EHR Patch Updates Office Hours EHRv1.1p7, TIUv1.0p1007, BHSv1.0p4, VENv26p2:

1. EHR Patch Updates Office Hours EHRv1.1p7, TIUv1.0p1007, BHSv1.0p4, VENv26p2: What’s new, What’s changed IHS-Office of Information Technology EHR Program

2. Agenda • Introduction • Presenters • Office Hour Presenters have different specialties within the EHR system who will be responding to your questions • Questions/Answers • “Raise your hand” through the WebEx features provided • Please state your name/site • Please state your question clearly • Please keep background noise to a minimum to better hear the questions/answers • Patch 7 Resources • Patch 7 resources will be placed on FTP site (RPMS patch folder) for your review after session • If you can not access the FTP site please e-mail barbara.hess@ihs.gov for a copy

3. Office Hour Presenters • CDR Susan Pierce-Richards, ARNP, OIT EHR Project Lead • CDR Mary Ann Niesen, PharmD, OIT, ARRA Deployment Pharmacist • CDR James Gemelas, RPh, CAC, Chair IHS Pharmacy PSG (Warm Springs) • Barbara Hess, ABD, OIT EHR Project analyst

4. What do I do if I haven’t installed EHR patch 6 yet? • You have a lot of work to do! • Need to engage IT and Pharmacy Ad Pac to prepare • Go back and review the EHRv1.1p6 recorded web ex presentations Recorded Web Ex trainings Posted here under Electronic Health Record http://www.ihs.gov/RPMS/index.cfm?module=home&option=OITTrainingLinks • Install EHRp6 prior to installing EHRp7

5. Topics • TIUv1.0p1007 • BHSv1.0p4 • VENv26p2 • EHRv1.1p7 • New Features/Modifications • Fixes • Known issues

6. TIUv1.0p1007 Installation • Mega patch to provide infrastructure. Must install 2 small USR patches at the same time. • Install with users OFF system • There is some mapping of 1 document title and some labs so have that ready • This is configuration of a VA specific tool

7. TIUv1.0p1007 During install you’ll be prompted to select a document class, you can accept the defaults or change Running Pre-Install Routine: EN^TIUWRII1 Select the DOCUMENT CLASS where the new title will be installed: NURSING DOCUMENT CLASS DOCUMENT CLASS

8. Enter your site's local lab name for CBC: CBC 1 CBC CBC/COMPLETE PROFILE (retired) 2 CBC HEMOGRAM CHOOSE 1-2: 2 HEMOGRAM Creation of TIU Object VA-WRIISC CBC successful... During install you’ll be prompted for several lab names: CBC Glucose Hematocrit Hemoglobin Hepatitis C Antibody Potassium Sodium Urinalysis TIUv1.0p1007

9. TIUv1.0p1007 New options and Menu A new menu was created for the new VA options. This new menu will be on the BTIU MENU2. It contains the new options HIMS Special HIMS TIU Reports ... [BTIU SPECIAL REPORTS] 1 Missing Text Report [TIU MISSING TEXT NODE] 2 Missing Text Cleanup [TIU MISSING TEXT CLEAN] 3 Reassignment Document Report [TIU REASSIGNMENT REPORT]

10. TIUv1.0p1007 Fixes the following objects |V TOTAL TIME| |MEDICATION RECONCILIATION| |MEDS BY CLINICAL INDICATION |

11. BHSv1.0p4 New Health Summary Components ASTHMA CONTROL ASTHMA PLAN (Asthma Action Plan)  ACTIVE WAIT LIST ENTRIES MEDICATION RECONCILIATION BRIEF DEM W/ADV DIRECTIVE IHS-IMAGING NUTRITIONAL RISK Supplements ANTICOAGULATION THERAPYASTHMA PATIENT CARE

12. BHSv1.0p4 Updates/Fixes Updates to sync with IHS Heath Summary changes Changes being delivered in BJPCv2.0p5 (in beta) are scheduled for BHSv1.0p5

13. VENv26p2 *** If you are currently using Well Child Module you MUST install this patch. EHR now logically deletes measurements a user deletes or changes (stores as entered in error in the background) and the Well Child Growth Charts and Graphs will not display correctly until you install this patch *** Install • VENv26p2 is a cumulative patch and installs the Well Child Module for EHR • If you previously installed VENv26p1 and are using the Well Module for EHR you only need to install KIDS. • If you have never installed the Well Child Module for EHR, then you install VENv26p2 – both the KIDS and the set up file (.exe). Fixes • Very small patch to correct 2 issues • Filters out entered in error measurements on the Growth Chart and Graph • Stores patient education time as an integer correcting a problem with uploading non integer data to the IHS Data Warehouse

14. EHRv1.1p7 New Features/Modifications • Vital entry • Medication reconciliation • Lab POC parameter added • New reminder dialog prompts • Quick Notes

15. Vital entry • “New date/time” button change When you click New Date/Time you will see this dialog. It is defaulted to NOW, you may change to the Current Visit date and time by clicking the radio button. You may also change the date/time by using the calendar […] button

16. Vital entry – Historical Measurement entry • Historical Measurements can now be entered through the Vital Entry component Historical entry is designed to capture measurements transcribed from outside records, such as birth weight, cardiac ejection fraction from Echocardiogram report. First click the Historical Visit radio button ============================== This is NOT late entry! This creates a historical event!! ============================

17. Vital entry – Historical Measurement entry • After clicking the Historical Visit button the Select Location for Historical Entry is presented

18. Vital entry – Historical Measurement entry • After clicking OK on the Select location for Historical Visit dialog you are returned to the Select New Date/Time dialog. • Enter the Date/Time of the historical measurement

19. Vital entry – Historical Measurement entry • After clicking OK, the column with the Historical date/time is available for entry. Enter the historical measurement and click OK. • This will store this as a historical EVENT type visit.

20. Vital entry – Historical Measurement entry

21. Medication Reconciliation Outside Medications component now enhanced to assist with medication reconciliation. If a patient cannot remember the med name, you can use the miscellaneous outside med (set up in P6 instructions) and enter as much or as little as the patient can give you)

22. Medication Reconciliation Dosage, route and schedule are not required.

23. Medication Reconciliation New fields for added info

24. Medication Reconciliation New action – to alert user that more info is needed before med is reconciled.

25. Medication Reconciliation New statuses

26. Lab POC parameter New parameter added to control whether the Ordering Provider is auto-populated or not based visit context provider. BEHOLR SET DEFAULT PROVIDER ------ Setting BEHOLR SET DEFAULT PROVIDER for Division: DEMO HOSPITAL ------ Set default provider: ?? Parameter is used by the LAB POC component to determine if the provider set in the visit context should be used as the ordering provider of the POC test.

27. Lab POC parameter ---- Setting BEHOLR SET DEFAULT PROVIDER for System: DEMO-HO.BEM.IHS.GOV ---- Set default provider: YES// When this setting is used, the Ordering Provider defaults to the visit context provider or “doc in the box”

28. Lab POC parameter ---- Setting BEHOLR SET DEFAULT PROVIDER for System: DEMO-HO.BEM.IHS.GOV ---- Set default provider: NO// When this setting is used, the Ordering Provider defaults blank and the user must select the appropriate provider

29. New reminder dialog prompts • The following measurements may now be used to create reminder dialog prompts. • Use only for resolution type “done at encounter.”

30. Quick Notes • Provides shortcut for users from a button that can be placed on the toolbar • Clicking quick note opens note and template (or reminder dialog template) based on predefined settings • Can have several different quick notes that create the same note title but each quick note launches different template or reminder dialog template • Can also be configured to create a visit. This is appropriate for the following type visits: • Chart review • Telephone calls • Telephone triage • Non-ambulatory case management

31. Quick notes set up Assign CAC access to create/modify quick notes CIAOQN QNOTES MODIFY - To assign access to the modify function. Keep in mind that this allows the user to modify both personal and public quick notes. • Consider restricting modify access to CAC and/or IT. • You will need to provide temporary modify access for users to set up their personal quick notes. • Recommend CAC providing assistance with general users in setting up any personal quick notes. • After the user has created their personal quick notes, the CAC can remove access and the user can still use the quick notes. CIAOQN PROMPT COSIGNER - used to prompt user for cosigner. This parameter controls whether or not a user will see the cosigner dialog when TIU reports that a cosigner is required.  If set to NO and the user has a default cosigner, the user will not see the dialog.

32. Quick notes – set up You need to know the following (write it down) • What note titles you want a quick note to open • What template you want to populate the quick note (write down the template/reminder dialog template name – case sensitive) • Do you want this quick note to create a visit and if so what kind • Would be mostly chart review or telephone but could be “on the fly” ambulatory visits for users who see drop in patients like PHN’s or DM educators. • Will this be public or personal • If personal, then the person who will use this needs temporary access to create/modify to make this one

33. Quick notes – add to EHR GUI • Super simple – add like any object. Best suited to toolbar so users can launch from anywhere in chart

34. Creating a quick note Click the quick notes button Then click Create

35. Creating a quick note Name the quick note and select Personal or Public

36. Creating a quick note Type in the note title – it will search with part of the name

37. Creating a quick note Now put in the template or reminder dialog name in. BE SPECIFIC – it searches all templates. Remember the system sees each template “part” of dialogs as individual templates!

38. Creating a quick note For a note written by a user during an ambulatory visit, you will have a visit created already and the user will be logged in. Selecting “Use Visit Dialog” and “Use current user for visit provider” will allow the user to quickly launch the note from within the visit. Click SAVE

39. Creating a quick note For common on the fly type documentation such as phone triage, you can force the creation of the visit when the note is launched. Visit Category of Telephonic Visit Location of Phone-Redlake Clicking User current user for visit provider picks up the logged in user as provider, this would be most common Set visit context – this is important because if you need to add any other visit data or orders the visit context will be set.

40. Using quick note Click Quick Notes button Then select the Quick Note and double click

41. Using quick notes For this one, it creates a visit, starts a note and opens the template:

42. Editing quick notes Launch quick notes and click on Quick Notes Click Remove to delete Click Rename to change name Click Properties to bring up the configuration dialog again

43. User launches from button that may be placed on toolbar

44. Quick Notes launches note AND TIU template (creates text note) OR Reminder Dialog template (enters RPMS data and creates text note) Can be configured to auto-populate clinic, hospital location and provider

45. Fixes • Clear now fully clears EHR screen • Outside meds are no longer duplicated on Cover Sheet • APSP 1009 fixed the problem with auto-finishing renewed meds • Inpatient panel now restored (was dropping off when patients were discharged too early) • Copy to new order default to the pick up location in original order • Message field, if configured in the drug file, now appears on med order dialog on new, change, renew, copy dialogs • Patient ed topics can now be stored more than once per visit. • The bug forcing the chart copy parameter to be set to prompt post patch 6 has been corrected • CPT modifiers are now returned when EDIT V CPT. This was only noted on sites with CSV installed and has been corrected. • Edema (measurement) now allows entry of Zero • Entering DBP>SBP no longer allowed • Suicide reporting form updated to most recent Behavioral Health version *** See patch notes for full list ***

46. Fixes – proper storage of provider narrative from Pharm Ed and Reminder Dialogs • Provider Narrative text was storing as text instead of a pointer to the Provider Narrative file in the V POV File. • This has been corrected • A post install utility will run to cleanup incorrect values

47. Fixes - notifications • EHR Patch 6 changed the way notifications were displayed. This was code from the VA software. • Only notifications for patients registered in the logged in division appeared. • Display of notifications was restored to pre EHRp6 functionality • Although this was "working as designed" in EHRp6, with feedback from the field the EHR team decided to restore the display so that all patients, even those patients not registered in the current logged in division, would be displayed for the user. • Although a user may need to log into a different division to resolve the notification, the user will always be able to see all notifications intended for him or her.

48. Known issues/Planned enhancements BEHOPTCX REQUIRES HRN parameter is only honored when selecting patient from the Patient context box (Patient Identification Header component). Problem Users can enter the record from the Notifications tab if they receive a notification on that patient. Providers can process notification per usual; however, acting on information from the notification, the provider could inadvertently create a visit on a patient in a division in which the patient is not registered. Fix A future patch (EHRp9 or 10) will add a check of this parameter when entering a chart from notifications and honor that parameter.

49. Known issues/Planned enhancements Vital Entry Dialog New date/Time button now launches a dialog with 3 radio buttons: Current Visit, Historical Visit and Now. The default is NOW. This might not be the preferred default for all users. Scheduled Enhancement EHR patch 9 (tentative) will deliver the ability to set the default as “Now” or “Visit Date/Time” as a parameter and will be available on the Vital Configuration menu in the RPMS EHR Configuration Master Menu.

50. Known issues/Planned enhancements Entering Historical Measurements through Reminder Dialogs is not available yet. Issue Now that historical measurement documentation is available in the EHR Vital Entry, sites would like the same functionality in Reminder Dialogs. This has never been available and currently stores “now” if you try to set up a measurement dialog element using resolution type “done elsewhere.” Scheduled Enhancement EHR p8 will deliver the ability to enter historical measurements through Reminder Dialogs.