NEXTGEN USER PERSONALIZATION DEMONSTRATION

1. NEXTGENUSER PERSONALIZATIONDEMONSTRATION This demonstration reviews some options the user has to personalize NextGen to meet personal preferences. Exact details may differ among specialties, especially with regard to the “Advanced Template Set” specialties of Family Medicine, Internal Medicine, and Pediatrics vs the other specialties. This review is directed primarily at the Advanced Templates, though users of the other specialties will often see similar opportunities, since this functionality was actually built into those specialties in older versions of the program. This has been prepared with EHR 5.6.4.15 and KBM 7.9.1-2. Subsequent updates may display cosmetic and functional changes. Slides are updated if the changes are pertinent to the points being illustrated. Use the keyboard or mouse to pause, review, and resume as necessary. There is no audio with this exercise.

2. User Preferences There are several initial preferences you’ll want to set up on the Tools menu.

3. NextGen KBM 7.9 and later provides many opportunities for the user to personalize the appearance and functionality of the program, enhancing efficiency and speeding data entry. First, we’ll look at some of the initial user preferences. What follows are some general recommendations. Some details will differ among specialties, and may depend upon whether the user is a provider, nurse, or front office staff. Click Tools|Preferences.

4. These are the initial settings recommended for most users. Some may prefer to leave Initial Module blank.

5. These are the stock settings, but also click Encounter Display.

6. These are the stock settings, but also click the Remarks checkbox if it is not already selected.

7. Under Display Order, click on the individual items, and use the < and > buttons to move items left and right. The recommended display order is: {Date/Time} {Remarks} {Provider} {Location}.

8. Users who work in only one location should click the location selection icon to pick the location. Those who work in multiple locations should leave this blank, though you may choose to select Default to last selected, especially if you often work in the same location several days in a row.

9. Providers should select themselves as the Provider. Other staff, such as nurses, may leave this blank, though you may choose to select Default to last selected, especially if you often work with the same provider several days in a row.

10. Preferred Templates will vary among specialties and users. Recommendations will be made by the EHR team as you begin to use NextGen.

11. These are recommended initial settings for everyone. Also click DUR.

12. Drug interaction reporting in NextGen is very conservative, to the point of being intrusive. We recommend setting both the 2nd and 3rd tabs at the lowest setting—Level 1. (The 1st tab may remain unset.)

13. These are the recommended settings. However, since Alabama Medicaid does not yet provide online formulary information, some users may find the resulting lack of formulary data for such a large portion of our patients intrusive. If so, clear this checkbox.

14. These are the stock settings. When done, click OK to apply your selections.

15. You can modify the appearance of the toolbar at the top of the program window. Text and Icons allow a few modifications. To select the icons you wish to have on the top toolbar, click Tools|TopToolbar|Customize. (You can also reach this by right-clicking on the toolbar itself.)

16. Use the Add and Remove buttons to move buttons to and from your toolbar. You can rearrange them on your toolbar with the Move Up and Move Down buttons. In this example, note that I’ve placed several buttons that are on the “tic tac toe” board on my toolbar. This is especially convenient now that the History Bar and “tic tac toe” board are not constantly displayed by default.

17. HPI You can define one or more HPI presets for a number of different chief complaints, to use as your standard starting points in various clinical situations.

18. In this example, we’ll open the Diarrhea-HPI popup, and make several selections that we’ll use as our standard diarrhea HPI starting point. Next, click the Save icon.

19. Type a name for your preset. If it is specific to age or gender, include that in the name. Leave the other selections as they are, and click Save and Close.

20. When you wish to recall this preset in the future, click the Open icon, and select your preset.

21. Some tips on saving HPI presets • Once you have saved a preset, you cannot modify it, so place some thought into your selections. You may wish to save these at the end of a clinic session rather than in the midst of seeing patients, or at some other time on a sample patient. • You can, however, save variations, e.g. Diarrhea01, Diarrhea02. • Obviously, there are a lot of chief complaints, and it could take some time to develop your ideal starting point for all of them. It would be reasonable to forgo defining a lot of HPI presets at first. As you use the program, you’ll discover a handful of situations where you document the same thing over and over. Those are good candidates for you to develop a standard HPI.

22. Review of Systems You can define one or more Review of Systems presets to use as your standard starting points in various clinical situations.

23. In this example, we’ll open a Review of Systems popup, and make several selections that we’ll use as our standard negative Review of Systems. Next, click the Save icon.

24. Type a name for your preset. If it is specific to age or gender, include that in the name. Leave the other selections as they are, and click Save and Close.

25. When you wish to recall this preset in the future, click the Open icon, and select your preset. Note the difference between having your own default normal ROS compared to just choosing “All negative,” “All others negative,” “Globally normal,” etc: you only include items you normally mention, rather than a long laundry list of items that may not be pertinent to the visit.

26. Some tips on saving ROS presets • Once you have saved a preset, you cannot modify it, so place some thought into your selections. You may wish to save these at the end of a clinic session rather than in the midst of seeing patients, or at some other time on a sample patient. • You can, however, save variations, e.g. StdROS1, StdROS2. • Recognize that symptoms you document in the HPI also populate the Review of Systems. If you complete the HPI, then apply your default ROS, you may reverse positive symptoms you have documented. Though it is an atypical clinical work order, you may wish to begin the encounter by applying your default ROS, then documenting the HPI. That way, positive symptoms you include in the HPI will be correctly posted and preserved in the ROS.

27. Physical Exam You can define several Physical Exam presets to use as your standard starting points in various clinical situations.

28. For the specialties that use the Advanced Template Set, you can make use of general exam presets through the Physical Exam link.

29. On the GYN Exam/Proc template, the Quick Exam link provides you the opportunity to document a general, multisystem exam that allows you to save presets. (Unfortunately, the Prenatal templates do not currently afford you the opportunity to use this general exam preset, though you can save presets for individual systems as illustrated below.)

30. In this example, we’ll open a Physical Exam popup, and make several selections that we’ll use as a standard negative brief exam. Next, click the Save icon.

31. Type a name for your preset; you may wish to incorporate your name/initials into the preset to make it easier to identify. If it is specific to age or gender, include that in the name as well. Leave the other selections as they are, and click Save and Close.

32. When you wish to recall this preset in the future, click the Open icon, and select your preset.

33. The headings of each section are also links to the detailed exam for that system. For this example, click Neurological.

34. As on the General Exam popup, you can save custom presets of detailed system exams.

35. Users sometimes ask about creating a blank template, so they can clear all boxes at one and start over again. You can’t do that, but there is no need to. You can always Right-Click anywhere on the template and choose Clear to accomplish this.

36. Some tips on saving Physical Exam presets • Once you have saved a preset, you cannot modify it, so place some thought into your selections. You may wish to save these at the end of a clinic session rather than in the midst of seeing patients. Even better would be to practice documenting exams in the TEST environment, generate the visit note, and see how it looks. When you’re satisfied with it, print your exam settings, so you can input them in the PROD environment. • In addition to saving default normal exams, you may wish to save typical abnormal exams appropriate for various clinical presentations. • Note that any further findings you document by clicking on the system details links are not preserved in your General Exam preset; only the things you see on the screen you’re saving are recalled.

37. Procedures You can define several Procedure presets to use as your standard starting points in various clinical situations.

38. Most procedure templates also allow the saving of presets. In this example, we’ve opened a Joint Injection/Aspiration template, and made several selections that we’ll use as a standard shoulder injection. Next, click the Save icon.

39. Type a name, then click Save and Close.

40. Some tips on saving Procedure presets • Once you have saved a preset, you cannot modify it, so place some thought into your selections. You may wish to save these at the end of a clinic session rather than in the midst of seeing patients, or at some other time on a sample patient. • Given that some of the procedure templates are a bit tedious to work with, carefully setting up your most commonly used procedure presets can save you time and frustration. • Note that text in the Comments box is not consistently preserved as part of the preset; you’ll have to experiment. But you can use My Phrases to add text you often repeat.

41. My Plan You can define several Plan presets to use as your standard starting points in various clinical situations.

42. In the My Plan template, NextGen provides several Quick Assessment sets of orders for common problems. These are often very useful, but if the patient’s problem is not listed, or you want to modify the plan, you may save an order set of your own. In this example, the patient has been diagnosed with migraines, but there is no Quick Assessment set for this diagnosis.

43. Let’s create an order set for migraines. First, say we often want to check a TSH on migraine patients. Click the next dropdown arrow under Lab Orders, click anywhere in the resulting popup, and type TSH.

44. When TSH appears, double-click on it.

45. In a similar fashion, we’ll add some diagnostic procedures, such as CT/MRI scans.

46. You can also remove items you don’t want. Click Clear. We don’t really want any of these injections listed, so we’ll choose to clear all.

47. As we did above, we’ll add a couple entries, choosing sumatriptan and ketorolac injections.

48. Lab orders (and to a lesser extent Diagnostics) are the two headings we’ll make the most use of.) Currently, the remaining sections aren’t really set up for use, since we have other ways in our work flow to order these items that are actually quicker and simpler. (As updates occur and we move to more specialties, we’ll continue to reevaluate use of these sections.)

49. You can also add a few brief instructions to your order set. In general, Plan Details, with the ability to save My Phrases, provides better functionality, and this is what we recommend. In addition, the setup of instructions here can be a bit confusing. However, for those users who wish to use this feature, a brief explanation follows.

50. We want to start by populating “My Instructions,” a list of instructions you frequently use. In the first Instructions line, type Keep headache diary. Click Add, and select 1 in the ensuing popup. Note that, while this is not made particularly clear, you are actually adding this to your list of “My Instructions.”