specialty limited to 4 characters • MTF • NHL = Naval Hospital Lemoore; • NMCSD = Naval Medical Center San Diego; • NHCL = Naval Hospital Camp Lejeune; • (NAV = Navy Enterprise level templates) • Initials 2 or 3 characters • Date in format 020405 (04 February 2005)

Navy Template Naming Convention • Specialties

Coding • Provider Tips • Communication with Coders/Auditors • Tasking module (Due summer 2006)

Coding in AHLTA • An E&M code and ICD-9 (diagnosis) code are required for a provider to sign and complete an encounter. • CPT-4 (procedure) codes, modifiers and extenders are not required. • Providers who have not coded before will be required to code now.

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