PowerChart and Inbox. Inpatient Physician Training Guide

Transcription

1 PowerChart and Inbox Inpatient Physician Training Guide

2 Table of Contents 1. Introduction... 6 What to Expect... 6 Instructional Goal... 6 Learning Objectives... 6 Course Length... 7 Evaluation... 7 Information Security and Confidentiality... 7 Tips and Tricks... 8 Cerner Application... 8 Help Files... 8 Solution Terms... 8 Solution Icons... 9 Terms with Which to be Familiar... 9 Review of Windows Terminology Getting Started Log On at Go-Live Log Out PowerChart Introduction Benefits of PowerChart The Two Main Parts of PowerChart The Organizer The Patient Chart Patient Lists Building a Patient List Building a Location List Add Provider Group List Building a Custom List Adding Patients to a Custom List Printing Patient List Removing a Patient List Deleting a Patient List Page 2 of 89

3 Inpatient Consult Process PowerChart Overview Menus Organizer Toolbar Action Toolbar Collections Inquiry Documents Clinical Calculator Patient Toolbar Patient Defining Area Recent Person Search Box Previous/Next Chart (available within the Chart) Refresh Button Menu (TOC) Pin and Unpin From the Toolbar Chart Basics Locate and Open a Chart Open a Chart from the Patient List Close a Chart Search for a Patient Select Correct Encounter Demographic Bar Name Hyperlink Allergy Hyperlink Chart Components Rounds Summary Report Print Rounds Summary Report Print Patient Face Sheet Results Review Using a Flowsheet Result Legend Changing Search Criteria Page 3 of 89

4 Page 4 of 89 Using Different Formats Refreshing the View Specialty FlowSheet Views Graphing a Patient s Test Results View PACS Image Intake and Output Notes Sort By Open a Clinical Note Right-Click Options Overview This Visit Since Last Time Patient Summary Review Chart Documents Encounters Orders (Non Med) Results Growth Chart Patient Information Patient Demographics Visit List Patient Provider Relationship Summary Scheduling Inquiry MAR MAR Summary Time Interval Settings MAR Summary Display Allergies Allergy Profile Basics Allergy Profile Options Right-Click Menu Options Documenting Allergies... 61

5 Adding No Known Allergies Adding an Allergy Using the Search Tab Adding an Allergy Using the Catalog Tab Unable to Obtain Modify an Allergy Allergy Favorites Orders Basics Navigator Overview Order Profile Overview Applying Filters Customize View Orders Buttons and Icons Order Statuses Medication List Print Medication Reconciliation Forms Medication Reconciliation Process Inbox Working with Documents Viewing a Document Signing a Document Signing and Forwarding Documents Forwarding a Document without Signing or Refusing It (Forward Only) Refusing a Document Modifying a Document Using Proxy Update Proxy View Proxies Given to You Appendix A: Using Cerner Help Appendix B: Using Cerner Millennium Support Guides Page 5 of 89

6 1. Introduction Welcome to the Inpatient Physician PowerChart training course. The purpose of this course is to teach you how to use Cerner Millennium Care Excellence solutions. During this course, you will view several demonstrations, and practice different scenarios that simulate your day-today workflow. This reference guide was designed to help you learn to navigate the patient s chart. Most, but not all, of the information in this guide will be covered during your training course. Some sections have been added for reference purposes. This guide includes pictures of various windows to familiarize you with information placement. These are only a small sample of the windows you will use. As you move through the guide, you might see repetitive information. This is intended to assist you in selecting the proper solution for the task you are doing. What to Expect This learning event is based on the principle of learn-by-doing. This performance-based approach acknowledges that you are responsible for your own learning and that practicing the tasks you need to learn is more effective than listening to a lecture or only watching a demonstration. For this approach to be successful, however, you must understand and involve yourself in the learning process. You might be asked to think and reason through situations that are new to you. Use the resources that are available to you and ask the instructor or super user for assistance or clarification as needed. Instructional Goal As a result of this course, participants will be able to use the appropriate Care Excellence solutions to perform activities in support of patient care including: electronic medical record retrieval, review of patient data, and review of transcribed documentation. Learning Objectives At the end of this course, class participants will be able to: Log on to PowerChart at HRMC. Navigate and use the tabs in the Organizer. Locate and open patient charts using a variety of techniques. Page 6 of 89

7 Review information in patient charts (Vitals, Labs, Reports, Medication History, Nursing Assessments). Sign, Review, and Forward Transcribed documents. Course Length This course is designed to be two hours. There are also open lab hours held in the Physician Lounge each week day if you would like to sign up for 1:1 assistance. Evaluation In this performance-based learning event, the instructor will evaluate your work and provide feedback as you go along to ensure that you learn from each activity. To complete this course, you must: Complete all course activities. Complete the course assessment with a score of 80% or higher. Information Security and Confidentiality When dealing with computerized healthcare records, specific confidentiality and security issues must be followed to protect the patient. There are increasing HIPAA and JC regulations that dictate how these records are handled. When selecting a password, do not choose anything obvious, such as your birth date, Social Security number, or spouse and children s names. Do not tell anyone your password. The system will require you to change your password every ninety days. The password will be at least eight characters long and must contain 1 numeral and 1 special character. When you open a chart you will be asked to identify your relationship to the patient, for example Admitting Physician or Consulting Physician. The system keeps an audit trail, or record, of who enters each chart and when. It records who read the chart and who recorded each piece of information in the chart. Security has been designed so that employees can only perform functions within the system that are necessary for their position or role. Also, employees are only able to view data that is necessary to perform their job. For example, a lab technician has the ability to Page 7 of 89

8 utilize all of the functions within the PathNet solution, but an ED nurse does not have that ability. Never leave the computer while still signed on. Never access any charts that do not apply to your current job and caseload. Each facility has its own specific confidentiality and information security policy. It describes the repercussions of not following these rules. All Adventist employees should follow AHC Administrative P 6.1 Information Systems Security, Confidentiality and Password Assignment. Tips and Tricks Cerner Application These are some tricks to use when you are in the Cerner Application: Press and release the right mouse button and see if any of the menu items apply. Use your cursor to hover over the buttons to see the button names. If a single-click does not work, try a double-click. Use the TAB key to navigate to the next box. In lists, type the first letter of the item you want to find. Help Files From the menu bar, click Help, to access Help for the application. Solution Terms In the Help table of contents, located in the left pane of the application s Help viewer, expand the Glossary book, and then select the Glossary topic to display the glossary in the main pane of the Help viewer. Select the first letter of the term you want defined, then click the term to display the definition. Throughout Help, words in green font with a dotted underline indicate terms with definitions. Click a term in green, dotted underlined text to display the term s definition. Page 8 of 89

9 Solution Icons Solutions use unique icons to designate buttons that have specific functionality. To view the icons and their meanings for a particular application, open the table of contents, located in the left pane of the application s Help viewer. Expand the Menus and Toolbars book, and then select the Toolbar topic to display the application s icons in the main pane of the Help viewer. Notes Terms with Which to be Familiar The following terms may be used in this guide and in the class sessions. Active window The window selected for current work. You can identify the window as active by looking at the top bar it should be a dark blue. Click To tap on a mouse button, pressing it down and then immediately releasing it. Note that clicking a mouse button is different from pressing (or dragging) a mouse button, which implies that you hold the button down without releasing it. Context menu Available when you right-click text, objects, or other items. Cursor The flashing marker that tells you where you are on the screen. Default Preset information in the system that automatically appears when you sign on to the system or when you access certain cells that must be completed. Demographics Patient information. Double-click Tapping a mouse button twice in rapid succession. Note that the second click must immediately follow the first; otherwise the program interprets them as two separate clicks rather than one doubleclick. Episode or encounter A patient interaction with the healthcare system. An episode or encounter can happen as an inpatient, an outpatient, with a clinic visit, or in the emergency department. Left-click To click the left mouse button. When instructions call for a screen object to be clicked, a left-click is what is meant. Maximize Located on the menu bar or title bar of the active window, it is used to maximize the window. Menu Displays a list of commands. Some of the commands have images next to them so you can quickly associate the command with the image. Menus are located on the menu bar at the top of the viewing window. Page 9 of 89

10 Minimize Located on the menu bar or title bar of the active window, it is used to minimize the window to a button on the Windows taskbar. Mnemonic In general, a mnemonic is an acronym or abbreviation for a much longer piece of information. The mnemonic format should be based on a standard established by the organization. Mouse A device used to move the cursor around on the screen. Patient demographics Information defined for the person or episode. Demographic information includes the current location (nursing station, room, and bed, for example), age, birth date, gender, and maiden name. PC A personal computer. Queue One or more items waiting to be acted on by the computer. Right-click Click the right mouse button. A right-click opens the Context menu with a list of options. Scroll bar Located on the right and bottom of some screens and is used to adjust the view on screen. Shortcut Menu Available when you right-click text, objects, or other items. Title bar Located at the top of the each window and is used to identify in which window you are currently working. Toolbar A toolbar can contain buttons with images (the same images you see next to corresponding menu commands), menus, or a combination of both. Page 10 of 89

11 Review of Windows Terminology PowerChart is based on the Microsoft Windows style. See the diagram below to review some basic terminology. If you are not clear on how to use Windows, speak with your manager or instructor. Title bar Maximize Close Menu bar Minimize Toolbar Status Page 11 of 89

12 2. Getting Started Log On at Go-Live Follow this procedure to log onto the system at Go-Live: 1) At the Main Menu, double-click the PowerChart icon. 2) At the Cerner log-in, type your user name in the User Name box. 3) Press the TAB key to move to the next box and type your password into the Password box. 4) Click OK or press the ENTER key. Page 12 of 89

13 Log Out Notes When you have completed your activities, remember to log out of the application you are working on for security purposes. Click from the menu. If the Exit Application window opens: The first option available allows you to prepare the application for the next user. This will return the screen to the Log On window and place the cursor in the User Name box. The second option, RECOMENDED, will completely shut down the application. Select Don t ask me this again Click on YES Page 13 of 89

14 3. PowerChart Introduction PowerChart is the automated solution customized to the needs of healthcare providers that facilitates the accurate and timely charting of patient data. As part of Cerner Millennium, each patient's medical record is instantly available online, and various displays regarding the patient's status are placed at your fingertips. At the same time, the confidentiality of the patient is protected by security safeguards. For example, the data display is governed by your privileges and relationship with the selected patient. If you do not have the qualifications to view a patient's data, it is not displayed for your log on. Use PowerChart as a tool to access patient lists, view pertinent patient information such as demographics and results, and, if you have been granted the proper security, perform functions that support clinical practice such as entering clinical documents. PowerChart is designed to operate in two main divisions or views: the Organizer and the Patient Chart. The Organizer allows you to access patient charts by Patient List, Patient Access List, or the Multi-Patient Task List. The Patient Chart view is equivalent to a physical paper chart. Your access will depend on your professional role and the security assigned to your position. Therefore, what you see when you begin working may vary from the screen prints in this guide. Benefits of PowerChart One of the basic advantages of using PowerChart is the ability to access a patient chart from multiple computers in the organization. In addition, multiple users can access the same chart at the same time. This decreases the number of times needed to manually step through the process of requesting a chart. Charts do not get lost or misplaced. Patient information and results are updated in real-time. Earlier detection of negative patient trends is possible due to the availability of results from all settings of care. The point and click windows format makes the Cerner system easier to learn, because it does not require the memorization of multiple keyboard strokes and abbreviations. Available access to the patient chart from anywhere with computer and internet access. Ability to print: Patient Lists, Rounds Summary Report (current Vitals, Allergies, Meds), Face Sheet, and Medication Reconciliation form. Page 14 of 89

15 The Two Main Parts of PowerChart Notes The Organizer The Organizer is like a chart rack holding multiple medical records. This is an example of the first screen displayed when a physician logs in to the system. Menu Organizer Toolbar Component Toolbar Patient Defining Area Last Refresh Component Workspace The Patient Chart Individual patient medical records are like single patient charts. This is an example of the first screen displayed when a physician opens a chart. Your view may vary. Patient Toolbar Demographic Banner Table of Contents (TOC) Patient Defining Area Last Refresh Quick Add In this lesson you will learn more about the toolbars and the use and importance of some key buttons. Page 15 of 89

16 4. Patient Lists What you see in the Organizer depends entirely on what patient lists you are using. It may seem a little early to jump right in and start building lists, but doing this first will help you understand why you are seeing what you are seeing when you select a particular view in the Organizer. You will be able to correctly: Build a location list Build a custom list Add patients to a custom list Remove a patient list Delete a patient list Building a Patient List Organize patient charts in a way that is useful to you by building patient lists. You can update your custom patient lists quickly by adding and removing patients as often as you like. Building a Location List The patients on a location list depends entirely on who is admitted to the chosen location. The system does not allow you to manually add or delete patients from a location list. To build a location list complete these steps; 1) Click Patient List on the Organizer toolbar. 2) Click the List Maintenance button. 3) Click New to activate the List Maintenance Wizard. 4) Select Location and click Next. Page 16 of 89

17 5) Click the plus + sign next to Hackettstown Regional Medical Center to open the menu tree. 6) Repeat the previous step, click the plus + sign next to Hackettstown Regional Medical Center to open the menu tree. This will now show the different locations within the hospital that can be added to your patient list. 7) Use the scroll bar to move down the list. 8) Select the unit and click Finish. Page 17 of 89

18 9) Select the new list in the Available Lists box and click the right blue arrow to move the new list to the Active List box. 10) Click OK to save your changes and return to the Patient List view. 11) You should now see a tab in the patient list organizer view for each active list. Note: To find patients in the Emergency Department, add the location HED. Add Provider Group List 1) Click Patient List on the Organizer toolbar. 2) Click the List Maintenance button. 3) Click New to activate the List Maintenance Wizard. 4) Select Provider Group. 5) Click Next. Page 18 of 89

19 6) Use the scroll bar to move to the right of the list. 7) Select Hospitalist. 8) Click Finish. 9) Select the new list in the Available Lists box and click the right blue arrow to move the new list to the Active List box. 10) Click OK to save your changes and return to the Patient List view. 11) You should now see a tab in the patient list organizer view for each active list. 12) Click Attending Physician to sort the columns alphabetically. Page 19 of 89

20 Building a Custom List 1) To begin building a custom list, click the List Maintenance button. 2) Click New to activate the List Maintenance Wizard. 3) Select Custom and click Next. 4) Type your name for this list. (example: Ken s List) 5) Click Finish. 6) Select the new list in the Available Lists box and click the right blue arrow to move the new list to the Active List box. 7) Click OK to save your changes and return to the Patient List view. Adding Patients to a Custom List You need to add patients to the custom list manually. If there are patients on a location list that you want to add to your custom list, follow these steps: 1) Click the Location List tab. 2) Select a patient name and click the Copy button on the Patient List toolbar. You can also right-click the patient and select Add to patient list > your patient list. Page 20 of 89

21 3) Click your custom tab. You could have named it anything. In this example, it is called Custom. (Ken s List your name) 4) Click the Paste button on the Patient List toolbar. If you added the patient through right-clicking, click the Refresh button instead of the Paste button. 5) The selected patient is added to your custom list. If you want to add patients that are not on another list, follow these steps: 1) Click the Custom tab. 2) Click the Add Patient button on the Patient List toolbar. 3) Search for the patient. Page 21 of 89

22 Patient Name Patient Encounter (Visit) 4) Select the correct encounter and click OK. 5) The patient is added to your custom list. Note: Patients must be manually removed from the custom list. Discharged patients will remain on the list. Printing Patient List 1) Click the Patient List tab you want to print. 2) Click Task from the menu. 3) Click Print. 4) Click Print again. 5) Select a Printer from the list. Page 22 of 89

23 6) Click OK. Removing a Patient List When you remove a patient list, you no longer see the tab in the organizer, but the list is still available to you for future use should you once again activate it. 1) To remove a patient list, click the List Maintenance button. 2) Select the list from the Active Lists box. 3) Click the left blue arrow to move the selected list from the Active Lists box to the Available Lists box.. 4) Click OK to return to Patient Lists. Deleting a Patient List You can delete patient lists that you no longer use. A deleted patient list is destroyed and must be reinstated to be used again. To delete a patient list, perform the following steps. 1) To delete a patient list, click the List Maintenance button. 2) Select the list from the Active Lists box. 3) Click the left blue arrow to move the selected list from the Active Lists box to the Available Lists box.. 4) Right-click the list in the Available Lists box and select Delete Patient List. 5) Click Yes in the Delete List dialog box. 6) Click OK to save the change and return to the Patient List view. Page 23 of 89

24 Inpatient Consult Process Page 24 of 89

25 5. PowerChart Overview Menus The gray bar just below the PowerChart Organizer window title is the menu bar. Click any menu to reveal more options. The following menus are available: Task menu Edit menu View menu Patient menu Chart menu Patient list Help menu Organizer Toolbar The next toolbar is the Organizer toolbar. The Organizer toolbar contains the Organizer components defined for your position by your organization s database administrator. The display order of the buttons is also determined by your database administrator. Elements on the Organizer toolbar may include the Patient List and Inbox buttons. Action Toolbar The Action toolbar consists of the buttons that enable you to perform additional actions or use other Cerner Millennium components such as: AdHoc Charting, Medication Administration Wizard, Clinical Calculator, Change User, Suspend, Exit, Collections Inquiry, Documents and others. If the button you need is not visible, click the down-pointing arrow on the far-right of the toolbar. Note: Change User allows you to leave PowerChart and display the Cerner Millennium log-on screen ready for the next user. But this is not the recommend procedure. Exit the application by clicking the Exit button. Collections Inquiry This inquiry provides you with collection information and allows you to reprint lab labels on the unit. Page 25 of 89

26 Documents At times it may be necessary to reprint patient documents such as face sheets, wristbands, and labels on demand. This may happen if, for some reason, the original document did not automatically print where you needed it or if the document was damaged. Clinical Calculator There are approximately 30 pre-built formulas in the clinical calculator. One reason you might access the calculator is to convert inches to centimeters or pounds to kilograms. To access the calculator: 1) Click the Calculator. 2) Select from the formulas in the Identify Formula list. You will then only need patient information to complete the calculations. 3) Enter formula information. Type this in with the keyboard or click the number buttons on the right. Page 26 of 89

27 4) Calculations are displayed as the required information is entered. Note: Doing a calculation such as Pounds to Kilograms will not automatically populate the Kilogram weight into any box. If you have any doubt about remembering the calculation result, be sure to jot it down. Patient Toolbar The Patient toolbar consists of the list of charts that are currently open. The following are features and limitations of the Patient toolbar: You may have up to four charts open at one time. To make another patient chart active click the patient identifier in the Patient toolbar. Close the patient chart by clicking the X in the upper-right corner of the patient chart. If the patient identifier exceeds the horizontal space available, the identifier is truncated and displays an ellipsis ( ). The complete patient identifier is displayed using the tooltip feature. Hover the cursor over the patient name. If the number of charts open exceeds the horizontal space available within the Patient toolbar, they display in a list on the right side of the toolbar. Page 27 of 89

28 Patient Defining Area The Patient Defining Area is part of the patient toolbar and includes several options for opening patient charts: Recent Contains the list of recently opened patient charts. Selecting a patient within the Recent list launches the selected patient s chart. Person Search Box You can search for a patient by MRN or Patient Name. Click the Binoculars button to launch the standard Person Search window. Previous/Next Chart (available within the Chart) When a Patient List is active within the Organizer, the List arrows close the current chart and open the chart of the previous/next patient in the Patient List. If you have multiple charts open the List arrows move you to the previous/next chart among those you have open and closes the current chart. Refresh Button The Refresh button reflects the time that has elapsed since the screen was last refreshed. Clicking the Refresh button refreshes the component and updates the indicator. For example, X minutes ago. If the time since the last refresh cannot be determined, the following is displayed. Note: This may be the most important button in the system. Make friends with it. Page 28 of 89

29 Menu (TOC) Notes The Chart components are accessed from the Table of Contents (TOC). If all of the Chart components cannot be displayed in the TOC within the vertical space available, a scroll bar is displayed and the additional items are accessed using the scroll bar. Pin and Unpin If you want to hide the TOC in order to see more of the actual chart, follow these steps to pin and unpin the TOC. 1) Click the Push-Pin button on the right edge of the TOC Menu to unpin (collapse) the TOC display. 2) The TOC collapses and displays a menu tab on the edge of the chart. 3) Click the Menu tab to maximize the TOC. 4) Access any chart component by selecting it within the TOC. From the Toolbar 1) From a patient list, click a patient name to select it. 2) From the toolbar menu bar, click Chart. 3) Access any chart component by clicking the name. Page 29 of 89

30 6. Chart Basics There are many ways to locate and open charts. You can open charts from a patient list. You can use the menu structure to search for patients and open charts. You can use the search box on the Patient Defining Area toolbar. You will be able to correctly: Open a chart from the patient list Close a chart Search for a patient chart Select the correct encounter Use hyperlinks in the demographic banner bar Locate and Open a Chart Open a Chart from the Patient List 1) Double-click the name of the patient. 2) In the Assign Relationship dialog box, select your relationship to the patient (Consulting, Covering, PCP (visit),referring, Reviewer). 3) Click OK. Close a Chart 4) Click the X in the upper-right corner to close the chart window. Page 30 of 89

31 Search for a Patient If a patient is not on one of your current patient lists, you will need to search for the patient. 1) Type the first few letters of the patient s last name in the Name box (Patient Defining Area) and click the Patient Search button. Patient Name Patient Encounter (Visit) 2) Select the patient name in the upper section of the Patient Search window. 3) The selected patient s visit history (encounters) will then be displayed in the bottom section of the window. Select Correct Encounter 4) Select the current encounter. Use the scroll bar to scroll to the right to view additional information. 5) Click the Preview to view even more information. 6) Once you have verified that you have selected the correct encounter, click OK. Page 31 of 89

32 Note: Be aware that all your actions are being recorded. Any charts you open will be time stamped with your activities. Demographic Bar The demographic bar is the colored band at the top of the patient s chart. It contains the patient s demographic information, such as name and age. Three shortcuts to additional information are available from the demographic bar. Name hyperlink Allergy hyperlink Location hyperlink Name Hyperlink 1) Click the patient s name to view additional demographic information. 2) Click OK to return to the chart. Allergy Hyperlink Existing allergies are displayed in the demographic bar. If the allergy list exceeds the horizontal space available, the system truncates the list. The complete list of allergies is displayed using a tooltip. If the patient does not have any allergies recorded, Allergies: Allergies Not Recorded will display. If the patient has No Know Allergies (NKA), the Allergy List box displays No Known Allergies. Allergies are displayed based on the defined severity (highest to lowest): Severe Moderate Mild All other severities Page 32 of 89

33 Allergies with the same severity are listed in alphabetical order. 1) Click the Allergies hyperlink to open the Allergies window. 2) Right-click any allergy to view a list of actions. 3) Select the desired action. 4) Click OK or Cancel to return to the Allergies window. 5) Click OK to close the Allergies window. Page 33 of 89

34 7. Chart Components At the end of this lesson you will be able to correctly: Review all components of a patient chart for which you have privileges to view. Print the Rounds Summary Report. Print a Patient Face Sheet. Change search criteria to customize viewable data. Apply sorting and filtering options where available. Use right-click options where available. Access and print drug and education reference information. Run queries to inquire about patient scheduled appointments. Rounds Summary Report The rounds report can be used by physicians to view pertinent patient information over the past 24 hours such as allergies, I&O, 36 hour lab results, active medications and vital signs. Note: Patients on ICU floors will have their vitals and I&O s documented on their current paper chart only, they will not be entered into PowerChart. Page 34 of 89

35 Print Rounds Summary Report You can print the Rounds Summary Report and use this information in your physician progress note in the paper chart. This will eliminate extra steps for physicians to rewrite patient information that has already been documented in PowerChart. This information will include the following data: Active Allergies Current Active Medication List Last 24 Hour I&O Last 24 Hour Vitals Last 36 Hour Lab Results Notes Note: Patients on ICU floors will have their vitals and I&O s documented on their current paper chart only, they will not be entered into PowerChart. You will handwrite this data in your notes if your patient is in the ICU. To Print the Report: 1) Select Reports from the Task menu. 2) The Reports dialog box opens. Page 35 of 89

36 3) Click the box next to Rounds Summary Report. 4) Click the list next to Printer Destination and select a printer. 5) Click Print. Print Patient Face Sheet 1) Click the Documents on the toolbar. You may have to click the black down arrow to show more buttons. 2) The Person Mgmt: Documents window opens. Page 36 of 89

37 3) Click the Find Person button to search for your patient. 4) The Patient Search dialog box opens. Type the patient s Last Name and First Name in the appropriate boxes. 5) Click Search. Patient Name Patient Encounter 6) Select the correct patient and encounter. 7) Click OK. Page 37 of 89

38 8) Your patient s information populates in the Person Mgmt: Documents window. 9) Click Facesheet in the Qualified documents box. 10) Click the Print button from the toolbar. 11) Select a Printer from the list menu. 12) Click OK. Page 38 of 89

39 Results Review Notes Using a Flowsheet Use flowsheets to view a patient's results. A flowsheet displays clinical information recorded for a patient. Results charted from the Nursing Task List and Ad Hoc Charting can be displayed in a flowsheet. The features of a flowsheet are designed to make finding clinical information as efficient as possible. Information is shown in a spreadsheet with flexible display features that make it possible to create an optimal view. A flowsheet is divided into two major sections. The left section is the Navigator. By selecting a category, you can zoom immediately to its contents, which are displayed as values in the grid on the right. The right section is the Results display. You can control both sections in the way best suited to get to needed information quickly. Note: Patients on ICU floors will have their vitals documented on their current paper chart only, they will not be entered into PowerChart. Page 39 of 89

40 Result Legend The Result Legend displays the colors and meanings of the data displayed in the flowsheet. 1) Click Options from the menu. 2) Click Result Legend. Note: If there is an S in the box with the result, there is a comment to view. To view the comment, double-click the cell and click the Comments tab. Page 40 of 89

41 Changing Search Criteria The Information Bar displays the date and time range for which results will be viewed. Notes 1) Right-click the Information Bar to display the Search Criteria menu. 2) Select Change Search Criteria. The Search Criteria window offers you several options to customize the results being displayed. Clinical Range Displays results with an occurrence time within the specified time range. Posting Range Displays results that have posting times within the specified time range. Result Count Allows you to select the specific number of latest entries to the patients chart to be displayed from 1 1,000. New Results View only the results not yet marked as viewed. Admission Date to Current Date View all results posted for the selected patient from admission date to current date. 3) Select one of the search options. 4) Click OK to retrieve results in the chosen range. Using Different Formats Several view formats are available for viewing results in the flowsheet: table view, group view, and list view. To display the flowsheet results in a specific view format select the Table View, Group View, or the List View option on the flowsheet dashboard. Refreshing the View When opening a patient chart the system will provide you with the most current data available; however, as time elapses and other people update the information, you may need to manually update or refresh your screen. For example, you may be in the process of reviewing results; meanwhile the lab has just entered a new result into the same chart. You would need to manually refresh to see that result immediately. 1) Click the Flowsheet tab. 2) Click the Refresh button. Note: You must refresh each tab individually. It is recommended that you refresh your tabs frequently. Page 41 of 89

42 Specialty FlowSheet Views The following Specialty Views allow the user a concise view of specialty related results. Anti Coagulation View The Anti Coagulation View includes results from the following categories: Routine Coagulation such as PT, PTT, INR; Coagulation Reference Laboratory; Other Coagulation Labs; Anticoagulation Medications Infectious Disease View Infectious Disease View includes results from the following categories: Microbiology, Laboratory Infectious Disease, Antibiotic Medications, Anti-fungal, Infection Control History, Immunology/Serology Pain Management View The Pain Management View includes tests from the following categories: CHEOPS Pain Scale, NIPS Pain Scale, RIPS Pain Scale, Comfort Measures, and Pain Medications Respiratory View The Respiratory View includes results from the following categories: Pulmonary Medicine, Respiratory, Pulmonology Procedures, Mycobacteriology, Computed Tomography, and Diagnostic Radiology. Click on RESULTS REVIEW form the Menu Click on the drop down arrow to display the list menu. Select the Anti Coagulation View from the last five views located at the bottom of the list Page 42 of 89

43 Graphing a Patient s Test Results While you are viewing a patient's Flowsheet, you can generate a graphic representation of the numeric results values. The graph plots the values and displays units of measure along the y axis. The values must all have the same units of measure in order for a graph to be generated. If no units are displayed, the graph is generated, but no units label is displayed along the y axis. Notes To view or print a graph of all results of a certain type, complete the following steps: 1) Select the name of a specific test or procedure for which results are given in a numeric value by selecting the option just to the left of the name. 2) If you want more than one graph generated at the same time, select another test name. 3) Click the Graph button. 4) The system generates and displays a graph for each type of test you selected in a split view so you can compare data from each graph. Page 43 of 89

44 5) Click Combine on the Flowsheet Graph window to plot the selected result types on the same axis (without units displayed). The time continuum represented along the x axis is consistent for all graphs. You can compare one result to another for possible cause and effect relationships. Page 44 of 89 Note: You can access the additional information window about any value represented on the graph by clicking the circle or shape surrounding the plotted value.

45 6) Click Print to print the graph you are viewing. a) If you are viewing a set of graphs, a dialog box prompts you to select which graph or graphs you want to print. b) If you are viewing a set of graphs, you can right-click one graph and select Print from the Context menu. c) To copy a graph to the clipboard, select Copy. This stores the graph as a bitmap (graphic) that can be pasted into a document. Only one graph can be copied at a time. 7) Click Close to return to the previous window. View PACS Image The PACS system has been interfaced into PowerChart. Due to this connection, physicians will be able to view their patients PACS images directly from the Radiology Reports located in the Results Review component of PowerChart. You will be able to bypass logging into PACs as you will only need to log into PowerChart. To access a PACS Image follow the steps below. 1) Select Results Review from the Menu. 2) Click the Radiology tab, unless the Diagnostic Radiology tab is already listed in Recent Results. 3) Double-click the exam cell. Page 45 of 89

46 4) The Radiology Report will display for your review. 5) Click Image. 6) Double-click Launch Image Tools. 7) MI View will display. Page 46 of 89

47 Intake and Output Notes The I&O flowsheet shows all the intake and output information available for a particular patient. The clinical range is divided into time ranges. Each range might have a Day Shift summary section showing a sub-total for that particular range. Intake and Output are separated, and a total is displayed at the end of each. The last column displays the clinical range for each row. The intersection of the Clinical Range Total and the Balance represents the Total output subtracted from total intake. Double-click a total or subtotal to see all volumes that contributed to the volume in that cell. The I&O flowsheet has the ability to display in chronological and reverse chronological order. To customize your I&O preferences, follow the tasks below. 1) Click the Customize button. (Located in the top left corner of the flowsheet). 2) The customize dialog box opens. 3) Click the Preferences tab. Page 47 of 89

48 4) Click the list arrow next to Default Time Scale and select the time frame you prefer to see your I&O results. 5) Click OK. Note: Patients on ICU floors will have their I &O s documented on their current paper chart. Notes Notes are where clinicians document textual results such as consult notes. Sort By At the bottom left of the Notes window, select the option to sort the forms: By Type By Status By Date Performed By By Encounter Page 48 of 89

49 Open a Clinical Note With a patient s chart open, complete the following steps to view a clinical document: 1) Click the Clinical Notes component. 2) Adjust the time range or document count (last documents) to encompass the appropriate range for document retrieval. Right-click the information bar where the date and time or document count are displayed, and select Change Search Criteria. 3) From the Index menu, select Change Search Criteria. 4) If documents are found for the time range, they are listed in the index tree. Click or double-click a folder to view its contents. (If a folder is displayed, it contains one or more documents.) 5) Click the plus sign, or double-click the folder that represents the document category. The individual documents are denoted by a colored icon that reflects document status. 6) Double-click the icon or the date of the document to open the document. 7) To view the history of the current document in detail, point to the lower border of the document display area until the cursor becomes a pair of opposing arrows. Drag the splitter bar (lower border of the document display) upwards. Right-Click Options If you right-click a note, a menu displays. Depending on the privileges assigned to your position, you may be able to perform one or more of the following actions: Open Open additional document Print documents Forward/Refuse documents Page 49 of 89

50 Overview The Overview component is designed to present a summarized view of patient data. Patient data is organized into paginated lists to optimize performance. The Overview is divided into three available subcomponents: This Visit, Since Last Time, and Patient Summary. This Visit The This Visit tab is designed to present a summarized view of patient data relevant to the selected patient encounter. Vital Signs The Vital Signs section displays the last two sets of vital signs for the patient. The results displayed within this section are not confined to the selected encounter. Note: Patients on ICU floors will have their vitals documented on their current paper chart only, they will not be entered into PowerChart. For example, if the patient has two encounters, the vital signs from the patient s previous encounter and the vital signs taken for the selected encounter are displayed. The date/time of each result is also displayed. Click the result displayed within the section to see result details. Page 50 of 89

51 Chief Complaint The Chief Complaint section displays the chief complaint result documented for the selected encounter. The box is populated with information from the Admission History form nursing completes. Click the result displayed within this section to see details. Documents The Documents section displays a list of documents for the patient. Click a document within the list to launch the appropriate viewer and view the document details. Sticky Notes This is a function that AHC has decided not utilize. This should always display No items found. Encounter The Encounter section displays details for the selected encounter. Appointments The Appointment section displays details for the selected encounter s appointments. Appointments in the following statuses are displayed: Checked In Checked Out Scheduled Confirmed If the selected encounter has multiple appointments, the appointments are displayed in reverse chronological order based on the appointment Date/Time. Since Last Time The Since Last Time tab is designed to present a summarized view of patient data items that have occurred since the Date/Time Stamp was last applied. For example, a physician can apply the Date/Time Stamp at the conclusion of seeing the patient. The next time the physician sees the patient, the Since Last Time component displays the items that have occurred since the Date/Time Stamp was applied at the previous visit. When you click the Date/Time Stamp button, the date and time of the last refresh is applied. Page 51 of 89

52 Note: The Date/Time stamp does NOT imply that you viewed any particular encounter, document, or medication. You may apply a date/time stamp to indicate that you consider yourself familiar with the items returned within the component and only want to see any items that occur or are new after the date/time stamp. The Since Last Time view includes the following items: Encounters Documents Medications Encounters The Encounters section displays the list of encounters with a service date/time after the defined date/time stamp. Note: The Service Date/Time reflects the patient s arrival date and time. It the arrival time is not defined in the system, this will be the registration date and time. If there is no registration date and time, this will be the pre-registration date and time. The Encounters are displayed in reverse chronological order based on the Service Date/Time. Select an Encounter and display the most recent document associated with that encounter. Documents The Documents section displays the list of documents with a service date/time after the defined date/time stamp. Documents are displayed in reverse chronological order based on the service date/time of the document. Select a document and display the document details within the Detail Pane. Medications The Medications section displays a list of medication orders with a clinically significant update after the defined date/time stamp. The Orders are displayed in reverse chronological order based on the clinically significant update date/time of the order. Right-click the order and display: Order Information Reference Text Page 52 of 89

53 Patient Summary The Patient Summary tab is designed to present a summarized view of patient data items that are not visit or time based. Notes The Patient Summary view includes the following items: Allergies Medications Problems Immunizations Procedures Blood Type and Antibodies Allergies The Allergy section displays the list of Allergies for the patient. Allergies are displayed in alphabetical order by substance name. Medications The Medications section displays the list of active medication orders for the patient. Problems The Problems section will display the list of problems for the patient. Problems are displayed in alphabetical order by problem name. Immunizations The Immunizations section displays the list of immunizations for the patient. Immunizations are displayed in alphabetical order by vaccine name. Procedures The Procedures section displays the list of Procedures for the patient. Procedures are displayed in alphabetical order by procedure name. Blood Type and Antibodies The Blood Type and Antibodies section displays blood bank information for the patient. Page 53 of 89

54 Review Chart The Review Chart component is designed to present a summarized view of patient data similar to the Since Last Time view of Overview. The Review Chart component includes several sub-tabs. Documents The Documents section displays the list of documents with a service date/time after the defined date/time stamp. Documents are displayed in reverse chronological order based on the service date/time of the document. Select a document to display the document details within the Detail Pane. Encounters The Encounters section displays the list of encounters with a service date/time after the defined date/time stamp. The Encounter section displays the following details: Note: The Service Date/Time reflects the patient s arrival date and time. If the arrival time is not defined in the system, this will be the registration date and time. If there is no registration date and time, this will be the pre-registration date and time. The Encounters are displayed in reverse chronological order based on the Service Date/Time. Select an Encounter to display the most recent document associated with that encounter. Orders (Non Med) The Orders (Non Medication) view displays the complete list of orders that you have the privilege to view. The Orders (Non Medication) section does NOT return any medication orders and may contain orders from a previous encounter. There is one exception, template non-formulary orders are displayed within the section. For example, if a patient has an order for Vital Signs Q4H with a start date/time of 06/01/ The orders displayed in the Orders (Non Medication) view are the child orders: Vital Signs 06/01/ Vital Signs 06/01/ Vital Signs 06/01/ Vital Signs 06/02/ Vital Signs 06/02/ Note: Task-based continuing orders will not display within the Orders (Non Med) view. Page 54 of 89

55 Orders are displayed in reverse chronological order based on the start date and time of the order. Select one or more orders to display the results associated to the order within the Detail Pane. Right-click the order to display: Reference Text Order Information Note: To review orders placed on the patient s current encounter, check the Orders tab of PowerChart. Orders in this view may contain information from a previous encounter Results The Results view displays a list of dates for which the patient has results. You must also have the appropriate privileges to view the results. Results are displayed in reverse chronological order. Select a date to display the results associated to the date in a List View flowsheet within the Detail Pane. Growth Chart The Growth Chart component will open automatically in a split-view based on the default settings that have set up by the system administrator. Growth charts for females display in red, while growth charts for males will display in blue. Patient Information The Patient Information component consists of three sub-tabs: Patient Demographics Visit List PPR Summary (Patient/Provider Relationship) Patient Demographics Use the Patient Demographics tab in the Patient Information view the same way that you would a paper chart s face sheet. It displays general information regarding the selected patient. This is a read-only screen. Page 55 of 89

56 Visit List The Visit List tab displays a patient visit summary to help you outline past admissions. The top section of this tab displays a list of the patient s visits including the admission and discharge date, facility, location, medical service, and visit type and reason. The highlighted visit corresponds to the visit details listed in the lower section of this tab. Select another visit by selecting that visit in the top section. The bottom section of this screen contains information specific to the selected visit. Page 56 of 89

57 Patient Provider Relationship Summary Use Patient Provider Relationship Summary tab in the Patient Information view to display a patient s relationships with healthcare providers known to the system. Notes Separate lists are provided for lifetime and visit-specific relationships. You can filter the lists to display only your relationships or current active relationships. The default view displays all relationships. Scheduling Inquiry Select the Scheduling Inquiry component to inquire about a patient s scheduled appointments. A patient s CT, MRI, OR Schedule, or Wound Care Clinic Visits will display in this section. Viewing the patient's schedule can be useful in helping you plan your work shift more efficiently. The available queries from the list include: Person Confirmed Only Person No Shows Only Person Inquiry w/orders Person Schedule Inquiry Standard Page 57 of 89

58 Person Schedule Inquiry No Actions Person with Orders No Reschedules Note: Surgery and Cath lab scheduling will be done in SurgiNet. Those appointments will not show here. MAR The MAR displays the Medication Administration Record. As the nursing staff administers medication, they will electronically chart the medication administration process. There are some medications physicians can administer to a patient. In order to document this electronically, the physician will need a nurse witness to document the medication administration process. The nurse will then document the physician s name as the provider who administered the medication. Medications documented in the MAR will also be viewed in the MAR Summary. MAR Summary The MAR Summary displays a condensed view of medication administration information to give you a high-level overview of the medications that are prescribed for a patient. The Summary allows you to modify the view to accommodate your individual needs. Time Interval Settings Time interval settings are customizable. The following displays the MAR Summary set with an 8-hour time interval. The following is an example of the 24-hour time interval MAR Summary. The time interval you define is saved when you change charts or log out of the system. Page 58 of 89

59 MAR Summary Display You have the ability to change properties or defaults for the MAR Summary. MAR Summary Defaults and MAR Summary Properties are saved when you exit PowerChart. The following are the default settings that can be modified: MAR summary properties such as the date range and filters are modifiable but are not saved. When you change focus from the current patient, the view returns to the default properties. Page 59 of 89

60 8. Allergies The allergy profile is used to document allergies on a patient. This profile is available through multiple areas of the chart including the Banner Bar and the Allergy component in the TOC. You will be able to correctly: Add an allergy to a patient s allergy profile Document that a patient has no known allergies Add an allergy to the allergy favorites folder Allergy Profile Basics To access the Allergy Profile from the PowerChart Banner Bar, click the allergy hyperlink. The Allergy Profile is also available from the Allergies component on the TOC. Allergy Profile Options The allergy profile offers you several allergy display options. From the Display box, select one of the following: Page 60 of 89

61 Active (default) Will include Active and Proposed Inactive Will include Resolved and Canceled All Will include Active, Proposed, Resolved, Canceled Sort any column by clicking the column heading. Click Reverse Allergy Check to compare the patient s allergies with current medications. The system will determine if there are any interactions. The Mark All Shown as Reviewed option allows you to document that the allergies have been reviewed. There is no way to display who has reviewed the allergies within the PowerChart application. Right-Click Menu Options The right-click menu and the Allergy menu contain several additional options that may be helpful when working with allergies. Documenting Allergies As mentioned above, there are many ways to access the allergy profile. You will find your favorite. The example below accesses the allergy profile from the patient chart TOC. Adding No Known Allergies If the patient reports that he has no allergies, you will add No Known Allergies to his allergy profile. This right-click menu option is only available if there are no active allergies already documented on the patient. Otherwise, the selection will be dithered. Adding an Allergy Using the Search Tab To document an allergy, follow these steps: 1) From the patient s chart, select the Allergies component from the TOC to open the Allergy profile. 2) Click Add. Page 61 of 89

62 3) The Add Allergy/Adverse Effect window opens. 4) Type the first few letters of the allergy into the Search box and click Search or press ENTER. Note: Free text has been disabled in the allergy box. If a patient states they have an allergy to something not on the list, you must notify pharmacy by phone they can add. 5) Highlight the appropriate substance to select it. Double-click the selected substance or click Select to add it to the profile. Page 62 of 89

63 Note: Once a substance has been selected, the Search window will automatically change to search for reaction. 6) Search for a codified symptom using the Search window. Confirm that the search is for Reaction, rather than Substance. 7) Select the appropriate reaction, highlight it and double-click or click OK to add to the profile. 8) The reaction will now show within the Reaction box. Codified reactions will display with the key icon. If the reaction you are entering does not appear on the list you may select Add Free Text to type in the reaction. 9) If known, you can answer the allergy details (such as Onset). This information is not required. 10) Click OK. The allergy will now display on the patient s Allergy Profile. Page 63 of 89

64 Adding an Allergy Using the Catalog Tab To document an allergy using the Catalog, follow these steps: 1) From the patient s chart, select the Allergies component from the TOC to open the Allergy profile. 2) Click Add. 3) The Add Allergy/Adverse Effect window will display. 4) Click the Catalog tab. This tab will allow you to select the most common allergies and will bypass using the Search tab. 5) Click the plus + sign next to the folder you want to select from. 6) Double-click the substance. 7) The Catalog will automatically return with Common Allergy Reactions for you to choose. 8) Click the plus + sign next to the Common Allergy Reactions folder. 9) Double-click the reaction you want to add. Page 64 of 89

65 10) The reaction will now show within the Reaction box. Codified reactions will display with the Key icon. If the reaction you are entering does not display on the list you can select Add Free Text to type in the reaction. 11) If known, you may answer the allergy details (such as Onset). This information is not required. 12) Click OK. The allergy will now display on the patient s Allergy Profile. Unable to Obtain When you are unable to obtain allergy information from a patient, there is an Unable to Obtain substance for allergies. To document an Unable to Obtain, follow these steps: 1) From the patient s chart, select the Allergies component from the TOC to open the Allergy profile. 2) Click Add. Page 65 of 89

66 3) Type Unable in the Search box. 4) Select Unable to Obtain from the Vocabularies list and click Select to add it to the profile. Note: Utilizing this option alerts the pharmacy so the pop up concerning height and weight does not fire. Modify an Allergy 1) From the patient s chart, select the Allergies component from the TOC to open the Allergy profile. 2) Select the Allergy you want to change, the row will highlight in blue. 3) Click Modify 4) Change details as needed. 5) Click OK in the Modify window. 6) Click OK. Page 66 of 89

67 Allergy Favorites To save time you can create a folder of frequently selected allergies. To add an allergy to the Favorites list, right-click the codified allergy and select Add to Favorites. To use the Allergy folder, click the My Favorites tab instead of search for an allergy and select the allergy from the list of favorites. Page 67 of 89

68 9. Orders Basics PowerOrders, an integral part of PowerChart, presents a view of the ordering process in a spreadsheet-like display similar to a flowsheet. PowerOrders also handles medication, nursing, and consult orders. It also provides access to patient allergies and diagnoses from the order window. The Orders tab is used to view various types of orders. The three main sections of the Orders tab are the Navigator, the Order Profile and the order history and medication reconciliation area. Note: To modify or cancel and order, please follow your current paper process. After this lesson, you will be able to: Differentiate the function of the Navigator and Order Profile sections Customize the Profile columns Apply Profile filters Identify order buttons and icons Differentiate various order statuses Page 68 of 89

69 Navigator Overview The left side of the orders tab is the Navigator. When the check mark on the left is selected, the category of orders from the profile section is displayed. When it is unchecked, the category and its orders are hidden. Clinical categories highlighted in bold font contain active orders. Clicking a category name will focus the screen directly to that category of orders. Show or hide the Navigator by selecting the left-pointing arrow to collapse the pane and the right-pointing arrow to expand it. Order Profile Overview The right side of the orders tab is called the Order Profile. It displays the patient s existing orders and provides a means for viewing order details and order statuses. Page 69 of 89

70 Applying Filters The view of existing orders can be filtered to display selected statuses most relevant for your role. A predefined set of orders filters are available. To apply filters to the list of existing orders: 1) Click the down arrow to Display list. 2) Select predefined filters from the Display list. Customize View By clicking the Customize view button located on the upper right side of the Order Profile window, the customize view window will open and allow further customization to the Order Profile View. Page 70 of 89

71 Orders Buttons and Icons Notes Orders buttons and icons are located in various places on the screen and provide easy access to orders functions. Toolbar buttons access additional functionality. Below is a list of common order buttons and icons: Expand and Collapse (Clinical Category) - A plus sign indicates that the item (clinical category) can be expanded. The minus sign means that the item is expanded and can be collapsed. Click either symbol to toggle between views. Expand and Collapse (Details Pane, Orders Navigator) - Click the up arrows to expand or collapse the detail screen. Active and Inactive Orders - A check mark indicates that the order is currently active. To inactivate an order, click the check mark to remove it. This action may cause a dialog box to be displayed requiring a reason for discontinuing the order. Orders that are in a final status, such as Completed or Discontinued, do not display check marks because they are no longer active. Care Set - Indicates a care set orderable in the Orders Search window. Clinical Calculator - Launches the clinical calculator. Nurse Review - This icon indicates that nurse review is required. Phase (Planned Pending) - Indicates a phase in a plan. The white Phase icon indicates that it has not been initiated. Phase (Initiated) -Indicates a phase in a plan. The yellow Phase icon indicates that it has been initiated. Phase (Completed) - Indicates a phase in a plan. The gray Phase icon indicates that it has been completed. Reference Text - This icon indicates that reference text is associated to the order. Rx Verify Indicator - The Rx prescription icon means that the order is subject to pharmacy review and has not yet been reviewed by a pharmacist. Page 71 of 89

72 Order Statuses Order statuses reflect the stage of completion for an order that has been entered into the system. The status progresses from blank (before the entered order is signed it has no status) to Complete, Discontinued, or some other final status. Other statuses reflect certain order actions as explained below. Order - The status of Order indicates that the order needs to be completed and signed. Processing - After signing a new order, the order status displays Processing. Clicking Refresh will update the system so that the status changes to Ordered. Ordered - An order successfully entered and signed has a status of Ordered until the order is completed. Completed A completed order has reached its defined stop date and time, or the associated tasks or procedures have been completed. Pending Complete - Pending Complete is the status given to a parent order when one or more of the child orders (but not all) have been completed. Pending Complete also applies to a parent order which has reached its defined stop date and time but still has tasks that have not been completed. Discontinued - An order with a frequency or interval associated with it can be discontinued after the procedure or medication has been administered at least once. The Multum drug interaction checking continues for Discontinued orders for their defined time frame. Canceled - Any order can be canceled to stop immediately, but certain conditions may cause the status of some orders to go to Discontinued rather than Canceled. The Canceled status for orders with frequencies or intervals associated with them indicates that the first instance was never administered. No Multum drug interaction checking is performed on orders with a status of Canceled. Page 72 of 89

73 Medication List Notes Click the Medication List component to view the Medication List. This is the recommended place to view all medication therapies for a particular patient. The Medication List has the same sorting and filtering ability as the orders tab, providing you have the ability to customize and manage your view. Print Medication Reconciliation Forms 1) Select Reports from the Task menu. 2) The Reports dialog box opens. Page 73 of 89

74 3) Select the option next to the Medication Reconciliation Rpt you want. This will place a check mark in the box. a) ADM = Admission b) DSCH= Discharge c) TRANSFER= Transfer 4) Click the list next to Printer Destination and select a printer. 5) Click Print. 6) You will then handwrite the Medication Reconciliation for your patient and place in the paper chart. Page 74 of 89

75 Medication Reconciliation Process Notes Page 75 of 89

76 10. Inbox Inbox is a component of Cerner Millennium used for managing workflow in the inpatient or outpatient setting. Inbox allows you to route information electronically as you work with transcribed documents and reports. Attending physicians, physician assistants, and nurse practitioners will be able to review, refuse, or sign transcribed documents within their inbox. Note: The HRMC Inbox is intended only for documents. Although Inbox has other features, we are not using those features at this time. Users should not customize their view by adding folders/icons to the list bar. Working with Documents The Sign and Review folder contains documents you need to dictate, transcription documents awaiting your signature, documents or reports you need to review, and documents forwarded to you for signature from another clinician. Inbox Summary Viewing a Document Complete the following steps to view a document: 1) Navigate to the Documents section in the Inbox Summary by clicking Sign and Review. 2) Select a folder and click the plus to the left of the folder to expand the documents. 3) Double-click a document to open it. 4) View the document. 5) Click Cancel. Page 76 of 89

77 Signing a Document To sign individual documents in the Documents to Sign folder, complete the following tasks: Notes 1) Navigate to Documents to Sign folder in the Inbox Summary. 2) Double-click a document to open it. 3) Review the document. 4) Select Sign from the Action pane. 5) Enter any comments. 6) Click OK or OK & Close. Signing and Forwarding Documents Cerner Millennium allows you to sign a document and then forward it on to another clinician in one action. To forward a document after signing it, complete the following tasks: 1) Open the document. 2) Review the content. 3) In the Action pane, select Sign. 4) In the Forward pane, click the ellipsis button. Page 77 of 89

78 5) If your recipient is not listed, type their last name and press ENTER. 6) Select the correct name from the list provided and click the right move arrow. The name will then be placed in the Sent to: column. You can add up to five recipients when forwarding. 7) Click OK. 8) In the Forward pane select Review or Sign. 9) Add any comments. 10) Click OK or OK & Close. Forwarding a Document without Signing or Refusing It (Forward Only) Cerner Millennium allows you to forward a document to another clinician without signing or refusing the document. For example, if you are a physician assistant or nurse practitioner, you could forward a document to a physician for their review and signature. To forward a document without signing it, complete the following steps: 1) Open the document. 2) Review the content and click Forward only. 3) Select an option from the Forward Action list. 4) Select any recipient from the To: list. 5) Enter any comments. 6) Click OK. Note: If you Forward only, this will not remove the original deficiency. Page 78 of 89

79 Refusing a Document To refuse a document, complete the following steps: 1) Open the document. 2) Review the document and select Refuse from the Action pane. 3) In the Forward pane, select Signature. 4) Click the ellipsis button and select Refuse,HRMC. You may need to search for the name if Refuse, HRMC is not in the list box. 5) Move Refuse, HRMC over to the Send to column. 6) Click OK. (This will direct your refusal to HRMC s Refusal Inbox for signature). 7) Select a reason for refusal. 8) Enter any comments. 9) Click OK or OK & Close. Page 79 of 89

80 Modifying a Document Coders might send messages to confirm the diagnosis codes used for your patient s visit. You will find these messages in your Sign and Review folder. You will need to modify the document and type your response to justify the coding usage and click Sign. 1) Open the Document. 2) Click the Modify button. 3) Type modifications below the Start typing document here message. 4) Click Sign. 5) Click Save & Close if you have modified the document but are not finished making changes. This document will then be stored in your Saved Documents folder to access later. In order for the coders to see your response, you must sign the document. Page 80 of 89

81 Using Proxy 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 folders to which you want 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. Update Proxy Updating Proxy will allow you to give another physician access to certain actions you would like them to use in your absence. Follow the steps below to update your proxy. 1) Select Inbox from the menu. Page 81 of 89

82 2) Select Update Proxy. 3) Select Proxy List Given by me. 4) Click Add Person or Add Group. 5) Search for a Proxy name by clicking the Binoculars. 6) The Provider Search window opens. Page 82 of 89

83 7) Complete the search boxes and click Search. 8) Select the proxy name from the list. 9) Click OK. 10) Select the Start date and End dates by selecting the Calendar list. 11) Select the actions you want to proxy and click the right Move arrow to send the items from the Available types for proxy to the Types to be shown for proxy. Page 83 of 89

84 Note: You can multi-select Available types by holding down the CTRL key and selecting each type. You can then move all selected types at once. 12) Click OK. View Proxies Given to You To view a proxy given to you by another clinician, follow the tasks below. 1) From the Inbox menu, select Update Proxy. 2) Select Proxy list received by me. Page 84 of 89

85 3) To view the types of proxies granted to you, click the folder and the list will expand. 4) Click OK. 5) You will now be able to view this proxy and perform the actions granted to you in your Inbox. The proxy will be listed at the bottom left corner of your Inbox. Proxies granted to you will display at the bottom of your Inbox. Click the Proxy name and this will open the actions you are able to complete based on the tasks this proxy has granted for you. Page 85 of 89

86 11. Appendix A: Using Cerner Help Each Cerner Millennium application and tool contains Help with topicoriented, procedural or reference information. Help is often used with the Cerner Millennium Support Guides (CMSGs), and other user training materials. From the Help menu, select the component, or HNA Help Topics. You also can press F1 on your keyboard to open the Help menu. To find information quickly, open the books displayed to the left on the Contents tab. Overview books contain a short overview of the application. Tasks books contain step-by-step instructions for completing tasks in the application. Menus and Toolbars books contain descriptions of menus and toolbars in the application. Troubleshooting books contain system messages, including an explanation of the issue, technical description, and the action you should take to correct the issue. Tips books contain useful tips, such as keyboard shortcuts and element descriptions. Glossary books open the Cerner Millennium Glossary. Page 86 of 89

87 You also can click the Index tab, and enter the subject for which you are looking. Click the Search tab, and enter a specific word to display all topics containing that word. Page 87 of 89

88 12. Appendix B: Using Cerner Millennium Support Guides The Cerner Millennium Support Guide (CMSG) is the online reference library for Cerner Millennium solutions, providing application, process, usage, and technical documentation. The CMSGs are located on cerner.com. You can either click CMSG under Quick Picks or navigate to CMSG from the Support tab. The CMSGs are organized into the following sections: Overview, User Training, Design, Build, All About, Maintenance and Monitoring, and Troubleshooting. Not all of the guides are available for each solution, and some solution have multiple guides of the same type. Overview The Solution Overview contains a brief introduction to the solution, list of benefits, and description of user and build applications. Release Updates are organized by CR number, and outline the documentation updates for each release. User Training The Solution Training Guide provides the steps for completing various tasks within the context of workflow. This content is similar to the solution's Help. The Open House Scripts are designed to illustrate the clinician's workflow and day-to-day activities within the solution. This content is often used for practice scenarios. The Quick Reference Card is a PDF or Visio document with icons, tips and tricks, and process flows. The layout and content is similar to the job aids. Page 88 of 89

89 Design The Design Considerations Guide helps you understand the design decisions made when implementing the solution. This guide often is used with the MethodM Online Design Decision Matrix. Process Maps illustrate the recommended workflow for a particular solution or functionality. Process Presentations and Descriptions are the textual version of the Process Maps, and often contain links to integration considerations, the Design Decision Matrix, measurements and metrics, policies and procedures, and validation and BDS scripts. Build The Database Build Guide provides an outline of the solution's build tasks, prerequisites, build tools, and considerations. The steps are sequenced in a coordinated manner to ensure all steps are completed in a way that will prevent errors in the build. This guide might not list the actual build steps needed for a task. You are encouraged to use the build tool's Help to view the detailed build steps. All About The All About Guide is a hybrid of the Solution Training Guide, Design Guide, Build Guide, and Troubleshooting Guide, and often developed to introduce new functionality. This guide is a replacement for the various Special Topic documents. Maintenance and Monitoring The Maintenance Guide is a reference for post-conversion database changes and considerations. Some of the content is similar or linked to the Database Build Guide. The Monitoring Guide discusses post-conversion monitoring recommendations. Troubleshooting The Troubleshooting Guide provides a foundation for troubleshooting Cerner systems, including the troubleshooting process, tips and tricks, and diagnostic tools. This guide does not contain solution-specific scenarios. If you encounter a solution-specific issue, see the Knowledge Base Search. Page 89 of 89