During Go-Live their will be roamers to support you and answer questions.

Transcription

1 Office Staff

2 IMPACT Support During Go-Live their will be roamers to support you and answer questions. Know who your clinic s super users are. They will be a valuable resource on going. Check out the UAB Ambulatory EHR web site. All training materials are posted there. Utilize the IMPACT Help feature. From any screen in IMPACT, choose Help from the menu bar. Call the UABHS Help Desk

3 Table of Contents Introductory Material 9 Information Security and Confidentiality 9 Device Types 9 Guidelines for Passwords 10 Logging Out 11 Schedule Viewer 13 Accessing Schedule Viewer 13 Overview--Schedule Viewer 13 Changing Views 14 PowerChart Basics 15 Menu Bars, Tool Bars, and Task Bar 15 Opening a Patient Chart 18 Patient Search 18 Select Patient from Recent Charts Opened 19 Open a Chart from Schedule View, Patient List, or Task List 19 Change Encounters from Visit List within EMR 20 Chart Overview 21 Demographic Bar 21 Menu 22 Compared to Inpatient 22 Data Retrieval 23 Chart Overview 25 Immunization Schedule 25 Advanced Growth Chart 26 Horizon Summary 27 Reference Text Browser 27 Printing 28 Additional Chart Menu Components 29 Ambulatory Summary 29 Overview 29 Other Features 29 Toolbar 30 Amb_Office_PG_final_ doc Page 3 of 148

4 Collapse All / Expand All 30 Customize View 30 Adding Orders 31 Managing Medications 31 Help 31 Reports and Documents 33 Problems and Diagnoses 34 Viewing Problems and Diagnoses 34 Add a Problem 35 Modify a Problem 36 Add a Diagnosis 37 Modify a Diagnosis 38 Remove a Diagnosis 38 Converting a Problem to a Diagnosis 39 Converting a Diagnoses to a Problem 40 Create a Favorites Folders 41 Adding a Problem or Diagnosis to a Folder 42 Mark All Problems and Diagnoses as Reviewed 42 Medication List 44 Documenting Historical / Home Medications 44 Right Click Options 46 MAR Summary 48 Allergies 50 Allergy Basics 50 Add an Allergy 50 Add an Allergy to Your Favorites 53 Tips and Tricks 53 View Allergy History 53 Cancel an Allergy 53 Modify an Allergy 53 Mark Allergies as Reviewed 54 Document No Known Allergies (NKA) 54 Perform a Reverse Allergy Check 54 Health Maintenance 56 Health Maintenance Basics 56 View Expectation History 57 Default Settings 58 Satisfy an Expectation 59 Order 59 Procedure 60 Amb_Office_PG_final_ doc Page 4 of 148

5 Performed Elsewhere 62 Postponed 62 Refused 63 Cancel Permanently 64 Adding Pending Expectations 65 Unchart an Expectation 66 Undo Satisfied Expectation 67 Sorting Reviewed Expectations 67 View Results in Recently Satisfied Expectations 67 Form Browser 69 Histories 70 Histories Basics 70 Adding History 70 Modify History 70 Mark as Reviewed 70 Filters 70 Past Medical History 71 Reviewing Past Medical History 71 Adding Past Medical History 71 Modify Past Medical History 71 Procedure History 73 Reviewing Procedure History 73 Adding Procedure History 73 Modify Procedure History 74 Family History 75 Reviewing Family History 75 Adding Family History 75 Quick List 76 Adding family members 77 Adding groups 77 Modify Family History 77 Social History 78 Reviewing Social History 78 Adding Social History 78 Types of Social History 80 Alcohol 80 Employment/School 81 Exercise 81 Home/Environment 82 Nutrition/Health 83 Amb_Office_PG_final_ doc Page 5 of 148

6 Other 83 Sexual 84 Substance Abuse 84 Tobacco 85 Modify Social History 85 Pregnancy History 86 Reviewing Pregnancy History 86 Adding Pregnancy History 86 Orders 88 Orders Basics 88 Navigator Overview 88 Order Profile Overview 89 Order Filters 91 Placing an Order 91 PowerPlans 96 Advance Beneficiary Notification (ABN) Checking 100 Order Actions 101 Displaying Order Information 102 Favorites 102 Adding Orders from the Ambulatory Summary 104 Acting on Proposed Orders 105 Task Lists 106 Task List Basics 106 Single Patient Task List Chart Level 106 Multi-Patient Task List Organizer Level 106 Task-at-a-Glance Legend 107 Using Task Filters 107 Charting Tasks 111 Chart Done 111 Chart Details 111 Chart Not Done 112 Unchart 112 Chart Med 112 Chart IV 113 Other Task List Actions 114 Reschedule a Task 114 Create and View an Admin Note 115 Multi-Select 115 Select All / Deselect All 116 Amb_Office_PG_final_ doc Page 6 of 148

7 eprescribe 117 Entering a New Prescription 117 Proposing Prescriptions 118 Routing Prescriptions 119 Adding/Selecting a Pharmacy 121 Rx Plan Eligibility 122 Formulary and Benefits 123 External Medication History 123 Create a Prescription from Favorites 125 Activating a Proposed Prescription 125 Reprint a Prescription 127 Depart Process 128 Follow-Up 128 Patient Summary 129 Medication Reconciliation 130 Message Center 131 Message Center Basics 131 Basic Navigation 131 Searching For Messages in a Specific Date Range 131 Creating a New Message 132 Additional Options when Creating a Message 133 Replying to Messages 133 Forwarding Messages 133 Deleting Messages 134 Signing Documents 134 Medication Renewals/Refills 134 Requesting a Medication Renewal (Non-Physicians) 134 Requesting a New Medication (Non-Physicians) 135 Approving a Refill Request 136 Refusing a Refill Request 136 Modifying a Refill Request 136 Approving a New Order Proposal 137 Results 137 Viewing a Result 137 Signing a Result 137 Forwarding a Result without Signing or Refusing It (Forward Only) 138 Signing and Forwarding Results 138 Refusing a Result 138 Amb_Office_PG_final_ doc Page 7 of 148

8 Generating a Patient Result Letter 138 Orders (Cosign and Refuse) 139 Approving Orders 139 Refusing Cosign Orders 139 Proxy Authorization 140 Granting Proxy Authorization 140 Updating Proxy Authorization 141 Viewing Messages as a Proxy 142 Viewing Proxy Authorizations Granted to You 142 Viewing Proxy Authorizations that you have granted 143 To Steal a Proxy 143 Pools 144 Working with Messages as a Member of a Pool 144 Managing Pools 144 Notifications and Reminders 145 Reminders and Notifications Basics 145 Creating a New Reminder 145 Reminder Options 146 Redirecting a Reminder 146 Rescheduling a Reminder 146 Generating Quick Reminders from Results 147 Setting a New Notification 147 Message Journal 147 Viewing the Message Journal for a Patient 148 Amb_Office_PG_final_ doc Page 8 of 148

9 Introductory Material IMPACT Ambulatory is a component of the electronic medical record. UAB Health System has customized Cerner Corporation s software to meet our organization s needs. The programs are housed on a secure computer server that can be accessed only by authorized users. Data storage and transmission along with computer and printer use are as important as personal actions when safeguarding confidential heath records. Information Security and Confidentiality Every employee must sign a Confidentiality Agreement Form after reading the standard Confidentiality of Information. This standard outlines the measures you must take to ensure the security of health information which includes protecting your password, accessing records only when you have a work-related need, and proper use of computers. Every person granted access to the electronic medical record is responsible for following the standards. You should not access information on patients unless you are directly involved in their care. This includes your own records and those of family members. Accessing information on patients when you are not directly involved in their care is considered a breach of confidentiality and is against Health System policy. This may result in termination. Employees should go through HIM (Health Information Management) department or the medical records person in a physician's office to view their own records. Device Types Computers used within the institution include: Desktops that contain a hard drive to run some programs Sun Ray machines (thin clients) that do not contain a hard drive but run programs on the Citrix Web. A sun card is required to use a thin client. Notebooks or tablet style computers Any identifiable patient data should not be downloaded to unencrypted transportable devices such as thumb drives or handheld computers. Printers are a part of the IMPACT configuration. Not all printers in the clinics are on the Cerner network. Some printers connected to a PC will not print from Cerner. Cerner network printers are labeled on the front with an identification name that can be found in IMPACT printer lists. Printers may be: Local printers that are not connected to IMPACT. Network printers that can be used for IMPACT printing. Amb_Office_PG_final_ doc Page 9 of 148

10 Multi-Function Devices (MFD) that have the capacity to print, fax, or print prescriptions on tamper proof prescription paper from a special drawer Printers set to accommodate printing portions of the record using Medical Record Publishing (MRP). Only select positions can use this functionality. Scanners are used to import printed material into the electronic record. Do not move a computer or printer in your work area. Place a request through HSIS to have a technician move the device. Guidelines for Passwords When selecting a password, don t choose anything obvious, such as your birth date, social security number, or spouse and children s names. Passwords need to be eight characters long and contain at least one number, three letters and one special character. Do not tell anyone your password. Your sign-on code to the IMPACT System should be protected the same ways you would protect your legal signature to keep it strictly confidential. Do not leave the computer while still signed on. If you leave the computer without signing off and someone else uses it to view or enter data, you are responsible. Always sign off the computer when you walk away. Giving your code to someone to use or signing on the computer and allowing someone to perform functions under your name is considered a breach of confidentiality and by Health System policy is grounds for termination. If you must write your password down to remember it, do not leave your password in a location that can be accessed by others. To help you remember, use the same password for Citrix and PowerChart..Log In Activities To access the IMPACT system you must first log in. There are two log in steps for IMPACT; the first log in is for Citrix Web Interface. Access the Citrix Web login screen by double clicking on the IMPACT icon on a desktop computer or inserting your Sun Ray Card in a Sun Ray machine. To use a Sun Ray, place your sunray card into the machine s slot with the gold label toward the machine. Type in your name and Citrix log in password. Amb_Office_PG_final_ doc Page 10 of 148

11 The second log in for IMPACT is for Cerner PowerChart. To log in to IMPACT PowerChart: 1. Verify the correct domain name appears in the Domain window. Actual patient care documentation will be performed in the PROD domain. Instructions will be provided when another domain is to be used for testing, training, or practice. 2. Type your User Id in the User name field. 3. Press the Tab Key on the keyboard OR click (with the mouse) in the Password field. 4. Type your password. 5. Press the Enter key OR click on OK. Logging Out When you have completed your activities, remember to log out of PowerChart for security purposes. Logging out of PowerChart is best done by clicking on the Exit icon in the Tool Bar. It is not necessary to log out of Citrix when you close PowerChart on a desktop work station. Amb_Office_PG_final_ doc Page 11 of 148

12 If you are working on a SunRay and are moving to another location to resume work immediately, you do not need to log out of PowerChart. Remove your sunray card and insert it in the machine in the new work location. Type in your Sunray password and select OK. The screen will appear as it did when you left it on the first machine. Do log out of PowerChart and Citrix by clicking the Exit icon on the PowerChart toolbar and selecting LogOut from the Start Menu when you are not going to be using IMPACT for a while. You must log out of a SunRay if you are moving to a PC to use IMPACT. Amb_Office_PG_final_ doc Page 12 of 148

13 Schedule Viewer Schedule Viewer is a tool to view the IDX schedule for a resource (provider or location) within Ambulatory IMPACT PowerChart. The schedule can be viewed in a daily, weekly, or monthly calendar. Patient charts can be opened from the Schedule Viewer by right-clicking the appointment line item, selecting Open Chart, and selecting the chart section. Double click a patient s name on the schedule to open that chart to the Ambulatory Summary. Accessing Schedule Viewer The schedule is the Home view. For some positions, the schedule will be the first screen seen at login. You can access the Schedule Viewer any time you are in PowerChart by clicking the Home icon on the toolbar Overview--Schedule Viewer (1) Message Center appears in the left pane. (2) Today s date defaults in the date field. Change the date by typing in the field or using the control buttons at the right of the field. (3) Click the recent button to display recent resources (providers, clinics) that you have viewed. Click on the resource to fill in the Resource Field. (4) Type in the last name of a provider or a clinic location and click the search icon to see potential matches; click on match to make a Resource selection. (5) View the patients scheduled for that day for the selected resource. Note times display at the left and when the application is opened, the schedule displays the current time. Use Amb_Office_PG_final_ doc Page 13 of 148

14 the scrollbar at the right to move up and down the page to see earlier and later appointments. If you leave your Schedule Viewer up, click the Refresh button to get up to the minute information about check-ins. The appointment line color indicates the appointment status: IDX Event Scheduled Checked In Cancelled No Show Color Teal Lime Green Red Peach If changes to appointment types, such as New or Return are made in IDX, the initial type will continue to display on the schedule in IMPACT. Changing Views To change the view of the schedule: 1. Click Schedule on the toolbar. 2. Select View from the dropdown list. 3. Select the view you prefer (Day View, Week View, Month View). Amb_Office_PG_final_ doc Page 14 of 148

15 PowerChart Basics IMPACT PowerChart is designed to operate in two main views: the Organizer and the Patient Chart. The Organizer allows you to access patient charts by a patient list, a schedule, or through the Message Center. The Patient Chart view is similar to a paper chart. It is made up of different pages or views where you can record or view patient specific information such as allergies, medications, immunizations, orders, and problems, among others. Access to views is dependent on your user sign on. Menu Bars, Tool Bars, and Task Bar The fist menu row on the screen is shown below. The menu row, like other chart options, may differ from that shown based on your sign-on. Clicking a menu item reveals the options shown in the table. Items that are dithered (grayed out) are not available for your access. Dropdown arrows separate the toolbars. It might be necessary to click the arrow to see hidden icons. Task Edit View Patient Chart Links Scheduling Help You can click on the arrow and drag the toolbars to rearrange them. Change password, Reports, Print, Refresh, Exit Options are dithered and unavailable for all users Home, Message Center, Patient List, Toolbars, Women s Health Tracking List, Case Selection, Hide Patient Demographic Bar Links to options offered on the Patient Toolbar: Patient Search, Recent Patients; New Medication List, Allergies, Orders, New Sticky Note and PowerNotes Menu links, Ad Hoc Charting, Clinical Calculator, Depart process and Close Chart FirstNet, Explorer Menu, Paging, LabSource, UAB Formulary, Help Scheduling Reports, View, Preferences Links to Cerner Help topics The Organizer Toolbar is divided into sections shown below: Click the icon to open the application. o Home view is the patient schedule. Amb_Office_PG_final_ doc Page 15 of 148

16 Links Toolbar: Notifications Toolbar: Alerts appears on toolbar for physician or mid level provider (MLP) positions when there are critical results to review, orders to cosign, or new messages. Action and Notification Toolbar: Click the Exit icon to exit the application. Click Communicate to enter a message. Click the dropdown arrow to select a message type. Patient Toolbar: The Recent button will display up to the last 5 patient records you have opened. In the Name field, you can type the patient s last name followed by a comma or Medical Record Number (MRN) and click the binoculars search icon to search for a patient. Amb_Office_PG_final_ doc Page 16 of 148

17 Refresh Button: In some views the refresh button appears. Click the refresh button (minutes ago) after taking action in IMPACT Ambulatory to ensure the system processes the action immediately so you see the most up to date information. The Task bar is at the bottom of your screen. In addition to Start, icons display for applications you have open. Minimized programs can be maximized by clicking the button on the task bar. When you leave a PC, you should exit IMPACT Ambulatory. Leaving a program minimized allows another user to enter data using your password. As seen in the example below, you must hover to see the details of two PowerChart applications that have been minimized. It is easy to mistakenly choose someone else s IMPACT session. The System tray is at the bottom right of the screen. Clicking the arrows <<< expands the bar to show system options. Note the Citrix- Logged On icon. Amb_Office_PG_final_ doc Page 17 of 148

18 Opening a Patient Chart It is critical when entering data that the correct patient and correct episode (visit) be selected. There are multiple ways to select a patient. Patient Search You can quickly search for a patient by name or medical record number (MRN). To select a patient by name, type the patient s last name, comma, first name in the Name box on the Patient toolbar and click the binocular search icon. To search by MRN, click the drop-down arrow at the end of the name field, select MRN, and type in the MRN before clicking the binocular search icon. Typing the last three letters of the patient s last name, first three letters of the first will yield search results but is not recommended due to the number of patient such a search returns compared with typing the full last name and full first name. The patient search window opens In this example, only the last name was entered for the search and multiple patients have been returned. The upper pane displays possible matches for the search. The bottom pane lists Amb_Office_PG_final_ doc Page 18 of 148

19 episodes for the highlighted patient. You can sort the columns (encounter type, registration date, etc) by clicking the column heading. Never double-click on the patient name in the upper pane to open a chart. Always select the correct encounter in the bottom pane and open the chart by double-clicking the encounter or highlighting the episode and clicking OK. You can search for patient by Name, Medical Record Number (MRN), Financial Number (FIN), and many other criteria. To open the search box without entering a patient name first, click on the binocular search icon. Click the search button after entering your search criteria. Select Patient from Recent Charts Opened Click on the drop-down arrow next to Recent in the Patient Toolbar to view up to the 5 last patient records you opened. The chart will open to the last visit you had open which may not be the correct visit for action you plan on this chart conversation. Open a Chart from Schedule View, Patient List, or Task List Right click the patient line and select Open Chart. From the Schedule Viewer, the chart will open to the scheduled visit. This may not be the correct visit on which you need to work. From the Patient List, the chart will open to the visit associated to the list. This may not be the correct visit on which you need to work. From the Task List, the chart will open to the visit on which the task was entered. Once again, this may not be the correct visit on which you need to work. Amb_Office_PG_final_ doc Page 19 of 148

20 Change Encounters from Visit List within EMR The Patient Info section of the medical record has several sub-sections. The Patient Demographics Tab tabs allow you to view insurance and contact information. The Patient Provider Relationship (PPR) Summary details who has viewed the record and that person s relationship to the patient. The Visit List is a record of previous and scheduled encounters. If you want to view or change encounters while working in a patient s medical record: 1) Click Patient Info on the chart Menu. 2) Click Visit List tab. 3) Click the column headings to sort data in that column to more easily locate the desired encounter date, visit type, service, or other available visit criteria. 4) Double click the encounter you want to open 5) When prompted, select Yes to confirm you want to change the patient s chart to the selected encounter. Amb_Office_PG_final_ doc Page 20 of 148

21 Chart Overview The patient chart is divided into several sections shown below: 1. Patient Demographic Bar 2. Chart Menu, sometimes referred to as the Navigator Bar or Table of Contents (TOC) 3. View Window Demographic Bar Name Allergies Loc Fin# MRN Attending Patient type Resus Status Name displayed in registration system Displays active allergies in order of severity; click to link to Allergies window Location to which patient is registered for visit being viewed Financial Number (Visit Number) for visit being viewed Medical Record Number Physician for visit Patient type for visit being viewed followed by registration date/time and discharge date if any Resuscitation Status for which there is an active order on the visit Before taking action, validate that you have opened the correct patient chart and have selected the right visit. Amb_Office_PG_final_ doc Page 21 of 148

22 Up to 3 patient records may be open at one time. When more than one record is open, the banner bars will each have a different color. Colors call attention to the different charts. To close a chart, click the X by the name. Menu The Menu provides navigation links for the patient s chart along the left side of the screen. Click on the icon on the Menu to link directly to the Add workspace for Orders, Medication List, PowerNotes, and Allergies. The Menu contents are dependent on your sign on and privileges. Compared to Inpatient Some positions use both IMPACT Inpatient and IMPACT Ambulatory; the menu options for the two components are different. Click on the down arrow at the top of the Menu between the Menu name and the Hide/Unhide push pin to see the options you have for menu views. Change views by clicking one of the options. Options include: All: a combination of Ambulatory and Inpatient Ambulatory Amb_Office_PG_final_ doc Page 22 of 148

23 Inpatient Option to set the checked view as a Default so each time you open a chart that view will display.. To begin, make sure you are in the Ambulatory View. To collapse the Menu and hide it to the left of the screen, click the pushpin icon so that it displays vertically. This allows the work section pane to fill the screen. To expand the Menu, click the Menu heading at the left of the screen and click the pushpin icon sot. The pushpin icon is in a vertical position when the Menu is visible. The pushpin is in a horizontal position when the Menu is hidden. Data Retrieval Several options on the chart menu allow you to look at results and other patient specific information. Click on 48 hour View on the Menu to display results. All result windows open with most recent 48 hours defaulted in the Clinical View. Amb_Office_PG_final_ doc Page 23 of 148

24 To change the timeframe: 6) Right-click on the blue Clinical Range bar. 7) Select Change Search Criteria. 8) Type in date range or use control buttons to reset From and To dates To Graph Results: 1) Click to check the results you want to graph. 2) Click the graph icon. 3) Click Close when review is complete. Amb_Office_PG_final_ doc Page 24 of 148

25 Chart Overview Chart Overview tabs provide quick access to review patient related data. This Visit displays results for the encounter you are viewing. Since Last Time displays information on Encounters, Laboratory Orders, Non Med Orders, Documents, Results (Day View), and Medication Administered that have been posted since your last review. 1) Click to check the box by an item to review details in the right Details pane. 2) Click the Date/Time Stamp button and click the refresh icon to mark information as reviewed and clear the selections. Patient Summary displays current information including: Immunizations, Procedures, Allergies, Problems, Medications, and Blood Bank Information. Interdisciplinary Summary allows you to select a time frame for review and what disciplines contributions to view. Immunization Schedule The Immunization Schedule is used to view and document previous immunizations. UAB chose not to use the Future Immunization Schedule so data will not display in that pane. To document a previously administered immunization: 1) Click the History button. 2) Click Add to Selections button. Amb_Office_PG_final_ doc Page 25 of 148

26 3) Click to highlight desired immunization; select Add. 4) Enter data in required fields: Source of Historical Info and Administration Date. 5) Click Chart to finish. Advanced Growth Chart The Advanced Growth Chart allows you to enter and view measurements, bone age values, and related data. To access the Advanced Growth Chart, click on the title from the chart Menu. 1) Click on the Change View button to open a box which allows you to change how data is displayed in the growth chart. Amb_Office_PG_final_ doc Page 26 of 148

27 2) To enter data, click a selection from the Add New menu options. 3) Complete the form and click the green check to sign on completion. Horizon Summary Clicking Horizon Summary on the Menu links you to select data on Horizon. Horizon Documents Horizon Patient Tracking Lists Horizon Medications Horizon Images In the Horizon Documents pane, click the down arrow by Type to filter the document types to narrow your search for a specific document. Use the scroll bar at the right to navigate through the list or click the arrows beside the Page to move forward and backwards. Click on the link in Horizon Images to view an image. Reference Text Browser Reference Text Browser is an option seen on the menu according to privilege. Click the option on the menu to go to the tool where information on drugs and diagnostic problems, if loaded, can be viewed or printed for patients. Use of this tool will be decided clinic by clinic. Amb_Office_PG_final_ doc Page 27 of 148

28 Printing Only printers designated as Cerner Printers are linked to IMPACT Ambulatory. Many printers associated with a desktop computer cannot be used to print certain documents from PowerChart applications. Cerner printers will be labeled with their name which contains the physical location of the printer followed by additional identifiers. If a printer needs to be relocated, call CenterNet Support at Moving a printer yourself will make the printer non-functional. To print from Impact Ambulatory, follow these steps: 1) Click the printer icon on the toolbar. 2) Select the printer from the list provided and click OK. Prescriptions must be printed on a printer with the rx prefix to insure it is printed on tamper proof prescription paper as required by Centers for Medicare and Medicaid Services (CMS). To prevent accidental selection, prescription printers are not listed with other printers in a clinic location. When searching for a prescription printer, choose Unknown from the bottom of the location list. Prescription printers with the rx prefix are listed in the right pane. Amb_Office_PG_final_ doc Page 28 of 148

29 Additional Chart Menu Components Ambulatory Summary Overview The Ambulatory Summary provides a patient summary view for ambulatory clinicians. Additional functionality allows clinicians to take action directly from the summary. The actions include adding allergies, documentation (PowerNotes ), and new orders in addition to managing medications and launching the Pediatric Growth Chart. The Ambulatory Summary links to other areas of the electronic record. Other Features The Ambulatory Summary has its own toolbar and several other features as described below. Amb_Office_PG_final_ doc Page 29 of 148

30 Toolbar Click the Search button to search for any text in the Ambulatory Summary. If the Ambulatory Summary contains the text you typed, the first instance is highlighted. If there are multiple occurrences of the text, the Next button will be active. Click Next to go to the next instance. If you navigate to another screen within the Ambulatory Summary you can click the home button to return to the main summary screen. Use the back and forward arrows to return to pages you have already visited. CollapseAll / Expand All The collapse all / expand all option is in the upper right hand corner of the screen. Click it to collapse everything on the summary page, and then click expand all to expand everything open again. Customize View In the Ambulatory Summary it is possible to rearrange components on the page and define the expand/collapse default for each component. To do this, click the Customize View link in the upper right-hand corner. From here click a component and drag it to its new location. It is possible to change the layout from a three column view to a two column view by moving everything over into the first two columns. Components that have a plus sign will default to being collapsed, and components with a negative sign will default to being expanded. The default can be changed by clicking on the icon. When finished, clicking on Save Preferences will reveal the summary screen with the new layout. Amb_Office_PG_final_ doc Page 30 of 148

31 Adding Orders You can launch the Orders window by clicking the +Add button by My Favorite Orders. To enter an order saved to your favorites folder, click the category header and make a selection from the favorites displayed. The order will display on the Scratch Pad. Click Submit for Signature. The order detail window will display if there are missing details. If Search Mode is checked, clicking Submit for Signature will launch the order search window to allow entry of orders not saved to Favorites. Managing Medications Click the Medications link to launch the medication order window. From that location you can add medication orders, prescriptions, or historical medications. Active medications will display if the Medication section is expanded. From the Ambulatory Summary, you can click on a medication and take one of the following actions by clicking the appropriate button: Renew (Prescription), Cancel/DC, or Complete. If Renew is selected, Routing will display the pharmacy or routing selected for the original prescription. Select Sign to process the medication order action. Help Use the Ambulatory Summary Help feature to obtain more information about each of the sections on the page. Amb_Office_PG_final_ doc Page 31 of 148

32 Across Encounters Some of the individual components will pull data across encounters and others only pull data from the current encounter. For example, Problems pull all active from across encounters but diagnoses are only for the current encounter. The table below shows the Look Back or Look Forward date range and status, if appropriate, for each component. Patient Info Lifetime and Admission Data Vitals & Measurements Last 6 months Documents Last 2 years Allergies Lifetime, Active and Proposed Labs Last 6 months New Order Entry Not Applicable Home Medications Lifetime, Active Diagnostics Last 6 months Microbiology Last 6 months Diagnoses Current Encounter, Active Health Maintenance Ahead 1 year Pathology Last 2 years Problems Lifetime, Active Immunizations - Lifetime Outstanding Orders Last 2 years Past Medical History Lifetime, Active and Resolved Visits 5 Previous, 5 Future Notes/Reminders Lifetime, Active Procedure History Lifetime, Active Social History - Lifetime Family History Lifetime, Positive Conditions Pregnancy History - Lifetime Amb_Office_PG_final_ doc Page 32 of 148

33 Reports and Documents Reports and Documents can be opened from the Navigator menu in PowerChart. The reports and documents section allows you search for patient information that has been stored in the folder structure that has been created. You can search for reports and documents by Type, Status, Date, Performed by, or Encounter. For example: The screen shot below shows reports and documents completed by specific healthcare providers. You can see operative reports, powerforms that are completed, physicians PowerNotes, messages saved to the chart, documents that have been scanned into the system, as well as Horizon Periscope notes that have benn interfaced to the system. You can change the date range when searching for forms by right clicking in the blue bar and selecting the specified date range. Amb_Office_PG_final_ doc Page 33 of 148

34 Problems and Diagnoses In the Problems and Diagnoses window, you can view problems and diagnoses together on the same window. Depending on your privileges, you can add and update problems and/or diagnoses, and convert problems to diagnoses or diagnoses to problems. The window allows you to create and view Problems and Diagnoses by status, classification, or management discipline and launch a Medline search to find information on an issue listed. A problem is an issue or risk that impacts the patient s health and well-being. Problems can be seen across visits. A diagnosis is a medical problem used to direct a plan of care; diagnoses are also used for billing to justify orders. Diagnoses are visit specific. Viewing Problems and Diagnoses To view Problems and Diagnoses, complete the following steps: Open a patient chart in PowerChart. On the chart Menu click Problems and Diagnoses. To change the Problem List or Diagnoses List view to meet your need, select one of the following options from the Display menu for the list with which you are working: All Active and Inactive Inactive Amb_Office_PG_final_ doc Page 34 of 148

35 The system displays the list you selected. You can sort the displayed list by clicking any of the column headings. Add a Problem To add a problem, complete the following steps: 1) Open a patient record in PowerChart. 2) From the Chart Menu, click Problems and Diagnoses. 3) In the Problem List pane, click Add. 4) In the Problem detail, you can enter a value by selecting an item from the Favorites folders displayed at the bottom of the window or by typing a term and clicking the binocular search icon and selecting a term from the options. 5) Enter values as appropriate in the available fields: Responsible Provider, Display As, At Age, Onset Date, Confirmation, Classification, Status, and Ranking. The Onset and At Age fields are complementary: If you enter a value in one of these details, the system calculates and populates the other fields with the appropriate value. o Click on Age in blue and select: Age, About, Before, After, or Unknown then enter data. Amb_Office_PG_final_ doc Page 35 of 148

36 o Click on Date in blue and select Date, Week of, Month, or Year then enter data. 6) To file this problem to past medical history, select the File to Past Medical History check box. 7) To add the problem and close the Add New Problem pane, click OK. 8) To add the problem and a diagnosis simultaneously, click Add to Problems and Diagnoses. The system closes the Add New Problem pane and displays the new diagnosis and new problem on the Problem and Diagnoses window. 9) To add the problem and keep the Add New Problem pane open to add another problem, click OK and Add New. 10) Click Cancel to discard your changes. Modify a Problem To modify a problem, complete the following steps: 1) Right-click a problem and select Modify Problem from options. 2) Make your changes. Remember you can also make changes to information revealed by clicking Show Additional Details. 3) Click OK when you are finished. Amb_Office_PG_final_ doc Page 36 of 148

37 Select any of the other options seen when you right click a problem to take the action described. Add a Diagnosis To add a diagnosis, complete the following steps: 1) Open a patient record in PowerChart. 2) From the Chart Menu click Problems and Diagnoses. 3) Click Add in the Diagnosis List pane. 4) You can enter a value by selecting an item from the folders displayed at the bottom of the window or by typing a term into the Diagnosis field and clicking the binocular search icon to search for a diagnosis. You can save any diagnosis to your Favorites folder by rightclicking and selecting the Add to Favorites button at the bottom of the Diagnosis Search window. If you choose to enter a diagnosis from common diagnoses by specialty: a. Click on Folders b. Click on Cerner ICD9 Common Diagnoses folder c. Click on a specialty folder d. Click the desired diagnosis e. Click OK to accept the diagnosis ICD9 codes with more digit s after the decimal are usually more specific than those with less. 5) Enter values for Clinical Service, Date, Type, Confirmation, and Classification. You can change any data the system auto populates. 6) You may enter information in any of the available fields. Click Show Additional Details to open an optional window that allows entry of data you may find helpful: Qualifier, Severity Class, Severity, Certainty, Probability, and Ranking. Amb_Office_PG_final_ doc Page 37 of 148

38 7) To add the diagnosis and close the Add New Diagnosis pane, click OK. 8) To add this diagnosis and a problem simultaneously, click Add to Problems and Diagnoses. 9) To add this diagnosis and keep the Add New Diagnosis pane open to add another problem, click OK and Add New. Modify a Diagnosis To modify a diagnosis, complete the following steps: 1) Right-click the diagnosis from the Diagnosis List. 2) Click Modify Diagnosis from the menu options. 3) Make your changes completing all required details: Clinical Service, Date, Type, Confirmation, and Classification. 4) Make changes to other fields, including those revealed by clicking Additional Details if you choose. 5) When finished, click OK. Remove a Diagnosis To remove a diagnosis, right-click the diagnosis you want to remove and select Remove Diagnosis from the menu options. Any diagnosis you remove goes to Inactive status. You can opt to view these items later by setting the display filter to include Inactive. Inactive items are displayed with a strikethrough mark. Amb_Office_PG_final_ doc Page 38 of 148

39 Converting a Problem to a Diagnosis To convert an existing problem to a diagnosis, complete the following steps: 1).In PowerChart, from the chart Menu, select Problems and Diagnoses. 2) In the Problem List pane, right-click the problem and choose Convert to Diagnosis from the menu selections. The problem will display as a diagnosis. 3) Click OK to save changes and return to the previous window or click Cancel to discard changes. Amb_Office_PG_final_ doc Page 39 of 148

40 Converting a Diagnoses to a Problem To convert an existing diagnosis to a problem: Right-click to select a diagnosis and select Convert to Problem from menu options. In the Select an item to map pane, select the item to convert. Click OK to verify the mapping details. The system automatically populates the target field, if possible. It also cross-maps the appropriate billing code and places the newly-created problem onto the patient encounter currently selected in the chart. If this is not auto-populated you will need to enter the entire or partial name of the problem you are seeking in the Search field. Amb_Office_PG_final_ doc Page 40 of 148

41 Create a Favorites Folders To create a new folder, complete the following steps when adding a diagnosis or problem:. 1) At the bottom of the pane, within the Favorites folder, select the dropdown arrow by Favorites to Organize Favorites. 2) Select the location where you want the new folder added, and click Create Folder. 3) Select to highlight New Folder and type your folder title and click the enter key. Amb_Office_PG_final_ doc Page 41 of 148

42 Adding a Problem or Diagnosis to a Folder To add a problem or diagnosis to your Favorites folder, complete the following steps: 4) Right-click on the problem or diagnosis you want to save in a Favorites Folder. 5) Select.Add to Favorites. 6) Click the folder to which you want to add the entry (or create a folder if necessary). 7) Click OK. Mark All Problems and Diagnoses as Reviewed To mark problems and diagnoses as reviewed, complete the following steps: 1) Open a patient chart in PowerChart. 2) Click Problems and Diagnoses on the Menu. Amb_Office_PG_final_ doc Page 42 of 148

43 3) Select Mark all as Reviewed button. The system automatically updates the date in the Last Reviewed column for all problems and diagnoses displayed. 4) Click Refresh button. Amb_Office_PG_final_ doc Page 43 of 148

44 Medication List The Medication List is the recommended place to view all medication therapies for a particular patient. The tab, to the right of the orders tab, provides an easy view of current and past inpatient, outpatient and home medications, allowing for efficient medications management. The medication list has the same sorting and filtering ability as the orders tab, providing the clinician the ability to customize and manage the view. Documenting Historical/Home Medications To document medications that the patient is currently taking at home, use the Document Medication by Hx function. 5) Click. 6) Click to enter the home medication. Note: This function can also be accessed by clicking section on the Ambulatory Summary. in the Home Medications 7) Type the first few letters of the drug in the Find window and select Search. 8) Select the medication from the list of medications and click Done. Note: The order Type window displays Document Medication by Hx. Amb_Office_PG_final_ doc Page 44 of 148

45 9) An Order Sentence dialog box may display 10) Complete the known medication details such as dose, route of administration, frequency, and duration. 11) Click the Compliance tab. 12) Optionally, complete the Status, Information Source, and Last dose date/time fields. Amb_Office_PG_final_ doc Page 45 of 148

46 13) Click to save the information. Right-Click Options There are five categories of medications on the Medications list: Inpatient, Outpatient, Prescription, Documented Medications by Hx, and Unspecified. There are different right-click options depending on what category the medication is in. Outpatient If a medication has been ordered to be administered during the clinic visit, the right-click options will look like this: Amb_Office_PG_final_ doc Page 46 of 148

47 Prescription If a medication has been ordered as a prescription, the right-click options will look like this: Documented Medications by Hx If a medication has been documented as a home medication, the rightt-click options will look like this: Amb_Office_PG_final_ doc Page 47 of 148

48 MAR Summary Overview MAR Summary To view a patient's Medication Administration Record (MAR) in a summary (grid) view, click on the MAR Summary component in the chart Menu. The current time interval is highlighted in yellow. Overdue tasks have a red background and contain an overdue icon. Scheduled tasks that have yet to be administered have a gray background. Charted tasks appear as black text on a white background. These tasks also contain the dose and time administered. Skipped tasks (charted as Not Done or Not Given) appear with an orange border and contain the reason and time documented Amb_Office_PG_final_ doc Page 48 of 148

49 Providers who have three chart menu options (Ambulatory, Inpatient, and All) will have two MAR Summary choices on the chart Menu. One is for the current encounter only and one is for across encounters. If you have a patient with multiple encounters and meds on each encounter, you will have to click on each one to see which one pulls across encounters. Change the Time Intervals 14) Click the navigator button in the upper left hand corner of the screen. 15) Select Change Interval and then choose the desired time interval. Change Date Range: 16) Right-click anywhere on the light blue date range bar. 17) Select Change Properties. 18) Adjust the From and Through dates to the desired date range. Note: You can also adjust the Column Time Intervals in this dialog box. Amb_Office_PG_final_ doc Page 49 of 148

50 Allergies You can view and modify allergies from the hyperlink in the demographic banner bar, from the Allergies component in the chart menu, from the allergies section of certain PowerForms, and the Allergies section of the Ambulatory Summary. Allergy Basics The Allergy Profile is used to record, modify, and review all allergies and drug reactions for a patient. By default, the allergies are listed alphabetically by substance. If severity is recorded, allergies sort by severity on the Demographic Banner bar. The display can be filtered by allergy status: Active - Displays only current/active allergies for the patient Inactive - Displays only inactive allergies for the patient All- Displays all allergies for the patient both active and inactive Add an Allergy To document an allergy, follow these steps: 1) Access the Allergy profile using one of the methods described above. Amb_Office_PG_final_ doc Page 50 of 148

51 2) Click. 3) The Add Allergy/Adverse Effect window will display. 4) Type the first few letters of the allergy into the search box and click Search. 5) Highlight the appropriate substance to select it. Double click the selected substance or click Select to add it to the profile. 6) If necessary, change the Category of the allergy. The default is Drug. If you are documenting a food allergy, be sure to change the Category to Food. 7) If desired, change the reaction type of the allergy. This reaction type will be used on the Allergy Profile to allow for easy grouping of allergies. 8) To search for a reaction, select the Reaction radio button Amb_Office_PG_final_ doc Page 51 of 148

52 Note: You do not need to enter a reaction. If you are not entering a reaction, skip the next 3 steps. 9) Search for a codified symptom using the search window. Confirm that the search is for Reaction, rather than Substance. 10) Select the appropriate reaction, highlight it and double-click or click Select to add to the profile. 11) The reaction will now show within the Reaction window. Codified reactions will display with the key icon. 12) Add other additional details as desired. 13) Add additional comments about the allergy in the comments section by clicking on the Add Comments button. Comments display in reverse chorological order. 14) Click OK. Amb_Office_PG_final_ doc Page 52 of 148

53 The allergy will now display on the patient s Allergy Profile. Add an Allergy to Your Favorites By adding allergies to your list of favorites, you can select them quickly. To add an allergy to your favorites, complete the following steps: 1) In the substance search box search for your substance that you would like to add to your favorites. 2) Right-click the substance and select Add to Favorites. 3) To access your list of favorites, click the My Favorites tab. Tips and Tricks When searching for allergies, type in the first 3-5 letters of the name. If no allergies are returned, type an asterisk (*) in the search box. Allergy checking takes place if any related allergy is documented, for example amoxicillin and penicillin. View Allergy History 1) Right-click the allergy you want and select View History of [Allergy]. 2) The View History dialog box opens. 3) When you are finished reviewing the history, click Cancel. Cancel an Allergy 1) In the profile, right-click the allergy you want to cancel. 2) Select Cancel [Allergy]. 3) Click OK to cancel the allergy. The dialog box closes, returning you to the Allergy Profile window. If you have selected All from the Display list, the allergy is displayed with a red line through it. If you do not have All selected form the Display list, canceled allergies are not displayed. Modify an Allergy 1) Right-click the allergy you want to Modify. 2) Select Modify [Allergy]. 3) Confirm that the name of the allergy you are modifying is displayed in the Substance box. 4) Make your changes to the displayed information. 5) Click OK. Amb_Office_PG_final_ doc Page 53 of 148

54 The changes you made take effect immediately and modification date and time are displayed in the history. Mark Allergies as Reviewed To mark all allergies as reviewed, click Mark All as Reviewed. The date is displayed in the Reviewed column for those allergies that you have reviewed. Document No Known Allergies (NKA) If a patient has No Known Allergies (NKA) you can indicate this in the chart by clicking No Known Allergies in the Allergy Profile window. Perform a Reverse Allergy Check You can check a patient's allergies against current medications (ordered, home meds, and prescriptions) at any time. To perform a reverse allergy check, click Reverse Allergy Check in the Allergy Profile window. A list of all current allergy alerts will be displayed. Amb_Office_PG_final_ doc Page 54 of 148

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56 Health Maintenance Health Maintenance is designed to provide a snapshot of recommended screening procedures and immunizations to maintain health and detect common problems. The recommendations are specific to age and sex of the patient. Health Maintenance Basics Health Maintenance can be accessed from the chart menu. The Health Maintenance window displays two sets of expectations: 1) Pending 2) Recently Satisfied As pending expectations are satisfied, they are seen on the lower half of the screen as recently satisfied expectations. Each pending expectation is displayed by: Name, Priority, Status Subtasks, Due Date, Who recently satisfied the expecation. Amb_Office_PG_final_ doc Page 56 of 148

57 Note: Pending expectations that are never satisfied will show up as overdue. View Expectation History You can select or deselect the icon to show the satisfiers for each expectation or hide them. The example below does not have the satisfiers shown. Pending expectations can be sorted by using the sort list with the following options: Status (Overdues is listed first by priority, then due date) Priority (High is listed first by overdue status) Expectation (All expectations will be listed alphabetically) Approximate Due Date (All expectations will be listed by due date) Note: Decision was made that all pending expectations are qualified as high. Recommendation is to sort by Approximate Due Date so that the pending expectations that are up-coming are at the top of the list. Amb_Office_PG_final_ doc Page 57 of 148

58 Default Settings The default settings for Pending and Recently Satisfied Expectations is set at one year but you can go in and set the defaults you want to see when you log in. To set default settings: 1) Click on the icon on the tool bar. 2) Select from the drop down menu. You can set a separate default for pending and satisfied. For example, you may only want to see the pending expectations for 6 months and you want to see satisfied expectations for 2 years. 3) You can click on the cursor and drag to time frame you want for both pending and/or satisfied expectations. Or you can enter the year(s) and month(s) in the boxes next to pending and satisfied to set the time intervals. The view changes to show the Pending expectations over 6 months. The view changes to show Satisfied expectations for the past 2 years. Amb_Office_PG_final_ doc Page 58 of 148

59 You can also set the defaults to sort the pending and satified sections by selecting from the options in the drop down box. Satisfy an Expectation Expectations are satisfied in Health Maintenance by the following: Orders Performed Elsewhere Postponed Refused Canceled Permanently Satisfied results or procedures Order Pending expectations can be satisfied by placing an order. 1) Select the order under the expectation you are attempting to satisfy. 2) Physicians select. 3) Non-physician staff, select proposal or order and enter the physician s name. Amb_Office_PG_final_ doc Page 59 of 148

60 4) Select. 5) Complete any required details in the order sentences and assign the correct diagnosis for the order. 6) Select Sign. 7) Select Refresh. By placing an order, the expectation will automatically be moved to the satisfied expectation section but will be classified as pending until a procedure is completed or vaccine administered. Note: Placing an order will satisfy and expectation for 7 days. Results or procedures will satisfy an expectation the specified length of time for that screening/immunization. Note: A satisfied expectation that is in a pending state can be undone up until the time the order is resulted. You do this by canceling the order. Procedure Documentation of certain procedures can satisfy pending expectations. The list of procedures documented under Procedure History that will satisfy an expectation is lengthy. The correct procedure with coding will satisfy an expectation. Otherwise this will have to be done manually. For example, your patient has a pending expectation for colorectal screening that is due 12/14/2010. The patient states to you when you are performing your assessment that they had a colonoscopy on 12/1/2010. When you document the Colonoscopy under the Procedure History the expectation will be satisfied. Here are the steps to satisfy an expectation by documenting a procedure. 1) Go to the Histories tab on the Navigator menu. 2) Select the tab for Procedure History. 3) Select + Add. 4) Begin typing in the name of the procedure in the search window. Amb_Office_PG_final_ doc Page 60 of 148

61 5) Click on the binoculars to search for the appropriate procedure and code. 6) Select Colonoscopy with the procedure code ) Select OK. 8) Enter the date the procedure was performed/completed. 9) Select Refresh 10) Move back to Health Maintenance on the Navigator Menu. 11) Select Refresh The expectation for colorectal screening moves to the satisfied expectations section. Note: You may document the procedure before you review Health Maintenance, therefore if an expectation has been satisfied it will be seen under Recently Satisfied expectations. If it is still listed under Pending Expectations, both the wrong procedure and code were added to the Procedure History or nothing was added to the Procedure History. Amb_Office_PG_final_ doc Page 61 of 148

62 Performed Elsewhere If patients have procedures, tests, or lab work performed at another clinic or hospital, you can manually go in and satisfy those expectations. To do so: 1) Select Performed Elsewhere for the specific expectation. 2) Select the reason from the drop down box. 3) Select OK. The pending expectation will be moved to the lower section of the screen under satisfied expectations. Note: Done-Transcribed Paper Chart should be selected if the procedure/test was performed at UAB and you obtained the documentation from the existing paper chart. Postponed Health Maintenance satisfiers can be postponed until another date. In order to do this: 1) Select 2) Select the reason for postponing the satisfier from the drop down box. Amb_Office_PG_final_ doc Page 62 of 148

63 3) Enter a Postponed Until date 4) Select OK. The Pending expectation will appear with the postponed date and available satisfiers. Note: You can undo expectations that have been Postponed. Refused Health Maintenance satisfiers can be refused. In order to do this: 1) Select 2) Select the reason for refusal from the drop down box. 3) Select OK. The expectation will move to the satisfied expectation as being refused. Amb_Office_PG_final_ doc Page 63 of 148

64 Note: You can undo expectations that have been Refused. Cancel Permanently You can also cancel a pending expectation permanently. For example, your patient has an upcoming Influenza vaccine, but has a severe allergy to eggs, and can never receive the flu vaccine. To Cancel the expectation: 1) Select from the list of satisfiers. 2) Select the reason for cancellation from the drop down box. 3) Select OK The expectation will move to the satisifed expectation as being canceled. Note: You can undo expectations that have been Canceled permanently. Placing a check mark in the Show all canceled records will move the canceled expectations to the top of the list. Amb_Office_PG_final_ doc Page 64 of 148

65 Adding Pending Expectations Based on the age and sex of the patient the following pending expectations will appear: Pneumococcal vaccine Tetanus vaccine HPV vaccine MMR vaccine Zoster vaccine Prostate Cancer screening Influenza vaccine Cervical Cancer screening Varicella vaccine Colorectal screening Lipid Screening Breast Cancer screening Bone Density screening Other Health Maintenance screening has been built and can be added based on the patient s history and diagnosis or conditions. Coumadin Monitoring Diabetes Management Traveler s vaccines Note: Any expectation can be added to patient s screening at any age. To add Health Maintenance screening: 1) Select Add next to Pending expectations. This window opens up. Amb_Office_PG_final_ doc Page 65 of 148

66 2) Place a check mark in the screening needed for your patient. This will place the selected screening on the scratch pad. You can modify the due date and frequency. 3) Double click on the Due date and/or Frequency to make changes. 4) Select OK to close the modify window 5) Select OK to add the selected screening to the pending expectation window. The Coumadin monitoring will appear with the icon has added this particular screening. indicating that a health care provider Unchart an Expectation When you unchart documentation that has previously satisfied and expectation the Health Maintenance section is updated and the expectation is placed back to pending. For example, earlier we add a procedure, colonoscopy, which satisfied the colorectal screening expectation. When you unchart the procedure, the colorectal screen becomes active again for the patient. To do this: 1) Go to the Procedure History from the Histories tab on the Navigation menu. 2) Highlight the colonoscopy procedure 3) Right click and select 4) Select Refresh The procedure will then display with a line through it indicating that it has been un-charted. 5) Select Refresh 6) Move to the Health Maintenance tab on the Navigator Menu. Amb_Office_PG_final_ doc Page 66 of 148

67 7) Select Refresh The Colorectal screening moves to the Pending expectations section with satisfiers and the Satisfied expectations is modified to Undone instead of satisfied. Undo Satisfied Expectation You can undo manually satisfied expectations by highlighting the expectation, right click, and choose Undo. You need to select the reason for undoing from the drop down box and the expecting will be moved to the pending section to be satisfied. Sorting Reviewed Expectations You can sort the satisfied expectations by clicking on the column header you wish to sort by. For example, if you want to see all of the pending orders, you can select the Status section and the expectations will be grouped together. View Results in Recently Satisfied Expectations You can review the results of satisfied expectations. To do this: 1) Right click on the expectation you want to review. Amb_Office_PG_final_ doc Page 67 of 148

68 2) Select View Result of. The result details window will open and you can review the test results. 3) Select Close Amb_Office_PG_final_ doc Page 68 of 148

69 Form Browser The Form Browser will show you all of the PowerForms that have been documented on each patient. Note: Physicians to not have Form Browser. Note: View can be customized by Date, Form, Status Encounter-Form, or Encounter-Date. You can change the date range when searching for forms by right clicking in the blue bar and selecting the specified date range. Note: PowerForms will display with a red icon if the form has been documented without completing all of the required fields. In the IMPACT Ambulatory design PowerForms will not allow you to sign the document without completing the required fields. Amb_Office_PG_final_ doc Page 69 of 148

70 Histories You can access the Histories tab(s) from the chart Menu. Using the controls to document a patient s history allows all health care provides a single source of truth for documentation. Patients are often asked by multiple healthcare providers about their history. Having a single source of truth allows health care providers to know that in order to view, add or modify information about the patient s history you go to the Histories section of the electronic medical record. Histories Basics Adding History Adding History is a little different between the types of history and will be reviewed in each section. Modify History Modifying History is a little different between the types of history and will be reviewed in each section. Mark as Reviewed You can review the history that has been documented by previous health care providers. If after you have reviewed the information and you find it to be correct, you can select the Filters button to document that you have reviewed the information. Each type of history has different ways to filter information. Past Medical History All Active Resolved Active and Resolved Inactive Canceled Procedure History Amb_Office_PG_final_ doc Page 70 of 148

71 All Active Inactive Family History Condition View Family Member (All) Family Member (Positive Only) Social History All Active Inactive Past Medical History Reviewing Past Medical History You can review the past medical history that has been documented by previous health care providers. If after reviewing the information and you find it to be correct, you can select the button to document that you have reviewed the information. Note: The past medical history grid has a column titled Last Reviewed, and the date the information was reviewed is added there after clicking Adding Past Medical History Amb_Office_PG_final_ doc Page 71 of 148

72 Add past medical history by selecting the icon. The window opens which allows you to search for and add conditions. Directions: 1) Begin to type in the patient s condition into the required field. (Use the binoculars to search for conditions) Note: If you cannot find what you are looking for you can select the check box in front of free text, and type in the name of a condition. 2) After selecting the correct condition, enter the age or date of onset of the condition. 3) Select OK and Add New if you need to add additional conditions for this patient. 4) Select OK if have entered all of the conditions. Modify Past Medical History If your patient has past medical history documented, you can modify the past medical history if needed. Amb_Office_PG_final_ doc Page 72 of 148

73 To Modify Past Medical History 1) Highlight the history you wish to modify. 2) Select. The window of information for your patient s medical condition will appear and you can make changes. 3) Modify any information. 4) Select OK. Procedure History Reviewing Procedure History You can review the procedure history that has been documented by previous health care providers. If after reviewing the information and you find it to be correct, you can select the button to document that you have reviewed the information. Note: The procedure history grid has a column titled Last Reviewed, and the date the information was reviewed is added after clicking Adding Procedure History Add procedure history by selecting the icon. The window opens which allows you to search for and add procedures. Amb_Office_PG_final_ doc Page 73 of 148

74 Directions: 1) Begin to type in the patient s procedure into the required field. (Use the binoculars to search for procedures) Note: If you cannot find what you are looking for you can select the check box in front of free text, and type in the name of a condition. 2) After selecting the correct procedure, enter the provider who performed the procedure and the date the procedure was performed. 3) Select OK and Add New if you need to add additional procedures for this patient. 4) Select OK if have entered all of the procedures. Modify Procedure History If your patient has past medical history documented, you can modify the procedure history if needed. To Modify Procedure History: Amb_Office_PG_final_ doc Page 74 of 148

75 1) Highlight the history you wish to modify. 2) Select. The window of information for your patient s procedure will appear and you can make changes. 3) Modify any information. 4) Select OK. Family History Reviewing Family History You can review the family history that has been documented by previous health care providers. If after reviewing the information and you find it to be correct, you can select the button to document that you have reviewed the information. Note: There is documentation on the back end indicating that you reviewed the family history after clicking Adding Family History Add family history by selecting the icon. The window opens which allows you to search for and add family history. Amb_Office_PG_final_ doc Page 75 of 148

76 Directions: 1) Click in the shaded cell to place a plus sign in the column for the family member(s) who have a history of the listed conditions 2) Click in the white cell to place a minus sign in the column for the family member(s) who do not have a history of the listed conditions 3) Select OK. Quick List To add conditions to the list: 1) Click the binoculars when adding family history to pull up a comprehensive list of conditions you can add. 2) Double-click on the condition(s) you wish to add to the list to move them to the scratch pad. 3) Select OK to add them to the list. Amb_Office_PG_final_ doc Page 76 of 148

77 4) After selecting the condition to the list, you can document positive and negative responses for each family member(s). 5) Select OK. Adding family members If you need to add a specific family member to the list, do so by clicking on the button and select the appropriate family member, The family member will be added with a new column so you can chart that family member s history. Adding groups If a group of conditions is not on the list you can select conditions. and a set of Modify Family History If your patient has family history documented, you can modify the family history if needed. To Modify Family History 1) Highlight the history you wish to modify. 2) Select. Amb_Office_PG_final_ doc Page 77 of 148

78 The window of information for your patient s family history will appear and you can make changes. 3) Modify any information. 4) Select OK. Note: On Family History you can select the name of the family member to modify only that family member s history. Or you can select the condition and modify all the family members history for that specific condition. Below is an example of modifying family history by selecting the name of the family member (i.e. Mother). Below is an example of modifying family history by selecting the condition (I.e. Hypotension). Social History Reviewing Social History You can review the social history that has been documented by previous health care providers. If after reviewing the information and you find it to be correct, you can select the button to document that you have reviewed the information. Note: The social history grid has a column titled Last Reviewed, and the date the information was reviewed is added after clicking Amb_Office_PG_final_ doc Page 78 of 148

79 Adding Social History Add social history by selecting the icon next to the category of social history you desire. The window will open to each social history category to document specific information within that category. You can also select from the drop down box the assessment findings for each category of social history. Amb_Office_PG_final_ doc Page 79 of 148

80 Types of Social History Alcohol Amb_Office_PG_final_ doc Page 80 of 148

81 Employment/School Exercise Amb_Office_PG_final_ doc Page 81 of 148

82 Home/Environment Amb_Office_PG_final_ doc Page 82 of 148

83 Nutrition/Health Other Amb_Office_PG_final_ doc Page 83 of 148

84 Sexual Substance Abuse Amb_Office_PG_final_ doc Page 84 of 148

85 Tobacco Modify Social History You can modify social history that has been entered on your patient. Directions: 1) Select the category you wish to modify by clicking on the category one time (highlighted blue) 2) Select the icon. 3) The window will open with previous documented information, make applicable changes. 4) Select OK. The details that were modified will be updated under that category. Amb_Office_PG_final_ doc Page 85 of 148

86 Note: Be sure to modify any existing history instead of adding new history in the same category or you will have multiple categories of the same social history and may become cluttered. Pregnancy History Reviewing Pregnancy History You can review the pregnancy history that has been documented by previous health care providers. If after reviewing the information and you find it to be correct, you can select the button to document that you have reviewed the information. Note: The pregnancy history grid has a column titled Last Review, and the date the information was reviewed is added after clicking Adding Pregnancy History To add pregnancy history 1) Select Histories from the menu. 2) Click Pregnancy History. 3) Select the icon. 4) Complete the information for each delivery. Amb_Office_PG_final_ doc Page 86 of 148

87 Note: When you add pregnancy history, the gravida count will increase by one. When you complete the required details including gestational age in the history the para counts will increase based on documentation entered. For example: Patient has had 2 previous deliveries; One delivery on 12/1/2008 at 40 weeks gestation and the other delivery on 12/1/2009 at 36 weeks gestation By selecting the gravida and para becomes G1 P0000 and when you enter the delivery of an infant at 40 weeks who was live born, the para needs to be adjusted to become G1 P1001. Selecting the gravida and para becomes G2 P1001 and when you enter the delivery of an infant at 36 weeks who was live born, the para needs to be adjusted to become G2 P1102. When you add the current pregnancy the gravida and para becomes G3 P1102. When the patient delivers, the gravida and para will be updated to reflect the correct counts. Amb_Office_PG_final_ doc Page 87 of 148

88 Orders The Orders window in IMPACT Ambulatory allows you to enter, view, cancel and take other actions with patient orders. You are responsible for following your clinic s policy on who can enter and act on orders. Orders Basics Navigator Overview The left pane of the Orders tab is the Navigator. Orders are listed in categories: Plans: This category contains PowerPlans which are orders grouped together as a convenience for ordering. Suggested Plans: Based on data entered on a patient, the system can generate Suggested Plans. Orders: Patient Care orders are divided by clinical category. Note that when a section has a check mark to the left, orders are displayed in the right order pane. To hide the orders in a section, uncheck the heading. You can also click on a heading that is checked to navigate to that group of orders. Show or hide the Navigator by selecting to hide or to expand it. Amb_Office_PG_final_ doc Page 88 of 148

89 Order Profile Overview The right side of the order window is the Order Profile. It displays orders and provides a place to view order details and modify active orders. Order buttons and icons provide easy access to order functions. Add Orders Tab Medication List Tab Filter Show more Orders Orders for Signature Missing Detail Sign Refresh Click to add an order; launches search window View Orders View of Medication orders, historical medications, and prescriptions Allows you to select what you would like to view in the Orders Window Becomes active when there are more orders to display than current screen allows Becomes active when there are orders to sign Displays when required fields in an order have not been addressed. Click to enter details. Click to electronically sign orders. Click to update the system with latest action Amb_Office_PG_final_ doc Page 89 of 148

90 The Order Profile columns can be customized. In the order shown in view: Start Shows start date of order Ordering Physician Name of physician who issued order Order Name Order selected for implementation Status Order Order added but not signed Processing Displays between the time an order is signed and the system is refreshed Ordered Order has been successfully entered and signed. Pending Complete Continuing order that has reached its defined stop date/time but still has tasks that have not been completed. Completed Order has reached its defined stop date and time, or whose associated tasks or procedures have been completed. Discontinued An order with an associated frequency or interval can be discontinued after the procedure or medication has been administered at least once. Canceled Order entered and then stopped before any associated action was documented. Proposed Order must be signed by a qualifying person before action can be taken. Future Applied to orders with a start date and time that is in the future. On Hold (Med Student) Order entered by a medical student; must be signed by a qualifying person before action can be taken. In Process Work is in progress. Example: A lab specimen has been logged in and is being processed. Suspended Order is temporarily on hold. These can later be resumed unless the stop date/time on the order has passed. Transfer Cancel Order selected to carry over when patient moved from one level of care to another. Physician on receiving service can continue or cancel order on patient s arrival Details Displays the order start date and time followed by the order name and details. Order Comment Displays order comments added to an order. Amb_Office_PG_final_ doc Page 90 of 148

91 Order Filters Use the order filter to select the orders displayed on the Order Profile. Click the dropdown arrow and select from the options available. Note the scrollbar at right that provides a view of additional options. Only orders for the patient s visit displayed on demographic bar are available to view. Use the order type selection to direct the system on how to manage the requested order. For all orders except prescriptions, set the Type to Ambulatory-In Office (Meds in Office). Placing an Order The following steps are required to place an order 1) Open the patient s chart to the visit on which action will be taken 2) Click Orders on the chart Menu 3) Verify Type displays Ambulatory-In Office-(Meds in Office) 4) Click the Add Button If the order has been saved to Favorites, open Favorites folder to select. 5) Set search criteria to Contains (recommended) or Starts with 6) Search for the order 7) Complete ordering physician dialog box (if indicated by sign-on privileges) 8) Complete the order details a) Save to Favorites if this is a commonly used order 9) Associate a diagnosis (allows ABN checking and accurate billing); use diagnosis table if 2 or more orders are being entered 10) Review the order 11) Sign the order 12) Refresh the system Amb_Office_PG_final_ doc Page 91 of 148

92 Search for an Order 1) Click the Add button to open the order window. o o The left pane displays the Diagnoses/Problem window. The right pane displays Order Favorite folders which can be opened for order selection. 2) Validate that the Order type is set to Ambulatory-In Office (Meds in Office). If entering a prescription, refer to the eprescribing lesson for the appropriate actions. 3) Set filter to desired setting: You can search for orders that start with a certain word or letter or you can search for any order or PowerPlan that contains a specific word. All medication orders for the ambulatory setting have the prefix AMB. All other orders to be used exclusively for ambulatory patients have the suffix AMB. Orders to be performed in radiology or the laboratory do not have AMB in the name. 4) Type your search term in the Find field and click the binocular search icon.. In this example, searching for a Point of Care Order using the search term POC yields many results. 5) Select to highlight the desired order (or multiple orders). Repeat the search and select steps if there are multiple orders. Amb_Office_PG_final_ doc Page 92 of 148

93 6) Click Done to close the order search window when all orders have been selected. This icon before an order name indicates the selection is a PowerPlan, a preconfigured grouping of orders. Ordering Physician Dialog If you are not authorized to independently issue an order by your license/position, the ordering physician dialog box will launch when an order is selected for entry. Physicians and Mid Level providers will not see this dialog box. 1) Select order action: a) Select Order if you are authorized to enter an order on which action can be taken prior to the authorizing provider s review and signature. b) Select Proposed if an authorized provider must approve the order before it can be acted upon. 2) Type in the name of the provider who has communicated the order or to whom it should be routed for signature. You can type in a partial last name and click the binocular search icon and make a selection from the results returned. 3) The Order Date and Time defaults to the current date/time. You can type over the information or use the control boxes to change the information if needed. 4) Select an order type: a) Med Student: Used only by Medical Students. Status will go into On-Hold medical student and be routed to the physician s inbox for action. b) Protocol/Standing Order: Use when there is a signed copy of a standing order and policy that authorizes the use of the order by someone in your position. c) Suggested: This order type should be used for proposed orders when there is no written, verbal, or protocol order to direct its entry. Amb_Office_PG_final_ doc Page 93 of 148

94 d) VORB: Use this to indicate the order is the result of a verbal order recorded following the verbal order read back process. e) Written: Use when a written order that is part of the patient s permanent medical record is being transcribed into the electronic medical record. 5) Click OK. 6) Click Done to close the ordering physician box. Order Details Orders selected will appear at the top of the screen in an area known as the Scratch Pad. The icon appears in front of orders missing required details. The Missing Required Details button at the bottom of the screen indicates there are 8 missing required details for the three orders shown. Click the Missing Required Detail button to move directly to the missing details or click the tab(s) displaying the missing detail icon for each individual order. Amb_Office_PG_final_ doc Page 94 of 148

95 This is the view when an individual order is selected: You can expose or collapse the detail box by clicking the arrow or dragging the detail box. Yellow Bold fields are required; click on each line and select the appropriate response for each question. As you update the order details, the scratch pad details will be completed. Click on the response in this field to respond to order details. Click the Diagnosis tab to associate the diagnosis for this order. In the example below, one diagnosis (Abdominal Pain) has been associated by placing a check in front of one of the two existing active diagnoses. If neither diagnosis was appropriate for this order, you would add a diagnosis. Amb_Office_PG_final_ doc Page 95 of 148

96 Click the Dx Table button when there are multiple orders to which a diagnosis must be associated. Orders on the scratch pad display along the left. Diagnoses display across the top. Click in the cell to assign a diagnosis for each order. Use the scroll bars at the top and side of the screen to view all the information. When you have made your associations, click OK. When you have completed all missing details, review the orders on the scratch pad and, if correct, select Sign. Orders will show as Processing. Click Refresh and orders will revert to their correct status. Lab and Radiology orders are built to default with a status of Future unless it is a study done within a clinic. For future orders, the requested start date and time should reflect the date the test should be done. PowerPlans PowerPlans are groups of orders, like an order set, prebuilt for a specific resource. If a PowerPlan has been selected, the Plan window will appear. Amb_Office_PG_final_ doc Page 96 of 148

97 In the left Navigator Bar, the name of the PowerPlan appears in the Plans section. The right pane displays the PowerPlan orders with details included in the plan. Hover over the details to see the full text or adjust the column width to see more. Orders in the PowerPlan are preceded by checkboxes. To select an order in a plan, place a check in the box. Some boxes may be prechecked but can be unselected by clicking the box to remove the check. Other orders are permanently selected and cannot be deselected. When an order has multiple common options for completing the details, such as various doses or formulations of a medication, choosing an order sentence makes completing details faster. PowerPlan orders with optional order sentences have an ellipsis displayed at the end of the order line. Click on the ellipsis to display potential selections. Click the appropriate selection to order. A PowerPlan may contain another PowerPlan. In the example above, the first line is an embedded PowerPlan. This is indicated by a double PowerPlan icon. before the plan name. To order from within the embedded PowerPlan: 1) Select the check box by the plan name. 2) Click on the plan name in the left View pane. 3) In the right pane, place a check by orders you want. 4) Click the Return to (Name of master PowerPlan) button at the top of the order pane. 5) Click the Diagnoses Button and associate a diagnosis to the orders. 6) Click Orders For Signature button 7) Review order details on scratchpad Amb_Office_PG_final_ doc Page 97 of 148

98 8) Click Sign. Status of PowerPlan will change from Initiated Pending to Initiated after you click minutes ago to refresh the system. PowerPlans in the Ambulatory setting are built to autoinitiate-- automatically become active orders-- when signed. This is different from PowerPlans used in the inpatient setting which are built to require a separate initiate step. You can enter a PowerPlan and leave it in a planned state. PowerPlans which have not been initiated are visible from one visit to another and can be initiated on a later encounter. To enter a PowerPlan and leave it in a planned state for initiation at a later time: 1) Select a PowerPlan to order. 2) Check the orders from the plan you want. 3) Right-click on the plan name in the left View pane. 4) Select Plan for later from the menu. 5) Verify plan order status changed to Planned Pending. 6) Click Sign. 7) Click minutes ago to refresh the system. To initiate a planned PowerPlan: 1) Click the PowerPlan name in the left navigator window. 2) Click the Initiate button over the right orders pane. 3) Complete the Ordering Physician/Communication type box, if necessary for your position. 4) Complete any missing details. 5) Click Orders for Signature button. 6) Click sign. 7) The plan state will change to Initiated in left navigator window after you click minutes ago to refresh the system. Amb_Office_PG_final_ doc Page 98 of 148

99 Add an order to a PowerPlan While working in a PowerPlan, you can add an order that doesn t exist within the plan. 1) Click the Add to Phase button. 2) Select Add an Order from the dropdown menu. 3) Search for order and select as you would outside a plan. Discontinue/Void a PowerPlan You can void or discontinue all orders within a PowerPlan without having to touch each individual order. Right click and select Void if no action has been taken on any orders within the PowerPlan or if the PowerPlan was entered in error. To discontinue a PowerPlan: 1) Right-click the name of the plan on which you wish to take action and select Discontinue. 2) Review orders to be discontinued. 3) Click Orders for Signature. 4) Click Sign 5) Click minutes ago to refresh the system Amb_Office_PG_final_ doc Page 99 of 148

100 Advance Beneficiary Notification (ABN) Checking Medicare requires that patients be informed if they may be financially responsible for tests to be performed. When an order is placed on a patient s record and the diagnosis associated with the test does not meet criteria for payment, the clinician is notified that an ABN form is required. Click the Print button to print the ABN. Attempts to close the ABN box will generate an alert notice directing that the ABN notice should be addressed. If the alert box is closed, the order cannot be signed. The Medical Necessity Print box will appear with a prompt to select a report from a drop down list as well as an output device (printer) location. After clicking on the desired form and choosing a printer, select OK. An Update State alert will display. Select yes to proceed. Amb_Office_PG_final_ doc Page 100 of 148

101 If you select Yes, the Medical Necessity update window will display and the options of Sign or Refuse to Sign appear. Indicate the patient or responsible party s response to the ABN conversation. If Sign is selected, the ABN is satisfied and the order status can be updated to Ordered. If Refused to Sign is selected, the order cannot be signed and should be cancelled. To see if an ABN notice is on file, right click the order line in the Order profile and select Order Information. Order Actions If an order has already been signed and it needs to be changed, right-click the order and select the following order actions: Activate Suspend Resume Cancel and Reorder Copy Renew Cancel/Discontinue Allows activation of a future order. Allows user to suspend, or pause, an existing signed order. Allows user to resume a suspended order. Allows user to cancel an existing order and place another order for the same orderable item. Allows user to copy ran existing signed order. Allows user to renew a continuing order Allows user to cancel a one time existing signed order or discontinue a continuing order. After taking any of these actions, click the Refresh button to process the transaction. Amb_Office_PG_final_ doc Page 101 of 148

102 Displaying Order Information A great deal of information about an order can be seen in the Order Information window. To view the information: 1) Right-click on an order 2) Select Order Information from the selections. 3) Click one of the 5 tabs to retrieve information Additional Information Comments Details History Results Displays the order name, start time, stop time, order ID number, and department status (Lab, Rad). Displays order comments entered for the selected order with the most recent on top. Displays the order format and the current details for the order. If any details have been modified, the newest values are displayed. Displays each action taken on the order including who took the action. Displays results for each order or order part after the tasks generated by the order have been charted or a result is posted. Favorites Organizing favorite orders in folders can hasten the order process. You can create and name folders and add orders, with or without pre completed details, for rapid selection in the future. When you open the Orders Window, your favorite orders and order folders will display. You may click the Favorites icon if they do not automatically appear. On the Favorites tool bar: Click the star icon to show Favorites Click the down arrow to organize favorites Amb_Office_PG_final_ doc Page 102 of 148

103 Click the folder icon to launch create a folder To create a folder, click the Organize Folder Type over the words New Folder with the name of your choice and click the Enter Key. Create Multiple Folders in this fashion and when complete, click Close to return to the order screen. To add orders to your Favorites Folder: 1) Right click on the order you select on the scratchpad before you sign the order 2) Select Add to Favorites 3) Select the destination folder and click OK or 4) Create a new folder at this point in which to store the order You can click Add to Favorites and then drag orders to a Favorites Folder you create at any time. To delete an order from a folder, right click and select Remove. Amb_Office_PG_final_ doc Page 103 of 148

104 Adding Orders from the Ambulatory Summary From the scratch pad, you can enter orders from your Favorites folders. 1) Click on the tab representing the order type 2) Click on the order: It will appear on the Scratch Pad 3) When orders are selected, click Submit for Signature 4) The order window will launch: Complete details and sign 5) Orders will clear from scratch pad 6) Refresh PowerPlans cannot be added to favorites so are not available for order from the Ambulatory Summary. Amb_Office_PG_final_ doc Page 104 of 148

105 Acting on Proposed Orders Providers to who proposed orders, including prescriptions, are routed for authorization can access the orders through their Message Center Inbox items. 1) Click on Proposed Orders. 2) Double click the order line in the right pane displaying proposed orders. 3) Modify the order as needed. Sign to enter the order or Reject to cancel the order. Amb_Office_PG_final_ doc Page 105 of 148

106 Task List Basics Task Lists Task Lists can be found in two places. At the organizer level, the Multi-Patient Task List displays tasks for patients based on the display filter criteria. At the chart level, the Single Patient Task List displays only those tasks for the patient whose chart is open and selected. Single Patient Task List Chart Level The Single-Patient Task List can be viewed by opening a patient s chart and selecting the Task List component from the Chart Menu (TOC). Multi-Patient Task List Organizer Level The Multi-Patient Task List is found in the Organizer. It is the default view for all Ambulatory non-physician positions. It lists the tasks for the selected patient list and displays limited additional information, such as the patient s medical record number, name, and details of the order associated to the task.. Note: In the Navigator on the left, names in green with a check mark have tasks on the list; names in gray with an X do not have any tasks. Amb_Office_PG_final_ doc Page 106 of 148

107 Task-at-a-Glance Legend The Task-at-a-Glance (TAG) legend is a useful tool when working in either the single-patient task list or the multi-patient task list. It will insure that you know the meaning of each task status icon and, therefore, the status of each task. To access the legend from either task list: 1) From the menu bar, select Options. 2) Select Task-at-a-Glance Legend. Using Task Filters Filters provide you the ability to limit the tasks that are displayed on the task list, thereby, keeping the task list more manageable. Task lists can be filtered by time (to see tasks for only one day or one shift) or by status (to show only Pending tasks or all tasks). Time Frame Filter Amb_Office_PG_final_ doc Page 107 of 148

108 Tasks may be filtered so that only the tasks for a specific time frame, such as a single day or an entire week, are displayed. To change the time frame, complete the following steps: 1) From the Options menu, select Task List Properties and select Change Time Frame Criteria. 2) When the Task List Properties window is displayed, select the appropriate option from the list: Defined Time Frame - A predefined time frame, such as a shift, that has been built into the database. Hour Interval - A filter of only one hour s time. Generic Time Frame - A time frame to be defined by the user. 3) Click OK. Task Display Filters The Task Display provides a means to filter the tasks by their status. The system always displays tasks in an Overdue or In Process status. These may not be de-selected. The task types are system defined for your position. You will not need to adjust these. Show additional or different statuses by changing the filter. Complete the following steps to change the filter: 1) While in the task list, select Options from the menu. 2) Select Task Display. The Viewing window displays. Amb_Office_PG_final_ doc Page 108 of 148

109 3) Under Status, select appropriate check boxes. Unless All is selected, more than one may be checked. 4) Click OK. 5) Tasks with the selected statuses are displayed. Patient List Filter (Multi-Patient Task List Only) The Multi-Patient Task List contains the Patient List filter. This filter allows you to select which patient list displays. Complete the following steps to change the Patient List filter. 1) From the Organizer, open the Multi-Patient Task List. 2) From the Options menu, select Task List Properties. 3) Select the Patient List tab. 4) If not already chosen, select the Choose a Patient List check box and select Departmental View. Amb_Office_PG_final_ doc Page 109 of 148

110 The settings shown above on the right side under Location Filters will show tasks for all patients at all clinics. It is unlikely that you will want those settings. To see tasks for patients at your clinic: 5) If the box by UABC is blue, click it. It turns white. 6) Click the plus sign by UABC to open the tree. 7) Click the plus sign by the second UABC to open the tree that displays the list of clinics. Amb_Office_PG_final_ doc Page 110 of 148

111 8) Select your clinic by clicking the white box by the name of your clinic. The box turns blue. 9) Click OK. Charting Tasks How a task is completed depends upon its type. Some tasks require additional details to be documented on a form, such as Point of Care (POC) testing, and others require only a confirmation of completion, such as Scheduling/Precert, Amb. The system keeps track of the type of task and makes only the appropriate options available to you. To chart a task from the Single or Multi Patient task lists, complete the following: 1) Select a task. More than one task may be selected at a time if the same type of charting is going to be done. Note: To deselect a task, click it again. 2) Right click the task and select a charting type as described below. Chart Done Use this selection to perform simple charting and confirm that a task has been completed. These tasks are typically simple to-dos that do not require any added detail other than a record of being completed. Chart Details Use this selection to record further information about the task that is being addressed. These are tasks that are connected to PowerForms. For example, tasks such as POC Hemoglobin, AMB or Amb_Office_PG_final_ doc Page 111 of 148

112 a medication administration. The appropriate form displays so you can enter the additional information. Note: The appropriate Chart Done or Chart Details option will display depending on the type of task selected. You do not have to determine the appropriate action. Chart Not Done Use this selection to record that a task was not completed. You will be asked to include the reason the task was not completed. After the charting is signed, notice that the status on the Task List is Complete; however, the symbol to the left of the task indicates that the task was Not Done. Chart Not Done displays for every task status other than Completed. Unchart Sometimes it is necessary to change a task back to Pending and undo the charting. This may be necessary if charting occurs on the wrong task or the wrong patient. Uncharting a task changes the status to Pending and changes the status of any associated documentation to In Error. The Unchart option displays only when a completed task is selected. Chart Med To chart that a medication was giving in the office: 1) From the task list, right-click the medication task and select Chart Details. 2) Complete the required details and optional details as appropriate. Amb_Office_PG_final_ doc Page 112 of 148

113 3) Sign your charting by clicking the green check mark. 4) The task is now in Completed status and will disappear from the task list the next time the list is refreshed. Chart IV To chart an IV that is administered in the office: 1) Right-click the IV task and select Chart Details. The charting form will display. 2) Review the medication dosage information. 3) Record the actual Performed date/time of the medication. 4) The number 1 appears in the Bag # field. 5) Select the Site from the list. 6) Review the Volume and Rate for accuracy. 7) Click Apply. Note: A date/time column is created for the first bag. Amb_Office_PG_final_ doc Page 113 of 148

114 8) Click the Sign button. 9) The original continuous infusion task is completed and another is generated for the next action on the IV. Other Task List Actions Reschedule a Task If you are unable to complete a task at the scheduled date and time, it may be possible to reschedule it. You must reschedule a task within 72 hours of the time it was originally scheduled. 1) From the Task List, select a Pending task.. 2) Right-click the task, and select Reschedule This Task from the menu. 3) The following dialog box appears: Amb_Office_PG_final_ doc Page 114 of 148

115 4) Select the Rescheduled date and time and a rescheduling reason. 5) Click OK. The task displays with the new date and time. Create and View an Admin Note An admin note is a clinician to clinician communication, such as Do not allow the patient to walk unassisted. Only one Admin Note icon is displayed, but multiple entries may be displayed on the same note. In the example below, the Diabetes Education task has an associated admin note. To create an admin note, complete the following steps: 1) Access the Multi-Patient Task List or select the Task List component from the chart Menu (TOC). 2) Right-click the task and select Create Admin Note from the menu displayed. The Admin Note window opens. 3) Click the white box to position the cursor, and enter the admin note. (You should date entries since multiple entries can be displayed on the same note.) To clear one entry, highlight it, and press DELETE. To clear all entries, simply click Clear. 4) Click OK to save your note and to return to the Task List window. Notice that the admin note icon now is displayed in the second column, indicating that a note has been created. To view an admin note, complete the following steps: 1) Click the Admin Note icon or right-click the task and select View Admin Note. The Admin Note window opens, and the contents of the note are displayed. 2) To clear one entry, highlight it, and press Delete. To clear all entries, simply click Clear. Multi-Select More than one task can be selected and completed at a time as long as they have the same method of completion. To complete two or more tasks simultaneously, complete the following steps: 1) Select two or more tasks that have the same method of completion. In this case these tasks require documentation. Once a task has been selected, the entire row changes color, usually to white. 2) Right-click and select Chart Details. The associated forms display sequentially. Amb_Office_PG_final_ doc Page 115 of 148

116 Note: If more than one task is selected and they do not have the same method of completion, all the completion options are dithered (grayed out). Select All / Deselect All At times you will want to select all of the tasks on the task list or you want to clear all of your selections. Right-click any task and select Select All or Deselect All. Amb_Office_PG_final_ doc Page 116 of 148

117 eprescribe E-Prescribe can be used to electronically write and transmit a prescription to a participating pharmacy or a printer supplied with tamper-proof prescription paper. Non-physician staff must follow their clinic s policy regarding who is allowed to enter prescriptions and whether the prescription should be entered as a proposed or actual order. Entering a New Prescription Allergies must be recorded on a patient before a medication order or prescription can be entered for a patient. To enter a new prescription: 1) Open a patient chart and select Orders on the Ambulatory Menu. 2) Click Add to launch the order search dialog box and type drug name in Find field. 3) Validate the venue type is set to the prescription ordering conversation: Ambulatory (Meds as Rx). 4) Select the product type for the prescription and click Done to close search window. The following order detail fields can be completed and sent to the pharmacy: Name of the drug being prescribed Order Date and time (date and time the order is signed) Dose strength, volume, or free text Route of Administration Frequency Duration Special instructions Dispense quantity Requested dispense duration Amb_Office_PG_final_ doc Page 117 of 148

118 Number of refills PRN and PRN instructions Dispense as written (DAW) 5) Click in each cell (dose, route of administration, duration and refill and select desired choice from the dropdown list. 6) Type in number to dispense before the dispense type. 7) Type in Special Instructions and requested refill date if indicated. 8) Choose a route for the prescription and then click the Sign Button in the bottom right to complete the ordered prescription. Proposing Prescriptions Clinic policy may allow you to propose, rather than order, a prescription. The proposed prescription order will not print or go to a pharmacy until a person with the rights to prescribe signs the order. To propose a prescription: 1) Open a patient chart and select Orders on the Ambulatory Chart Menu. 2) Click Add to launch the order search dialog box. 3) Change the order venue to Ambulatory (Meds as Rx). 4) Type the drug name in the Find box; products will appear in the window below. Amb_Office_PG_final_ doc Page 118 of 148

119 5) Click on the appropriate product; the ordering physician window opens. 6) The order type will display as Proposal. 7) Type in the name of the doctor to authorize prescription. 8) Choose the order type Suggested. 9) Select from the order sentences (the product and preselected details) display. 10) Click OK. 11) Click Done. 12) Click in each cell (dose, route of administration, duration and refill and select desired choice from the dropdown list. 13) Type in number to dispense before the dispense type. 14) Type in Special Instructions and requested refill date if indicated. 15) Choose a route for the prescription (Information in next section). 16) Click the Sign Button in the bottom right to complete the ordered prescription. 17) Click the Refresh button. 18) The order will not display in the order window. Click the Medication List tab to view the proposed prescription. The proposed prescription is routed to the prescriber s inbox for signature and the recipient is alerted to a new inbox order. Routing Prescriptions Controlled substances cannot be routed to a pharmacy electronically; they must be printed on the prescription printer or called into the pharmacy. Amb_Office_PG_final_ doc Page 119 of 148

120 After completing the order details, choose how and where to route the prescription. Click the Select Routing button at the top of the detail window to see choices. Routing choices include: Do Not Send: called to pharmacy (Rx). Printer: Select printer from list if the prescription is for a controlled substance or if the patient wants to carry the prescription to a pharmacy Pharmacy: Select Routing. Start here to choose the pharmacy. The last pharmacy entered will appear in the selections; click to select that pharmacy or choose Other to select another pharmacy. Selecting a Printer Prescriptions must be printed on tamperproof prescription paper that is loaded into predetermined paper trays of designated printers. The printers are named with an rx prefix. To avoid confusion, printers are not listed by location. To find prescription printers: 1) Select printer from routing menu if available or click the Launch Routing Dialog button. 2) If the printer has not been saved to your favorites, click the Other Output Devices Tab. 3) Scroll to the bottom of the list and select Unknown. Printers with rx are listed in the right pane for selection. Amb_Office_PG_final_ doc Page 120 of 148

121 Adding/Selecting a Pharmacy Pharmacies can be added at any time by clicking the Patient Preferred button on the action toolbar to launch a search process. If preferred pharmacies are not entered prior to prescription entry, the ordering clinician can add a pharmacy during prescription routing. Ninety-five percent of retail pharmacies in the United States are part of the pharmacy directory from which you can choose to send an electronic prescription. 1) In Select Routing, select Other; the Prescription Routing window opens. The Patient Preferred tab is the default view when a prescription has been sent in the past. This list automatically updates when new prescriptions are sent. 2) Click the Search tab. 3) The search window opens with patient s city and state defaulted. Tips for using the pharmacy search: : Less is more. Do not try to enter the entire pharmacy name or address into the search fields. Start searching with one word from the name or just the street name. If you have a pill bottle or fax from a pharmacy in hand, search by the Street Number only. Also make sure the defaulted city and state are correct. Amb_Office_PG_final_ doc Page 121 of 148

122 If you do not have the street address and are seeing the patient, search by Pharmacy Name or search by Pharmacy Name in combination with Street Name if known. Also make sure the defaulted city and state are correct. If the patient has the pharmacy number in their cell phone, that can be used to verify the correct pharmacy if multiples are returned or if they are not sure of street. Do not enter extra street information into the address like Ave, Dr, St, etc. 4) Enter data using tips and select Search. 5) Right click on pharmacy and select Add. 6) The pharmacy will display on the Patient Preferred tab. Hover over selected line to see pharmacy details Rx Plan Eligibility Automatic checking of drug orders eligibility under the patient s insurance plan is completed at the time of orders. Using the Rx Plans functionality, you can view and select from the appropriate plans and view eligibility details. 1) Click the Rx Plans button. If there are multiple plans, select the one you want. If there is only one plan, the name will be displayed. 2) Click the dropdown arrow at the end of the plan name and click on Eligibility Details to view information about the plan. Amb_Office_PG_final_ doc Page 122 of 148

123 Formulary and Benefits Formulary status provides information about the level of coverage for a specific drug. Formulary status icons display for prescriptions and home medications on the order profile. These include: Level of preferedness Copay Restrictions Alternatives The color and text within the icon provide the most critical information. Click on the icon indicating formulary status and select see more details. Selecting the formulary details will also allow you to search for alternatives for non-formulary items. Right-click on the drug line and select Reference Information to open a link to information about the drug. External Medication History SureScripts is a clearing house for many medication insurance benefit plans. You can review the history of claims made when prescriptions are filled through this company s link to IMPACT Ambulatory. The patient s consent is required to access information from this site. To document consent: 1) Click the External Rx History button; if the patient s consent has not been documented within the past year, this message will appear. Amb_Office_PG_final_ doc Page 123 of 148

124 2) If the patient gives consent to allow access, click Consent Granted. If the patient denies consent, click Consent Denied. The external medication history will not be queried and the consent dialog box will pop up again the next time an external med history request is made. Working within the External Rx History window: The disclaimer display can be hidden by clicking the expand/collapse button and the view you select will be the future default display. 2. Select the date range to display from 3 to 24 months by clicking the dropdown arrow and making your selection. 3. Click Show Individual instances to change the display. When this option is checked, same orders are displayed together. 4. When the window is opened, only the first 100 items are loaded. Click Show More Medications to load additional items. Amb_Office_PG_final_ doc Page 124 of 148

125 Convert External Rx History to Active Prescription 1) Right-click over an item on the External Rx History and Select Convert to Prescription. 2) Select Orders for Signature at bottom right 3) Select Sign Create a Prescription from Favorites You can add a prescription to your Favorites Folder by right-clicking the prescription order before it is signed and selecting Save to Favorites. To use the order saved to the Favorites folder for a future prescription: 1) Click on the order in the Favorites Folder. 2) Click Done. 3) Review and change any details needed. 4) Review and change routing as needed. 5) Click Sign. Activating a Proposed Prescription When a prescription is proposed, the proposal is routed to the inbox of the person named in the Ordering Physician field. The notification toolbar is updated to alert you to a new message. You can click on the Order icon to open the orders to approve window.. In this example, there are two proposed orders Amb_Office_PG_final_ doc Page 125 of 148

126 1) Double-click the line you wish to view. 2) Choices for action are: Click to Accept and click the Sign button that appears, or Click to Reject and provide a reject reason on the screen that opens, or Click to Accept with Modify to open the prescription detail field 3) After taking action, click Refresh. 4) Order will display with status of ordered in Medication List Window. Right-click and select Order Details, then History to see details of proposal and order action. Amb_Office_PG_final_ doc Page 126 of 148

127 Reprint a Prescription Limited positions have the ability to reprint a prescription. To complete this task: 1) Right-click on the order you want to reprint. 2) Click Resend from the list. 3) Select one of the Send to menu options in the Prescription Routing window: Pharmacy, Do Not Send, or Print. 4) Click OK. Amb_Office_PG_final_ doc Page 127 of 148

128 Depart Process Once the patient had been assessed and care has been given, it is time to begin the Depart process. This process includes but is not limited to: Performing a patient task review Completing documentation Reviewing the medication list Creating prescriptions Specifying follow-up instructions Printing the Patient Summary This section focuses on those activities that are accomplished by clicking toolbar. on the Note: You may need to click the down arrow on the far right of the tool bar to see this button. Follow-Up Each clinic will decide whether to use the Follow-Up feature in IMPACT. You may continue to use the appointment card or hand-write on the printed depart summary. If you want to include follow-up instructions in the Patient Summary: 1) Click the button on the toolbar. 2) In the navigator on the left, click next to Follow-up date 3) Verify that you are on the Follow Up tab. 4) Complete the Who, When, and Where sections. 5) Add a comment if desired. Amb_Office_PG_final_ doc Page 128 of 148

129 6) Click Print to print a copy of the follow up instructions for the patient. 7) Click Sign to include the follow up instructions in the Patient Summary. Patient Summary Once you have completed all the items in the bulleted list above, you are ready to print the Patient Summary. 1) Verify that the information in the Patient Summary is complete and accurate. Amb_Office_PG_final_ doc Page 129 of 148

130 2) If appropriate, click the box in the lower left hand corner indicating that the Patient verbalizes understanding of instructions given. 3) Click Print to print a copy of the Patient Summary for the patient. 4) Click OK. Medication Reconciliation At the time of this writing (3/14/2011), the only part of Medication Reconciliation that will be done in an Ambulatory clinic is Meds History. This is done by documenting medications taken at home. See Documenting Historical/Home Medications in the Medication List section for detailed instructions. Only physician-type providers will see this status bar. Amb_Office_PG_final_ doc Page 130 of 148

131 Message Center The Message Center enables you to review or sign results, documents, orders, and prescription requests, as well as work with phone and other messages. All positions can use the Message Center to work with phone and other messages, such as reminders. Note: The words Inbox and Message Center are referred to interchangeably throughout this document. Message Center Basics The navigator on the left is the Inbox Summary and the larger pane on the right is the Summary Pane/Workspace. Inbox Summary Summary Pane/workspace Basic Navigation You can move between folders in the Message Center items using one of the following methods: Use the Inbox Summary to find and view individual messages. With a message open, click or to move to the previous or next message. Click Accept & Next or OK & Next after viewing the message or notification. Searching For Messages in a Specific Date Range Amb_Office_PG_final_ doc Page 131 of 148

132 Set the date range in the Inbox Summary using one of the following methods: Select a predefined date range from the Display list. Click the ellipsis next to the display list, enter a beginning date, and click OK. Creating a New Message To create a new message, complete the following steps: 1) Click on the Action tool bar or on the Inbox tool bar. 2) Enter the patient s last name in the Patient box and click. The Person Search window opens. 3) Select the correct patient, the correct encounter, and click OK. Note: Each patient will have a Documentation encounter that will be used for between-visit care. Pick that encounter if your communication does not apply to a particular clinic visit. 4) The patient s name will automatically be entered in the Caller box. If the caller is not the patient, enter their name and phone number in the Caller and Caller # fields. 5) Enter the recipient(s) in the To and CC boxes by entering the first few letters of their last name and clicking or ENTER. To include yourself, select Include Me. 6) In the Subject box, select Phone Message or Clinic Message. 7) Type the message. Note: As you become more experienced with Message Center, you may want to explore the use of templates. Click available. 8) If necessary, set a reminder or due date for the message. 9) Select any additional messaging options. 10) When you have completed the message, click Send. on the Message toolbar to see what templates are Amb_Office_PG_final_ doc Page 132 of 148

133 Additional Options when Creating a Message The following options are available when creating a new message: Urgency: Clicking marks the message as urgent. Notify: Allows you to request a notify receipt to be generated when a message is overdue or opened. Message Journal: Clicking opens the Message Journal, allowing view all Inbox messages recorded for this patient. Include Me: Forwards a copy of the message to your Inbox. Save to Chart: Saves a copy of the message to the patients chart. Actions: Allows you to select a follow-up action. Remind On: Allows you to set a reminder date/time. The message appears in italics when the remind date/time is reached. Due On: Allows you to set a due date for the message. Messages with past their due date are indicated in red and moved to the Priority folder. Replying to Messages To reply to a message, complete the following steps: 1) Open and read the message. 2) Click either Reply to reply to only the sender or Reply All to reply to the sender and all recipients of the message. 3) Compose the message. 4) Select any additional messaging options. 5) Click Send. Forwarding Messages 1) With the message open, click Forward. 2) Click next to the To box. 3) Select a recipient and click OK. 4) Compose the message. 5) If you would like to save a copy of the message to the patient s chart, click Save to Chart. 6) Select any additional messaging options. Amb_Office_PG_final_ doc Page 133 of 148

134 7) Click Send. Note: You can also forward a message directly from the list of messages displayed in the Message Center workspace without opening it by selecting the message in the notification list and clicking Forward. Deleting Messages Messages can be deleted in one of two ways: Select the message you want to delete from the message list in the Message Center workspace and click. With the message open, click. Note: Deleted messages are sent to the Messaging Trash folder and can be recovered until the Messaging Trash folder is emptied. Signing Documents Documents that require your review or signature are displayed in the Inbox Summary. Notifications that require your signature include transcribed documents, saved documents, as well as documents forwarded to you by another provider. To sign or review a notification, complete the following steps: 1) Open and read the message. 2) Review the notification and select Sign. Note: Documents can be modified prior to signature. 3) Click OK or OK & Next. Medication Renewals/Refills When a patient or pharmacy calls to request a refill you can easily document the request as an Inbox message and forward it to the appropriate clinician for approval. Similarly, clinicians can create and sign their own refills or approve, modify or refuse refill requests that are called in. Requesting a Medication Renewal (Non-Physicians) If a pharmacy or patient calls to request a medication renewal, you can document the phone call and request the refill using Inbox messaging. The refill request is then forwarded on to the patient s physician for approval. It is also possible to propose an order for acceptance by the physician. Amb_Office_PG_final_ doc Page 134 of 148

135 To renew a patient's medication while creating a message, complete the following steps: 1) Click on the Action tool bar or on the Inbox tool bar. 2) Enter the patient s last name in the Patient box and click. The Person Search window opens. 3) Select the correct patient, the Documentation encounter, and click OK. 4) The patient s name will automatically be entered in the Caller box. If the caller is not the patient, enter their name and phone number in the Caller and Caller # fields. 5) Enter the recipient in the To and CC boxes by entering the first few letters of their last name and clicking or ENTER. Note: If you would like to be copied on the message, select Include Me. Select the Phone Into Pharmacy option if appropriate. 6) Enter the message in the Message box. 7) Click Med List. 8) Select an existing medication right click and select Renew. 9) Click Sign. 10) Click Send. 11) The request is forwarded to the patient s physician for approval. Note: The status of this request is Proposal until it is signed by the physician. Requesting a New Medication (Non-Physicians) If a pharmacy or patient calls to request a new medication, you can chart the medication, as well as the phone call, directly from the Inbox. To chart a new medication compete the following tasks: 1) Click on the Action tool bar or on the Inbox tool bar. 2) If the patient s name is not already indicated in the Patient box, enter the first few letters of their name click ENTER. Select the patient and click OK. 3) By default, Caller and Caller # are filled in automatically. 4) Enter the approving clinicians name in the To box. Note: If necessary, repeat the above process for the cc box. If you would like to be copied on the message, select Include Me. If you would like to forward a copy to the consumer, select To Consumer. 5) Enter the message in the Message box. 6) Click Med List. Amb_Office_PG_final_ doc Page 135 of 148

136 7) Click Add. 8) Search for and select the medication. 9) Fill out the required order details. 10) Click Sign. 11) Click Send. Note: The status of this request is Proposal until it is signed by the physician. Approving a Refill Request Note: This feature will not be turned on for 6 months from the time of this writing (1/12/2011). To approve a refill request, complete the following steps: 1) Double-click Renewal Requests in the Inbox Summary. 2) Select a request and double-click to open it. 3) Review the request. 4) Select a Routing option. 5) Click Accept or Accept All & Next to approve the request. 6) Click Sign. Refusing a Refill Request To refuse a refill request containing proposed orders, complete the following steps: 1) Double-click Renewal Requests in the Inbox Summary. 2) Select a request and double-click to open it. 3) Review the request. 4) Click Reject or Reject All & Next. 5) Select a Reject Reason or enter a Freetext Reason. 6) Click Sign. Modifying a Refill Request To modify a refill request, complete the following steps: 1) Double-click Renewal Requests in the Inbox Summary. 2) Select a refill request from the list view and double-click to open it. 3) Review the request. 4) Click Med List. Amb_Office_PG_final_ doc Page 136 of 148

137 Note: If multiple medication refills are requested, you can accept, reject or modify them individually. 5) To refuse a medication order, right-click the medication and select Reject. 6) To modify and accept a medication order, right-click the medication, select Accept with Modification and modify the order. 7) Click Sign. Approving a New Order Proposal To approve a refill request, complete the following steps: 1) Double-click Proposed Orders in the Inbox Summary. 2) Select a request and double-click to open it. 3) Review the request. 4) Click Accept or Accept All & Next to approve the request. Results The Results folder contains normal and abnormal results that require physician review. Results in this folder can be signed, refused, or forwarded to another clinician or to the patient. Viewing a Result Complete the following steps to view a result: 1) Navigate to the Results section in the Inbox Summary. 2) Double-click a result or select the result and click Open. 3) View the result. 4) Sign, refuse, forward, or forward the result without signing it. Depending on site configuration, you may need to scroll to view all results before signing. Signing a Result To sign individual results, complete the following tasks: 1) Navigate to Results folder in the Inbox Summary. 2) Double-click a result or, or select it and click Open. 3) Review the result. 4) Verify that the Sign radio button is selected. 5) Enter any comments. 6) Click OK or OK & Next. Amb_Office_PG_final_ doc Page 137 of 148

138 Forwarding a Result without Signing or Refusing It (Forward Only) IMPACT allows you to forward a result to another clinician without signing or refusing it. For example, if you are a medical student or nurse, you could forward a result to a physician for their review and signature. To forward a result without signing it, complete the following steps: 1) Open the Result. 2) Review the content and click Forward only. 3) Select an option from the Additional Forward Action list. 4) Select recipients from the To: list. 5) Enter any comments. 6) Click OK. Signing and Forwarding Results You can sign a result and then forward it on to another clinician. To forward a result after signing it, complete the following tasks: 1) Open the Result. 2) Review the content. 3) In the Action pane, select Endorse. 4) Select an option from the Additional Forward Action list. 5) Select any recipient(s) from the To: list. 6) Enter any comments. 7) Click OK or OK & Next. Refusing a Result To refuse a result, complete the following steps: 1) Open the Result. 2) Review the Result and select Refuse. 3) Select a reason for refusal. 4) Enter any comments. 5) Click OK or OK & Next. Generating a Patient Result Letter To create a patient letter that incorporates results: 1) Navigate to Results folder in the Inbox Summary. Amb_Office_PG_final_ doc Page 138 of 148

139 2) Double-click a result or select it and click Open. 3) Click the down-arrow by Create and select Letter. 4) Type your message in the Patient message field. Note: The template includes a salutation and statement about the inclusion of results. 5) Results from the opened Message Center display in the Results to Include pane. 6) To include additional results, click the Add Results icon and from the All Results section that displays, place checkmarks by the results you want to include and close the All Results section. 7) Place checkmarks by the results you want to include in the letter and click the Include Selected button or to include all results displayed, click Select A.: 8) Click Preview to review the letter. 9) Select Cancel to close the preview window. 10) In the Action Pane, select Print Now to print, or Do Not Print Now. Note: You can print to a local desktop printer. A Cerner Network printer is not required. Note: From the Action pane, you can forward the letter to another Message Center user and add a comment or instructions. The comments will not appear on the letter. Orders (Cosign and Refuse) Orders to Approve are orders placed by non-physician users and require co-signature from a physician. Note: If an RN user places an order, it becomes a co-signature item for the provider specified in the order. If a medical student places an order, it becomes a Medical Student Order, which has an on-hold status until signed by a physician. Approving Orders To sign an Order to Approve, complete the following steps: 1) Open the Order to Approve. The Order Information window opens. 2) Click Approve or Refuse. If approved, a statement is added to the patient's chart, stating you cosigned the order, and the Order Information window closes. 3) Click OK or OK & Next. Refusing Cosign Orders To refuse an Order to Approve, complete the following steps: 1) Open the Order to Approve. The Order Information window opens. Amb_Office_PG_final_ doc Page 139 of 148

140 2) Select Refuse and select a reason for your refusal. A statement is added to the patient's chart, stating you refused to cosign the order. 3) Click OK or OK & Next. Note: Refusing to cosign an order that is not a med student order does not stop or cancel it. Proxy Authorization Granting proxy authorization enables another provider to access your Inbox and work with it as your proxy. Additionally, you may be able to take proxy from another provider and access their Inbox as their proxy. Your proxy can perform any activities for which you have granted them authorization, such as signing, refusing and forwarding messages and results. When granting proxy authorization, you specify the provider, the specific Inbox folder(s) to which you wish to give proxy as well as the effective dates for the proxy. As a proxy to another user s Inbox you have access to the folders and functions that have been granted to you. The proxy Inbox has the same look and feel as your Inbox, except that all actions that you take are on behalf of the individual for which you are proxy. Note that any activities that you perform as a proxy are logged. If you have proxy access to a provider s Inbox, you will have the ability to endorse lab results and respond to messages. Each clinic will decide who will actually do this. Even though you have the ability, you should only endorse results or respond to messages when instructed to do so. You will also see orders to approve (cosign) and proposed orders, but you will not be able to sign or activate them. You will not be able to sign PowerNotes. You will see Consult orders if that consult service inbox has been proxied on the inpatient side. Granting Proxy Authorization Granting proxy authorization to another provider or provider group enables the proxy to perform any activities for which you have granted them authorization, such as signing, refusing and forwarding messages and results. Amb_Office_PG_final_ doc Page 140 of 148

141 To grant proxy authorization to another provider, complete the following steps: 1) From the Proxies tab in the Inbox Summary, click Manage and click the Manage Proxy tab. 2) Click Add. 3) From the User list select the user that you want to give proxy to. 4) To grant proxy to more than one user use the arrow to move the current user to the additional user's box and continue searching. 5) Specify a Start Date/Time and End Date/Time. For example, if you will be out of the office for two weeks, specifying the Start Date/Time and End Date/Time ensures the proxy will be able to access your Inbox messages during that period only. Note: The default length of a proxy authorization is 1 month. If you want to authorize proxy for a longer period of time, be sure to adjust the End Date/Time. 6) To grant all permissions to the selected user, click the Grant All. To grant selected permissions to the proxy, select the permission and click Grant. 7) Click Accept & Next. 8) Click OK. 9) In the Commit Progress dialog box, click OK. Updating Proxy Authorization Once you have granted proxy authorization, you can update the proxy as necessary. Complete the following steps to update a proxy that has been previously configured. 1) From the Proxies tab in the Inbox Summary, click Manage and click the Manage Proxy tab. Amb_Office_PG_final_ doc Page 141 of 148

142 2) From the Proxy list, select the proxy you want to update and click Details. 3) Modify the proxy as needed. For information on the options that can be configured, click here. 4) Click Accept & Next. 5) Click OK. 6) In the Commit Progress dialog box, click OK. Viewing Messages as a Proxy To access an Inbox to which you have proxy, complete the following tasks: 1) Click the Proxies tab in the Inbox Summary. 2) From the Proxy list, select the name of the user s Inbox you want to work with. The folders to which you have been given proxy authorization are displayed in the Inbox Summary. At this point, you are able to complete all of the tasks for which you have proxy rights. Note: If you sign an Inbox item as a proxy, the signature will state you have signed on behalf of the individual s Inbox you have proxied. If you review an item and want to leave it for the original provider to review as well, close the notification or move to the next Inbox item. Do not sign, refuse, or forward the notification. 3) When you are finished working in the proxy Inbox. Click the Inbox tab in the Inbox Summary. Your Inbox folders are displayed. Viewing Proxy Authorizations Granted to You To view a list of all providers and document types for which you have been granted proxy authorization, complete the following steps: 1) From the Inbox menu, click Manage. 2) Click the Received tab. 3) The users displayed in the Proxies Received by Me pane are authorizations that have been granted to you. 4) To view detailed information about the privileges granted by a particular user, select user and click Details. Amb_Office_PG_final_ doc Page 142 of 148

143 Viewing Proxy Authorizations that you have granted To view a list of all individuals to which you have granted proxy authorization, as well as specific permissions of each authorization, complete the following steps: 1) From the Proxies tab in the Inbox Summary, click Manage and click the Manage Proxy tab. 2) All proxies that you have granted are listed in the Proxies Given By Me pane. 3) Select the proxy that you would like to view and click Details. The specific permissions that you have granted are displayed. To Steal a Proxy Taking or stealing proxy authorization from another provider enables you to review, sign, refuse, and forward messages for them. To steal a proxy, follow these steps: 1) From the Proxies tab in the Inbox Summary, click Manage and click the Manage Proxy tab. 2) Click the Received tab at the bottom left of the screen. 3) Under the Proxies Taken By Me pane, click Add. 4) In the User search box, type the name of the user that you want to get access to. 5) Click the Search button (binoculars). 6) Select the user that you want to take proxy from. 7) Click Grant All or select the particular items you need... Note: The system automatically sets up the Consult for a month; you can change the length of time as desired. 8) Click Accept & Next. 9) Click OK. 10) In the Commit Progress dialog box, click OK. Amb_Office_PG_final_ doc Page 143 of 148