Electronic Medical Records (EMR) Centricity EMR What s New in 9.2

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1 Electronic Medical Records (EMR) Centricity EMR What s New in 9.2

2 CENTRICITY EMR WHAT S NEW IN 9.2 PURPOSE The intent of this document is to inform and instruct HealthTeam staff and providers on the use of new features in Centricity EMR 9.2, as well as changes in the functionality of features previously available in Centricity EMR TABLE OF CONTENTS WHAT S NEW IN CENTRICITY EMR 9.2 GETTING STARTED...1 Logging into Centricity EMR Your Centricity EMR 9.2 Desktop...2 Appointments on your Desktop Summary...2 Care Alerts on your Desktop Summary...2 Your Alerts/Flags Desktop Tab...3 Retrieving Hidden and Removed Care Alerts and Flags...4 The Centricity EMR 9.2 Chart Toolbar Button...4 CENTRICITY EMR 9.2 THE PATIENT CHART...5 No Known Medications...5 Medications Prescribed by a Non-HealthTeam Clinician...5 Care Alerts in the Patient Chart...6 Popups in the Patient Chart...7 The Alerts/Flags Tab...7 Creating a Care Alert or Popup...8 Disabling Popups...9 Restoring Popups...9 The History Tab...10 Growth Charts...11 Growth Chart Tools a Brief Overview...12 CENTRICITY EMR 9.2 UPDATING THE PATIENT RECORD...13 Advanced Directives...13 Adding a New Directive...13 Reviewing Directives...14 Updating Medications...14 No Known Medications...14 Medications Reviewed...15 The New Medication, Change Medication, and Updating Medication Windows...15 Current Problems Display...15 New Criteria Options for Medication Searches...16 Medication Handouts...16 Medication Monographs...17 The Dosing Calculator...18 Using the Dosing Calculator...19 Selecting a Pharmacy...20 Documenting Prescriptions Provided by a non-healthteam Clinician...20 Refilling Prescriptions: an Interaction/Adverse Reaction Cross-check...20 Updating Problems...21 New Options for Problem Searches...21 Drug to Disease Interaction...22 GETTING HELP...23 Centricity EMR 9.2 Help Online...23 EMR Implementation Team...23 HealthTeam Information Technology...23 Michigan State University EMR Rev. Date: 7/2/2010

3 WHAT S NEW IN CENTRICITY EMR 9.2 GETTING STARTED Before you can begin a Centricity EMR 9.2 session, you will need to first log into the HealthTeam network. The User ID and password that you use for logging into the HealthTeam network will vary, depending on your location and the device you are using; however, you will always use your unique Centricity EMR User ID and password to log into Centricity EMR 9.2. If you have difficulty logging into either the HealthTeam network or Centricity, call the Health Information Technology (HIT) Help line at (517) Logging into Centricity EMR With a network connection established, double-click on the Centricity 9.2 icon on your computer Desktop. The Centricity 9.2 icon is similar to that of Centricity EMR a white background, with a blue picture of a woman and child on it text Centricity EMR directly below. 2. The login screen opens, where you will enter your Centricity EMR User ID and password. Your Centricity EMR ID typically consists of the first 6 letters of your last name, followed by the first 2 letters of your first name. 3. Type your password in the Password field. 4. Tab to the Location of Care field, or click directly in that field. The system authenticates your ID and password, then provides the Location options to which you have EMR access privileges. Select the appropriate Location of Care for your current working session. If you work in more than one HealthTeam location, be sure to verify that the correct Location is selected each time you log in. 5. Click OK, or use the [Enter] key of your keyboard. Enter your User ID and Password, then select the appropriate Location of Care. NOTE In Centricity EMR 9.2 you must enter both your User ID and password correctly before you are given Location of Care options. Once your ID and password have been authenticated, the Locations of Care for which you have access rights become available. At that point, be sure to select the Location of Care appropriate for the current work session. Michigan State University EMR Page 1 of 23

4 Your Centricity EMR 9.2 Desktop While your Centricity EMR 9.2 Desktop remains relatively unchanged from earlier versions of Centricity EMR, a few features have been enhanced. Appointments on your Desktop Summary The functionality of Appointments displayed on the Desktop Summary tab has been modified. Now, if you doubleclick directly on an appointment on the Summary tab, you are automatically taken to the chart of the patient scheduled to be seen. To see details of an appointment without leaving your Desktop Summary, click once on an appointment displayed, then click the View Details button. Double-click on an appointment to go directly to that patient s chart. NOTE: This feature works only on your Desktop Summary tab; it does not work when in the actual Appointment Book module. Care Alerts on your Desktop Summary Along with Flags in the upper right portion of your Desktop Summary tab, in Centricity EMR 9.2 you can also view and respond to Care Alerts. A Care Alert is much like a flag; however, it must always be associated with a specific patient, either to his or her chart, registration, or scheduled appointment. Care Alerts, displayed along with your Flags on your Desktop Summary, have a red + in front of them. Those deemed Urgent also have a red!, and Important Alerts are marked with a yellow!. Michigan State University EMR Page 2 of 23

5 Care Alerts can be prioritized as normal, important, or urgent. Also, they can be assigned Start dates, Expiration dates, and specific Locations of Care. You can sort the Flags and Alerts by clicking the header bar of the Alerts/Care section of your Dekstop Summary. Sort Flags and Care Alerts by one of the header options. This illustration shows the notes being sorted by Start Date. On the far right side of the Alerts/Flags toolbar you ll find a Remove button and a Hide button. In clicking Remove, the selected Care Alert or Flag is removed both from your Desktop and the patient s chart. Clicking the Hide button removes the selected Care Alert or Flag from your Desktop, but preserves it in the patient s chart. Your Alerts/Flags Desktop Tab To have more room to view and work with your Care Alerts, click on the Alerts/Flags tab on your Centricity EMR 9.2 Desktop. The details and content of the Care Alert or Flag selected in the upper portion of the window are displayed in the lower portion. You can use the View alerts/flags to dropdown arrow to locate and select another individual s Care Alerts and Flags, or those on the Desktops of Group members. 1 To navigate to the chart of the patient associated with a particular Alert, double-click on that Alert. 1 To learn more about creating Desktop Groups, go to Help Help Topics on the Search tab search for set up desktop group. Michigan State University EMR Page 3 of 23

6 Retrieving Hidden and Removed Care Alerts and Flags You can view hidden Care Alerts and removed Care Alerts and Flags while working on your Desktop Alerts/Flags window. Click the Organize button, located on the far right side of the Alerts/Flags toolbar. This opens the Organize Alerts/Flags window. Check View removed alerts/flags to view those messages which have been removed for less than 30 days. Check View hidden care alerts to see messages hidden from your Desktop, but not actually removed from patient charts. Make other adjustments to how you view Alerts and Flags, if desired, then click OK. Organize Options The options available in the Organize window vary, depending on where you are at in Centricity EMR 9.2 when you click the Organize button. If you do not see the option to View hidden care alerts, you were probably in a patient s chart when you clicked Organize. NOTE Like Flags, Care Alerts are only temporary and are not to be used to record information that should be part of that patient s permanent medical record. If the content of a Care Alert needs to be saved in the patient s chart, use the Convert tool to convert the Care Alert to a Phone Note or other document type that can then be signed and saved in the patient s Centricity EMR 9.2 chart. The Centricity EMR 9.2 Chart Toolbar Button In Centricity EMR 9.2, the list of most recently visited patient records maintained on the main toolbar s chart button has been expanded from five to ten. This facilitates navigation between those charts in which you are working over the course of your work session. The list is also retained from one login session to the next. Michigan State University EMR Page 4 of 23

7 CENTRICITY EMR 9.2 THE PATIENT CHART Several new features have been added to the functionality of patient charts in Centricity EMR 9.2. Many of those new features are introduced here. No Known Medications If during a previous, signed chart update it has been documented that a patient has no known medications, that information is displayed on the chart s Summary tab. This helps users differentiate between patients who truly have no known medications, and those whose medications have not yet been documented in his or her EMR chart. Additionally, if No known medications has been recorded in the patient s chart, it is also displayed as a watermark on that patient s Medications tab. (For more on this topic, see No Known Medications page 14.) Medications Prescribed by a Non-HealthTeam Clinician Medications prescribed to a HealthTeam patient by a non-healthteam clinician can be displayed as such on the patient s Medication tab. (For more on this topic, see Documenting Prescriptions Provided by a non-healthteam Clinician, page 20.) Michigan State University EMR Page 5 of 23

8 Care Alerts in the Patient Chart When a HealthTeam clinician or staff member accesses a patient s Centricity EMR 9.2 chart, Care Alerts associated with that individual s authorized Location(s) of Care are displayed on the Summary tab of the patient s chart. Small displays alerting the user to the fact that there are Care Alerts and/or Flags associated with a patient are also visible on other tabs in that patient s chart. For example, the illustration below shows the small display on the chart s History tab; the patient has one (1) Alert and zero (0) Flags. Also, if you rest the mouse over such a display, a fly-out provides a more expansive view of the content. To access more Care Alerts/Flags viewing and editing options, click directly on the small Alerts/Flags display. NOTE On a patient s Summary tab you see only Care Alerts that are associated with your designated Centricity EMR 9.2 Location(s) of Care. However, all Care Alerts generated in a HealthTeam Location are visible on the Alerts/Flags tab of the patient s chart. Michigan State University EMR Page 6 of 23

9 Popups in the Patient Chart In Centricity EMR 9.2, you can create Popups in patient charts that appear when you and others in your clinic access those charts. You can quickly access more information about a Popup and other Alerts and Flags in the patient s chart by clicking the View Details button in a Popup s Care Alert Warning window. The Alerts/Flags Tab The Alerts/Flags tab in the patient s Centricity EMR 9.2 chart is divided into three sections: Allergies and Adverse Reactions Directives, and Care Alerts and Flags Michigan State University EMR Page 7 of 23

10 In the Care Alerts and Flags section, you may choose to see Alerts and Flags with start dates Today or Anytime. You can also work with existing Alerts and Flags, as well as generate new ones, using the various Alerts/Flags toolbar buttons. For the most part, these buttons work the same as their counterparts available on the Alerts/Flags tab of your Centricity EMR 9.2 Desktop. This includes the Convert button, which you can use to change an Alert or Flag from a temporary note to a permanent, signed document in the patient s record. Use the Organize button to open the Organize Alerts/Flags window, where you can reactivate Popups, if you deactivated them during a previous or current work session. Creating a Care Alert or Popup Creating a Care Alert or Popup is much like creating a Flag in previous versions of Centricity EMR. 1. In the patient s chart, click the New button, either on the main Centricity EMR 9.2 toolbar, or on the toolbar of the Alerts/Flags tab. 2. If you want the new Alert or Popup to display for only persons with access to a particular Location of Care, select that Location from the options in the To Location field s dropdown list. This does not actually send an Alert to the Desktops of everyone in a specified Location; it only appears on the patient s Chart Summary tab when someone with privileges to that Location accesses that patient s chart. 3. In the To User field, indicate if you want to actually send the Alert to the Desktop of one or more HealthTeam Centricity EMR users. Michigan State University EMR Page 8 of 23

11 4. Set the Priority as is appropriate for the given instance. Priority options are Normal, Important, and Urgent. 5. Select the note Type: Flag, Care Alert, or Popup. 6. (Optional) Assign a Start date. 7. (Optional) Assign an Expiration date. 8. Attach the Alert/Popup to the Patient s Chart, Registration, or Appointments. 9. Type the content in the Message field. 10. Click Send. Or, if you need to stop entering the Message before having completed it, click Save as Draft, which will save your work and send the unfinished Care Alert, Popup, or Flag to your Desktop. Popups and Care Alerts can be useful, but they should not be over-used, or HealthTeam clinicians and staff members may become desensitized to all Popups and Alerts, and miss something critical about a patient s medical care. Disabling Popups At some point, you might turn off the Popup functionality, intentionally or inadvertently. This happens when you check Disable popup care alerts, in a Care Alert Warning window. NOTE: Disabling Popups turns off the Popup functionality for all Popups in HeatlhTeam patient charts to which you have access not just in a specific patient s chart. Restoring Popups If you have disabled Popup Care Alerts and want to re-activate this feature, go to the Options menu, then select Display In Display Options, check Restore warning message dialogs, then click OK. Michigan State University EMR Page 9 of 23

12 The History Tab The patient chart in Centricity EMR 9.2 has a new tab the History tab. Like the Flowsheet tab, the History tab has a View dropdown list that allows you to switch between views of predefined observations saved in the patient record. The benefit of the History tab is that its designated area where those historic entries are displayed is large enough to show lengthier, narrative-type data sets. For example, the illustration below shows a patient s Past Medical History, Social History, and Family History. Michigan State University EMR Page 10 of 23

13 Growth Charts 2 In previous versions of Centricity EMR you have been able to graph height, weight, and other growth-related values recorded in the patient s chart. In Centricity EMR 9.2, you can also view that information plotted on various growth charts, toggle between units of measure, and compare percentiles for patients up to 20 years of age. In the patient s chart, click the Graph button; this opens the Graph Observations window, where you then click the Growth Chart button, in the upper right corner of that window. The Growth Chart window opens, displaying the patient s recorded values in the default growth chart view. Many tools are available in the Growth Chart window that allow you to customize the way in which you see the patient s recorded data. 2 Learn more about Growth Charts in the training materials available online at Michigan State University EMR Page 11 of 23

14 Growth Chart Tools a Brief Overview When you click on the Growth Chart button, Centricity EMR 9.2 generates the Stature vs. Age chart most appropriate for that patient s age and gender. Once this is displayed, you can use the tools as applicable to that patient and the information you wish to review. Click directly on a plotted point to see details of that entry. Click the Zoom tool to expand the display. Toggle from one graph to the next using the pink arrows. (Ex: Stature vs. Age to Weight vs. Stature ) Right-click in the Growth Chart window to open a list of display options. Click with the left mouse button directly on one of the options to change the Growth Chart view to that which you have selected. Included in the pop-up menu opened when you right-click in the Growth Chart window is the ability to alter the parameters per the patient s gestational age at birth. The reference curve can be set to either Normal or Downs Syndrome, as well. In clicking the Percentiles button in the Growth Chart window you can view patient data in a table format, and print that information, if desired. Michigan State University EMR Page 12 of 23

15 CENTRICITY EMR 9.2 UPDATING THE PATIENT RECORD While many of the processes used to update patient records in Centricity EMR 9.2 remain unchanged, there are some new features, and enhancements made to previously-existing features, as well. Advanced Directives While in an update, choose from the options available in the expanded dropdown list of Advanced Directives, to add or modify Directives in a patient s Centricity EMR 9.2 chart. Or, you can indicate that the patient s Directives have been reviewed. This adds the value Done to the observation term designated for Advanced Directives having been reviewed, and can be included in flowsheet views, and included in inquiries and reports, as desired. Adding a New Directive 1. In a chart update, click the Directives button or the charting toolbar to open the Update Directives window. (Some form components include action buttons that can be used to open the Update Directives window, as well.) 2. Click New. 3. Use the dropdown list to locate and select the appropriate entry for the Description field. 4. Using the Calendar utility or simply typing in the Start Date field, enter the date when the new Directive is to take effect. 5. (When applicable) Click Save & Continue if you want to add another Directive, then repeat the process. 6. When finished adding new Directives to the patient s chart, click OK to close the New Directives window. 7. Having made all changes needed, close the Update Directives window by clicking OK once again. Michigan State University EMR Page 13 of 23

16 Reviewing Directives 1. In a chart update, click the Directives toolbar button to open the Update Directives window. 2. In the Update Directives window, place a checkmark ( ) in the checkbox to indicate that the Directive list has been reviewed in the current update. 3. Click OK. Updating Medications While in a chart update, you can document that a patient has no known medications which. You can also indicate that the patient s medications have been reviewed during the current chart update. No Known Medications 1. With a chart update already in progress, click the Medications button of the charting toolbar. (Some form components include action buttons that can be used to open the Update Medications window.) 2. In the Update Medications window, check This patient takes no known medications (NKMED). 3. Click OK to close the Update Medications window. Michigan State University EMR Page 14 of 23

17 Medications Reviewed 1. With a chart update already in progress, click the Medications button of the charting toolbar. 2. In the Update Medications window, check Medication list reviewed during this update. 3. Click OK to close the Update Medications window. The New Medication, Change Medication, and Updating Medication Windows Current Problems Display While in either the New Medication, Update Medication, or Change Medication window, Centricity EMR 9.2 displays the patient s current Problem list, in the left column. Michigan State University EMR Page 15 of 23

18 New Criteria Options for Medication Searches The search options in Centricity EMR 9.2 have been expanded. Now when you click the Reference button to access the full list of medications, you can search by Brand Name, Generic Name, or Keyword. If you choose to search by either Brand Name or Generic name, the Search method options are: beginning with, containing, and ending with. Enter a value in the Search for field, then click the Search button. Medications meeting the criteria you have defined will be displayed in the main portion of the Find Medication window. Medication Handouts Once you have located and selected a medication in the Find Medication window (as illustrated above), you can click the Print Handout button, which opens a print window that offers new print options. The medication handout can be printed in large or normal font, and it can be in either English or Spanish. Preview the handout, continue on and Print the handout, or close the window without printing. Michigan State University EMR Page 16 of 23

19 Medication Monographs 3 Prior to prescribing a medication in Centricity EMR 9.2, you may want to use the Monograph tool, available in the New Medication window, as well as in Update Medication and Change Medication. Select the medication you wish to look up using the Monograph tool, then click the Monograph button. In clicking Monograph, Centricity EMR 9.2 launches a new window linked to a predetermined website, typically Lexi-Drugs Online. Precautions, contraindications, standard dosing, and other information is provided. Adult and Pediatric Patient Education handouts are available for both review and printing. Use the various buttons and dropdown field options to expand your research still further. For example, click Images to access pictures of the various medication options for that particular medication. Click the little house icon or printer picture, both in the upper right corner of the window, to navigate to the Monograph home page, or to print the current page, respectively. 3 Learn more about Monographs in the training materials available online at Michigan State University EMR Page 17 of 23

20 The Dosing Calculator Along with the Monograph utility, the Dosing Calculator is available for use in Centricity EMR 9.2. The Dosing Calculator is designed to assist a prescribing clinician in determining how much medication should be prescribed. The clinician verifies that the formula and the components factored in are accurate, then selects the desired calculation and dosing interval. The value selected becomes part of that medication s Instructions. Most medications included in the full medication Reference list in Centricity EMR 9.2 can be used with the Dosing Calculator. Exceptions include medications that do not specify a strength or unit of measure. Also, some units of measure, such as displayed in the illustration here, cannot be calculated, as well. In such cases, Centricity EMR 9.2 alerts you to that system limitation. NOTE The Dosing Calculator is a tool designed to assist clinicians in performing mathematical calculations, and it displays computed dosage options. However, the clinician remains solely responsible for choosing the dosage correct for a given patient, under the circumstances of that current prescription. Michigan State University EMR Page 18 of 23

21 Using the Dosing Calculator 1. Just as with the Monograph tool, you first select a medication in either the New Medication window, Change Medication Window, or Update Medication window. 2. Then click the Dosing Calculator button. 3. The patient s documented weight is included in the Dosing Calculator window. Verify that the weight displayed is correct before continuing on with the calculation process. Change the weight, if necessary. NOTE: If you change the weight in the Dosing Calculator, that change is not saved in the patient chart, and should also be updated in the Nurse Intake form. Click to select the dosage to be prescribed in the current chart update. 4. Use the dropdown arrows in the various fields to customize their content, as applicable. 5. Click to select the desired dosage (typically the one that most closely matches the target dose) in the lower portion of the Dosing Calculator window. The selection made here is automatically sent to the Instruction field of the prescribing Medication window. 6. Click Close to close the Dosing Calculator, near the top of the Dosing Calculator window. 7. Verify that the instruction set entered via the Dosing Calculator is correct, and complete the medication prescription process as normal. Michigan State University EMR Page 19 of 23

22 Selecting a Pharmacy When applicable, once you have entered all the pertinent information in the prescription to be generated in a main prescribing Medication window, you ll click the Select button to open the Select Pharmacy window. In Centricity EMR 9.2 you have the option to search for either a Mail-order pharmacy or a Retail pharmacy. Enter text in the main Search field, indicate either Mail-order or Retail, then click Search. Documenting Prescriptions Provided by a non-healthteam Clinician Medications provided by a non-healthteam clinician and/or at a non-healthteam location should be recorded in the patient s chart at the HealthTeam. The lower right corner of the New Medication window offers fields that facilitate entering that information. The illustration on page 5, under Medications Prescribed by a Non-HealthTeam Clinician, shows how a medication documented in this manner is displayed on the patient s Medications tab. The Steps Set the Authorized By field to Provider, Non-MSU. Use the binoculars to locate and select this user, if it doesn t appear in the dropdown list for that field. Choose the Prescribing Method: Historical. The State should always be set to Michigan; the graphic here is different, merely due to the mock clinical practice used in the training system. Set the Authorized By field to Provider, Non- MSU. (Use the binoculars, if it doesn t appear in the field s dropdown list.) Set the Prescribing Method to Historical. Refilling Prescriptions: an Interaction/Adverse Reaction Cross-check When refilling a prescription in Centricity EMR 9.2, you select the medication to be refilled, and verify the correct quantity and number of refills. The system checks for potential interactions and adverse reactions, and displays a warning or caution icon, as applicable. Hover over the caution or warning to see a list of warnings, or click on the icon to open a separate window with complete details. Michigan State University EMR Page 20 of 23

23 Updating Problems While in the Update Problems window of a chart update in Centricity EMR 9.2 you can easily identify who initially entered a problem on the patient s problem list, and who has been identified as being responsible for that problem. In previous versions of Centricity EMR this information was only visible on the actual Problems tab of the patient chart, and not readily accessible in the areas of the program where one would be adding new problems or accessing already-recorded diagnoses. New Options for Problem Searches There are new search options you can use when searching for a problem (diagnosis) to add to a patient s problem list. 1. In a chart update, open the Update Problems window, either by clicking the Probs button of the charting toolbar, or via an action button in a form component in that chart update. 2. In the lower left corner of the Update Problems window, click the New button. 3. Now in the New Problem window, click the Reference List button. 4. In the Search by field, choose to search by Code (CPT or ICD-9), Description, or Keyword. 5. If you Code or Description, you can then set the Search method to one of the following: beginning with containing ending with 6. Having defined the search criteria, enter text in the Search for field, then click the Search button. All diagnoses that meet the search criteria and free-text entered will be displayed in the lower portion of the window. Michigan State University EMR Page 21 of 23

24 Drug to Disease Interaction When a new medication or diagnosis is added to a patient s Centricity EMR 9.2 chart, the system runs a cross-check in the background for possible interactions between the patient s active medications and problems. If an interaction is determined, an alert appears in the window near the newly-added diagnosis or medication. Hover the mouse pointer over the alert to see more about the interaction. Or, click directly on the alert to see the complete summary and report. Michigan State University EMR Page 22 of 23

25 GETTING HELP Centricity EMR 9.2 Help Online When working in Centricity EMR 9.2, click on the Help menu to learn more about the various features and functions in Centricity. In selecting Help Help on this Screen, you get content-specific Help topics. For example, if you are on the Alerts/Flags tab of your Desktop and choose Help Help on this Screen, Centricity s Help window displays several entries relating to various aspects of managing Care Alerts and Flags from your Desktop. Check out Help What s New for more specifics on the various aspects of Centricity EMR 9.2. Utilize the other Help options, as well, to strengthen your EMR computing skills, enabling you to optimize the various tools. Additionally, in most screens the Centricity toolbar provides a Help on this Screen button, which opens the screenspecific help page. This button is located on the far right side of the toolbar, just to the left of the Exit button. If you prefer using keyboard shortcuts, the [F1] key of your Desktop PC also activates the screen-specific Help feature. EMR Implementation Team Instructional documentation and videos are available online at Use these tools at your convenience to become familiar with the various aspects of Centricity EMR 9.2 and how the program is used to document patient care in MSU HealthTeam clinics. HealthTeam Information Technology In order to work in Centricity EMR 9.2 you must first log onto the HealthTeam network. If you have difficulty doing so, call Health Information Technology (HIT) at (517) Also call this number if you are experiencing difficulty with your computer system, or if you are unable to print from your HealthTeam computer. You can also submit a request for help from HIT by going to their website, at Michigan State University EMR Page 23 of 23

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