Meditech PDoc Training

1. Meditech PDoc Training Ali Bahadori, MD

2. Agenda • General access • Medication Reconciliation • Discharge

3. Access • Meditech can be accessed via the start menu as before • As of January 31st, you will be brought into a new application called physician desktop • The first screen you will see will be the patient list

4. Patient List • Several types of lists can be accessed from the menu on the right, but for most users, the Rounding List is adequate. This is similar to the old PCI list or the BICS list • In addition to basic patient information, you will see indications for recent results, documents requiring signature and other notifications

5. Manage patients in list • You can add patient by going clicking on Find Patient and doing a search • Once you find a patient, inpatients can be added to the list • A patient on the list can be removed by clicking the □ box on left and choosing REMOVE from the right menu

6. Patient Search

7. Add to list

8. Remove from list

9. Universal Buttons • The selections button on the bottom strip are present on most screens • “Review” will take you to Clinical Review which replaces the old PCI. It includes labs, micro, notes, etc • “Order” takes you to the existing ordering application. This is where the new med reconciliation and discharge module is located • “Document” takes you to the note writing application (PDoc) where you can work on the discharge “worksheet” prior to the day of discharge • “Desktop” takes you to a notification application where your signing queue is located

10. Clinical Review • Pt summary is analogous to LMR summary • Special panel are pre-assembled collection of results for various scenarios (card, ID, critical care, etc) • Daily review will give recent results (this will be the first screen when you come to Clinical Review) • Other choices include micro, meds, etc. • Notes can be read in “Notes Review”

11. Order • This screen is already familiar • There are two new icons “Reconcile Meds” and “Discharge” which will be covered in detail later

12. Document • Document will bring you to the note writing application • At this time, the only document you will be working on will be the “Discharge Worksheet” • In the near future, admit, progress, and consult notes will be available here as well

13. Admission Medication Reconciliation • Screen: • Select patient • ORDER module • RECONCILE MEDS • Process • Create accurate home med list • Reconcile • DONE to save changes • SUBMIT and OK

14. Med Rec Screen

15. Add New Med • RECONCILE MEDS • UPDATE MED LIST • Type in new med • Make sure type generic, (brand search brings up a long list) • SELECT med • Pick order string (you can modify the details after you pick the closest string) • Modify details as you see fit • Click DONE • Click OK on the Last Taken screen • Type in the next med

16. ADD a PRN Medication • When adding a home med or a prescription, you can designate PRN by selecting the PRN box • The PRN selection box is ONLY visible when you are IN the frequency field.

17. Modify an Existing Med • In general, it is easier and safer to CANCEL the wrong med and re-enter it correctly • If you must modify, Highlight the med of interest • CHANGE • Make modification • KEEP AS REPORTED • Do not modify the NAME of the drug. CANCEL the wrong med and enter the correct one

18. Remove a Med • If a Med should not be on the list (not a home med), then highlight and CANCEL • Do not modify the NAME of the drug. CANCEL the wrong med and enter the correct one

19. Reconcile • Once you have documented an accurate home med list, you can do reconciliation • Options are • CONT: it is a home med and you want to continue as inpatient • A subset of meds will then automatically convert to inpatient med • If no exact match is found, CONT will bring you to the inpatient med order screen and you can enter the proper drug. You will then be brought back to the reconciliation screen • HOLD: it is a home med, you do not wish to continue as inpatient • There is no STOP during admission med rec. • If the patient was not on the drug to begin with, correct the list by CANCEL the wrong med • If the patient was on the drug as outpatient, but you no longer want them to taking it, HOLD during admission med rec. You will have the option to resume or permanently stop it during discharge med rec

20. Discharge Documents • Process: • Complete the Discharge Worksheet document over the days preceding the discharge • At each time point, SIGN the worksheet and start a NEW one the next time you want to work on it. All the old info will pull in. • Data from this document contain all necessary elements for the discharge summary and discharge instructions, with the exception of disch med rec • On day of discharge, go to ORDERDISCHARGE, do the discharge med rec and “create” the final documents (Discharge summary and Instructions). The old Page 1 content is integrated in the DC Instructions document • Click OK/NEXT through all the fields to make sure the data pulls in from the Worksheet and other sources. Review the data, make any final changes, SUBMIT and SIGNED • Fields with * are required. Some in the Instructions are required, but the needed content will automatically populate once you land on the field • Remember to enter your attending as a “COSIGNER” for the Summary prior to signing it

21. FAU Disch Worksheet • Select patient • DOCUMENT • ENTER NEW • FAU Disch Worksheet • Do NOT select the Discharge summary or instructions at this point

22. Discharge Worksheet

23. Documentation • Click on the first field to begin documenting • Use OK/NEXT to navigate to the next field • By using OK/Next you will automatically skip queries based on answers to the current question

24. Special Fields • There are certain special fields that will be addressed later • Secondary diagnosis • Discharge meds • Warfarin and quality measures

25. How to use canned text • TEXT: this button will open a list of prebuilt canned text. At this time, they are mainly patient instruction content • In the relevant free text field, click TEXT • Select the text and INSERT • You can modify the text after insertion

26. How to Insert Labs • There are prebuilt sets of labs that can be entered via the DATA FORMATS button • In a free text field • DATA FORMATS • Select the data subset • INSERT • You can also manually select specific labs • In a free text field • REVIEW • Go to Lab or Micro or other sections (will not work in DAILY REVIEW) • Right click on the desired labs or reports • RETURN • INSERT • You can also cut and paste from external sources

27. Secondary Diagnosis • This field allows you to access the PROBLEM LIST • You can update the problem list here and the “Acute and Active Problems” will be inserted into the secondary diagnosis field • ADD NEW to enter a new problem • By default, new problems are placed in both the Acute and Chronic section • You can move problems from Acute to Chronic by selecting the problem and using the checkmark Check and uncheck to place or remove problems in sections. Uncheck all to remove problem completely

28. Warfarin • Warfarin is one of the mandatory fields • If patient not on warfarin, select NO and upon OK/NEXT the subsequent related questions will be skipped • Similar behavior for the quality questions

29. Resume Document • If your documentation session times out, data is automatically saved in TEMP status • You can resume where you left off by going to DOCUMENT highlight the particular form EDIT/AMEND RESUME • A Queue of your incomplete document (discharge summary and instructions) is at PATIENT LISTDESKTOP

30. Submit Document • Once you are done with the document, you can SUBMIT • At this time, your options are: • CoSigner this will bring a lookup where you will designate a physician as a cosigner for the current document (this designation can only be made before the author signs) • DRAFT this will save your document for you to resume in the future • SIGNED the document is final • Required fields must be completed before the document can be SIGNED • Documents awaiting your signature or co-signature are accessible via PATIENT LIST DESKTOP

31. Discharge Meds • Discharge meds are inserted into discharge documents once the reconciliation is done. • Reconciliation is performed via the discharge order • Select patient • ORDER • DISCHARGE (go through date and disposition screens) • Pencil next to “Prescriptions” • FYI lower on the same screen is when you “create” the final discharge summary and instructions

32. Review Home List Use to enter an existing home med that is missing from the list Use to write for a NEW home med/prescription

33. Discharge Reconciliation • Process • To be done at day of discharge (or night before) • Review home med list and modify if not accurate • Reconcile • DONE

34. Discharge Reconcile • CAN: Drug was on the list by mistake • CONT: Was a home med and continue on discharge • STOP: Was a home med, stop on discharge • RENEW: Was a home med and needs a new prescription (FUTURE functionality) • For the inpatient list, • CONV: Convert an inpatient med into a new home med • New prescriptions can also be printed

35. Finalizing Discharge • Enter DONESUBMIT once you are done with discharge med rec, discharge instructions

36. Printing of Prescriptions • Once you enter your KEY you will come to the printing screen • You can print your prescriptions • Select Print under ACTION • Enter your printer number • There is no need to print the discharge instruction. Nursing will print it as part of their workflow