Vitera Intergy EHR New System Features, Version 9.00

Vitera Intergy EHR New System Features, Version 9.00

Vitera Intergy EHR 9.00 New System Features Confidential This document and the information it contains are the confidential information of Vitera Healthcare Solutions. Neither this document nor the information it contains may be disclosed to any third party or reproduced, in whole or in part, without the express prior written consent of Vitera. Vitera reserves the right to change, without notice, product offerings, product specifications and the information in this document. This document supersedes any prior document containing similar subject matter with regard to the descriptions of features and functionality of product offerings. You may receive supplements to this document based on changes that may occur in the product. This document may not be reproduced in any form without prior written permission from Vitera. 2013 Vitera Healthcare Solutions, LLC. All rights reserved. Vitera, the Vitera logo, Intergy, and Intergy EHR are registered trademarks or trademarks of Vitera Healthcare Solutions, LLC., or its affiliated entities. All other trademarks are the property of their respective owners. MSO# 18966 11/22/2013 For more information about Vitera, please contact us on the Web at www.viterahealthcare.com If you have any feedback on this document, or would like to request changes, please send an e-mail to documentationfeedback@viterahealthcare.com. In your message, please include the title and date of the document (listed above) as well as any other information you feel will help with your suggestion. 4301 West Boy Scout Blvd., Suite 800 Tampa, FL 33607 877-932-6301 www.viterahealthcare.com

Table of Contents Version 9.00 New System Features..................... 1 Intergy EHR Basics.............................. 2 Selecting Patients................................. 3 Closing the Current Patient............................. 4 New Select Diagnosis Dialog Box......................... 5 Prescription Information Added to Chart List Pop-Up................ 8 Care Team.................................. 9 Provider Roles Renamed Care Team........................ 10 Chart................................... 12 Displaying Specimens for Lab Test Results..................... 13 Including Images when Printing the Patient s Chart................ 14 Patient Education and Provider Reference Information............... 16 Renaming Zip Files When Exporting a Patient s Full Chart............. 18 Patient Internet Access Status........................... 20 Patient Care Program............................... 21 Preferred Communication Method.........................24 Encounter Note.............................. 25 E&M Calculator Enhancement........................... 26 SNOMED Code Compatibility............................ 31 Voiding Vital Signs in an Encounter Note...................... 32 Health Information Exchange....................... 33 Document List Views for the Exchange Tab..................... 34 Enhanced CCD Import Functionality........................35 Generating an Exchange Document........................ 36 Exchange Documents as Secure Message Attachments............... 43 Exporting an Exchange Document to an HIE.................... 45 Printing an Exchange Document.......................... 48 Health Reminders............................. 50 Selecting an ICD-10 Code for a Diagnosis on the Add to Orders Tab........ 51 Selecting an ICD-10 Code for a Diagnosis on the Health Reminders Window.... 53 Vitera Intergy EHR 9.00 New System Features i

ICD-10................................... 55 ICD Code Overview................................. 56 ICD-10 Readiness Setup.............................. 57 Setting Up Intergy EHR for ICD-10......................... 59 Using ICD-9 and ICD-10 Diagnosis Codes...................... 61 Converting Diagnoses to Findings......................... 64 ICD-10 to ICD-9 Mapping Rx Summary...................... 65 Immunizations.............................. 66 Immunity Flag on Immunizations Page....................... 67 New Immunization Fields............................. 69 Recording Immunization History Information Source.............. 71 Selecting ICD-10 Codes When Administering Immunizations............ 73 VFC Eligibility................................... 75 Vaccine Information Statements.......................... 78 Labs.................................... 80 Test Groups.................................... 81 Orders/Charges.............................. 84 Selecting an ICD-10 Code for a Diagnosis in Orders/Charges............ 85 Using Macros with ICD-10 Codes.......................... 86 Practice Portal............................... 87 Activity on Patient Health Information Recorded and Provided........... 88 Customize Practice Portal Exchange Documents.................. 89 Direct Messaging Now Supported......................... 91 Patient Cell Phone Support for New Patient Registration Secure Messages..... 92 Predictive Order Management....................... 93 Selecting an ICD-10 Code for an Order or Diagnosis on the POM Tab........ 94 Prescriptions............................... 96 Medication Reconciliation............................. 97 Recording Formulary Checks............................ 99 Problems................................ 100 Care Plan..................................... 101 Copying Assessments to the Problems List.................... 102 Copying Diagnoses to the Problems List..................... 103 Converting Problems to Findings......................... 104 Including Voided Problems in the Problem List.................. 106 ii Vitera Intergy EHR 9.00 New System Features

Quick Text................................ 107 Personal Quick Text Added............................ 108 Tasks.................................. 109 Changes to Cardiology Result Tasks....................... 110 Sending Secure Messages When Working a Lab Results Review Task....... 111 Visit Note................................ 113 User Preferences............................. 114 Default Procedure/Diagnosis Favorites List.................... 115 Vitals.................................. 116 Vital Signs Now Displayed in Your Preferred Units of Measure.......... 117 Vitera Intergy EHR 9.00 New System Features iii

Vitera Intergy EHR Version 9.00 New System Features The Vitera Intergy EHR 9.00 New System Features document summarizes the new features and enhancements of Vitera Intergy EHR, version 9.00. The purpose of this document is to guide you through a high-level set of the most meaningful changes, including the primary purpose of each new feature and enhancement, and how each can be used. Pro Tip How To Search the NSF Effectively When searching this document for information about a feature, you can first scan the Table of Contents. Topics are grouped into sections based on the area of the system they affect, and the sections are listed alphabetically. Also, when viewing this document online, be sure to make use of the handy Search tool in Adobe enter your search term here Tools Comment Share Reader. For example, if you are looking for topics related to Chart, enter chart in the search field. Adobe Reader will find all instances of your search term in the document, which allows you to quickly browse the sections that interest you. Vitera Intergy EHR Version 9.00 New System chart use the forward and back arrows to find other instances of your search term The Vitera Intergy EHR 9.00 New System Features document summarizes the new features You can access the Search tool either by pressing CTRL F, or from the Adobe Reader menu by selecting Edit, then Find. Vitera Intergy EHR 9.00 New System Features 1

Intergy EHR Basics Intergy EHR Basics This section describes the enhancements made to Chart. Selecting Patients Closing the Current Patient New Select Diagnosis Dialog Box Prescription Information Added to Chart List Pop-Up 2 Vitera Intergy EHR 9.00 New System Features

Intergy EHR Basics Selecting Patients Selecting Patients In Chart, the Patient Search (magnifying glass) button has been moved beside the Patient tab for consistency and ease of access. Previously, the Patient Search button was on the right side of the window. With this change, you now have the following options for switching from the currently-selected patient to another patient: Click the Patient Search button to open the Select Patient dialog box; Click the drop-down menu under the patient s name in the patient header, which allows you to select a recent patient or open the Select Patient dialog box; or Click the patient s chart tab in the Patient Queue. The following illustration shows the location of each method of switching from one patient to another in Chart. Intergy EHR Madison Medical Center P.A. Appointments for: David Ford My Day Patient Murphy, Sham... 9:10A Asthma Abner, Darlene E 1:10P Allergy Carlson, Sharo... 3:30P Follow-up Visit Aaron, Alice B 4:50P Chest Pain Allergies Info Reminders Carlson, Sh.... select the magnifying glass 03/12/1934 button... 79y F Clin Hx JUNE Appts Chg Hx Diag Hx Select Patient... Abner, Darlene E. Medications GlipiZIDE-MetFORMIN... 07/07/2001 11y 10m F twice a day for 30 days. 1 refill Ford, David E. MD Abner, Carla D. Coumadin 2.5 MG TABS 11/22/1986 26y 10m F 07/31/2007-08/30/2007 League, Claire E. Actos TABS 09/30/1944 69y F 07/31/2007-08/30/2007 Aaron, Alice B.. Actos TABS 07/31/2007-08/30/2007 12/11/1940 72y F Chest Pain at 4:50 PM Actos TABS Murphy, Eileen W. 07Murphy - Eileen007 06/03/1979 34y F Well Baby Check Ford, David E. MD All...or the drop-down arrow to search for another patient 01/08/2012 60 days left 01/08/2012 10/17/2012 Scheduled 10/17/2012 10/17/2012 Scheduled 11/08/2012 select a patient s chart tab Chart Flowsheets Note Orders/Charges to switch to that OB patient Chart SPLIT Problems Carlson, Sharon A. 03/12/1934 79y F SSN: xxx-xx-5639 Allergies Ragweed COMN MIGRNE WO NTRC MGRN Note: You can still use the Select Patient option in the Intergy EHR menu on the title bar as well. You have reached the end of the Selecting Patients topic. Vitera Intergy EHR 9.00 New System Features 3

Intergy EHR Basics Closing the Current Patient Closing the Current Patient When you finish working with the records for a patient in Intergy EHR, you can close that patient s chart and return to the My Day page. The workflow below describes how to close the current patient. Workflow: Closing the Current Patient 1. Hover the mouse pointer over the patient s name in the patient header. The Close Patient button displays to the right of the patient s name. 2. Select the Close Patient button. The patient s records are closed, and Intergy EHR returns you to the My Day page. Intergy EHR Madison Medical Center P.A. Aiken, Isabella Dr. Close Patient button My Day Patient Carlson, Steven W. 08/16/1938 74y M Info Chart SSN: xxx-xx-3434 Patient: Close Patient 10 Phone: (916) 555-3293 Chart: 10 Tasks Send Secure Message More You have reached the end of the Closing the Current Patient topic. 4 Vitera Intergy EHR 9.00 New System Features

Intergy EHR Basics New Select Diagnosis Dialog Box New Select Diagnosis Dialog Box The new Select Diagnosis dialog box has been added in the Intergy and Intergy EHR systems. This dialog box provides you with enhanced diagnosis search and selection options. Additionally, the new dialog box provides you with the ability to work with ICD-9 and ICD-10 diagnosis codes. The new dialog box replaces the existing Select Diagnosis dialog box in the Intergy and Intergy EHR systems. Previously, the Intergy and Intergy EHR systems had different Select Diagnosis dialog boxes. Now, both the Intergy and Intergy EHR systems have the same dialog box. Note: Some Select Diagnosis dialog boxes also allow you to select the Findings or ICD tab. Whether the Findings and ICD tabs display depends upon the area of the system in which you are working, and whether the tabs are relevant to the diagnosis search. For more information, see Selecting ICD-9 and ICD-10 Codes for Problems and Findings on page 62. The workflow below describes how to use the new Select Diagnosis dialog box. Vitera Intergy EHR 9.00 New System Features 5

Intergy EHR Basics New Select Diagnosis Dialog Box Workflow: Using the New Select Diagnosis Dialog Box 1. Specify the set of diagnoses that you want to include in the diagnosis list. You can select whether to list all diagnoses, patient diagnoses, or favorite diagnoses by using the All, Patient, and Favorite buttons located in the upper portion of the dialog above the list of diagnoses. To list All diagnoses Diagnoses that have been used for the current patient Favorite diagnoses for the user who is currently logged in Do this Select the All button. All diagnosis codes in the Intergy system are displayed. Select the Patient button. The diagnoses that have been used previously for the patient are displayed. Select the Favorites button. You can select whether to list all favorites or the favorite diagnoses in a specific category, such as blood diseases or circulatory system. You can list a category if favorites diagnoses by clicking the down arrow on the right side of the button for all or a category diagnoses. The list that is displayed is based on the setting of the Default Procedure/Diagnosis Favorites List user preference. Favorite diagnoses lists are maintained under Favorite Procedure/Diagnosis List Maintenance in Intergy Practice Administration. The list displays the description and ICD diagnosis code for each diagnosis. Either ICD-9 or ICD-10 codes will be displayed, based on the ICD-10 Diagnosis Code Effective Date System Parameter and the date of service or encounter date in context when the dialog is called. For example, if the current date is 06/01/2013 and the ICD-10-Diagnosis Code Effective Date parameter value is 10/01/2014, the Select Diagnosis dialog diagnosis list will display ICD-9 diagnosis descriptions and codes because the current date is prior to the ICD-10 effective date. 2. Sort the diagnoses in the Select Diagnosis dialog box. To sort by diagnosis description, click the Description column heading. To sort by ICD diagnosis code, click the ICD column heading (ICD-9 or ICD-10). 3. Search for a diagnosis in the Select Diagnosis dialog box. After you have set up a list of diagnoses, you can shorten or limit the list of diagnoses and search for a diagnosis. You can shorten the list by typing numbers, letters, or words from a diagnosis code or description in the Search diagnoses text box located in the upper left portion of the dialog box. The more characters you type, the shorter the list becomes. The matching characters of the diagnoses listed for the search are highlighted. If no diagnoses match the search, the message No matches found for is displayed in the list area. To see the full list, clear the search field. 6 Vitera Intergy EHR 9.00 New System Features

Intergy EHR Basics New Select Diagnosis Dialog Box If the window is in ICD-10 mode, you can search matching ICD-9 codes by entering 9- before the code you are searching for. For example, entering 9-250.00 will search for ICD-9 code 250.00. Additionally, if the window is in ICD-10 mode and your search returns no matches, an option to search the entire ICD-10 master list is displayed below the message. You can click the Search the entire ICD-10 master list link to perform the search. Note that the ICD-10 Master List search filter is displayed above the list only after search of the ICD-10 master list was performed for the current work session in the window. If a matching diagnosis is found, the diagnosis is displayed. If the diagnosis is selected, the diagnosis is added to the list for the Select Diagnosis dialog box. 4. Select the diagnosis you want by clicking the row of the diagnosis. The Select Diagnosis dialog box closes and the diagnosis code is displayed in the field displays in the field of the window for which you were selecting a diagnosis. You have reached the end of the New Select Diagnosis Dialog Box topic. Vitera Intergy EHR 9.00 New System Features 7

Intergy EHR Basics Prescription Information Added to Chart List Pop-Up Prescription Information Added to Chart List Pop-Up When viewing prescription information in the Chart List, you now can see how a prescription was issued in the informational pop-up window that appears when you hover the mouse pointer over the prescription. For example, you can see whether the prescription was handwritten, printed, or issued electronically. The following illustration shows where the information about how the prescription was issued displays in the pop-up: Problems Admin Rx Meds Vitals Docs Labs Immun. Imaging Darvocet-N 50 50-325 MG TABS 04/02/2012-04/12/2012 Lapsed Lipitor 20 MG TABS 04/02/2012-04/22/2012 Lipitor 20 MG TABS Amoxicillin 500 MG TABS 03/25/2011-04/04/2011 Lapsed Crestor 10 MG TABS 03/25/2011-04/02/2012 Darvocet-N 50 50-325 MG TABS 03/25/2011-04/02/2012 Naprosyn 500 MG TABS 03/25/2011-05/24/2011 Lipitor 20 MG TABS 03/21/2011-04/02/2012 Amoxicillin 500 MG TABS 02/17/2011-03/18/2011 Vioxx 25 MG TABS 04/08/2031-03/25/2011 Patient Encounter - Ford, David E. MD General Check-up - Ford, David E. MD mouse pointer hovering over this prescription No images since last appointment Reported Amoxicillin 500 MG TABS Recent e Images Clinical History Discontinued Dx: 726.10 - ROTATOR CUFF SYND NOS Qty: 40 days: 10 refills: 0 sig: 1 every 6 hours Discontinued Issued Via: Hand Written Provider: Ford, David E. MD Discontinued Pharmacy: Sunshine Drugs Information about how the Discontinued Take 1 tablet every 6 hours with a full glass of water prescription was issued Discontinued Discontinued Lapsed s Section You have reached the end of the Prescription Information Added to Chart List Pop-Up topic. 8 Vitera Intergy EHR 9.00 New System Features

Care Team Prescription Information Added to Chart List Pop-Up Care Team This section describes the enhancements made to Care Teams, which were formerly referred to as Provider Roles. Provider Roles Renamed Care Team Vitera Intergy EHR 9.00 New System Features 9

Care Team Provider Roles Renamed Care Team Provider Roles Renamed Care Team In version 9.00 of Intergy EHR, Provider Roles have been renamed Care Team. Following is a review of Care Teams in Intergy EHR. The Care Team page displays a list of providers associated with the patient s care and specifies each provider s role as associated with the care of the patient. For example, in addition to a primary care provider, patients may have providers assigned to their care for specific conditions or procedures, such as surgery and gastroenterology. My Day Clin Hx Allergies Info Reminders JUNE Appts Chg Hx Patient Abner, Carl... 05/08/1965 48y F SSN: xxx-xx-0206 Phone: (916) 555-3293 Email: abnerc@e4health.com PROBLEMS Asthma URIN TRACT INFECTION NOS ALLERGIES Latex MEDICATIONS None Patient: 1 Chart: 1 More No appointments for the selected doctor and date Chart Flowsheets Note Orders/Charges OB Chart SPLIT Provider Bennett, Joel W. CRNA Johnson, Katrina L. MD Morris, Thomas J. Specialty Anesthesiology Family Practice General Surgery Office # (916) 555-5455 (916) 555-9010 (916) 555-8019 Care Team: Carla D. Abner Mobile # Care Team for patient Carla Abner Comments Diag Hx JUNE Recalls Tasks APPOINTMENTS NO UPCOMING APPOINTMENTS RECENT Asthma Allergy Allergy Discuss Results Abdominal Pain 10/25/2012 04/19/2012 04/05/2012 04/03/2012 03/16/2011 Problems Admin Rx INSURANCE Anaheim Managed Health PHARMACY No Default Pharmacy Vitals Docs Meds OTHER INFO Account & Guarantor Info Advance Directives Patient Alerts and Notes Patient on Account Care Team Rx Benefit Plans Sliding Fee Labs The Care Team List displays the following information: the name of the provider, the specialty of each provider who is caring for the patient, the office phone number and the mobile phone number of the provider, any comments regarding the provider and his or her role in the patient's care (for example, noting that the provider is a referring or consulting physician), the practice user who last updated the care team information (automatically updated by the system based on the current user logon), and 10 Vitera Intergy EHR 9.00 New System Features

Care Team Provider Roles Renamed Care Team the date the care team information was last updated (automatically updated by the system based on the system date). You have reached the end of the Provider Roles Renamed Care Team topic. Vitera Intergy EHR 9.00 New System Features 11

Chart Provider Roles Renamed Care Team Chart This section describes the enhancements made to Chart. Displaying Specimens for Lab Test Results Patient Education and Provider Reference Information Renaming Zip Files When Exporting a Patient s Full Chart Patient Internet Access Status Patient Care Program Preferred Communication Method Including Images when Printing the Patient s Chart 12 Vitera Intergy EHR 9.00 New System Features

Chart Displaying Specimens for Lab Test Results Displaying Specimens for Lab Test Results In the Labs list in Chart, if specimen information is available for a lab result, the specimen information will now be included in the lab result information in the hover. Additionally, when you display a lab test in the Details view, if specimen information is available for a lab test result, the indicator Comments is now displayed as a blue hypertext link on the right side of the lab test name that is located above the Component list. You can view the specimen information in the lab test in the Lab Test Comments dialog box by clicking the Comments hypertext link. You have reached the end of the Displaying Specimens for Lab Test Results topic. Vitera Intergy EHR 9.00 New System Features 13

Chart Including Images when Printing the Patient s Chart Including Images when Printing the Patient s Chart All documents and images are now included when you print a patient s chart. In addition, all the chart images are printed in a single PDF file, rather than individually, which makes printing charts with many images easier and more efficient. Previously, images were not included as part of the print job, and each document was a separate print job. The only thing necessary to combine chart images into a single PDF file is to have the Microsoft XPS Document Writer installed as a printer on your system. Once you have done this, then the images are automatically combined into one PDF and printed on whichever printer you select. You do not need to perform any special steps while printing the chart. If the Microsoft XPS Document Writer is not installed on your system, the chart images will continue to be printed individually on the printer you select. The workflow below describes how to print a patient s chart images as a single PDF file. Workflow: Printing a Patient s Chart Images as a Single PDF File 1. Verify that the Microsoft XPS Document Writer is installed as a printer on your system. 2. Open the Chart window and select the patient for whom you want to print chart data. 3. From the Intergy EHR menu, select Print Patient Chart. The Print Patient Chart dialog box opens, through which you can specify which patient chart data should be included in the printout. 14 Vitera Intergy EHR 9.00 New System Features

Chart Including Images when Printing the Patient s Chart Note: When you select a printer, you do not need to select the Microsoft XPS Document Writer in order to print the images in a single PDF file. The Microsoft XPS Document Writer only needs to be installed. The images will automatically be combined into a single PDF file, regardless of which printer you select. 4. Continue making selections and printing the patient s chart as you normally would. You have reached the end of the Including Images when Printing the Patient s Chart topic. Vitera Intergy EHR 9.00 New System Features 15

Chart Patient Education and Provider Reference Information Patient Education and Provider Reference Information From Chart you can now access and display patient education and patient-specific provider referential information from specific medications, problems, and lab results that have been recorded for a patient. You can access the information by using the new right-click options and buttons that have been added in Chart. For example, in Chart you can access patient education resources for a medication from the following locations: Location Chart Tab Info chart list Meds chart list A selected medication Description In the Patient Summary, locate the Medications section, right-click on the medication for which you want to access information, and select Patient Education from the pop-up menu that displays. In the chart lists on the left side, select the Info chart tab to display the Info chart list, locate the Medications section, right-click on the medication for which you want access information, and select Patient Education from the pop-up menu that displays. In the chart list on the left side, select the Meds chart tab to display the Meds chart list, locate the medication for which you want access information, right-click on the medication, and select Patient Education from the pop-up menu that displays. Select a medication in the Patient Summary, the Info chart list, or the Meds chart list. The medication details display and the Patient Education button is available. Select the Patient Education button. Patient education When you access patient education resources for a lab component result, a web page of information about the lab component result is displayed. The information that is displayed is based on the current patient s demographic information, such as age, gender, and language.the web page can be viewed, printed, and provided to the patient. Provider reference information When you access provider education resources, a web page of diagnostic or therapeutic information is displayed. The web page can be viewed and printed. The provider referential options are available to users who have been permitted security access for Health Management in Users and Security in the Intergy system. Patient Education/Provider Reference information website The website that displays the provider reference information and patient education information is based on the URL that is specified as the value of the new Patient Education/ Reference Information Website Address system/practice parameter. The URL value for the 16 Vitera Intergy EHR 9.00 New System Features

Chart Patient Education and Provider Reference Information parameter can be set in System Configuration in System Administration and Practice Configuration in Practice Administration. You have reached the end of the Patient Education and Provider Reference Information topic. Vitera Intergy EHR 9.00 New System Features 17

Chart Renaming Zip Files When Exporting a Patient s Full Chart Renaming Zip Files When Exporting a Patient s Full Chart When you export a patient s full chart to a file archive (.zip file), the default naming convention of zip archive file is Last_First_FullChart.zip, where Last is the patient s last name and First is the patient s first name. For example: Carlson_Steven_FullChart.zip. With this enhancement, you now can change the default name of the zip file during the export process. For example, if you prefer to include the current date in the file name, you could rename it Carlson_Steven_FullChart041013.zip. Note: Images and voided documents in the patient chart are not included in the zip archive file. The workflow below describes how to export a patient s full chart, and how to change the name of the zip file in the process. You can find the enhancement described above in the Zip File field in step 3 of the workflow. Workflow: Exporting a Patient s Full Chart to an Archive File 1. Select the patient whose chart you want to export. 2. From the Intergy EHR menu, select Tools and then select Export Full Chart. The Export Full Chart dialog box displays. 3. Make entries in the following fields: Field Zip File Description Specify the folder and file name where you want to save the exported archive file. The location can be the path to a directory on your computer or network (such as c:\exportedcharts), or it can be external storage media (such as a flash drive or DVD). The default file name is created as described above. However, you can rename the file if you want. The default file path is the one from the last successful chart export. For example, if the last successful chart export was to the c:\chartexport directory, that same file path is used as the default the next time you perform a chart export on the same workstation. 18 Vitera Intergy EHR 9.00 New System Features

Chart Renaming Zip Files When Exporting a Patient s Full Chart Field Zip File Password Protection Password Description Specify whether you want the exported archive file to be protected with a password. If you password-protect the archive file, anyone who wants to open the file will have to enter the password. To password-protect the archive file, check this box, then type the password in the Password field. If you do not want to password-protect the archive file, leave this box unchecked. Type the password to be used for opening the exported archive file containing the full patient chart. Note: This field is only available if the Zip File Password Protection box is checked. 4. Select the Export button to start the export process. A progress bar is displayed on the Export Full Chart dialog box. The exported files are then archived and the zip archive file is placed in the specified folder. When processing is completed, an information window opens, indicating the full path name of the zip file and confirming the password, if one was entered. 5. Select the OK button to close the message box and the Export Full Chart dialog box. You have reached the end of the Renaming Zip Files When Exporting a Patient s Full Chart topic. Vitera Intergy EHR 9.00 New System Features 19

Chart Patient Internet Access Status Patient Internet Access Status You can now view the status of whether a patient has access to use the internet. The status provides information about whether the patient has access to the internet for the ability to view, download, or transmit his or her health information online. The new Patient Internet Access field has been added to Chart (Patient Demographics section). (Y)es Indicates that the patient has internet access. (N)o Indicates that the patient does not have internet access. Additionally, the new Internet Access field has been added in the Intergy system in Patient Registration (Contact Information page), Patient Information (Personal page, Contacts tab) and Person Maintenance. You can set the patient internet access status when you are registering a patient, editing patient information, and adding or editing person information in the Intergy system. You can select one of the following options: (Y)es Indicates that the patient does have internet access. (N)o Indicates that the patient does not have internet access. The field is shipped with a default value of (Y)es. You have reached the end of the Patient Internet Access Status topic. 20 Vitera Intergy EHR 9.00 New System Features

Chart Patient Care Program Patient Care Program Using the Care Program section of Chart, you can now assign a risk level to selected patients, which allows you to use Practice Analytics to report on patients by risk level and care program, such as ACO. The Care Program section has been moved higher up on the Patient Info List. In addition, a similar Care Program section now is located in the patient banner. Both Care Program sections list the codes of the care programs in which the patient is included, as well as the risk level assigned to the patient. Risk levels range from 1 (lowest), indicated by a green icon, to 6 (highest), indicated by a red icon. If no care program has been assigned to the patient, the message Not included in a care program displays. Vitera Intergy EHR 9.00 New System Features 21

Chart Patient Care Program Pro Tip Care Program and Risk Level Setup Care programs are set up in System-Defined Lookup Maintenance in Intergy, and their use is governed by the practice parameter This Practice Participates in a PCMH/ACO Program. While the Risk level lookups are defined as levels 1 through 6, the definitions of these risk levels are based on criteria set up by each individual practice. For example, one practice s criteria for assigning a risk level 3 to a patient might be different from another practice s criteria. The name of the Patient Care Program particular lookup is PatientCareProgram in System- Defined Lookup Maintenance in Intergy. Many care programs are shipped with Intergy EHR, but are inactive until you activate them. For more information about setting up a Care Program, refer to the topic Patient Care Program Setup in the Intergy System in the Intergy New System Features document. The workflow below describes how to assign a care program and risk level to a patient. Workflow: Assigning a Care Program and Risk Level to a Patient 1. On the patient s chart, click on Care Program and select Edit from the pop-up menu that displays. Alternately, if you want to edit an existing care program or risk level, you can click on the care program codes or the risk indicator in the Care Program section. 22 Vitera Intergy EHR 9.00 New System Features

Chart Patient Care Program The Edit Patient Care Programs dialog box displays. 2. Make entries in the following sections: Section Care Program(s) Patient Risk Level Description Check the box by each care program that the patient is in. Select the patient s risk level. Definitions of risk levels are based on criteria set up by each individual practice. 3. Click the OK button. The code for each selected care program and the patient s risk level display in the Care Program section of the patient s chart. You have reached the end of the Patient Care Program topic. Vitera Intergy EHR 9.00 New System Features 23

Chart Preferred Communication Method Preferred Communication Method The preferred communication method can now be selected and displayed for a patient. This allows you to indicate, display, and identify the method of communication preferred by a patient. The following enhancements have been implemented: The updated Comm. Method field is now included in Chart (Patient Demographics section. Previously, the field was labeled Recall Method. Now, the field is labeled Comm. Method. The updated Set Comm. Method button is now included in the lower portion of the Chart window. Previously, the button was labeled Set Recall Method. The updated Patient Comm. Method dialog box displays when you click the Set Comm. Method button. Previously, the Patient Recall Method dialog box displayed. Note: The patient communication method is only available for setting if your practice is using the optional Practice Portal feature, and if the patient is set up to use secure messaging. Otherwise, the preferred communication method is automatically set to Paper and the method cannot be edited. In the Intergy system, the updated Preferred Communication Method field is included in the Patient Information (Personal page, Contacts tab) window and the Edit Patient Contacts window. Additionally, the updated Select Preferred Communication dialog box is now available. You have reached the end of the Preferred Communication Method topic. 24 Vitera Intergy EHR 9.00 New System Features

Encounter Note Preferred Communication Method Encounter Note This section describes the enhancements made to Encounter Note. E&M Calculator Enhancement SNOMED Code Compatibility Voiding Vital Signs in an Encounter Note Vitera Intergy EHR 9.00 New System Features 25

Encounter Note E&M Calculator Enhancement E&M Calculator Enhancement Encounter Note includes a tool for estimating the evaluation and management (E&M) code for a patient visit. The E&M Calculator provides this automated estimate based on the current encounter findings and other information for the visit. In version 9.00 of Intergy EHR, the E&M Calculator has been enhanced to show any previously selected codes for a note, as well as newly calculated ones. That is, if you chose an E&M code but then made changes to the note that resulted in a different E&M code being calculated, the E&M Calculator now displays both the code you selected previously and the newly calculated ones. The workflow below describes how to estimate the E&M code using the E&M Calculator. You can find the enhancement described above in step 7 of the workflow. Workflow: Estimating the Evaluation and Management Code 1. From the Encounter Note toolbar, select the E&M button. The Evaluation and Management Form dialog box opens, containing the default E&M code calculated from the findings selected in the encounter note for the patient visit. 2. In the Step 1 section at the top of the dialog box, verify the visit information and enter or edit any further details about the patient visit. The values entered in these fields are 26 Vitera Intergy EHR 9.00 New System Features

Encounter Note E&M Calculator Enhancement factored into the E&M code calculation, so changes to these field may cause the estimated E&M Code to change: Use the radio buttons to specify whether the patient is a new patient or an existing patient. In the Setting field, you can specify the type of facility at which treatment is provided. Further information about the service provided can be entered in the Service Type field. The Exam Type field allows you to select the specific system designated for medical examination, which results in greater accuracy in code calculation. The >50% time spent counseling check box is used to determine the accurate percentage of time a caregiver has devoted to face-to-face communication with the patient. You can specify the amount of time spent with the patient in the Total face to face or Floor time field. 3. If assessment findings exist for the encounter, they will display in the Assessment table. You can further modify the assessment by selecting the appropriate check boxes for each finding. Selecting these modifiers may affect how the data is assessed for the E&M code. For example, indicating that a problem is New with planned Additional Workup may be assessed differently than an existing problem which is indicated solely as Active. 4. To include your changes into the E&M code calculation, select the Recalculate E&M button. Your changes are then applied to the E&M code. 5. The table in the Step 2 section of the dialog box shows the level of service calculated for the various components of the examination, based on the encounter note. You can override the estimated level of service value for an examination component, if you decide that it should be different than the calculated value. Vitera Intergy EHR 9.00 New System Features 27

Encounter Note E&M Calculator Enhancement You can review the details of those sections which feature a blue linked title in the table. Selecting the link opens a details panel below the table which displays the details from the encounter note used to calculate the E&M code. 6. To override a level of service value, select the level of service field for the corresponding examination component. The letter 'U' (for User) will display in each field that you enter 28 Vitera Intergy EHR 9.00 New System Features

Encounter Note E&M Calculator Enhancement an override. Level of service override values may only be selected in the table fields with a white background. Table fields with a gray background cannot be changed. 7. When completed, select the Calculate Override button. The system will recalculate the E&M code using the override values. If the E&M code calculated using the override values is different than the code calculated from the documentation, both the Documented E&M code and the Override E&M code will display. In addition, if an E&M code was selected for the current note, and then you made more changes to the note which resulted in a different E&M code being calculated, the Vitera Intergy EHR 9.00 New System Features 29

Encounter Note E&M Calculator Enhancement Previously Selected code displays along with the newly-calculated one. You can select which of these E&M codes you want to charge for the visit. 8. When you are satisfied with the E&M code selection, choose the Accept button. The selected E&M code will display on the Charges tab on the Intergy EHR Orders/Charges window. You have reached the end of the E&M Calculator Enhancement topic. 30 Vitera Intergy EHR 9.00 New System Features

Encounter Note SNOMED Code Compatibility SNOMED Code Compatibility You can search for a MEDCIN finding based on a SNOMED (Systemized Nomenclature of Medicine) code, and problems are now mapped to SNOMED codes in Intergy EHR. SNOMED codes are displayed in the Problems Details screen. Intergy EHR now also uses them in addition to ICD-9 codes and MEDCIN findings to determine if a problem listed in the Continuity of Care Document (CCD) is already present in the Patient Chart. You have reached the end of the SNOMED Code Compatibility topic. Vitera Intergy EHR 9.00 New System Features 31

Encounter Note Voiding Vital Signs in an Encounter Note Voiding Vital Signs in an Encounter Note In Encounter Note, the Delete button has been replaced by the Void button. However, the functionality of the button itself did not change. You still cannot view a patient s vital sign records after they have been voided. Note: You can also void a set of vitals by right-clicking the link of the vital set you want to void and selecting Void from the pop-up menu that displays. You have reached the end of the Voiding Vital Signs in an Encounter Note topic. 32 Vitera Intergy EHR 9.00 New System Features

Health Information Exchange Voiding Vital Signs in an Encounter Note Health Information Exchange This section describes enhancements to Health Information Exchange functionality. Document List Views for the Exchange Tab Enhanced CCD Import Functionality Generating an Exchange Document Exchange Documents as Secure Message Attachments Exporting an Exchange Document to an HIE Printing an Exchange Document Vitera Intergy EHR 9.00 New System Features 33

Health Information Exchange Document List Views for the Exchange Tab Document List Views for the Exchange Tab You can set the document list view for the Exchange tab to show all documents, only documents that you generated, or only documents you retrieved from outside sources. In addition, you can include voided documents in any of those views. In Intergy EHR, the drop-down menu for selecting Exchange document views has changed slightly, with the Include Voided option now available as a separate check box that you can use with any of the views. For example, you could display only generated Exchange documents, and also include any voided documents in the list. The workflow below describes how to set the document list view for the Exchange tab. Workflow: Setting the Document List View for the Exchange Tab 1. From the drop-down menu above the Exchange documents directory, select one of the following views: All Display all Exchange documents in the view. Generated Display only previously-generated Exchange documents in the view. Retrieved Display only retrieved Exchange documents in the view. 2. If you want to include voided documents in any of the views you select, check the Include Voided box. To exclude voided documents, leave the box unchecked. Intergy EHR displays the Exchange documents that match the display settings you selected. You have reached the end of the Document List Views for the Exchange Tab topic. 34 Vitera Intergy EHR 9.00 New System Features

Health Information Exchange Enhanced CCD Import Functionality Enhanced CCD Import Functionality From the updated Exchange List in Chart, you can import clinical data from Continuity of Care Documents (CCDs) into patients medical records in your practice s Intergy EHR system. Now, when you import a patient s medications, including lapsed and discontinued medications, Intergy EHR now uses the RxNorm code in addition to the Medi-Span drug code and prescription issue date to determine if a medication listed in the CCD is already present in the Patient Chart. Intergy EHR now uses SNOMED codes in addition to ICD-9 codes and MEDCIN findings to determine if a problem listed in the CCD is already present in the Patient Chart. When you import a patient s drug-specific allergies, Intergy EHR now uses the RxNorm code in addition to the Medi-Span drug code to determine if drug-specific allergies listed in the CCD are already present in the Patient Chart. You can now preview your import selections and the clinical items that are already in the Patient Chart by using the updated Preview button located at the bottom of the window. To preview the Patient Chart items, change the preview setting from Off to On by selecting the blue button on the left side of the Off indicator. In the Chart column, the items that are already in the Patient Chart have a check inside a circle. The items that have been selected for import have a check inside a circle. To close the preview of the Patient Chart items, change the preview setting from On to Off by selecting the blue button on the right side of the On indicator. You can also right-click items from the patient s Intergy EHR chart and select Deactivate/ Discontinue. You have reached the end of the Enhanced CCD Import Functionality topic. Vitera Intergy EHR 9.00 New System Features 35

Health Information Exchange Generating an Exchange Document Generating an Exchange Document The process of generating an Exchange document has been enhanced with more intuitive dialog boxes that help provide a smoother workflow. The old Generate Document dialog box has been replaced with the new Generate Exchange Document dialog box: The following changes were made in the new Generate Exchange Document dialog box: No. Description The new TO section replaces the Send To section from the previous dialog box. The new WHAT section allows you to choose the type of Exchange document you want to send: Clinical Summary, Referral Summary, or Full Chart. The new INCLUDE section replaces the area of the previous dialog box where you selected the information to include in the Exchange document. In addition, the following changes were also made: The type of information to include in the Exchange document is now selected through the new Included Sections - Patient dialog box, as explained in the workflow below. The De-identify Patient check box has been moved to the new Included Sections - Patient dialog box. After you have generated a Clinical Summary Exchange document, a check mark displays beside the Print Summary button on the Today panel of the Patient Summary page. A similar check mark displays beside the Exchange Document check box on the Sign Encounter Note dialog box if a Clinical Summary has already been generated. 36 Vitera Intergy EHR 9.00 New System Features

Health Information Exchange Generating an Exchange Document The workflow below describes how to generate an Exchange document using the improved, redesigned dialog boxes. Workflow: Generating an Exchange Document with Encryption 1. Open the Chart window and select the patient for whom you want to generate an Exchange document. 2. Select the Exchange button to display the Exchange tab. 3. Select the Generate button. The Generate Exchange Document dialog box opens, containing options for specifying what patient clinical data should be included in the Exchange document. Vitera Intergy EHR 9.00 New System Features 37

Health Information Exchange Generating an Exchange Document 4. Complete the following sections of the dialog box to specify information about the Exchange document: Section TO Description Select one of the following to choose the recipient to whom the Exchange document will be sent: Patient Generate the Exchange document for the patient. Referring Provider Generate the Exchange document for the referring provider that you select from the drop-down list. Person/Organization Select either the Person or the Organization radio button, then type their name in the Name field. Intergy EHR will generate the Exchange document for the recipient you specify. WHAT Select what type of information you want to include in the Exchange document. 1. From the drop-down menu, select Clinical Summary, Referral Summary, or Full Chart. 2. If you selected Clinical Summary or Referral Summary, click Choose Encounter to select the encounter from the Select Encounter dialog box that displays. The Exchange document will include information from that encounter. Note: If you selected Full Chart, you do not need to select an encounter, because the patient s entire chart will be included. 38 Vitera Intergy EHR 9.00 New System Features

Health Information Exchange Generating an Exchange Document Section INCLUDE Description Select the information you want to include in the Exchange document, such as allergies, medications, problems, social history, and so forth. The information to be included is listed on the dialog box. If you want to change it: 1. Click the Change link at the end of the list. The Included Sections - Patient dialog box displays, through which you can select the information to include in the Exchange document. 2. Check the box by each section of information you want to include. Uncheck any boxes you do not want to include. 3. To keep the patient s information from displaying in the Patient Detail section of the Exchange document, check the De-identify Patient box. The patient s name will display as Anonymous in the Exchange document, and the Date of Birth and Gender fields will display as empty. 4. When you are finished making selections, click the Save button. Vitera Intergy EHR 9.00 New System Features 39

Health Information Exchange Generating an Exchange Document TIP If you want to save your selections as the default for the next time you generate an Exchange document, check the Save as Default box in the Included Sections - Patient dialog box. 5. When you save the generated Exchange document to a file directory of external storage (such as a flash drive or CD ROM), you can save the Exchange document as a chart copy, or you can save the document to a file. Saving the Exchange document as a chart copy is useful if you want to view or print an Exchange document that represents a patient s clinical history for a given point in time. Saving the Exchange document as a file is useful when you want the patient s complete history. Both options are described below. To save the Exchange document as a chart copy Select the Save button, then select Save To Chart from the drop-down menu. The Exchange document is saved as a chart copy. 40 Vitera Intergy EHR 9.00 New System Features

Health Information Exchange Generating an Exchange Document To save the Exchange document to a file 1. Select the Save button, then select Save To File from the drop-down menu. The Export Document dialog box displays a preview of the Exchange document. Note: If you the document preview does not look correct, you can cancel generating the Exchange document by selecting Close. 2. To format the document, select either Standard Stylesheet or Raw Data View from the drop-down menu in the lower left. 3. Select Save to File. The Save to file... dialog box displays. Vitera Intergy EHR 9.00 New System Features 41

Health Information Exchange Generating an Exchange Document 4. Make entries in the following fields: Field Destination Data Format Description Displays a system-generated file name. You can change the file name and path if needed by typing in the new file name and selecting a new path. Note: You can set a default location for generated files by specifying the Patient EHR File Directory user preference in the Intergy Practice Administration desktop. Select one of the following: 5. Select Save. Note: Encrypted Encrypt the generated Exchange document for greater security. Unencrypted Do not encrypt the generated Exchange document. If you select the Encrypted option, the Password dialog box displays. Type a password for the generated Exchange file in the Password and Confirm fields, then select the OK button. Intergy EHR saves the generated Exchange document to a file. You have reached the end of the Generating an Exchange Document topic. 42 Vitera Intergy EHR 9.00 New System Features

Health Information Exchange Exchange Documents as Secure Message Attachments Exchange Documents as Secure Message Attachments When generating an Exchange document, you can send a secure message with a copy of the Exchange document attached. In previous versions of Intergy EHR, the Secure Messaging option was selected from the Via field on the Generate Document dialog box. Now, you use the Send button on the Generate Exchange Document dialog box. When you generate an Exchange document, the system determines whether the selected patient has a Practice Portal account. If the patient is a Practice Portal user, the Send button will be available on the Generate Exchange Document dialog box. The workflow below describes how to generate and send an Exchange document as a secure message attachment. Workflow: Generating and Sending an Exchange Document as a Secure Message Attachment 1. Open the Chart window and select the patient for whom you want to generate and send an Exchange document. 2. Select the Exchange button to display the Exchange tab. 3. Select the Generate button. Vitera Intergy EHR 9.00 New System Features 43

Health Information Exchange Exchange Documents as Secure Message Attachments The Generate Exchange Document dialog box opens, containing options for specifying what patient clinical data should be included in the Exchange document. Note: The Send button is only available if secure messaging is available for the patient. 4. Complete the TO, WHAT, and INCLUDE sections as described in Generating an Exchange Document on page 36. 5. Select the Send button. The Secure Messaging dialog box opens with the Exchange document automatically selected as an attachment. 6. In the To field, enter the e-mail address to which you want to send the secure message. 7. In the text box, enter a message to the patient or authorized recipient. 8. Select additional options on the Secure Message dialog box, as needed. If you want to save the secure message, attachments, or both to the patient s chart, check the CC Chart box. Before sending the secure message, the system will display a dialog box in which you can specify options for saving the secure message and attachments to the patient s chart. 9. Select the Send button. You have reached the end of the Exchange Documents as Secure Message Attachments topic. 44 Vitera Intergy EHR 9.00 New System Features

Health Information Exchange Exporting an Exchange Document to an HIE Exporting an Exchange Document to an HIE Exporting an Exchange document enables you to share an Exchange document with a Health Information Exchange (HIE) repository. In previous versions of Intergy EHR, the HIE Repository option was selected from the Via field on the Generate Document dialog box. Now, you use the Share button on the Generate Exchange Document dialog box. The workflow below describes how to share an Exchange document with an HIE. Workflow: Sharing an Exchange Document with an HIE 1. Open the Chart window and select the patient for whom you want to generate an Exchange document. 2. Select the Exchange button to display the Exchange tab. 3. Select the Generate button. Vitera Intergy EHR 9.00 New System Features 45

Health Information Exchange Exporting an Exchange Document to an HIE The Generate Exchange Document dialog box opens, containing options for specifying what patient clinical data should be included in the Exchange document. 4. Select the Share button. The Export Document dialog box displays. Note: If you the document preview does not look correct, you can cancel generating the Exchange document by selecting Close. 5. To format the document, select either Standard Stylesheet or Raw Data View from the drop-down menu in the lower left. 46 Vitera Intergy EHR 9.00 New System Features

Health Information Exchange Exporting an Exchange Document to an HIE 6. Click Submit to HIE. The Exchange document is sent to the HIE. You have reached the end of the Exporting an Exchange Document to an HIE topic. Vitera Intergy EHR 9.00 New System Features 47

Health Information Exchange Printing an Exchange Document Printing an Exchange Document You can print a hard copy of an Exchange document to give to a patient, a provider, or to keep in a file if necessary. In previous versions of Intergy EHR, the Print option was selected from the Via field on the Generate Document dialog box. Now, you use the Print button on the Generate Exchange Document dialog box. The workflow below describes how to print a hard copy of an Exchange document. Workflow: Printing a Hard Copy of an Exchange Document 1. Open the Chart window and select the patient for whom you want to print an Exchange document. 2. Select the Exchange button to display the Exchange tab. 3. Select the Generate button. 48 Vitera Intergy EHR 9.00 New System Features

Health Information Exchange Printing an Exchange Document The Generate Exchange Document dialog box opens, containing options for specifying what patient clinical data should be included in the Exchange document. 4. Complete the TO, WHAT, and INCLUDE sections as described in Generating an Exchange Document on page 36. 5. Select the Print button. The Print options dialog box opens. 6. Select the appropriate print options, and then select the Print button. The Exchange document is printed. You have reached the end of the Printing an Exchange Document topic. Vitera Intergy EHR 9.00 New System Features 49

Health Reminders Printing an Exchange Document Health Reminders This section describes the enhancements made to Health Reminders. Selecting an ICD-10 Code for a Diagnosis on the Add to Orders Tab Selecting an ICD-10 Code for a Diagnosis on the Health Reminders Window 50 Vitera Intergy EHR 9.00 New System Features

Health Reminders Selecting an ICD-10 Code for a Diagnosis on the Add to Orders Tab Selecting an ICD-10 Code for a Diagnosis on the Add to Orders Tab The Add to Orders tab in Health Reminders displays the orders associated with a reminder. If your system is in ICD-10 mode and a diagnosis for an order was entered in ICD-9 mode, Intergy EHR prompts you to select the corresponding ICD-10 code for the order. If your practice has already imported ICD-10 codes that can be mapped to a given ICD-9 code, the search with the 9: prefix gives you a list of those mapped diagnosis codes. This allows you to select the ICD-10 code that is most appropriate for the ICD-9 code that was originally entered. If the ICD-10 code that you are searching for is not displayed in the search window, you can click the link Search the entire ICD-10 master list to display the full ICD-10 code master list and select a code from it. Vitera Intergy EHR 9.00 New System Features 51

Health Reminders Selecting an ICD-10 Code for a Diagnosis on the Add to Orders Tab For more information about ICD-10 codes, see ICD-10 on page 55. You have reached the end of the Selecting an ICD-10 Code for a Diagnosis on the Add to Orders Tab topic. 52 Vitera Intergy EHR 9.00 New System Features

Health Reminders Selecting an ICD-10 Code for a Diagnosis on the Health Reminders Window Selecting an ICD-10 Code for a Diagnosis on the Health Reminders Window The Health Reminders window in Orders/Charges displays a full list of the orders on the patient s due reminders. If your system is in ICD-10 mode and a diagnosis for an order was entered in ICD-9 mode, Intergy EHR prompts you to select the corresponding ICD-10 code for the order. If your practice has already imported ICD-10 codes that can be mapped to a given ICD-9 code, the search with the 9: prefix gives you a list of those mapped diagnosis codes. This allows you to select the ICD-10 code that is most appropriate for the ICD-9 code that was originally entered. If the ICD-10 code that you are searching for is not displayed in the search window, you can click the link Search the entire ICD-10 master list to display the full ICD-10 code master list and select a code from it. Vitera Intergy EHR 9.00 New System Features 53

Health Reminders Selecting an ICD-10 Code for a Diagnosis on the Health Reminders Window For more information about ICD-10 codes, see ICD-10 on page 55. You have reached the end of the Selecting an ICD-10 Code for a Diagnosis on the Health Reminders Window topic. 54 Vitera Intergy EHR 9.00 New System Features

ICD-10 Selecting an ICD-10 Code for a Diagnosis on the Health Reminders Window ICD-10 This chapter describes enhancements made to Intergy EHR to allow you to use the ICD-10 diagnosis code set, which according to regulations from the Center for Medicare and Medicaid Services (CMS) will replace the ICD-9 code set for both institutional and professional claims. ICD Code Overview ICD-10 Readiness Setup Setting Up Intergy EHR for ICD-10 Using ICD-9 and ICD-10 Diagnosis Codes Converting Diagnoses to Findings ICD-10 to ICD-9 Mapping Rx Summary Vitera Intergy EHR 9.00 New System Features 55

ICD-10 ICD Code Overview ICD Code Overview The International Classification of Diseases (ICD) is a standard classification of diseases, injuries, and causes of death as determined by the World Health Organization. These ICD diagnosis codes provide an official and consistent system of identifying, coding, and grouping health conditions. ICD-9 is the Ninth Revision of the official ICD system that is currently used to classify and assign codes to health conditions and related information. The Centers for Medicare and Medicaid Services (CMS) began using the Tenth Revision of ICD diagnosis codes (ICD-10) on April 1, 2010. On October 1, 2014, all insurance payers are expected to begin requiring ICD-10 for claims instead of ICD-9 diagnosis codes. ICD-9 diagnosis codes can no longer be used on or after October 1, 2014. For more information about the upcoming ICD-10 requirements, see the CMS website at https://www.cms.gov/icd10/. Intergy EHR version 9.00 incorporates comprehensive changes into its design to support ICD-10 coding, as well as to simplify the transition period from ICD-9 to ICD-10 for your practice. You have reached the end of the ICD Code Overview topic. 56 Vitera Intergy EHR 9.00 New System Features

ICD-10 ICD-10 Readiness Setup ICD-10 Readiness Setup You can now set up ICD-10 codes in specific Intergy system and Intergy EHR maintenance and setup windows while your system continues to use ICD-9 diagnosis codes. This allows your practice to begin setup for ICD-10 readiness prior to the system switchover date for actual ICD-10 use. The Select Diagnosis dialog box has been modified to include the option to display and select ICD-10 codes in specific setup windows. The new ICD-9 and ICD-10 radio buttons now display when the Use ICD-10 Diagnosis Codes parameter has been set to (Y)es in System Configuration in Intergy System Administration or in Practice Configuration in Intergy Practice Administration. Note: ICD-10 readiness setup is not based on the setting of the ICD-10 Diagnosis Code Effective Date system and practice parameter. To prevent ICD-10 codes from being shown and to show only ICD-9 codes in the Select Diagnosis dialog box, you can set the Use ICD-10 Diagnosis Codes parameter to (N)o. For example, if you have set the Use ICD-10 Diagnosis Codes parameter to (Y)es, you can use the Select Diagnosis dialog box to set up ICD-10 diagnosis codes as confidential problems. The workflow below describes how to set up your Intergy system for ICD-10 readiness. Workflow: Setting Up Intergy for ICD-10 Readiness 1. From the Intergy Desktop, open the Confidential Problem Maintenance window by selecting the Setup menu, selecting Codes, and then selecting Confidential Problem. 2. Select the Add button. The Add Diagnosis Codes dialog box displays. 3. Click in the Code field and then click the down arrow. The Select Diagnosis dialog box displays. In the upper right portion, the ICD-10 radio button is selected. The ICD-10 column heading indicates the list of ICD-10 diagnosis codes. Optionally, you can show and select ICD-9 codes by clicking the ICD-9 radio button. To show ICD-10 codes again, click the ICD-10 radio button again. 4. You can select an ICD-10 diagnosis by clicking the row of the diagnosis. The Add Diagnosis Codes dialog box closes. The ICD-10 diagnosis is included in the Confidential Diagnosis Codes list in the Confidential Problem Maintenance window. The Confidential Diagnosis Codes list can include both ICD-9 codes and ICD-10 codes. Vitera Intergy EHR 9.00 New System Features 57

ICD-10 ICD-10 Readiness Setup The following setup windows allow the Select Diagnosis dialog box to display for ICD-10 readiness setup: Setup window ICD-10 Select Diagnosis dialog boxes affected Intergy Desktop New Ailment or Edit Ailment Procedure Code Maintenance RIS Study Macro Maintenance Macro Maintenance Rx Utilities Confidential Problem Maintenance Medicaid Clinic Rate Maintenance Standard Referral In Maintenance Standard Referral Out Maintenance Medical Necessity Intergy Practice Administration HL7 Queue Manager HL7 Remote Maintenance Flowsheet setup Intergy EHR Health Management Setup Immunization Setup Pro Tip Setting Up Intergy and Intergy EHR for ICD-10 For more information about setting up your Intergy and Intergy EHR system to use ICD-10 codes, refer to the Intergy v9.00 New System Features document. You have reached the end of the ICD-10 Readiness Setup topic. 58 Vitera Intergy EHR 9.00 New System Features

ICD-10 Setting Up Intergy EHR for ICD-10 Setting Up Intergy EHR for ICD-10 The settings of the Use ICD-10 Diagnosis Codes system/practice parameter and the ICD-10 Diagnosis Codes Effective Date system parameter determine whether ICD-10 diagnosis codes are used in your Intergy/Intergy EHR system, and the effective date for ICD-10 code usage. However, the way Intergy and Intergy EHR use the ICD-10 effective date differs depending upon the area of the system. In Intergy setup windows such as Favorite Diagnosis setup and Health Management setup, you can use either ICD-9 or ICD-10 codes at any time. For Intergy billing functions such as Charge Posting, if the charge date is after any of the payer ICD-10 effective dates of any payers in the coverage list, then that charge must use ICD-10 codes exclusively. For all other functions, Intergy and Intergy EHR use the system effective date set in the ICD-10 Diagnosis Codes Effective Date system parameter. Note: When working with an encounter in an area of the system such as Orders/ Charges, Intergy EHR compares the encounter date to the system effective date to determine whether ICD-9 or ICD-10 codes should be used. In contrast, when working without a specific encounter in areas of the system such as My Day, Intergy EHR compares the current date to the system effective date. The following parameters affect ICD-10 code usage in Intergy/Intergy EHR: Parameter Use ICD-10 Diagnosis Codes ICD-10 Diagnosis Codes Effective Date Description The Use ICD-10 Diagnosis Codes system/practice parameter is available in System Configuration in Intergy System Administration and Practice Configuration in Intergy Practice Administration. The parameter provides you with the ability to work with ICD-10 diagnosis codes in Intergy/Intergy EHR. The shipped system default setting of the parameter is No. To enable your system to use ICD-10 codes, change this setting to Yes. The ICD-10 Diagnosis Codes Effective Date system parameter is available in System Configuration in the Intergy System Administration desktop. The parameter specifies the effective date (also known as compliance date) for ICD-10. The shipped system default setting of the parameter is 10/01/2014. When the Use ICD-10 Diagnosis Codes parameter is set to Yes, and the ICD-10 Diagnosis Codes Effective Date parameter is set for a specific date, Intergy/Intergy EHR system features can validate the diagnosis codes that are used and display validation information messages. Vitera Intergy EHR 9.00 New System Features 59

ICD-10 Setting Up Intergy EHR for ICD-10 TIP If your site uses HL7 for electronic data interchange, it is recommended for HL7 ICD-10 processing that you import ICD-10 diagnosis codes prior to receiving inbound HL7 messages that could contain diagnosis codes. This allows inbound HL7 messages that have ICD-10 diagnosis codes to be received promptly. You have reached the end of the Setting Up Intergy EHR for ICD-10 topic. 60 Vitera Intergy EHR 9.00 New System Features

ICD-10 Using ICD-9 and ICD-10 Diagnosis Codes Using ICD-9 and ICD-10 Diagnosis Codes Intergy EHR allows you to use either the ICD-9 or the ICD-10 code set. For the system effective date for implementing ICD-10 codes, Intergy EHR uses the date designated by CMS, which is 10/01/2014. The default system effective date indicates when your system switches from ICD-9 codes to using the new ICD-10 codes. You can enter ICD-9 codes prior to the effective date, and only use ICD-10 codes on or after the effective date. Initially all payers (insurance carriers and plans) are set up to use the default effective date. However, if necessary you can set different effective dates for individual payers. For example, if United General is implementing the ICD-10 code set a month after the default effective date, you can set up your system to reflect that through the ICD-10 Payer Effective Date Utility window in Intergy. When you submit claims after the system effective date for payers who are not yet accepting ICD-10 codes, Intergy EHR maps claims for those payers to use ICD-9 codes instead. ICD-10 codes are only available if the Use ICD10 Diagnosis Codes parameter is set to Yes, and the date is on or after the system effective date, which is specified in the ICD10 Diagnosis Code Effective Date parameter. The workflow below describes how to use ICD-9 and ICD-10 diagnosis codes in Intergy EHR. Vitera Intergy EHR 9.00 New System Features 61

ICD-10 Using ICD-9 and ICD-10 Diagnosis Codes Workflow: Selecting ICD-9 and ICD-10 Codes for Problems and Findings 1. In any dialog box such as Select Diagnosis that allows you to select ICD codes, click the ICD tab. Note: Not all Select Diagnosis dialog boxes allow you to select the Findings or ICD tab. Many Select Diagnosis dialog boxes only contain the diagnosis lists and filters (All, Patient, Favorite). For more information about using those filters, see New Select Diagnosis Dialog Box on page 5. 2. Do one of the following: To search by ICD description Do this Type the description of the ICD code you are searching for. A list of codes matching your description displays. Note: If the date is on or after the system effective date for using ICD-10 codes, the Select Diagnosis dialog box also displays a link that enables you to search the entire ICD-10 master list. 62 Vitera Intergy EHR 9.00 New System Features

ICD-10 Using ICD-9 and ICD-10 Diagnosis Codes To search by ICD-9 code Do this Do one of the following: If the date is before the system effective date for using ICD-10 codes, type the ICD-9 code you are searching for. If the date is after the system effective date for using ICD-10 codes, type 9: followed by the ICD-9 code you are searching for. For example, to search for ICD-9 code 250.0, type 9:250.0. A list of ICD-10 codes matching your ICD-9 code displays. ICD-10 code Type the ICD-10 code you are searching for. For example, to search for Dyspnea, type R06.00. 3. From the list of codes displayed in the dialog box, select the ICD code you want to use. You have reached the end of the Using ICD-9 and ICD-10 Diagnosis Codes topic. Vitera Intergy EHR 9.00 New System Features 63

ICD-10 Converting Diagnoses to Findings Converting Diagnoses to Findings When your system is in ICD-10 mode, when a diagnosis has been entered as a Problem with an ICD-9 code, Intergy EHR will now prompt you to convert it to a finding-based problem when you click on it in Orders/Charges. Clicking on the diagnosis displays the Convert ICD to Finding dialog box, which prompts you to select the appropriate MEDCIN finding for the problem: Note: This option is also available if you right-click on a problem in Chart. The Convert ICD to Finding dialog box displays all findings matching the problem s ICD-9 code. After you make your selection, the diagnosis is no longer based on an ICD-9 code, but rather on a MEDCIN finding. Note: If your system is in ICD-10 mode, you can select a specific ICD-10 code to associate with the finding-based diagnosis. In ICD-10 mode, clicking a finding-based diagnosis in Orders/Charges displays the new Select Diagnosis dialog box, through which you can select the appropriate ICD-10 code. For more information, see New Select Diagnosis Dialog Box on page 5. You have reached the end of the Converting Diagnoses to Findings topic. 64 Vitera Intergy EHR 9.00 New System Features

ICD-10 ICD-10 to ICD-9 Mapping Rx Summary ICD-10 to ICD-9 Mapping Rx Summary When you submit prescriptions electronically after the ICD-10 effective date, Intergy EHR maps those electronic submissions to use ICD-9 codes instead. The Rx Summary on the Rx Details dialog box displays the ICD-9 code that will be sent electronically. The original ICD-10 diagnosis code is retained when the prescription is saved. Intergy EHR uses This ICD-9 mapping functionality for new prescriptions, renewals, authorizations, and quick authorizations. Similarly, the Meds page of Chart also displays the ICD-9 code used for electronic transmissions when applicable. You have reached the end of the ICD-10 to ICD-9 Mapping Rx Summary topic. Vitera Intergy EHR 9.00 New System Features 65

Immunizations ICD-10 to ICD-9 Mapping Rx Summary Immunizations This section describes the enhancements made for immunizations. Immunity Flag on Immunizations Page New Immunization Fields Recording Immunization History Information Source Selecting ICD-10 Codes When Administering Immunizations VFC Eligibility Vaccine Information Statements 66 Vitera Intergy EHR 9.00 New System Features

Immunizations Immunity Flag on Immunizations Page Immunity Flag on Immunizations Page When entering a patient s immunization information, you now have the option of indicating that the patient has immunity to the vaccine. Note: When a patient is marked immune to a vaccine, that vaccine is no longer considered Due, and will be excluded from Batch Posting Recalls in Intergy. The workflow below describes how to record a patient s immunity to a vaccine. Workflow: Recording a Patient s Immunity to a Vaccine 1. Select the patient for whom you want to record immunity to the vaccine. 2. From the navigation bar, select the Immun button. The Immunizations page of the patient s chart displays. 3. Select the Order button. 4. Right-click on the vaccine for which you want to record that patient s immunity, then select Immune from the drop-down list that displays. Immune displays in the cell to indicate that the status has been updated. Vitera Intergy EHR 9.00 New System Features 67

Immunizations Immunity Flag on Immunizations Page 5. Click Save. The patient s immunity to the vaccine is recorded, and is added to the patient s encounter note. You have reached the end of the Immunity Flag on Immunizations Page topic. 68 Vitera Intergy EHR 9.00 New System Features

Immunizations New Immunization Fields New Immunization Fields The following new immunization fields have been added to the Administer Immunizations dialog box in Intergy EHR. No. Field Description Route Amount Units Administer Time Displays the route by which the vaccine was administered, such as Injection. This field uses same remember/default rules as Admin Site and can be edited. Displays the amount of the vaccine that was administered. The entry in this field defaults from Vaccine Setup and can be edited. Displays the units in which the vaccine was administered, such as milliliters (ml). Units are set in Vaccine Setup. Displays the time at which the vaccination was administered. This field can be edited. Vitera Intergy EHR 9.00 New System Features 69

Immunizations New Immunization Fields In addition, the Administered column was renamed Admin d to help make room for other new information now included on the dialog box. You have reached the end of the New Immunization Fields topic. 70 Vitera Intergy EHR 9.00 New System Features

Immunizations Recording Immunization History Information Source Recording Immunization History Information Source When recording a patient s immunization history, you now can select the source of information for the patient s vaccination history. The new Information Source field allows you to select one of the following options: source unspecified from other provider from parent s written record from parent s recall from other registry from birth certificate from school record from public agency The default is source unspecified. The workflow below describes how to record the source of information for a patient s immunization history. Workflow: Recording the Source of Information for a Patient s Immunization History 1. From the Schedule view of the Immunizations tab (View option), select the View menu, and then select the schedule to be used for the patient. Vitera Intergy EHR 9.00 New System Features 71

Immunizations Recording Immunization History Information Source 2. At the bottom of the Immunizations tab, select the Record Hist button. The Immunizations tab displays in Record History mode, with the Imm. Date option selected by default. 3. From the Information Source drop-down list, select the source of information for the patient s immunization history. For example, you could select from parent s written record or from birth certificate. 4. Continue recording the patient s immunization history as you normally would. You have reached the end of the Recording Immunization History Information Source topic. 72 Vitera Intergy EHR 9.00 New System Features

Immunizations Selecting ICD-10 Codes When Administering Immunizations Selecting ICD-10 Codes When Administering Immunizations If your system is in ICD-10 mode when administering immunizations, and a vaccine is associated with an ICD-9 diagnosis code, you can select the appropriate ICD-10 code for the vaccination. Note: For more information about ICD-10 codes, see Using ICD-9 and ICD-10 Diagnosis Codes on page 61. The workflow below describes how to select an ICD-10 code when administering an immunization. Workflow: Selecting an ICD-10 Code When Administering an Immunization 1. When you select the Admin Charges button on the Administer Immunizations dialog box, the Select Administration Codes dialog box displays. 2. From the Diagnosis drop-down list, select Select Diagnosis. 3. The Select Diagnosis dialog box displays, through which you can select the appropriate ICD-10 code for the vaccination. Note: If you do not select a diagnosis code, the immunization is recorded as having No Diagnosis. Vitera Intergy EHR 9.00 New System Features 73

Immunizations Selecting ICD-10 Codes When Administering Immunizations 4. After selecting the appropriate diagnosis, continue completing the Administer Immunization dialog box as you normally would. You have reached the end of the Selecting ICD-10 Codes When Administering Immunizations topic. 74 Vitera Intergy EHR 9.00 New System Features

Immunizations VFC Eligibility VFC Eligibility Vaccines for Children (VFC) Eligibility information now is recorded at the vaccine level. When a vaccine is administered, the current VFC status and date are saved with the administration information. When you enter VFC Eligibility information in the Intergy desktop, you can view and edit the information in Intergy EHR on the Insurance page of the Patient Info tab, the Immunizations tab, and the Imms Details window. The VFC Eligibility program is a federally funded program that provides vaccines at no cost to children who might not otherwise be vaccinated because of an inability to pay. This feature is useful for practices participating in the VFC Eligibility program. Note that since it is a program for pediatric patients, VFC Eligibility information displays in the system for patients who are 18 years old and younger. Note: VFC Eligibility information only displays for patients who are 18 years of age and younger. While VFC Eligibility information is typically entered when registering a patient in the Intergy system, you can enter and edit VFC Eligibility information in Patient Chart (Patient Info Tab, Insurance Info page) of the Intergy EHR system. TIP You should change the VFC status before administering the vaccines so that the VFC status will apply to all of the vaccines at once. The workflow below describes how to enter and edit VFC Eligibility information for a patient. Vitera Intergy EHR 9.00 New System Features 75

Immunizations VFC Eligibility Workflow: Entering/Editing VFC Eligibility Information for a Patient 1. Select the Immunizations tab for a patient. If the selected patient is 18 years of age or younger, the VFC information displays below the listed immunizations. 2. To enter or edit VFC Eligibility information for the patient, click the VFC Eligibility link. The Edit VFC Eligibility dialog box opens. Make entries in the following fields: Field Vaccine for Children Eligibility Effective Date Description From the drop-down list, select the type of VFC Eligibility for the patient. Valid entries are user-defined using the VFCCode lookup type in Lookup Code Maintenance in the Intergy Desktop. Some VFC eligibility lookup codes are also installed with the system. Specifies the date that the patient s Vaccine for Children eligibility begins. It must be a valid date in the format MM/DD/YYYY. 76 Vitera Intergy EHR 9.00 New System Features

Immunizations VFC Eligibility 3. Select the Save button. The new information is saved. You have reached the end of the VFC Eligibility topic. Vitera Intergy EHR 9.00 New System Features 77

Immunizations Vaccine Information Statements Vaccine Information Statements Intergy EHR s Vaccines Information Statements (VISs) feature enables you to document that you gave the parent a Vaccine Information Statement. If a compound vaccine is administered, multiple VISs can be given. For example, the vaccine Pediarix includes DTaP, Hep B, and IPV, and would have three VISs. When you administer a vaccine to a patient, Intergy EHR remembers the VISs that you selected for that vaccine. The next time you administer the same vaccine to a patient, Intergy EHR automatically displays those VISs in the VIS section in the bottom-right corner of the Administer Vaccines dialog box. You can edit those VISs if necessary. Note: Intergy EHR provides you with the ability to keep a record of each VIS you give to a patient. However, you cannot print a VIS through Intergy EHR itself. Your practice is responsible for printing its own VISs, which is usually done through the CDC website. The workflow below describes how to select a VIS when administering a vaccine. Workflow: Selecting a VIS When Administering a Vaccine 1. Record the administered vaccine as you normally would. 78 Vitera Intergy EHR 9.00 New System Features

Immunizations Vaccine Information Statements 2. In the VIS section of the Administer Immunizations dialog box, select the Add button. The Select Vaccine Information Statements dialog box displays. 3. Check the box beside each VIS that you want to include for the vaccination. 4. Select the OK button. The Select Vaccine Information Statements dialog box closes and the system returns you to the Administer Immunizations dialog box. After you have selected the VIS for the vaccine, the VIS details display in the VIS section of the Administer Immunizations dialog box. In addition, the Add button changes to Edit, allowing you to edit the VIS information if necessary. Note: If you want to remove a VIS from this section, right-click on it and select Delete from the pop-up menu that displays. 5. Finish recording the administered vaccine as you normally would. You have reached the end of the Vaccine Information Statements topic. Vitera Intergy EHR 9.00 New System Features 79

Labs Vaccine Information Statements Labs This section describes the enhancements made for Labs. Test Groups 80 Vitera Intergy EHR 9.00 New System Features

Labs Test Groups Test Groups Test groups are groups of tests defined by Clinician, and are used to select multiple tests at once when entering a lab order in Intergy EHR. For example, you could set up a test group called Thyroid Profile that contained all the tests you would normally run for a patient with thyroid problems, so that you wouldn t have to select each test individually. Intergy EHR allows you to create new test groups to use when adding tests for a lab order. You can add tests to a test group through the New Lab Order window. You can also remove a test from a test group, which can be useful if a test is no longer used, or if a test was added erroneously to a test group. The workflows below describe how to create test groups, how to add tests to a test group, and how to remove tests from a test group. Workflow: Creating a New Test Group 1. In the Step 2: Tests section of the New Lab Order window, right-click on a test in the Favorite Tests list. 2. From the menu that displays, select Add to Test Group, and then select New Test Group. The Add New Test Group dialog box displays. 3. Make entries in the following fields: Field Test Group Name Description Description Type the name of the test group. This name displays in parentheses in the right-hand side of the list in the Step 2: Tests section of the New Lab Order window. Type a description of the test group. This description displays in the left-hand side of the list in the Step 2: Tests section of the New Lab Order window. Vitera Intergy EHR 9.00 New System Features 81

Labs Test Groups Field Save In Description Select one of the following radio buttons to specify which list the test group should be saved in: 4. Click the Save button. The new test group is saved. Client ID Add the test group to the list of test groups associated with the Client ID. Provider Add the test group to the list of personal test groups associated with the provider. Shared Add the test group to the list of test groups that are available to all practice providers. Workflow: Adding Tests to a Test Group 1. In the New Lab Order window, select each test that you want to add to the test group. As each test is selected, it displays in the Selected Tests list in the Requisition Preview section of the window. If you select a test erroneously and want to remove it from the Requisition Preview section, click the x to the right of the test. The test is removed from the list of Selected Tests in the Requisition Preview section. Note: Exclusive tests, which are indicated by an asterisk (*), cannot be added to a test group, because they are required to be the only test on the requisition. 2. When you have selected all the tests that you want to add to the test group, select Save as Test Group in the Requisition Preview section. The Add New Test Group dialog box displays. 3. Make entries in the fields in the Add New Test Group dialog box, as described in Creating a New Test Group on page 81, above. 4. Click the Save button. The new test group is saved. 82 Vitera Intergy EHR 9.00 New System Features

Labs Test Groups Pro Tip Adding a Test to an Existing Test Group You can add a test to an existing test group by right-clicking on the test in the Step 2: Tests section of the New Lab Order window. From the menu that displays, select Add to Test Group, and then select the specific test group that you want to add the test to. Workflow: Removing a Test from a Test Group 1. Right-click on the test group that contains the test you want to remove. Intergy EHR displays a menu listing the tests in that group. 2. Click the x to the right of the test that you want to remove. Note: The test is removed from the test group. If you remove all the tests from a test group, the test group is not deleted and still displays in the list. The empty test group is grayed-out, cannot be selected, and displays the message No Tests in Group next to the description. However, if you add a test to an empty test group, the test group will once again become available for selection. You have reached the end of the Test Groups topic. Vitera Intergy EHR 9.00 New System Features 83

Orders/Charges Test Groups Orders/Charges This section describes the enhancements made for Orders/Charges. Selecting an ICD-10 Code for a Diagnosis in Orders/Charges Using Macros with ICD-10 Codes 84 Vitera Intergy EHR 9.00 New System Features

Orders/Charges Selecting an ICD-10 Code for a Diagnosis in Orders/Charges Selecting an ICD-10 Code for a Diagnosis in Orders/Charges If your system is in ICD-10 mode, the new Select ICD-10 dialog box allows you to select a specific ICD-10 code to be associated with a diagnosis in Orders/Charges. For example, if your system is in ICD-10 mode and one of the selected diagnoses was entered in the Encounter Note, the Selected Diagnoses and Orders list of Orders/Charges allows you to pick the specific ICD-10 code for that diagnosis. Clicking the drop-down arrow beside the diagnosis in the Selected Diagnoses and Orders list opens the Select ICD-10 dialog box that allows you to choose the exact ICD-10 code for the finding. Following is an example of the Select ICD-10 dialog box displaying possible matches for the diagnosis Corneal Disorder : Because ICD-10 codes are very specific, a finding-based diagnosis might match multiple ICD-10 codes. The Select ICD-10 dialog box displays a list of possible matches, from which you can select the appropriate one. Depending on the diagnosis, the Select ICD-10 dialog box enables you to narrow the search by using quick filters such as left, right, or bilateral. For example, if the diagnosis applied to the patient s right eye, you could select the filter right to narrow down the list of ICD-10 codes displayed. For more information about ICD-10 codes, see Using ICD-9 and ICD-10 Diagnosis Codes on page 61. You have reached the end of the Selecting an ICD-10 Code for a Diagnosis in Orders/Charges topic. Vitera Intergy EHR 9.00 New System Features 85

Orders/Charges Using Macros with ICD-10 Codes Using Macros with ICD-10 Codes When adding a macro procedure, Intergy EHR only uses procedures that have a diagnosis code that matches the ICD-9 or ICD-10 mode your system is using. The following table explains how Intergy EHR handles ICD codes within macro procedures: If The macro contains both ICD-9 and ICD-10 codes The macro contains only ICD-9 codes The macro contains only ICD-10 codes The macro contains one or more procedures that have no diagnosis Then Intergy EHR only shows ICD-9 codes when in ICD-9 mode, and only shows ICD-10 codes when in ICD-10 mode. The macro will be hidden when your system is in ICD-10 mode. The macro will be hidden when your system is in ICD-9 mode. If there is no diagnosis selected, the system warns you that one or more detail procedures on the macro do not have a default diagnosis, and that those procedures will not be added. You have reached the end of the Using Macros with ICD-10 Codes topic. 86 Vitera Intergy EHR 9.00 New System Features

Practice Portal Using Macros with ICD-10 Codes Practice Portal This section describes new features and enhancements for Practice Portal. Activity on Patient Health Information Recorded and Provided Customize Practice Portal Exchange Documents Direct Messaging Now Supported Patient Cell Phone Support for New Patient Registration Secure Messages Vitera Intergy EHR 9.00 New System Features 87

Practice Portal Activity on Patient Health Information Recorded and Provided Activity on Patient Health Information Recorded and Provided Patients can now view records of user activity with their health information. When patient electronic health information is viewed, downloaded, or transmitted to a third party from within the portal, the Intergy Practice Portal now records the activity in a log and provides access to the log for patients. The following patient health information activity is logged: The electronic health information affected by the action(s) The date and time each action occurred The action(s) that occurred User identification You have reached the end of the Activity on Patient Health Information Recorded and Provided topic. 88 Vitera Intergy EHR 9.00 New System Features

Practice Portal Customize Practice Portal Exchange Documents Customize Practice Portal Exchange Documents Your practice can now specify the Continuity of Care Document (CCD) sections and date ranges of clinical information that can be included in Exchange documents. This allows you to set up the Continuity of Care Document (CCD) sections and date ranges of clinical information that the practice supports, which can then be made available for a patient on an Exchange document. The following new practice parameters have been added to System Configuration in Intergy System Administration and Practice Configuration in Intergy Practice Administration: Sections in Exchange Documents - Practice Portal - Specifies the CCD sections supported by the practice that can be included in Exchange documents for patients. You can select one or more of the following choices: Code A AD CP CS E FA FH FS FT GH HP I IN IS LR M MA MH P PC Description Allergies Advance Directives Care Plan Cognitive Status Encounters Future Appointments Family History Functional Status Future Tests Surgical History History of Present Illness Immunizations Instructions Insurance Lab Results Medications Medications Administered Medical History Problems Plan of Care Vitera Intergy EHR 9.00 New System Features 89

Practice Portal Customize Practice Portal Exchange Documents Code PE PR PT RF RR RS RV SH V Description Physical Exam Procedures Pending Tests Referrals Reason for Referral Review of Systems Reason for Visit/Chief Complaint Social History Vital Signs The parameter is shipped with a default value of AD, A, CP, CS, E, FH, FS, FA, FT, HP, I, IN, IS, LR, MH, M, MA, PT, PE, PC, P, PR, RR, RV, RF, RS, SH, GH, V. Date Range in Exchange Documents - Practice Portal - Specifies the CCD date range of lab results, vitals, and encounters supported by the practice that can be included in Exchange documents for patients. You can select one of the following choices: Code 6M 1Y 3Y 5Y AD Description 6 Months 1 Year 3 Years 5 Years All Dates The parameter i shipped with a default value of 1Y. You have reached the end of the Customize Practice Portal Exchange Documents topic. 90 Vitera Intergy EHR 9.00 New System Features

Practice Portal Direct Messaging Now Supported Direct Messaging Now Supported The Intergy Practice Portal now supports Direct messaging for providers. This allows you to send e-mail messages via Direct messaging to a provider who has a Direct messaging address. Direct messaging provides a secure method of e-mail communication for the sender and receiver. You have reached the end of the Direct Messaging Now Supported topic. Vitera Intergy EHR 9.00 New System Features 91

Practice Portal Patient Cell Phone Support for New Patient Registration Secure Messages Patient Cell Phone Support for New Patient Registration Secure Messages The patient cell phone number can now be gathered from Practice Portal new patient enrollment. This allows you to have the patient cell phone number default in Patient Registration in Intergy when you are working the new patient enrollment secure message. The new cell phone number support has been added on incoming Practice Portal new patient registration secure messages by using the export term KQ_CellPhone on the portal question. You have reached the end of the Patient Cell Phone Support for New Patient Registration Secure Messages topic. 92 Vitera Intergy EHR 9.00 New System Features

Predictive Order Management Patient Cell Phone Support for New Patient Registration Secure Messages Predictive Order Management This section describes the enhancements made to Predictive Order Management (the POM tab of Orders/Charges). Selecting an ICD-10 Code for an Order or Diagnosis on the POM Tab Vitera Intergy EHR 9.00 New System Features 93

Predictive Order Management Selecting an ICD-10 Code for an Order or Diagnosis on the POM Tab Selecting an ICD-10 Code for an Order or Diagnosis on the POM Tab The Orders from Last Visit panel in Predictive Order Management (the POM tab of Orders/ Charges) displays a list of the orders from the patient s most recent encounter when orders were assigned, excluding the current encounter. You can select an order link to add it to the Selected Diagnoses and Orders list. The Orders for Reminders Due panel in Predictive Order Management displays a chronological list of the orders for all the reminders that are due for the patient. You can select an order link to add it to the Selected Diagnoses and Orders list. Note: In ICD-10 mode, if one of the orders has an ICD-9 code on it, you cannot add orders by clicking Select All. Intergy EHR displays a message indicating that you need to resolve the ICD-9 code first. The Procedures panel in Predictive Order Management displays a charge selection list generated from procedures specified on the patient's encounter note and the estimated E&M code from Encounter Note. You can select a procedure code link to add it to the Selected Diagnoses and Orders list or click the Select All link to add all the charges in the panel to the Selected Diagnoses and Orders list. In the following panels, if your system is in ICD-10 mode and one or more of the orders or diagnoses was entered in ICD-9 mode, Intergy EHR prompts you to select the corresponding ICD-10 code for the order: Orders from Last Visit Orders for Reminders Due Procedures Current Medications Renewable Rx s Rx Order (on Current Patient tab) Procedure (on Current Patient tab) If your practice has already imported ICD-10 codes that can be mapped to a given ICD-9 code, the search with the 9: prefix gives you a list of those mapped diagnosis codes. This allows you to select the ICD-10 code that is most appropriate for the ICD-9 code that was originally entered. 94 Vitera Intergy EHR 9.00 New System Features

Predictive Order Management Selecting an ICD-10 Code for an Order or Diagnosis on the POM Tab If the ICD-10 code that you are searching for is not displayed in the search window, you can click the link Search the entire ICD-10 master list to display the full ICD-10 code master list and select a code from it. For more information about ICD-10 codes, see ICD-10 on page 55. You have reached the end of the Selecting an ICD-10 Code for an Order or Diagnosis on the POM Tab topic. Vitera Intergy EHR 9.00 New System Features 95

Prescriptions Selecting an ICD-10 Code for an Order or Diagnosis on the POM Tab Prescriptions This section describes the enhancements made to Prescriptions. Medication Reconciliation Recording Formulary Checks 96 Vitera Intergy EHR 9.00 New System Features

Prescriptions Medication Reconciliation Medication Reconciliation Medications reconciliation is the process of identifying the most accurate list of all medications that the patient is taking by comparing the medical record to an external list of medications obtained from a patient, hospital, or other provider. Reconciliation is done to avoid medication errors, particularly at transitions of care. For example, a reconciliation might be done when a patient is admitted to a hospital and a new medication is ordered. Additionally, if an encounter is in context when you add a reported medication and when you import medications from CCD or PBM Rx, the Medications list is reconciled at the same time. You can perform medications reconciliation in the Intergy EHR system if you have a security level that permits you to add a reported medication. You can now determine whether a patient s medications have been reconciled by viewing the medications reconciliation item that is displayed at the top of the Medications list. If the Mark as Reconciled button displays, the medications list has not been reconciled, and you can use the button to perform the reconciliation for a specific encounter. When the Medications list has been reconciled for an encounter and the encounter is in context, the Reconciled indicator displays in green text with a green check mark to show that the Medications list has been reconciled. Workflow: Reconciling Medications 1. Select the patient whose medications you want to reconcile. 2. Open the Patient Chart window and then select the Meds tab. 3. At the top of the Medications list, select the Mark as Reconciled button. The Select Encounter dialog box displays. If the patient does not have a recent open encounter, the New Encounter dialog box displays. 4. Select an encounter or add a new encounter for the patient. When you select or add the encounter, the medications are reconciled. The Reconciled indicator displays at the top of the Medications list in green text with a green check mark to show that the patient s medications have been reconciled. Note: The encounter also indicates that the medications have been reconciled by displaying the Medication List was Reconciled message in the upper portion of the encounter information. When you hover your mouse pointer over the message, the name of the user who performed the reconciliation is displayed. Vitera Intergy EHR 9.00 New System Features 97

Prescriptions Medication Reconciliation TIP Optionally, you can reconcile medications from the Patient Information Medications list or the Patient Summary Medications list by clicking the drop-down arrow and selecting Mark as Reconciled. You have reached the end of the Medication Reconciliation topic. 98 Vitera Intergy EHR 9.00 New System Features

Prescriptions Recording Formulary Checks Recording Formulary Checks When a formulary check is performed, the formulary check is now recorded, and a message displays to inform you that a formulary check was performed for the medication. Formulary checks can be run and recorded when you are selecting a drug and performing tasks such as entering as prescription and renewing a prescription. Formulary checks can be recorded for both the Infoscan formulary and the RxHub formulary. The Patient Chart medications details now displays an indicator that a formulary check was performed. You have reached the end of the Recording Formulary Checks topic. Vitera Intergy EHR 9.00 New System Features 99

Problems Recording Formulary Checks Problems This section describes the changes made to Problems in Intergy EHR. Care Plan Copying Assessments to the Problems List Copying Diagnoses to the Problems List Converting Problems to Findings Including Voided Problems in the Problem List 100 Vitera Intergy EHR 9.00 New System Features

Problems Care Plan Care Plan A patient problem can now include a Care Plan. A Care Plan consists of goals of care and patient instructions. The goals of care are the expected outcome of the patient care. The patient instructions are instructions that the provider has given to the patient for the problem. In the Patient Information problems list and in the Problems List, you can hover your mouse over a problem to view details of the Care Plan in a hover pane. When you select a problem, the Goals of Care and Patient Instructions sections are displayed in the Problem Details page. The Problem History also includes the Care Plan goals of care and patient instructions. The new Care Plan tab has been added to the Add Patient Problem dialog box and the Edit Patient Problem dialog box. You can add or edit Care Plan information for the problem by selecting the Care Plan tab. In the Goals of Care section, you can add the expected outcomes of the patient care for the problem. You can add goals by typing in the Goals of Care text box or by selecting the button for quick text and selecting a quick text entry to enter. Optionally, you can create a quick text entry to add. In the Patient Instructions section, you can add the instructions that provider has given to the patient for the problem. You can add instructions by typing in the Patient Instructions text box or by selecting the button for quick text and selecting a quick text entry to enter. Optionally, you can create a quick text entry to add. Additionally, you can cite Care Plan data into encounter notes and visit notes. You have reached the end of the Care Plan topic. Vitera Intergy EHR 9.00 New System Features 101

Problems Copying Assessments to the Problems List Copying Assessments to the Problems List You can now copy an assessment to the Problems List from the Assessment section of the Encounter Note. To copy it to the Problems List, right-click on the assessment and select Copy To Problem from the menu that displays. The assessment will be copied to the Problems List. You have reached the end of the Copying Assessments to the Problems List topic. 102 Vitera Intergy EHR 9.00 New System Features

Problems Copying Diagnoses to the Problems List Copying Diagnoses to the Problems List You can now copy a diagnosis to the Problems List from the Selected Diagnosis and Orders panel of Orders/Charges. To copy the diagnosis to the Problems List, right-click on the diagnosis and select Copy To Problem from the menu that displays. The diagnosis will be copied to the Problems List. You have reached the end of the Copying Diagnoses to the Problems List topic. Vitera Intergy EHR 9.00 New System Features 103

Problems Converting Problems to Findings Converting Problems to Findings You can now convert a problem entered as an ICD-9 code so that it is based instead on a MEDCIN finding. If a problem was entered using an ICD-9 code, you can click on it in the following areas of the system and select Convert to Finding from the menu that displays: the Problems List the patient s problems list in Chart the Patient Info List Being able to convert problems to findings will be helpful when your practice starts to use ICD-10 codes. This functionality is also helpful for the Copy Problems to Assessments workflow. The following workflow shows how to convert an ICD-9-based problem in the Problems List to a MEDCIN-based finding. Workflow: Converting a Problem to a Finding 1. Right-click on the problem in the Problems List and select Convert to Finding from the menu that displays. 104 Vitera Intergy EHR 9.00 New System Features

Problems Converting Problems to Findings The Convert ICD to Finding dialog box displays. 2. Select the appropriate MEDCIN finding from the list that displays. The problem is converted to a finding and will display as a finding, not an ICD-9 code, in areas of the system such as Orders/Charges. You have reached the end of the Converting Problems to Findings topic. Vitera Intergy EHR 9.00 New System Features 105

Problems Including Voided Problems in the Problem List Including Voided Problems in the Problem List The various Problem List views provide you with the information needed to manage your patient s care. By default, the Problem List displays active problems only. However, you can change the Problem List view using the menu located in the list title bar. The new Include Void option has been added to the menu. Selecting Include Void displays problems with a status of both Voided and Entered in Error. You have reached the end of the Including Voided Problems in the Problem List topic. 106 Vitera Intergy EHR 9.00 New System Features

Quick Text Including Voided Problems in the Problem List Quick Text The following enhancement has been made to Quick Text. Personal Quick Text Added Vitera Intergy EHR 9.00 New System Features 107

Quick Text Personal Quick Text Added Personal Quick Text Added Within Intergy EHR you can now create and maintain personal quick text entries for yourself to use. (Previously, only shared quick text entries were available.) This allows you to add, edit, copy, and delete personal quick text entries that can be used to enter personal quick text entries in notes in the Intergy and Intergy EHR systems. The new Shared and Personal radio buttons have been added to the New Quick Text, Edit Quick Text windows. You can use the radio buttons to specify whether the quick text entry is a shared quick text entry for all users or a personal quick text entry for only a specific practice user. To Create a quick text entry that is shared for all users Create a quick text entry for a specific user Do this Select the Shared radio button. Select the User radio button. In the field that displays on the right side of the User radio button, specify a user for the new quick text entry by clicking in the field and clicking the down arrow button. The Select Practice User dialog box displays. Select the row of a practice user and click OK. The Select Practice User dialog box closes and the user logon displays in the field for the user in the New Quick Text dialog box. The new Shared and Personal check boxes have been added to the Select Quick Text window. You can use the check boxes to specify whether to display shared and/or personal quick text entries in the list. Selecting a check box will include the Shared or Personal quick text entries in the list. Clearing a check box prevents the Shared or Personal quick text entries from being included in the list. Personal quick text entries are marked by a blue diamond in the first column of the row of a personal quick text entry. Pro Tip Maintaining Quick Text Entries Through the Select Quick Text window you can maintain existing quick text entries in Intergy EHR without having to go to the Maintenance window in Intergy. To edit a quick text entry, right-click the entry and select Edit. To delete a quick text entry, right-click the entry and select Delete. You have reached the end of the Personal Quick Text Added topic. 108 Vitera Intergy EHR 9.00 New System Features

Tasks Personal Quick Text Added Tasks This section describes the changes made to Tasks in Intergy EHR. Changes to Cardiology Result Tasks Sending Secure Messages When Working a Lab Results Review Task Vitera Intergy EHR 9.00 New System Features 109

Tasks Changes to Cardiology Result Tasks Changes to Cardiology Result Tasks Following is a review of how Cardiology Result tasks were processed in previous versions of Intergy EHR: When it detects that cardiology test results are available from the HeartCentrix software, Intergy will retrieve the results. After the results data is downloaded, the system attempts to match the result to a patient and provider in the Intergy system, as follows: The system attempts to match the result to an existing order, and to the patient and provider for that order. If the result cannot be automatically matched to an order based on order number, the system will attempt to automatically match the patient, provider, encounter, and order for the result. If the system is unable to automatically match the patient or provider, then the result is added to the unmatched cardiology results list, and can be manually matched in the Unmatched Cardiology Results window. When it automatically matches a cardiology test result downloaded from HeartCentrix to a patient and provider, the system automatically sends a Cardiology Result task to the provider s task list. When the results are manually matched to a patient or provider, the user who matched the result has the option to send a Cardiology Result task to the provider's task list. In version 9.00, Intergy EHR continues to process Cardiology Result tasks as described above. However, the following additional changes have been made to make the process even more precise: If the To provider is blank or is a provider outside the practice, then the cardiology result is only created for the provider listed on the encounter. An Order Result task is not created. If the To provider is not the encounter provider, then the To provider receives the Cardiology Result task. The encounter provider receives the Order Result task because he or she is the person who entered the order. Note: The To provider is set on the Orders/Charges window when placing the order. You have reached the end of the Changes to Cardiology Result Tasks topic. 110 Vitera Intergy EHR 9.00 New System Features

Tasks Sending Secure Messages When Working a Lab Results Review Task Sending Secure Messages When Working a Lab Results Review Task The Work Task - Lab Result dialog box has been modified to add a check box for the new Preview Secure Message option. This new option helps simplify your secure messaging workflow when working lab results review tasks in Intergy EHR. The workflow below describes how to use the Preview Secure Message check box when working a lab results review task. Steps 3 and 5 describe how to use the new check box. Workflow: Using the Preview Secure Message Option when Working a Lab Results Review Task 1. From the Summary or Tasks page in My Day, select the lab results task you want to review. The task details display. 2. Select the Reviewed button. The Work Task dialog box opens, in which you can enter notes about the lab results. Vitera Intergy EHR 9.00 New System Features 111

Tasks Sending Secure Messages When Working a Lab Results Review Task 3. Check or uncheck the boxes on the dialog box as described below: If You want to send a secure message to the patient You want to preview the secure message You want to copy the secure message to the patient s chart You want to forward a marked-as-reviewed lab results task to another user Then Check the Send Secure Message to Patient box. Check the Preview Secure Message box. Intergy EHR replaces the Copy Secure Message to Chart check box with the message Select CC Chart in Preview. If you want to copy the secure message to the patient s chart, you can do so from the Secure Messaging dialog box that will display after you finish reviewing the lab result. Check the Copy Secure Message to Chart box. Check the Forward to User box at the bottom of the dialog box, and select a user by clicking the ellipsis button that appears. This enables you to forward reviewed lab results tasks to another user so the user can call the patient with the lab results. 4. Select the Reviewed/Complete button. 5. If you checked the Preview Secure Message box, Intergy EHR displays the Secure Messaging dialog box and remembers the To, Subject, and Body information from the Work Task dialog box. Note: If you want to copy the secure message to the patient s chart, check the CC Chart box in the Secure Messaging dialog box. The process of reviewing the lab results task is complete. You have reached the end of the Sending Secure Messages When Working a Lab Results Review Task topic. 112 Vitera Intergy EHR 9.00 New System Features

Visit Note Sending Secure Messages When Working a Lab Results Review Task Visit Note The new Visit Note feature was added to the Intergy EHR software in version 9.00. Visit Note is described in detail in a separate New System Features document, which you can access by clicking the link below. Visit Note New System Features You have reached the end of the Visit Note section. Vitera Intergy EHR 9.00 New System Features 113

User Preferences Sending Secure Messages When Working a Lab Results Review Task User Preferences This section describes changes made to user preferences in Intergy and Intergy EHR. Default Procedure/Diagnosis Favorites List 114 Vitera Intergy EHR 9.00 New System Features

User Preferences Default Procedure/Diagnosis Favorites List Default Procedure/Diagnosis Favorites List The new Default Procedure/Diagnosis Favorites List preference specifies the favorites list of procedures and/or diagnoses that will be available to the user who is currently logged on to the Intergy system or the Intergy EHR system. Note: This preference was previously called e-encounter list, and was located at the provider level. In Intergy EHR 9.00 it has been moved to the user level and renamed. The default procedure/diagnosis favorites list is available in the Select Diagnosis dialog box. Using a favorites list can be helpful when searching for a specific diagnosis code. Field Setup Valid entries User-defined in Favorite Procedure/Diagnosis List Maintenance. You have reached the end of the Default Procedure/Diagnosis Favorites List topic. Vitera Intergy EHR 9.00 New System Features 115

Vitals Default Procedure/Diagnosis Favorites List Vitals This section describes the changes made to Vitals in Intergy EHR. Vital Signs Now Displayed in Your Preferred Units of Measure 116 Vitera Intergy EHR 9.00 New System Features

Vitals Vital Signs Now Displayed in Your Preferred Units of Measure Vital Signs Now Displayed in Your Preferred Units of Measure When adding or editing vital signs in Encounter Note using the Welch Allyn Spot Vital Signs device, the patient s temperature, weight, and height now display in the units specified in your Intergy EHR preferences: Fahrenheit/Celsius, inches/centimeters, pounds/kilograms, and so forth. The example above shows the vitals displayed in inches, Fahrenheit, and pounds. A practice whose preferences were set to use the Metric system would see the vitals displayed in centimeters, Celsius, and kilograms. You have reached the end of the Vital Signs Now Displayed in Your Preferred Units of Measure topic. Vitera Intergy EHR 9.00 New System Features 117