Transition to the Electronic Medical Record (EMR) eKiDs POWERCHART EMR OVERVIEW

1. Transition to the Electronic Medical Record (EMR)eKiDs POWERCHART EMR OVERVIEW If you need assistance, please call the Direct Support Line at 668-5470 or the Information Services Help Desk at 668-7075

2. Presented by Information Services Training Department ofChildren’s Hospital of The King’s Daughters Revised April 2012_CET

3. Transition to theElectronic Medical Record Contents • Introduction to the EMR • PowerChart Banner Bar • PowerChart Menu Items • iView / I&O (click to go directly to new content)

4. Electronic Medical Record Introduction • The Electronic Medical Record (EMR) is being introduced in phases for inpatient and ambulatory areas. • The ability to enter and edit patient documentation relative to care administered is limited at this time to providers working in an area that has adopted the EMR. • All staff members with appropriate PowerChart credentials can view electronic documentation. • In this presentation features that are italicized and green are only available to providers in areas live using the EMR.

5. This presentation gives clinical staff an overview of where to find patient information in the EMR. The EMR currently includes documentation from ambulatory sites and patients cared for on nursing units where the EMR has been adopted, replacing the paper flowsheet and medication administration record (MAR). The first inpatient unit adoption was TCU in June, 2011. The second inpatient site, NICU / stepdown, is scheduled to go-live in May, 2012. As of March, 2012 eight CMG ambulatory sites have gone live with EMR. Paper Chart vs. EMR

6. Paper Chart vs. EMR (continued) Nursing documentation provides an account of the judgment and critical thinking used in the nursing process (i.e., assessment, diagnosis, planning, intervention and evaluation). Accurate, timely documentation reflects care provided; facilitates communication between nurses and other healthcare providers; and promotes enhanced care for patients.With the transition from the paper chart to the electronic medical record, some information previously found in the paper chart will now be available immediately in PowerChart.

7. PowerChart Banner Bar • The Banner Bar provides specific patient demographic information such as: • -Name -Inpatient Encounter Admission Date • -Age -Outpatient Encounter Date of Service • -DOB -Dosing Weight • -Sex -Allergies • -Location • -EMR (Medical Record Number) • -Financial Number • -Privacy Restrictions Some Banner Bar items (Name, Allergies, Location) are hyperlinks. A left mouse-click on a hyperlink opens a new window with additional information. Other items (Location) display additional information when the user “hovers” the mouse pointer over the item.

8. PowerChart Banner Bar Features Forward and Back browser-style buttons permit back-and-forth movement within previously viewed sections of the same patient chart without reloading or refreshing. A Drop-down arrow allows quick access to menu items previously selected within the same patient chart. Click the Home icon to return to the first menu item. to click the Refreshicon to update information.

9. PowerChart Menu Important Tip: Use the pushpin to fix the Menu in position or hide the Menu when not in use. View detailed information in the patient chart such as orders, results and documentation by clicking the Menu Item. (These are similar to the sections of a paper chart.) The Menu Items may appear in a different order depending on your role.

10. Orders Menu Item The Orders menu item allows providers to view a patient’s orders. The View window is used to filter the display. Users may choose to view Active orders, Inactive orders, or All Orders. Inpatient orders are currently NOT entered by providers. The Orders tab will display some of the items that were previously recorded on the paper Kardex.

11. Inpatient Summary Menu Item The Inpatient Summary displays an overview of clinical data as staff contribute documented results to the patient’s EMR. The types of results that populate this page include: - Problems –entered by providers across all patient encounters where the EMR is live - Height and Weight Measurements – last 10 days - Intake and Output – last 10 days - Vital Signs – last 10 days - Diagnostic Results –radiology, laboratory & pathology (last 10 days) The Ambulatory Summary displays a similar overview with information appropriate for an outpatient visit.

12. Inpatient Summary - Collapsed View Information entered in different areas of the patient’s chart is visible from a single view within the Inpatient Summary. Click the “+” to expand an individual section. The Collapse All view displays only the section headings. Click a section heading to “jump” to certain areas of the patient’s chart. Click Expand All option to view a summary of results in the chart.

13. Inpatient Summary - ExpandedView The Expanded View of the Inpatient Summary displays information such as problems documented on the Problems List, Measurements and Weights, Allergies, Isolation Precautions, Documents, and Medications. Hover the mouse pointer over a result to view additional details. Some information will only be available for the last 10 daysfrom the current date as designated in the section header.

14. Patient Information Menu Item • The Patient Information menu item contains multiple TABS: • Patient Demographics • Visit List • Allergies • PPR Summary (Patient – Provider Relationship) • Other tabs may be displayed, depending upon your position

15. Patient Information - Demographics Tab Use the Patient Demographics tab the same way that you would a paper chart's face sheet. The tab displays pre-defined, general information regarding the selected patient. The information typically includes data such as the name or alias of the patient along with address, phone number, and emergency contacts.

16. Patient Information – Visit List Tab The patient visit information is vital to ensure you are looking at the correct visit for selected patient. The top panel displays a list of the patient's visits, including the admission and discharge date, facility, location, medical service, visit type and reason. The bottom panel contains information specific to the highlighted visit selected in the upper panel. Some common types of information include the financial number, the admission date and time, and the reason for the visit.

17. Patient Information –Allergies Tab The Allergies Tab allows a spreadsheet view of any allergic reactions or intolerances that a patient may have. The ability to enter or edit allergies is limited to staff documenting in the EMR. Right click in the white section of the grid to access additional options.

18. Patient Information – PPR Summary Tab Use the Patient Provider Relationship Summary tab (PPR) to display a patient’s relationship with healthcare providers known to CHKDHS. Filter the lists to display only your relationships or current active relationships. The default view displays all relationships. Inactivate your relationship by right-clicking and choosing “inactivate” from the menu.

19. Recent Results Menu Item Date and Time Range • The Recent Results menu item provides a flowsheet view of Laboratory and Radiology result information. Results 48 hours in the past and tests ordered for the next 24 hours are displayed. • Recent Results may be viewed as a Table,Group, or List. • Use the drop arrows to select other flowsheets or levels to view. • Right Click the blue bar to edit the view • by selecting “Change Search Criteria” or • “Set to Today”.

20. Lab Menu Item • Select the Lab menu item to view only clinical laboratory results. • By using the drop arrow you may view other Flowsheets from • within the Lab menu item. • Lab may be viewed as a Table, Group, or List. • Right click the blue bar to change the search criteria.

21. Radiology Menu Item • Select the Radiology menu item to view Radiology results. • View other Flowsheets by clicking the down arrow. • Results may be viewed as a: • Table – standard flowsheet viewing method • Group – view trends in data for specific date/time • List – view all results charted for a specific time

22. Patient Care Results Menu Item Patient Care Results menu item allows you to view notes that were entered from a form by a nurse or respiratory therapist, as well as other results entered during a patient’s assessment and care throughout a shift. This is where you will find much of the information that used to be documented on the nursing flowsheet. If a CHKD Nursing or Respiratory charting form is completed, those notes can be accessed for 48 hours by clicking on the Patient Care Results menu item. After 48 hours, these notes can be viewed from the Form Browser menu item.

23. Patient Care Results Menu Item (continued) Select the Patient Care Results menu item to view results associated with the patient’s visit, such as Intake and Output, Measurements, and Vital Signs. From the Navigator on the left select a category to display the applicable results. Right click the blue bar to change the search criteria.

24. Summary Documents Menu Item The Summary Documents menu item allows you to view documents such as operative reports , discharge summaries, or H&P’s. Click to open the folders in the left column to locate the form you want to view. Use the radio buttons at the bottom of the left column to change the way documents are organized for selection (see next slide). Right click on the blue bar to access the Clinical Notes – Document Lookup window to filter documents by Date Range, Document Count, or Admission - Current.

25. All Documents Menu Item The All Documents menu item displays all documents submitted into the system. Click to open the folders in the left top column to locate the desired document. Use Radio Buttons to display By (document) type, By status, By date, Performed by, or By encounter.

26. Form Browser Menu Item Use Form Browser to see patient information entered through a form. Right click on the blue bar to change your search criteria.

27. MAR Summary Menu Item The MAR Summary menu item displays the patient's medications in a view only mode. This menu item will be utilized by providers to view medication administration information. Hovering the mouse pointer over a medication displays additional information regarding that medication. To Change Properties or Change Defaults right-click the blue date range bar.

28. Overview Menu Item The Overview menu item provides an interim view of charted data for the selected patient. It is designed to present a summarized view of patient data that has been recorded since the last time the Date/Time Stamp button was clicked. To clear the data from this view, click the Date/Time Stamp button.

29. Advanced Growth Chart Menu Item The Advanced Growth Chart menu item (for selected positions) provides a graphic view of the patient’s growth. The appropriate growth chart is selected from the navigator. This information can be viewed and printed. (Growth charts do not print correctly on secure printers used for prescriptions.)

30. Immunizations Menu Item The Immunizations menu item allows you to view past immunizations documented by CHKD sites that are live with the EMR. Right-click the blue date range bar to Change Search Criteria you want to view.

31. Immunization Schedule Menu Item Ambulatory providers use the Immunization Schedule menu item to view administered immunizations within the context of the recommended immunization schedule.

32. Appointments Menu Item Selecting the Appointments menu item displays information in a split screen. Scheduled Future Appointments may be viewed in the upper screen. Past Appointments during the previous 365 days are displayed in the bottom screen. Appointments may be sorted by left-clicking any of the column headings listed beneath Future Appointments or Past Appointments.

33. iView/I&O Menu Item Result information such as vital signs, intake and output, admission assessment data and some nursing procedures is visible for providers. This tab also displays results captured by bedside physiologic monitors that record heart rate, blood pressure, respiratory rate and oxygen saturation.

34. iView/I&O Menu Item Overview • This new menu item is a view only option available to providers. It is an interactive display that enables review of a wide variety of patient data in a spreadsheet format similar to an Excel worksheet. • Along the top of the grid are date and time columns. The time columns vary depending on the user’s selected preference, such as Interval or Actual time. • Results are displayed in the individual cells of the grid.

35. iView/I&O Menu Item Overview (Continued) • Selecting the iView/I&O menu item displays information entered by nurses, clinicians and respiratory therapists during a given shift. • This view only access is available only for patients who are cared for on a unit where we are live with the EMR. Patient care information can be viewed across the time continuum for the selected visit. • The iView Bands (“Bands” are explained in subsequent slides) you see depend on the location of the patient. For instance, if the patient is admitted to the NICU, then the iView display will only show NICU Bands.

36. iView/I&O Documentation Workflow

37. iView/I&O Display Bands iView for the provider displays the documented results in a flowsheet format. You can right-click on a result to see more detail. Cells Sections iView is composed of Bands(bolded) and Sections. Each section contains Cells where the data is displayed.

38. iView - Physician View Band The  indicates that the section contains data. Pictured is the physician specific band comprised of sections that display Vital Signs, Measurements, IV Drips, Point of Care Testing and Pulse Oximeter data.

39. iView - Section A section contains related groups of items used for completing the patient’s documentation. In the example displayed, the Vital Signs section displays all the items pulled into the flowsheet for the selected patient. Results for each of the corresponding sections are visible in the cells.

40. iView - Cells Each cell displays the actual result data for the related item, such as temperature, heart rate and blood pressure for the Vital Signs section.

41. iView - Result Details Right-clicking a result within a cell opens the “Result Details” window. On the Result tab you can see the recorded result at the top of the screen as well as the normal high and low values (if applicable) of the selected result item. Clicking on the Action List tab displays information regarding the user who captured and verified the displayed result. The upper portion of the split screen displays the actual result value.

42. iView/I&O Timeframe • The iView/I&O menu item defaults to the “Last 12 hours” on • most of the bands. You can right click on the blue time range • bar to change the displayed results in any section. This action • displays a drop down list to select a result time range. • Select the “Other” option to display the Search Criteria window and select to view results in the following display options: • Clinical Range: enter a specific From /To Date and Time Range • Today’s Results • Last ___Hours: you enter the time period in hours for results to display

43. Filtering iView/I&O Results • You can filter the information displayed by high, low, critical, abnormal, unauth and flagged results. • A result that is listed as “unauth” indicates that the entry is unauthenticated(the entry has not been verified or signed. ) • A nurse or respiratory therapist entering iView data may “flag” a result as a visual cue to draw attention to the result when it is reviewed. There is also a feature to add a comment to the flagged result. Filtered results display in the pane below the filter selection checkboxes located at the top of the screen.

44. Filtering iView/I&O Results (continued) • Using the options at the top of the result window, you can select the filter option you want to see. • In the below example, the display is filtered to show flaggedresults. • When the filtered results are in view, you can hover the mouse over the triangle to view details of the flagged result. Filtered results display in the pane below the filter selection checkboxes located at the top of the screen.

45. iView/I&O Graphs • An option of the iView/I&O menu item is the ability to graph results. You can use Advanced Graphing to create a standard set of graphs that display patient results. The different types of advanced graphs available include: • Intake and Output Totals: graphs display intake and output totals, subtotals, and net balances for 24-hour periods. Subtotals are differentiated by color while a black line across the selected 24-hour period indicates net balance totals. • BMDI Acquired Data (bedside physiologic monitors): graphs display all data points defined for the graph in both verified and unverified statuses. • Standard graphs display verified data points only defined for the graph. The Graphs tutorial is under construction.

46. iView Graphs Example: iView Intake and Output Graph

47. This concludes this presentation of “Transition to the Electronic Medical Record (EMR)” If you need assistance, please call the Direct Support Line at 668-5470 or the Information Service Help Desk at 668-7075