Problem List 8-3: There is a new way to manage problems in 8-3

The Problem List gives you the ability to mark problems as chronic, as secondary conditions or as problems you wish to track (such as otitis or strep).

You can first access the Problem List in the Summary section (remember the little house)

You can see that the little house is selected & using the cycle command I have opened the Problem List.

There are a number of columns for each problem & you can drag them across the top grey heading bar to set them the way you prefer

For example, here I have made the Notes column larger & hidden the other columns. They are still available if you scroll to the right.

You can see 2 small boxes above the grey heading bar on the left. If you click either of these the Problem List will only show you problems that you have marked as chronic or as tracked.

Below the Problem List you can see that you can Add or Edit information. Clicking on the Add button takes you to the Problem Template.

From the problem template you can add new problems, resolve old problems & make notes on current active problems. You can also send problems to the billing ICD9 side.

Here you can see that I highlighted a problem then I pressed the View/Add Notes button. This opens a dialogue box and I can add a note for today. It keeps the previous notes so you can review past comments.

More to come...

KBM 8-3 Quick Look

Hey guys. Here is a quick look at the new "pill tab" for the new KBM

You can see it is a bit cleaner looking. The Summary page is now a cute little house on the far left.

If you look above the grid on the right you will see something called Panel Control.

Toggle allows you to open all the categories & scroll through them like we do currently. Or you could close all the categories at once.

Cycle allows you to open one category at a time & cycle through each of them as you review the chart. Only one section will open at a time. You can move each category so it is in the order you wish to view the chart. Once you arrange it the way you like, it should be that way for all future patient charts.

EHR Odds & Ends

The blog lives!! It has been on a temporary sabbatical but is back in time to prepare you for our next upgrade. You all remember our Go-Live date is 8/18/14, a mere month away.

Next week I plan to have lunch in the conference room each day & ask you to join, when you can, for your first look at the new KBM. I will try to do this in SHO on wednesday if Annette can set me up.

Annette will be setting up some evenings over the next month for Kathy to show you the upgrade in more detail. She will do this by Webinar, but will be with us in person for the upgrade.

Other EHR news includes:

I have been working with Kathy Tremble on using Provider Test Action to update providers on their complex patients. She has started to do this for me & can do it for you too if you are interested. She is learning how to update chronic conditions & the medication list. She is trying to add the names of the subspecialists to the chronic conditions so it shows up easily in the summary screen. In the upgrade there is a Case Management Template that she can use for these complex patients. She will plan to update the patient's record before their appointment. You will then be able to cut & paste any information you wish to throw into your note.

I am training Mary O. to put the birth history into the EHR before the babies arrive for their 4 day check. So far this has been a hit with the staff & Mary enjoys it. Please try to make your newborn rounding sheets as complete as possible because it really shortens the amount of time she has to spend trying to recover the info.

I have shown Sandie Martin how to do Tasks in the EHR & how to use the Provider Test Action. Betsy's committee is still working out the details on how we will address normal & abnormal labs as a group, but once that is finalized I will help train whichever staff will be involved.

Patti & Scott have been working on improving the saved " Quick Visit" physicals so it reflects more of what the majority of providers want. I believe there is a document, with the new suggestions for how the visits should look, being drawn up & should go to the partners soon. I hope I will be able to get these visits into the computer in time for the upgrade.

Adair & myself have started to work on Nextpen. We have a training coming up. I think this will save the staff a lot of time in collecting social Hx, Family Hx, etc from the patients. We will see.

Some of us have started to look at Portal. We have the Portal but just have to turn it on. We will not do this til we have procedures in place to address anything that comes in over the portal. We think we will let families use the Portal to access billing first. We would like to get to sending lab results thru the Portal soon after that. Annette will set up a training to start this process.

There are now 2 front desk staff taking pictures of patients when they arrive for WCC. This seems to be going smoothly. We need to set up something in SHO & I will work with Annette on moving this forward once she is back from vacation.

Check out is still a work in progress. The staff are doing well with this but many patients are not stopping at check out & a number of providers are not doing plans in time for them to get anything at check out. I hope we can work on this. Patient plans may be one of the few really meaningful things in Meaningful Use. I have started to give my patients the purple chart with the billing slip & ask them to take it to check out. Most of them have stopped because they think they are carrying something of importance to the check out staff. Once there, I have asked the check out staff to give them the plan. I will let you know how this works.

Please remember for meaningful use stage 2 money we must be giving patient plans to a certain % of our patients. If you have fallen off the Check Out wagon, I hope you will consider jumping back on.

More to come...

EHR Manners. Improving the Provider-Patient Interaction

Here is a Medscape article addressing a common concern with EHRs, inferior patient interaction.
The article has a few tips on trying to incorporate the EHR into the visit in a way that includes the patient. I often use the EHR to show families the growth curves of their children. This allows me to turn the computer around & let patients/families experience the EHR.


http://www.medscape.com/viewarticle/809237_print

How to Set Up a Default RX Printer in the Medication Module

You can now save the Rx (blue paper) printer in the medication module. You no longer have to press preview & then go to the printer selection up in the upper left hand corner to get the Rx printer.

To set the Rx printer as your favorite, start by going to Tools & then Preferences on the upper navigation bar.

From Preferences select Medication Tab

On the Medication Tab you will see a Printing & Faxing drop down menu. Pick the printer you wish to be your default. Since we ERx most of our scripts, this should probably be the blue paper printer at your station. Press Apply then OK.

Now when you choose to print a script, you just need to press the Print button in the Medication Module.

If you wish to use a different Printer than the default printer, you can press the  (...) button next to the Printer path & you will get a drop down menu again to choose from. This will not change your default printer but will just print that one script on a different printer.

Setting this preference up does not change your printer for documents, only for scripts.

Update on Possible Meaningful Use Changes Proposed by CMS

CMS Proposes to Let Docs Use Older EHRs in Incentive Program

Robert Lowes

May 20, 2014
 
In another victory for organized medicine, the Centers for Medicare & Medicaid Services (CMS) proposed today to let physicians in its "meaningful use" incentive program for electronic health record (EHR) systems use Stage 1 technology to satisfy Stage 2 requirements in 2014.

The proposal also would allow some physicians to achieve Stage 2 meaningful use in 2014 using Stage 1 objectives and measures for patient care.

What does this mean? Read full article.

http://www.medscape.com/viewarticle/825469?src=wnl_edit_tpal&uac=137896DK

The upgrade to 5.8 and, later this summer to 8.3, is to make our EHR 2014 compliant. " Organized Medicine" seems to be a day or 2 behind our upgrade schedule!

External Resources for Patient Education

Welcome to 5.8!! Let us all keep our fingers crossed. We hope today will go smoothly.

There are a number of cool things that I want to show you all, but for today I want to share with you new options for Patient Education.

Healthwise is still available & can be saved to the patient visit. The Check Out staff should be able to see it in the right navigation bar & therefore be able to hand it to the patient. Annette & I will make sure we train the staff to look for it. Until that is fully implemented you may want to tell your patients to ask for it at Check Out. Once we go to Portal you can send the Healthwise information to the Portal - more on this later.

We have also added Healthykids as an education source. To find it you must look in the problems module. There are 2 ways to get to this module. One is using the right hand navigation bar and it is in the lower Tic-Tac-Toe boxes under Dx. The other way is to use the new Patient Information Bar at the top of the visit. If you click into the number after the word problems it will open the module.

From here you can see 2 tabs - Problem List & Billing ICD list. If you have given the patient a Dx in the assesment/plan section of the SOAP note, you will see it under the  Billing Tab. If not, you can add a problem ( see the button in the left lower corner) from here to the problem list. Either way, from the Problem list or the Billing List, you can see a tab with a blue circle called Resources :

If you click on the Resources button you get a drop down. Internal Patient Education takes you to Healthwise, from here Heathwise will suggest Patient Education that is close to the Dx you have selected. You can pick from the options presented or search for something else.

You can also pick External Patient ( or Provider) References and it will take you to the Healthykids website where you can find the info you want and right click to print. This information does not save to the encounter but you could say you gave the information in your note if you wanted to.

The same thing exists in the Medication Module, but the External Resource is Epocrates. Once you click into the website you go to "Epocrates on-line" to search. There is Patient Information on medications here if you wish to give more than the monograph. If you are not registered with Epocrates you may have limited use of this site.

Tell me how it works for you.