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.

Getting Ready for 5-8

If you still have a pin to log into Nextgen it will be going away on Monday. If you can fix it before then it may save you a headache. Annette has given all pin users a dummy password of "nextgen".
You can sign in using your user name & this password.

Once you are in you should go to EPM & under tasks go to change password. Once there you can pick a new password. Next time you login you will use this new password.

Another thing I learned today:
   
If it takes forever for your patient appointments & tasks to load it is probably due to your email being attached to this box. If you drop your email off of this square everything will load faster.

If you right click into the upper left hand corner of the workflow box you can reconfigure the box to only have your schedule & your tasks. The email is still available in the left lower corner , as always.

Hope this is helpful. See you Thursday at the Provider meeting.

New Test Result Document

Annette has created for us a test result form that is located in the document folder.

If you click on HPA_TestResults you will see this form:

You are able to put an X on the test ordered & make comments. You can then print it out & put in the box to be mailed out. It will show up on the right navigation bar that you printed it. I also record in Provider Test Action(PTA) that I have seen the result & sent a letter.

We could set up a protocol that we send these to a staff member to call the normal results to the family, or we can ask staff to do this right from PTA if you prefer. Please let me know if you would like me to set up a protocol for staff to call normal test results.

Another Way to Find Last WCC

I have found another way to see the last WCC. If you look at your inbox you will see a little cog in the left upper corner. Highlight the name of the patient you wish to search & then click the cog icon.

If you click on the cog you will see a menu. Click on Edit...

This will open the Patient Appointment Box

You can see the last WCC appointment from here, as well as the PCP & all other appointments. The columns can be dragged over so they line up as you like.

How to Find the Last WCC

Dave G. has asked that we all check for the last WCC whenever a patient touches the practice. The supervisors will work with the staff to make sure they are checking. I wanted to make sure I showed all of you how to quickly check.

When I open my computer in the morning I always open both EHR & EPM. Having both open allows me to quickly flip back & forth between both of them. The EPM side shows me who the PCP is & when the last WCC was in a very easy format.

in EPM click on Appointments

You can see last WCC and PCP easily from here

In the EHR, you can also look in the right hand navigation bar under Categories, you will see a Category of WCC if the patient was seen since our upgrade in September 2013.

Click WCC to open the last visit

Annette has also added lots of links on other templates like the Provider Test Action and Telephone Template.

Click on View Scheduled Visits opens a box that shows last WCC

Annette has also added a box on to the top of the SOAP Note with last WCC noted. Unfortunately because of how our billing office processes each WCC this box is not always accurate. We will work on this process once we have upgraded.

Click to enlarge

Help Us Improve Quick Visit WCC

Quick Visit WCC

Scott Cochrane & Patti have very kindly agreed to look at all the Quick Visit WCCs and update them as needed. Patti, Scott Lemme & I built them a few months ago for all of us to try. We have been using them now for a bit & I am sure we have all found things that we think can be improved.

If you have suggestion on any of the WCC visits, please let Patti or Scott know. They will collect all of your thoughts and then get the updates cleared by the group. Once we have decided, as a group, how we want each visit to look, they will be rebuilt.

Please help with this important project.

Today Peggy suggested that the Teen PE defaults to "no scoliosis" on the exam. I have passed this great suggestion on to Scott & Patti. This is exactly what we need. Thank you Peggy!

Patient Plan

Dave Norton gave Annette a lot of good feedback on the Patient Plan.  Based on that she was able to make a lot of modifications. Now it looks more streamlined! There are some things we can not fix because of Meaningful Use. Unfortunately because instructions were added to the My Plan orders section there is no way to not have them repeat under orders & then instructions. Nextgen strongly advised against deleting one of these ( orders or instructions) from the Patient Plan. I will continue to work on this.

Pictures on Demographic Bar!

Adair, Annette & myself are working on adding pictures of our patients to the demographic bar. This is wonderful, not just because it is cute, but because it meets HIPPA standards of insuring that patients are who they say they are (not really an issue for us) and also because it decreases medical ordering errors. When you can see the patients picture and the patient at the same time, you know you are in the correct chart.

There are 2 ways to enter a picture. For older kids with picture IDs, the ID can be scanned at the front desk. For younger kids, we are taking their picture with a digital camera & uploading them into the chart the next day. Both methods are easy.

We are asking parents, or older patients, to give verbal consent. I document this by clicking on a saved phrase saying I obtained verbal consent. The consent is then added to the patient plan for that visit. We plan to update photos at yearly PEs. We are thinking of doing babies (under 1 year of age) with their moms.

Here is how it looks.

We are planning to start rolling this out to other providers soon. Stay tuned.

HPA Lab Results Form

Today Annette developed an HPA lab result form so you can send your patients their results if you wish to. This form can be found in Documents, in the pediatric folder, labeled as HPA -Lab results.

This form pulls the patient name, DOB, address.
It also adds your name to the end.
You can type on this, or you can just print it out and write on it.
Once complete you can put it in the outbox to be mailed.

My Plans - En Español

Per your requests, I have modified two My Plans so now you can print out instructions in Spanish.
If you look at the Otitis Media or the Viral Syndrome Plan you will see that the instructions alternate between an English phrase with the equivalent Spanish phrase just under it.

Please note that instead of 11 English instructions, we now have 5 instructions - each in English & Spanish. These instructions also print on the Encounter Note, therefore if you are giving instructions in Spanish you should also include the English translation so the note is complete.

click on to enlarge

If you like this concept, please let me know and we can translate more plans.

Schedule Follow up appointments in My Plan

The Check Out staff have mentioned to me that it is really helpful if we put when we want patients to follow up in the plan so they can see it. This is very easily done through My Plan.

In the lower right hand corner of My Plan (Follow-up visit/referral Section)
you will find a blue arrow next to : He will be scheduled for follow up today.

If you click on that it opens a schedule follow up box

Check follow up checkbox.
Pick your provider, reason for follow up and timeframe.
Click OK
It will take you back to My Plan. Place Order, save and close.
Then this information will display in Check Out and the staff will be able to schedule the appointment.

This is how it will display in Check Out

Medication Module SIG Builder Tool 5.8

The 5.8 upgrade brings some enhancements for building the SIGs for medications.

In the picture below you can see that there are "spinners" or arrows to change the number of tablets, as well as times of day given.

Click to enlarge

If you want to do more complete editing, click on the SIG and this builder will appear.

There are drop down menus. You can also Show or Hide different attributes (route/duration/interval)

Click to enlarge

 

Update on 5-8, 8-3 post ICD-10 Apocalypse

The Senate in it's great wisdom has given us another year to get to ICD-10. I am sure that date is as firm as the last one.

We will still go ahead with the planned upgrade to get to MU2. However, we have decided to change our timeline to something that feels more manageable, since we do not have the 10/1/14 date hanging over us.

The new timeline is Go-Live 5-8 May 19th. The Go-Live date for 8-3 has been pushed back from June 9th to August 19th.

We have meetings set up weekly with Kathy or other trainers for myself, the billing staff &/or a group of Staff trainers (Elsie, Adair, Michelle Sleeper & Brooke). We will keep you posted as we move forward.

ICD-10 Fiasco & Metric System Flashback

Please enjoy this YouTube video - Deirdre Flint The Metric System

Do you see any similarities between the metric conversion and IDC-10?

ICD-10 Delayed. Unbelievable!!!!

An hour or so ago the Senate decided to delay ICD-10 by a year. They are expecting the President will sign it into law. I am not sure if this is good or bad but it does give us some breathing room.

Nextgen Odds & Ends

Upgrade
Our Go Live date for 5.8 is 5/19/14. Our Go Live Date for KBM 8.3 is 6/9/14. The usual time between upgrade is 12 weeks. We are pushing Nextgen to do the two upgrades closer together to shorten the pain & get us up & running before the summer. This will give us the summer to start dual coding with ICD-10. Remember the Go Live Date for ICD-10 is 10/1/14!!! This will give us almost 4 months on the new system.

Annette & I are having weekly phone conversations with our project manager, Judy, to help us move forward with the upgrades. Please let us know if you have any questions you wish us to ask.

Vital Sign Machines
Michele will place the order this week for the 2 other vital sign machines. These were OK'ed by exec committee ~ 1 year ago. Sandie Martin reported to us today that there is universal agreement among the staff at OMN that the vital signs machine saves them significant time. The biggest issue with the vital signs machine, at this time, is the wait to get to it.

NextPen
Exec committee approved Adair & myself for the trial of Nextpen. This is a pen that parents can use to fill out forms that we generate. The information obtained by the pen can be downloaded into the computer with a simple docking station. The Nextpen can capture family history & social history. It can capture anything that requires structured data.We are going to trial this to see if it can lessen the staff work flow. I will keep you posted.

Patient Portal
We have been given the go ahead to order Patient Portal. We will start this process but expect the upgrades to happen first.

Patient Photos
We have asked Nextgen to send us the information needed to start taking pictures of our patients at their yearly physicals to add to the patient demographic bar. It turns out that, not only is it cute but, it cuts down on computer generated order errors when the provider can see the picture of the patient they are placing orders. The pictures will be taken at the front desk.

Labs: Best Practice for Ordering

With the impending closure of our lab, we have started to look at best practices for ordering labs and resulting them. This is a work in progress. Sandy Martin will be meeting with Laura and Pam to figure out best work flows.

I have looked at a number of different options for ordering labs. I believe the best option is to order from the lab section of My Plan.

The reason for this is that if that if you order from here, it shows up in Check Out. The Check Out staff can then make sure it is done in house or can task it to a Lab Group (we are setting up) saying that the patient will have it drawn at an outside lab. This Lab Group will then follow up to make sure the labs are drawn. If the labs are not drawn within two weeks they will task the provider.

The second reason to order the labs this way is because it will show up in Provider Test Action. PTA will allow you to result the labs and close the loop. If you order the labs from the Test Tube Labs site, the labs neither show up at Check Out or Provider Test Action (PTA).

Here are some screen shots

My Plan / Labs can be order from the top Lab tab
or from Labs under My Plan Lab Orders

If you click on the Lab tab at the top of My Plan, the lab template will open
Note: if lab is not displayed, click on "blue menu links"
i.e. chemistry, hematology, etc. to display more labs

Ordered labs show up in the Lab Order grid at the bottom of the page (status)

Labs ordered this way show up in Check Out
and a requisition can be printed from this area

These labs also show up in Provider Test Action (PTA) under Lab Orders
and can be resulted from here

Click on highlighted Lab Order in PTA
to open the result box
Click on "Received:", " Completed:" and "Interpretation"
in right upper corner to result the lab.
Save and Close

Resulted Lab shows up in PTA

Highlight the Lab of interest and click Add to Note below the grid
to drop it into Action Detail Notes.
From here you can Task it to someone to complete or
you can add a "My Phrase" saying that you contacted the family/sent letter/etc.

NextGen Access from Home!

Remote Desktop Connection

Lesley is now connected!

You can be connected too. We hope.

Jane is working on getting a group of people together to install Remote Desktop & VPN for home access. If you are interested contact Jane or let me know. We will meet you at home whenever it works for you.

Mobile Access 

a lite version of NextGen

If you would like to access NextGen on the go (while you round), please contact me. We have purchased 5 licenses, we can purchase more if there is interest.

 

New Patient ID Bar in 5-8, 8-3

With our next upgrade 5.8/8.3 the demographic bar will contain a lot more information!

In addition to the standard Name, DOB, Gender, it will contain address, contact info, Insurance info, allergies, problems, medications, PCP and rendering provider.

If there are allergies, problems or meds,  a number will display indicating that there is information in that category. You will be able to hover over each of these to see more detail. You will also be able to quickly access different templates & modules with a single click on the demographic bar.

Here is how it will look:

Click to Enlarge