Creating Clinical Content for Centricity Physician Office - EMR 2005

GE Healthcare Creating Clinical Content for Centricity Physician Office - EMR 2005 July 2006 2027167-002 Rev B Centricity Physician Office EMR 2005 2027167-002 Rev B 2006 General Electric Company

All information is subject to change without notice. This information is the confidential and proprietary information of General Electric Company. Unauthorized duplication is strictly prohibited. Centricity and Logician are registered trademarks of General Electric Company. 2006 General Electric Company. All rights reserved. GE Medical Systems, Information Technologies, Inc., a General Electric Company going to market as GE Healthcare, 8200 West Tower Avenue, Milwaukee, Wisconsin, USA

CONTENTS About this guide...xiii Getting the latest information...xiii Documentation conventions...xiv Other resources...xiv EMR online help (F1)...xiv Documentation area on the...xiv Centricity Physician Office Services Web site...xiv Training databases...xv If you encounter a problem...xv Report a defect or an enhancement idea...xvi Contact us...xvi 1 Getting started...3 About form components... 3 About Encounter Form Editor... 5 New features in Encounter Form Editor... 5 Encounter Form Editor compatibility... 6 Microsoft Access compatibility... 6 Operating system compatibility... 6 About the KnowledgeBank... 6 Install Encounter Form Editor... 7 Install observation term files (if necessary)... 7 Install Acrobat Reader and online manuals... 8 Encounter form tips and limitations... 8 Encounter form examples... 10 Form design process... 11 Design steps... 11 Create a simple form... 13 2 Design the form component...21 About the sample form... 22 Gather preliminary information... 22 Sample form information worksheet... 23 Form Information Sheet... 24 Additional information:... 24 List your form items... 25 2027167-002 Rev B 2006 General Electric Company iii

Creating Clinical Content for Centricity Physician Office - EMR 2005 Example... 25 Choose connections... 26 About observations... 26 Storage connections... 27 Data display connections... 29 Flowsheet... 31 Action connections... 31 Connections example... 34 Choose form items... 35 Use library items... 35 Use custom form items... 36 Determine item properties... 39 Design for text translation... 40 Heading suppression... 40 Example... 41 Create preliminary form design... 44 Visual design characteristics... 44 Formatting items... 46 Plan for visibility regions... 47 Visual design tips... 48 Style guidelines... 49 3 Use Encounter Form Editor...51 Start Encounter Form Editor... 51 Supply registration information... 51 View Encounter Form Editor s main window... 52 Exit Encounter Form Editor... 52 Work with forms... 53 Create a new form... 53 Open an existing form... 54 Edit a form... 55 Understand the item list... 56 Select a form item... 56 Find a form item... 57 Add form items... 58 Use Centricity Physician Office Term Finder... 64 Edit an existing form item... 66 Rearrange items... 66 Delete an item... 66 Customize form appearance... 66 iv 2006 General Electric Company July 2006

Chart Update and Printed Form translations... 67 Text alignment... 68 Font... 68 Text color... 69 Horizontal percentage... 71 Pixel height per line... 72 Save a form as a clinical kit... 72 View and correct errors... 74 Understand encounter form files... 75 Save a form in an existing clinical kit... 76 Rename a form and form description files... 77 View the form.txt file... 78 Preview a form... 79 Print an item report... 80 Work with item and item group libraries... 81 Add and delete items from an item library... 82 Add and delete groups from an item group library... 84 Import and export libraries... 87 Create a new library... 88 Compact the database... 89 4 Use advanced features...91 About advanced features... 91 About MEL and data symbols... 92 About data symbols... 92 About MEL syntax... 94 MEL operators... 96 Write conditional MEL expressions... 97 Understand rich text formatting (fmt and cfmt)... 100 MEL functions... 104 Evaluating MEL expressions in forms... 108 About watchers and triggers... 109 Use global variables... 110 Use the MEL Expression Builder... 110 Insert a symbol... 111 Insert an observation term... 111 Create Data Display items... 112 Create dynamic drop-down/list boxes... 114 Example... 115 Use visibility regions... 116 2027167-002 Rev B 2006 General Electric Company v

Creating Clinical Content for Centricity Physician Office - EMR 2005 Write visibility conditions... 118 Use Set Values Action Buttons... 121 Add a Set Values Action Button... 123 About superbuttons... 124 Use MEL Function/Expression items... 125 Write calculations... 126 Use the Action Button calculation connection... 126 Use MEL Expression/Function items for calculations... 128 Customize text translations... 131 Change text translation... 132 Ways to customize text translations... 133 About default translations... 134 Customized text translation examples... 135 Retain customized translations... 137 Customize printed form translations... 137 Printed form contents... 138 About default printed form translations... 138 Ways to customize printed form translations... 140 Change a printed form translation expression... 140 Retain printed form customizations... 142 Execute MEL scripts at close/traversal of forms... 142 5 Create E&M Advisor forms... 145 About E&M Advisor... 145 How E&M Advisor works... 145 About HCFA guidelines... 147 About CPT coding levels... 147 Understand buckets and bullets... 147 E&M Advisor requirements... 150 View existing E&M form components... 153 About E&M Advisor observation terms... 154 Locate E&M Advisor observation terms... 154 Design E&M form components... 155 Document history... 155 Document physical exams... 157 Document medical decision-making... 160 Document counseling and coordination... 162 6 Import and test forms... 165 Import the form into the EMR application... 165 Test the onscreen form in the EMR application... 166 vi 2006 General Electric Company July 2006

Review form design... 167 Test the form... 168 Review text and printed form translations... 169 Use MEL tracing... 170 7 Use data symbols... 173 What is MEL?... 173 About data symbols... 174 About functions... 174 About MEL... 175 Where to use MEL and data symbols... 177 Use the Insert Symbol dialog box... 177 Insert a symbol... 178 Finding symbols and functions... 178 When to evaluate data symbols... 179 Types of data symbols... 181 Text symbols... 182 Number symbols... 182 Boolean symbols... 182 Date symbols... 183 Using data symbol functions with arguments... 183 Syntax for arguments... 184 Use observation terms as arguments... 185 Look up observation terms... 188 Look up observation terms in EMR... 188 Tips on searching for observation terms... 190 Print a report of observation terms... 191 8 Write MEL expressions... 193 About MEL syntax... 193 Write if-then-else expressions... 196 Rules for long form if-then-else expressions... 197 Long form vs. short form MEL syntax... 199 Using short form syntax... 199 Rules for short form if-then-else expressions... 200 Test for returned values... 200 Use MEL operators... 202 Make complex comparisons... 203 Use case expressions... 204 Syntax for case expressions... 204 Use mathematical operators... 205 2027167-002 Rev B 2006 General Electric Company vii

Creating Clinical Content for Centricity Physician Office - EMR 2005 About value types... 206 Use MEL rich text formatting functions... 207 fmt vs. cfmt... 207 fmt syntax... 207 fmt examples... 208 cfmt syntax... 209 cfmt examples... 211 Use cfmt and fmt in EMR form editors... 211 9 Use data symbols with MEL in EMR... 213 Use the rich text format (RTF) editor... 213 RTF editor options... 214 RTF editor tips... 215 Create patient banners... 216 Headers for letters, handouts, and chart documents... 218 About location of care symbols... 219 Header examples... 220 Text components and templates for letters and handouts... 220 View sample templates... 221 Create a new letter template... 223 Selecting data symbols for letter and handout templates... 227 Template and component examples... 228 Quick text... 229 Chart notes... 231 Form components... 231 10 Test and deploy clinical content... 233 Guidelines for testing clinical content... 233 Create patient data to test conditions... 233 Test text components in a chart update... 235 Deploy your created content... 236 Export item from the training database... 236 Import item into your clinic database... 237 Build a library of MEL functions... 238 Troubleshoot MEL and data symbols... 239 11 MEL syntax basics... 241 Keywords... 241 Comments... 244 Operators... 244 MEL expressions... 245 viii 2006 General Electric Company July 2006

Multiple statements... 246 12 Values and variables... 247 Dynamic typing in MEL... 247 MEL values... 247 Simple values... 248 String... 248 Complex values... 249 Array... 249 Variables... 250 Data symbols... 250 Assignment behavior... 251 UNDEFINED... 252 Special operators... 253 Errors... 253 Compile errors... 254 Runtime errors... 254 13 Flow control... 255 Conditional statements... 255 If statement... 255 Short form if statement... 256 Case statement... 257 Loop statements... 258 While statement... 258 For statement... 258 Break statement... 259 Continue statement... 260 14 MEL functions... 261 Define MEL functions... 261 Call functions... 262 Define arguments... 262 Arguments with simple values... 262 Arguments with complex values... 263 Return statement... 263 15 Scoping of variables... 265 Individual scoping... 265 Global scoping... 265 Local scoping... 266 2027167-002 Rev B 2006 General Electric Company ix

Creating Clinical Content for Centricity Physician Office - EMR 2005 Community scoping... 266 Document-scoped variables... 266 Database-scoped variables... 268 Variable summary... 269 16 Advanced topics... 271 Evaluating data symbols during chart updates... 271 Rules for evaluating data symbol functions... 271 Evaluating symbols during multiple updates... 272 Evaluating data symbols and expressions in forms... 273 Data symbol dependency analysis... 274 Visibility... 274 Watcher expressions... 275 Watcher expression triggers... 275 Watcher function and buttons... 276 17 Troubleshooting MEL... 279 MEL error messages... 279 Use MEL tracing... 281 A Form item and connection reference... 283 Formatting items... 283 Begin Section... 283 Begin Multi-Item Row... 284 Column Break... 284 End Suppression Block... 285 Function/MEL Expression... 285 Begin Visibility Region... 285 End Visibility Region... 286 Form items... 286 Action Button... 286 Check box... 287 Data display... 288 Drop-down list... 289 Edit field... 291 Flowsheet View... 293 Heading... 293 List box... 294 Multiline edit field... 296 Radio buttons... 297 Text... 298 x 2006 General Electric Company July 2006

Library items... 299 Assess or update problems... 299 Chief Complaint... 299 Clinical list subset... 299 Disposition... 300 Family History... 300 History of Present Illness... 300 Past medical history... 301 Preventive care reminders... 301 Library groups... 301 Active Problems/Meds Boxes... 302 Add Allergy/Directive/Medication/Problem... 302 Calculations... 304 Family/Social History... 305 Multiple items stored in one observation... 305 Narrative style... 305 Visibility controlled by an observation... 306 Visibility controlled by radio button... 306 Vital Signs... 307 Connection reference... 307 Observation terms... 307 Clinical functions... 308 Patient attributes... 310 Actions... 312 Flowsheet views... 313 Flowsheet labels... 313 B Update the EMR forms... 317 C Update flowsheet views... 317 Update text and printed form translations... 318 Update MEL functions and Set Values action buttons... 319 Use EMR E&M Advisor forms... 319 Edit EMR 2005 E&M Advisor forms... 320 E&M Advisor observations and exam requirements321 Observations recognized by E&M Advisor... 321 Observation terms by exam focus... 333 Comprehensive exam requirements... 343 2027167-002 Rev B 2006 General Electric Company xi

Creating Clinical Content for Centricity Physician Office - EMR 2005 D Technical information... 347 Uninstall Encounter Form Editor... 347 Reinstall Encounter Form Editor... 347 Microsoft Access considerations... 347 Run-time version... 347 E Style guide... 349 Font, style, and capitalization guidelines... 349 Clinical workflow... 350 xii 2006 General Electric Company July 2006

About this guide Getting the latest information xiii Documentation conventions xiv Other resources xiv If you encounter a problem xv Contact us xvi Creating Clinical Content for Centricity Physician Office - EMR 2005 is for Centricity TM Physician Office Electronic Medical Record 2005 users who want to customize the EMR application for use in a clinic. This guide comprises two parts. The first part, Part A - Creating Encounter Forms, describes the steps to design customized encounter form components using Encounter Form Editor. It includes information that helps in making decisions about forms, directions for using Encounter Form Editor, and reference material that will help in the design of effective forms. The second part, Part B- Using MEL, explains the MEL programming language. MEL can be used to customize the EMR application and create tailor-made encounter forms. Customizations in the EMR application include patient banners, letter and handout templates, chart note templates, and quick text. This manual is also useful for EMR users in creating their own encounter form components using Encounter Form Editor. Getting the latest information To get the latest version of this guide that includes any new or updated information added after product release, go to the Centricity Physician Office Services Web site at http://support.medicalogic.com. The publication date of the guide is listed on the document page to make it easy for you to know if you need to download a version that is more recent than the one you currently are using. 2006 General Electric Company

Creating Clinical Content for Centricity Physician Office - EMR 2005 Documentation conventions The Creating Clinical Content for Centricity Physician Office - EMR 2005 documentation uses the following conventions to represent different types of information: Other resources This convention... monospaced type Ctrl + U Chart > Clinical Lists italic type!!! Means this... Type this text exactly as it appears. Hold down the Ctrl key while you press U, then release both keys. Open the Chart folder and select the Clinical Lists item. A term that is being defined. Indicates a note: the information is important and should not be overlooked. Indicates a tip: the information points out a shortcut or other convenient, but optional, information Indicates a caution: the information presented can prevent loss of data. Indicates a warning: the information presented can prevent patient harm. EMR online help (F1) GE offers a variety of other resources to help you get up and running with the EMR application on a daily basis. When you need a quick answer about using a particular feature in the EMR application, online help is your fastest route. Wherever you are in the EMR application, simply press F1 for relevant help about the task at hand. You can read about screen items, follow procedures, and browse notes and tips. Documentation area on the Centricity Physician Office Services Web site The Centricity Physician Office Services Web site at http://support.medicalogic.com, contains the latest, downloadable versions xiv 2006 General Electric Company July 2006

If you encounter a problem Training databases of all documentation for the EMR application, LinkLogic, the Formulary Editor, the Encounter Form Editor, and the Messaging applications (with the exception of the online help systems.) You need a login ID and password to access the documentation area. Contact your EMR Manager if you are unsure of which sign-on information to use. While at the site you can also: Review known issues. Search for clinical content in the KnowledgeBank (http://knowledge.medicalogic.com/) a repository of encounter forms and other clinical content ready-made by other EMR users. Join the mailing list and receive email newsletters on topics related to clinical content and the Encounter Form Editor, service packs, and technical alerts. If you encounter a problem The EMR Single-User Training Database helps you get up to speed with the EMR application and LinkLogic. The database contains a set of patient records that you can practice on without affecting your production records. The EMR Network Training Database is installed when you install the EMR application. You can use this database to simulate multi-user workflows and test setup options without affecting patient records in the production database. If you run into a problem while using the EMR application, first try the following: If you re in the EMR application, press F1 and read the online help for your current location in the program and the task you re trying to perform. Read any related information in the printed manuals. Ask your clinic s EMR Manager or LinkLogic Manager for help. If you re still having trouble, please contact Centricity Physician Office Services at: Inside the United States, dial 800.957.6837 Outside of the United States dial 503.531.7100 Be sure to call from a phone next to the workstation where the problem is occurring so it s easier to answer questions from Customer Services Engineers. Customer Services are available between 5 a.m. to 6 p.m., Pacific Time. 2027167-002 Rev B 2005 General Electric Company xv

Creating Clinical Content for Centricity Physician Office - EMR 2005 E-mail centricityemrsupport@ge.com Ask questions and receive detailed answers from Centricity Physician Office Services. If you have an urgent question and need immediate help, don t send e-mail. Instead, call the appropriate phone number above. Report a defect or an enhancement idea Contact us To report a defect or drop us a line about an enhancement idea, use the Product Feedback Form on Centricity Physician Office Services Web site at http://support.medicalogic.com. The Centricity Physician Office Services can be reached by phone in the Portland, Oregon area at 503.531.7000 and elsewhere in the U.S. at 800.322.5538. xvi 2006 General Electric Company July 2006

Part I Creating Encounter Forms Creating Encounter Forms describes how to design and create encounter form components for use with the EMR application. This part of the guide is intended to help providers and those who work in clinics design custom forms. Chapter 1 gives an overview of the EMR application's encounter form components and Encounter Form Editor (a program that creates form components). Chapters 2 and 3 explain the process of designing encounter form components and describe the basic features of Encounter Form Editor. Chapter 4 explains MEL, a built-in programming language that is used to further customize encounter forms in Encounter Form Editor. Chapter 5 explains the steps involved in creating Evaluation and Management (E&M) Advisor forms. E&M Advisor helps providers meet Health Care Financing Administration coding guidelines, which specify what, must be documented to bill for a given level of service. Chapter 6 explains the process of importing the customised encounter forms into the EMR application. 2006 General Electric Company

Creating Clinical Content for Centricity Physician Office - EMR 2005 2 2006 General Electric Company July 2006

CHAPTER 1 Getting started About form components 3 About Encounter Form Editor 5 About the KnowledgeBank 6 Encounter form tips and limitations 8 Encounter form examples 10 Form design process 11 Create a simple form 13 Encounter form component: A form used by providers to enter patient information into the EMR application The EMR application includes a variety of standard encounter form components that make it convenient for doctors, nurses, and other clinicians to enter information into patient charts. If the standard encounter form components don t support the way you work at your clinic, or don t collect the right data, you can customize them or design new form components. About form components Form components are data entry tools available within the EMR application that make it easy to enter information into patient charts. Form components include point and click features such as lists and check boxes to make recording information quick and easy. Providers insert form components directly into c`hart notes. The form appears onscreen. As the provider enters information in the form, the information appears in the chart note. A form component consists of three parts, all of which you create with Encounter Form Editor: Onscreen form component. This is the point-and-click screen that you use to capture data while updating a chart in the EMR application. 2006 General Electric Company

Creating Clinical Content for Centricity Physician Office - EMR 2005 The onscreen form can t be printed on paper; it can be used only in the EMR application. Text translation. As a provider enters data into a form component, the EMR application translates the data entered in the form to narrative text in the chart note. Items not filled out do not appear in the text translation. When the chart note is signed, the translation becomes a permanent part of the patient chart, and the filled-out onscreen forms for the encounter are no longer available. Providers can review the translation at any time by opening the patient s chart and clicking the Documents tab. Printed form. Sometimes it is useful to print out a text-only version of the onscreen form. The printed form provides spaces for recording data. If the form has been partially filled out onscreen, the data appears in the printed form. Instead of using the EMR application during the encounter for example, if there are no workstations in the exam room providers can take notes on the printed form. Later, someone else can use the filled-out form to enter data into the EMR application. 4 2006 General Electric Company July 2006

About Encounter Form Editor About Encounter Form Editor Encounter Form Editor is a program for creating form components. You specify the form items that you want on your form and how you want the data to appear in the chart note. Encounter Form Editor then creates a form file that you can import into the EMR application. Encounter Form Editor handles many design settings for you, such as item placement, font, and color. Of course, you can customize your forms if the default settings don t suit your needs. It s easy to create simple, effective forms using the defaults supplied by Encounter Form Editor. You can also create complex, sophisticated forms using Encounter Form Editor s advanced features. New features in Encounter Form Editor Encounter Form Editor adds several new features to help you create more useful forms. Here is a list of features added since version 2.1: Form navigation. New form navigation action buttons add a form component to an update without opening it, open another form component from within a form, or move to a specified page within a form. See Appendix A, Action Button, on page 286. Neworder. Like Newmed and Newproblem, Neworder opens the New Order window with a custom list of orders. (Added with Encounter Form Editor 2.4) See Action connections on page 31. Handout printing. Now you can open the print education handout window and specify a handout to print from a custom list of handouts you create for the form. See Action connections on page 31. Enhanced usability. New larger windows reduce scrolling. Clear buttons on the Customize window automatically clear the Chart Update and Printed Form translation windows. Open recent form. Click and hold the Open button on the main screen to select from the last six form documents you ve worked on. New group library items. New form items in the group library include Add Allergy and Add Directive and Add Medication and Add Problem. See Add Allergy/Directive/Medication/Problem on page 302. Online access to reference manuals. Clicking the View Manual button on any help screen opens the Creating Clinical Content reference manual in a searchable Adobe Acrobat PDF format. Clicking the Reference button in the MEL Expression Builder window opens the Data Symbols online help. 2027167-002 Rev B 2006 General Electric Company 5

Creating Clinical Content for Centricity Physician Office - EMR 2005 Encounter Form Editor compatibility New forms that you create must be edited with with same version of Encounter Form Editor you use to create them. If you open them in an older version, it may break the form, particularly if the form uses new features. You can easily update older forms by opening them in the current version of Encounter Form Editor. When you save the form, Encounter Form Editor automatically converts it to the current version. See Appendix B, Update the EMR forms. Microsoft Access compatibility Operating system compatibility If you have installed other tools that are based on Microsoft Access or if you have a full copy of MS Access installed on your workstation, please read Microsoft Access considerations on page 347. About the KnowledgeBank You can run Encounter Form Editor on workstations equipped with Windows 2000 Professional and Windows XP Professional. You cannot run Encounter Form Editor 2.1 on Windows Terminal Server/MetaFrame. Clinical kit: A set of EMR clinical content files that can be imported into the EMR application GE encourages providers to develop form components and share them with others. The forms are available as clinical kits on the World Wide Web at the KnowledgeBank (http://knowledge.medicalogic.com/). The kits contain editable form description files as well as custom components used by forms, such as flowsheet views and custom problem and medication lists. Check the KnowledgeBank before you start designing forms. You may find one there that you can use or modify to meet your needs. Also, consider submitting any forms that you design to the KnowledgeBank (http://knowledge.medicalogic.com/). The KnowledgeBank (http://knowledge.medicalogic.com/) Web site contains complete instructions for downloading forms and submitting your own forms. 6 2006 General Electric Company July 2006

About the KnowledgeBank Install Encounter Form Editor GE supplies Encounter Form Editor on CD-ROM. You ll use the Setup program to install Encounter Form Editor on a workstation running Windows 2000 Professional and Windows XP Professional operating systems. If you have installed a previous version of Encounter Form Editor, you must remove it before installing Encounter Form Editor. For information, see Appendix D, Technical information. To install Encounter Form Editor 1 Exit all applications. 2 Insert the CD-ROM into your CD-ROM drive. 3 Do one of the following: Click Start, select Run, and type: F:\SETUP.EXE For F, substitute the letter for your CD-ROM drive. Open My Computer, open your CD-ROM drive, scroll until you see the icon for SETUP.EXE, and double-click it. 4 On the Welcome window, click Next to begin installing Encounter Form Editor. 5 On Choose Destination Location, verify the default destination folder or click Browse to select a different folder. 6 Click Next. 7 On Select Components, do the following: Make certain that Encounter Form Editor is checked. Verify that the selected location has sufficient space for Encounter Form Editor. 8 Click Next. 9 On Ready to Install Program, click Install. 10 When the installation is complete, click Finish to close Setup. Install observation term files (if necessary) Observation terms are the names of items that can be stored in the EMR database. You may need to install local term files or updated term files. 2027167-002 Rev B 2006 General Electric Company 7

Creating Clinical Content for Centricity Physician Office - EMR 2005 Local term files. Your site may have requested that GE provide you with special observation terms if the terms supplied with the EMR application don t meet your needs. Check with the EMR Manager to find out if your site has received local observation term files. The observation term files are named site.lot and site.lgr, where site is replaced by your EMR site number for example 1057.LOT and 1057.LGR. You may also receive a new KEYWORDS.TXT file. Updated term files. GE periodically updates the list of observation terms based on customer requests. You can always download the latest observation terms from the KnowledgeBank (http://knowledge.medicalogic.com/). Always use the latest terms when creating form components or your form may not work properly on other EMR systems. When you download observation terms from the KnowledgeBank (http://knowledge.medicalogic.com/), you receive a Zip archive with several files. Encounter Form Editor uses the files TERMS.FOT, TERMS.FGR, and KEYWORDS.TXT. To install local or updated observation term files, copy the unzipped files into the Encounter Form Editor installation directory, usually C:\CLINICAL TOOLS. Use Windows Explorer to copy the files. If you use a DOS window, the files may not copy correctly. Make sure you re using the same set of observation terms present in the EMR application. Ask your EMR Manager if you re not sure. Avoid using local observation terms in your forms if you intend to share them with providers outside your organization. Install Acrobat Reader and online manuals The Encounter Form Editor CD-ROM includes the Creating Cliniccal Content for EMR 2005 guide in Adobe Acrobat format (PDF). When you install Encounter Form Editor, this document is saved to your computer. The CD-ROM also includes Acrobat Reader 5. You do not need to install Acrobat Reader from the CD-ROM if you already have Acrobat 5on your computer. Encounter form tips and limitations Here are some tips to keep in mind while designing forms: Check the KnowledgeBank (http://knowledge.medicalogic.com/) to see if there s a form you can use as is or modify. Modifying forms is usually easier than starting from scratch. 8 2006 General Electric Company July 2006

Encounter form tips and limitations Document template: A chart note template that includes form and text components Become familiar with the EMR application. Get to know the EMR application s capabilities before you start designing forms. In the training database, open several of the supplied form components to become familiar with how they work. Practice with Encounter Form Editor first. Become familiar with its items and libraries before you start designing actual forms. Work with small form components. Small forms are easier to work with than large ones. You can combine several form components in a document template for a specific type of encounter. If your components are modular, you can use them in several document templates. Consider the order of your form items. The flow of the form should follow the flow of the clinical encounter in which the information is collected. Group related items. Consider how the form component will fit in with other components in a document template. Design form components with the user in mind. Create separate form components to be used by providers with different roles. For example, a nurse may fill in the vital signs on one form component, while a physician might record the results of a review of systems with another component. Two smaller forms are much easier to use than one large form. Enhance form flexibility. Take advantage of action buttons and form navigation features that permit the user to add a form component to an update without opening it, open a new form component from within a form, or jump to another page within a form. Use E&M Advisor to evaluate encounters. There are special considerations for designing E&M-compliant forms. See Chapter 5, Create E&M Advisor forms. Involve users of a form in its design. For example, if a form will be used by physicians, those users should get a chance to review its design. The physician on the Implementation Team is an ideal form designer especially if that person has taken the Building Forms and Templates class. For more information about classes: Go to the Centricity Physician Office Services Web site at http://support.medicalogic.com and click EMR 2005, then Training Information. Inquire by email at centricityemrsupport@ge.com. Test your forms. Test forms thoroughly using the training database. Never import untested content into a live patient database. Compact the database frequently. This will make Encounter Form Editor run faster. See Compact the database on page 89. Backup your forms. Make a backup copy of a form before you modify it. 2027167-002 Rev B 2006 General Electric Company 9

Creating Clinical Content for Centricity Physician Office - EMR 2005 Encounter form examples Don t copy your existing paper form. Encounter forms are more efficient and easier to use than paper. For example, it may be possible to condense several questions into a list or turn a yes/no question into a set of radio buttons. Don t worry about formatting. Plan the flow and content of your form first, without thinking too much about appearance and layout of item location, text color, or font. Most of Encounter Form Editor s defaults are probably fine. Don t include patient information on your forms. The EMR application displays this information onscreen during the chart update. Design your forms to fit the EMR application s capabilities. If you can t do something with the EMR application, chances are you can t do it with a form component. For example, the EMR application doesn t support interactive graphics, so you can t draw with the mouse on a form component. Encounter Form Editor comes with two sample forms: History of Present Illness-Heart Failure and Review of Systems. This book relies heavily on these two forms to demonstrate concepts and techniques for form building. Other sample forms are those included with the EMR application. You can find them in your EMR staging area in: <FOLDER WHERE THE EMR APPLICATION IS INSTALLED>\CLIN- KITS\BASICPR\ITEMS\FORMCOMP <FOLDER WHERE THE EMR APPLICATION IS INSTALLED>\CLINKITS\SPECLTY\ITEMS\FORMCOMP For SPECLTY, substitute one of the specialties in this list: Cardio Derm Ent Gastro HemeOnc IntMed Neuro Obgyn Ophthal Ortho Peds Psych Pulm Uro!!! If you want to modify or practice with forms from the EMR application s standard clinical kits, make a copy first. Encounter Form Editor s libraries also include many samples. The item and item group libraries contain preformatted items or groups of items that you can use on your forms. For example, the item library contains a form item for Chief Complaint and the item group library includes a set of form items that 10 2006 General Electric Company July 2006

Form design process Form design process collect vital signs. You can use these items and groups as examples or you can put them in your forms, modifying them if necessary. For more information, see Use library items on page 35, and Work with item and item group libraries on page 81. Structured data: Data that is highly quantifiable or that limits the number of possible responses Involve users in the design. Designing and creating a form component is usually a collaborative process involving providers, other medical personnel, the EMR Manager, and the person who creates the form. You may want to form a committee to work on form design. Think carefully about types of components you ll need. Remember that forms are often used as components within a document template. Be sure to consider the other items addressed in the document template. Because you can easily mix text and form components, think about what type of component is best for each part of a patient encounter. Remember that text components cannot store observations. Expect to revise several times before you are done. You may create several revisions of the form component. Collecting information electronically is quite different from using a paper chart and paper forms. As you work with the form, you will often discover ways to make it easier to use, more useful, or more complete. Structure your data. As you design your form, think about the possible ways you might use the data you collect. Keep in mind that forms have two purposes: to document an encounter and to collect data for future analysis. You may want to be able to graph a patient s weight changes over time, or you may be collecting data for outcomes research. In both cases, the more structured your data, the easier it will be to review, graph, report on, and analyze. For example, your clinic might want to evaluate treatment modalities for low back pain. If you design your forms to collect very specific data on patient pain levels and treatment options, you can create reports that show how effective each type of treatment was for your patient population. You might do this by using a form item that rates pain numerically rather than just noting that the patient has pain. Design steps Here is a brief list of steps used in designing a form. For each step, it shows where you can get more information. Use these steps as a guideline. You may find it more convenient to perform them in a different order. For example, some people start right out by drawing the form on paper (step 6). 2027167-002 Rev B 2006 General Electric Company 11

Creating Clinical Content for Centricity Physician Office - EMR 2005 To create an onscreen form component Form item: A screen object such as an edit field or check box Properties: Characteristics of a form or formatting item Formatting item: A form item that controls appearance 1 Gather preliminary information about the form. See Gather preliminary information on page 22. 2 Start a list of the information items the form will collect and display. See List your form items on page 25. 3 Choose item connections. For each piece of information, decide how data will be stored, what data will be displayed, or what action will be performed. See Choose connections on page 26. 4 Choose an appropriate form item for each piece of data. Look at the list of items available in Encounter Form Editor, or use Form item and connection reference on page 283. Add the form items to your list. Remember, you can also use form items or item groups from the libraries described in Appendix A. See Choose form items on page 35. 5 Determine each item s properties. Each type of item has different properties. For example, you can specify the choices in a list or the number of lines in a multiline edit field. See Determine item properties on page 39. 6 Plan the flow of your form items. Consider the most natural workflow for prospective users of your form and plan the order of your form items. Map out how you will make your form easy for users to navigate and complete. See Create preliminary form design on page 44. 7 Decide which formatting items you need to make your form look good. Design the form s visual appearance using paper, a whiteboard, or other techniques. Designing on paper or a whiteboard helps you visualize how the form will look. See Formatting items on page 46. 8 Use Encounter Form Editor to create the form. See Work with forms on page 53. 9 Customize the appearance of form items. See Customize form appearance on page 66. 10 Import the form into the EMR application. See Import the form into the EMR application on page 165. 11 Test your form in the Single-User or Network Training database. 12 2006 General Electric Company July 2006

Create a simple form Create a simple form Enter information in your form onscreen and review the printed version and the text translation. Change the form as necessary. See Test the onscreen form in the EMR application on page 166. The process of designing and refining a form is iterative, which means that you ll repeat many of the steps several times. You may also want to perform the steps in a different order. Use the process presented here as a guide to develop your own methods for creating and testing forms. This brief tutorial leads you through creating a very simple form component with Encounter Form Editor. You will create a form that collects a patient s temperature (typed into a box) and temperature site (selected from a drop-down list). Step 1: Start Encounter Form Editor Click the Start button on your Windows taskbar. Select the Programs menu, then the Encounter Form Editor program group, and click Encounter Form Editor. If this is the first time you ve used Encounter Form Editor, you ll need to enter registration information. See Supply registration information on page 51. If you don t have the information, call Centricity Physician Office Services at 800.957.6837. You see Encounter Form Editor s main screen. Step 2: Name and describe your form Before you start creating your form, you need to name and describe the form. Do the following: Type a name for your form in the Form Name field. For this example, use the name Temperature. Provide a short description of the form. It s also useful to include a version number and the author s name. Type the path for the folder in the EMR application where you want users to find your form. Type: ENTERPRISE\BASIC\EXAM\TEMPERATURE This is not a Windows file system path. This is the folder hierarchy in the EMR application. The actual hierarchy depends on how the EMR application is set up. If your folder does not exist in the EMR application, it will be created. 2027167-002 Rev B 2006 General Electric Company 13

Creating Clinical Content for Centricity Physician Office - EMR 2005 Encounter Form Editor looks like this: Enter the form name here Describe the form here Set default font and style here Step 3: Set font and style for text translations You can set the default font and text style for your form s chart note text translation on the main screen. You can also customize the appearance of individual form items as you add them. 1 To set a default font for the text translation click in the Chart Note Font list. The default font setting is Arial 10 point. 2 To set a default style, click a radio button under Chart Note Style. You can choose bold labels only, bold values only, or neither bold. Step 4: Edit the form and add a Begin Section item Now you re ready to start adding items to your form. Click the Edit button to begin. Because you re starting a new form, the Edit Form window appears ready to insert a Begin Section item. Since every form must start with a Begin Section, we ll add one. 1 Provide a name in the Section Name field. This name is also the page name for our form, so let s make it descriptive. Type: Temperature 2 Check Group Box for First Column so the form will have a group box around it. 14 2006 General Electric Company July 2006

Create a simple form The Edit Item window should look like this: 3 Click Close. Step 5: Add items to the form After you ve added the Begin Section item, you see the Edit Form window. This is where you add items to your form. Click here to add a new item 1 Click New Item to bring up the Item Finder. 2027167-002 Rev B 2006 General Electric Company 15

Creating Clinical Content for Centricity Physician Office - EMR 2005 2 Select Edit Field, which is the type of item you ll use to collect temperature. Click OK. 3 In the Label field, type: Temperature: 16 2006 General Electric Company July 2006

Create a simple form 4 To connect the temperature field to an observation, click Connect To and select New Observation in the Connect Item Finder. Click OK. You see the Centricity Physician Office Term Finder. 2027167-002 Rev B 2006 General Electric Company 17

Creating Clinical Content for Centricity Physician Office - EMR 2005 5 Type temp in the Search For field and click Search. 6 Select the observation term Temperature. Then click OK. You see the Edit Item window again. Click here to add another item 1 Click the Next Item button to add a temperature site item. 2 Click Item Type and select Drop-Down List from the Item Finder. Click OK. 3 In the Label field, type: Temperature site: 4 Type the following in the choice list. Separate the words with commas. oral, rectal, axillary, tympanic You can add spaces between the items to improve readability, but they re not necessary. 5 Check the Limit Entry to Choice List check box. The Edit Item window looks like this: 6 Click Close in the Edit Item window. You see the Edit Form window again with your two form items. Click here when you ve finished adding items 18 2006 General Electric Company July 2006

Create a simple form 7 Click Close on the Edit Form window. You see the main window for Encounter Form Editor. Step 6: Save your form Once you ve added the items to your form, you need to save it. Encounter Form Editor saves your form in multiple file formats, two of which are especially important: A copy of the form description (.fd) file that you can edit using Encounter Form Editor. A clinical kit (.ckt) file which you can import into the EMR application. 1 Click Save As on Encounter Form Editor s main window. Click here to save your form The name you gave the form appears as the file name in the Save File window. 2 Click Save. 2027167-002 Rev B 2006 General Electric Company 19

Creating Clinical Content for Centricity Physician Office - EMR 2005 Encounter Form Editor shows its progress as it saves your form and creates a clinical kit for import into the EMR application. 3 Click Close in the Save window. Saving in Encounter Form Editor is different from saving in most applications. Because your work in Encounter Form Editor takes place in a database, it saves every change you make as you make it. That means that if your computer crashes, the power goes out, or you inadvertently close Encounter Form Editor, you won t lose any information. When you open it again, Encounter Form Editor will ask you if you want to recover the form you were working on. When you save a form in Encounter Form Editor, it creates a set of files that can be imported in the EMR application or read back into Encounter Form Editor. Step 7: Exit Encounter Form Editor Click the Exit button to exit Encounter Form Editor. That s it! You ve created a form component. You ll need to import the form into the EMR application to view or use the form. For instructions, see Chapter 6, Import and test forms. 20 2006 General Electric Company July 2006

CHAPTER 2 Design the form component About the sample form 22 Gather preliminary information 22 List your form items 25 Choose connections 26 Choose form items 35 Determine item properties 39 Design for text translation 40 Create preliminary form design 44 This chapter details the steps you take to design a form. Using the History of Present Illness - Heart Failure form as an example, you ll walk through gathering up-front information gathering and specifying form items for a preliminary form design. Depending on how you like to work, you can do these steps in advance or start building the form in Encounter Form Editor as soon as you jot down some basics ideas. If you want to work with Encounter Form Editor directly, read Chapter 3, Use Encounter Form Editor, before you start. 2006 General Electric Company

Creating Clinical Content for Centricity Physician Office - EMR 2005 About the sample form The sample form, History of Present Illness - Heart Failure, is supplied with Encounter Form Editor. It looks like this: Gather preliminary information The first thing to do is to gather basic information about the form. For a guide to organizing form requirements, see Form Information Sheet on page 24. Collect this information: Organization. The name of the organization for which you are designing the form. Contact name. The person you can contact with questions about the form. This is usually a provider. Phone. Your contact s phone number. Name of form. The title of your form as it will appear in the EMR application s list of form components. The form s title should accurately describe its purpose, whether the form is used for diagnostic purposes or for post-exam documentation. Titles can be up to 30 characters. If you use abbreviations or acronyms, be sure they re easily understood. EMR location. The folder path of the form. Purpose. Briefly state the purpose of the form. What information is being collected and why? What happens to it after it is collected? Will the information being collected be used to document a patient encounter or for later analysis? 22 2006 General Electric Company July 2006

Gather preliminary information Users. List the form s users: physicians, nurses, lab staff. Keep your users in mind as you design the form. Use appropriate terminology and level of detail for your audience. When. How often is the form used? For more frequently used forms, it may be appropriate to use more abbreviations. If a form is used infrequently, you need to make sure it is very easy to understand and use. Disposition. If the form is based on a paper form, note what usually happens to the paper form after it is filled out. If the form you re designing is based on a paper form, try to get at least three different examples of the filled-out form. Reviewing the information typically recorded on the form helps you understand how to convert it to an onscreen form. For confidentiality, hide any sensitive information on the paper copies. Sample form information worksheet Imagine that you have been asked to create a form component for collecting History of Present Illness information for patients with congestive heart failure. We ll use this form component as an example throughout this manual. As your first step, you gather general information about the form. Use the following worksheet as a guide for the type of information to collect. 2027167-002 Rev B 2006 General Electric Company 23

Creating Clinical Content for Centricity Physician Office - EMR 2005 Form Information Sheet Organization: Contact name: Westside Clinic Dr. Alice P. Merriwether Phone: 503-555-1234 Name of form: (limit 30 characters) Purpose: Why collect this information? Used by: Who will use the form? When: When and how often is this form used? Disposition: If based on a paper form, what happens to the paper form after it is filled out? HPI - Heart Failure Part of standard exam for congestive heart failure patients. Physicians, nurses 1 to 2 times per day Used for data entry Faxed to Filed in paper chart Other Mailed to Additional information: Should work with E&M Advisor 24 2006 General Electric Company July 2006

List your form items List your form items Example Next, start listing the items to be included on your form. Think of your list as an evolving document. As you work with the form, you will probably revise the list. Make a list of form items 1 Consider which items of information you want to collect and which you want to display. Information to collect. First, list the information you want to collect. For example, your list for a History of Present Illness component might include Chief Complaint, Referral Source, and Symptoms. Information to display. Next, think about other information that would be useful to display on the form. You can display patient attributes, data collected from previous encounters, or lists of problems, medications, allergies, directives, orders, and preventive protocols. If any of this information would help the person filling out the form, include it in your list. Use the paper form that you want to convert as a guide as you list the form requirements. 2 Decide the order that items should follow. Examine your list of items and decide what order they should appear in. The form should follow standard clinical workflow. Revise your list as appropriate. For a suggested clinical workflow, see Clinical workflow on page 350. 3 Revise the list and label each item. Make a final list using a word processor or spreadsheet. Add a descriptive label for each item or group of items. Your clinic wants to convert a paper form for collecting history of present illness information for congestive heart failure patients. You use the paper form to determine the items for the electronic version of the form. You may even start drawing sketches of what you want the form to look like so you can group related items. Later, you ll expand this list with connections, form items, and properties for each item. Here s what you came up with: Referral source History from Reason for visit 2027167-002 Rev B 2006 General Electric Company 25

Creating Clinical Content for Centricity Physician Office - EMR 2005 Chief complaint Current symptoms Choose connections About observations Current treatment items Diet Home oxygen (flowrate if yes) Compliance with treatment regime Comments E&M evaluation Many form items have connections, item properties that store data, display data that s already in the database, or perform an action. Encounter Form Editor supports three basic types of connections. Storage connections store data from the form in the EMR database. Display connections display data that can t be changed on the form. Action connections cause changes on your form, help you navigate through form pages, interact with other parts of the EMR application, or run another program on your computer. Not all types of connections are available for each form item. Appendix A, Form item and connection reference, contains information about the connection types, which form items can use them, and the connection options for each type. Observation: Qualitative, quantitative, or semi-quantitative clinical facts about the patient One of the most powerful features of forms is their ability to display and store clinical observations. You can do things with observations that you can t do with text in the chart note: View observations in the flowsheet to track them over time. You can view all observation values under 255 characters in the Flowsheet. Some larger observations for example, Chief Complaint may be cumbersome be viewed in the flowsheet. You can still display them in encounter form data display items or reports, however. Graph numeric observations to see trends. Include observations in reports. Use observations in inquiries to find certain patient records. For example, you can select all patients with cholesterol values over 200. 26 2006 General Electric Company July 2006

Choose connections How to find observations Protocol: A set of rules that determine whether a patient is due for a test or other procedure Use observations to trigger protocols, informing the provider that specific interventions are due. Many, but not all, EMR observations can be evaluated by the EMR application s E&M Advisor, a form-based tool that helps providers meet coding requirements. If you plan to use E&M Advisor with your forms, you should choose observations that E&M Advisor knows about. For more information about E&M Advisor forms, see Chapter 5, Create E&M Advisor forms. There are two ways to locate the observation terms you need: Print a report Search and browse the list of observation terms Report. You can print a report of all the observation terms in the EMR application that you can keep handy while designing forms. See Observation terms on page 307 for instructions. Search or browse. Encounter Form Editor provides the Centricity Physician Office Term Finder, which enables you to search for observations using key words. You can also browse a categorized list of observation terms. See Use Centricity Physician Office Term Finder on page 64. Local observation terms, if you have them, appear in the report and in the Centricity Physician Office Term Finder. If you can t find an observation term you need, you can ask GE to create one for you. A request form is available on the KnowledgeBank (http://knowledge.medicalogic.com/) or you can contact your GE account representative. Storage connections You ll need to decide how to store each piece of information that providers enter on your form. Storage connections dictate how the data can be used later. Information from forms can be saved as text or it can be stored as observations in the EMR database. The chart note provides a good summary of everything that happened in an encounter for the patient record. However, information that is saved only in the chart note can t be used easily in reports and inquiries, and it can t be graphed or shown in the flowsheet the way observations can. 2027167-002 Rev B 2006 General Electric Company 27

Creating Clinical Content for Centricity Physician Office - EMR 2005 Encounter Form Editor supports three types of storage connections. See the following headings for details on each type. Temporary Variable connections store data temporarily in the database and permanently in the chart note as text. The temporary variable connection is selected by default in the Connect Item Finder for items that support this connection. Temporary Variable connections Temporary variable: A temporary storage place for form data until the update is signed New Observation connections New Obs (Default Prev) New Observation connections store data as observations in the EMR database as well as in the chart note. New Obs (Default Prev) connections display the most recent observation value and allow you to enter and store new data. The previous value is displayed for reference purposes. New data is stored as an observation in the database and the chart note only if it is entered on the form. If the clinician doesn t enter any new data, the previous value for the item is recorded in the chart by default, but not as a new observation. Use a Temporary Variable connection to store data in a chart note. The chart note displays information as it is entered in the form and holds it until the chart update is signed and the information is permanently stored in a chart document. In Encounter Form Editor, this method of storage is known as a temporary variable, because the information is held temporarily until the update is signed. Use the New Observation connection to record new data as an observation. Observations are stored in the EMR database, where they can be easily searched. The EMR application supplies hundreds of observation terms, which are categories of observations, such as weight. Some observations can be evaluated by E&M Advisor. For a list of E&M observations, see Appendix C, E&M Advisor observations and exam requirements. Use the New Obs (Default Prev) connection to display observation data already in the database and collect new data if anything has changed. 28 2006 General Electric Company July 2006

Choose connections Data display connections For example, family histories don t change very often. If you use New Obs (Default Prev), the current family history from the database is displayed on the form, and you can change it if the patient reports anything new. If the provider does not enter any new information for the item, the text translation displays the previous value by default. A new observation is not recorded in the database. Previous Observation Prev Obs with Date You can display patient registration or clinical information already stored in the EMR application on your form. This information cannot be edited directly on the form, although you can include an action button to take the user to the part of the EMR application where they can change clinical data, such as the Update Problems dialog box. Encounter Form Editor supports the following connections that display previously collected data. See the following sections for details on each connection. Previous Observation connections display the most recent signed observation value. Prev Obs with Date connections display the most recent signed observation value and its date. Clinical Function connections display stored clinical information about the patient, such as problems, medications, allergies, and directives. Patient Attribute connections display demographic information about the patient, such as phone number or employer. Flowsheet connections display observations collected over time. MEL expressions allow you to customize the data display. You can display observations recorded during previous encounters. Only the most recent signed observation can be displayed with a Previous Observation connection. For example, you could use a Previous Observation to display an adult patient s height. (Because a child s height changes, you d want to use an Edit Field instead of a Data Display item.) You can display the most recent signed observation along with the date it was entered. Use this for a single observation. To display several observations over time, use a Flowsheet connection instead. 2027167-002 Rev B 2006 General Electric Company 29

Creating Clinical Content for Centricity Physician Office - EMR 2005 Clinical Functions Clinical function: A data display connection that displays a clinical list The EMR application also supports inclusion of clinical functions, which display a patient s clinical lists of coded items with descriptions. Clinical lists include: Problem list. Medical problems. Medication list. Medications. Allergy list. Patient allergies. Directive list. Patient directives, such as living will information. Order list. Medical orders. See Clinical functions on page 308 for a complete list of clinical functions. You can display the contents of the clinical lists in several ways: This type of display... After New Prior Removed Changes Shows this data... Items on the list before the current update and items added during the current update Items added during the current update Items on the list before the current update Items removed from the list during the current update Changes made to the list during the current update You can also use clinical functions to show observations made during the encounter, to display a list of assessments made during the encounter, to list observations and interventions due according to patient protocols, and to list medication refills made during the update. For medications, none of these clinical functions will show expired medications entered during the update. For example, if the data isn t entered until three weeks after the encounter and the prescription was for only a week, the medication won t be displayed. Patient Attribute You can display patient registration information. For example, you may want to display the name of a pediatric patient s parent or guardian. 30 2006 General Electric Company July 2006

Choose connections Flowsheet Flowsheet: A tabular view of clinical observations over time Flowsheet connections enable you to display one or more flowsheet views on your form. Flowsheet views are set up in the EMR application to display a set of related observations together, such as vital signs or immunizations. To connect a flowsheet view to your form, you must know the pathname for the folder that contains the view in the EMR application. You can determine the pathname in the EMR application by using the Large List Lookup function on the chart Flowsheet tab. Determine flowsheet pathnames 1 Start the EMR application. 2 Open a patient chart. 3 Click on the Flowsheet tab. 4 Click the Large List Lookup icon. 5 Click on the Enterprise folder, then on the folder that contains the view you want. 6 Record the folder hierarchy as shown at the top of the Find Flowsheet View window. For example, you want to display a flowsheet view with the results of a lab test for lipids. You use the Large List Lookup function to examine several flowsheet views and note the path for the one you want to use: ENTERPRISE\LAB PANELS\LIPIDS When using flowsheet path names, be sure to note them exactly as they appear in the EMR application, including capitalization. MEL expression Action connections A MEL expression connection allows you to create a custom data display using EMR data symbols and observations. For more information about writing MEL expressions, see Chapter 4, Use advanced features. With action connections, you can make buttons on your form that take you to other screens in the EMR application or run other programs on your workstation. Supported action connections include the following: Add Allergies opens the Update Allergies dialog box so you can view, add, change, or remove allergies. 2027167-002 Rev B 2006 General Electric Company 31

Creating Clinical Content for Centricity Physician Office - EMR 2005 Custom list: A user-defined list of problems or medications Add Directives opens the Update Directives dialog box so you can view, add, change, or remove patient directives. Add Flowsheet opens the Update Flowsheet dialog box so you can view, add, change, or remove observations or change the flowsheet view. Add Form Component adds a form component to an update without opening it. Add Medication opens the Update Medications dialog box so you can view, add, change, or remove medications. Add Orders opens the Update Orders dialog box so you can view, add, change, or remove orders. Add Problems opens the Update Problems dialog box so you can view, add, change, or remove problems. Jump to Tab opens a specified page within a form. Calculation performs a calculation and displays the results in one of the other form items. You write calculations using MEL. For more information, see Write calculations on page 126. New Handout opens the Print Education Handout dialog box to a specific custom list of handouts. New Med opens the New Medication dialog box with a specified custom list of medications. 32 2006 General Electric Company July 2006

Choose connections New Order opens the New Order dialog box with a specified custom order list. New Problem opens the New Problem dialog box with a specified custom problem list. Open Form Component closes the current form and opens another form component. Run Process lets you run a program that isn t part of the EMR application. It could be an executable file (program.exe), a batch process (job.bat), or any other program that you can run from a DOS command line. For example, you can run a process that reads data from a home monitoring device and places it into the patient s chart. You could also open the Windows Calculator, if that is useful in your form. Set Values buttons fill in values in other form items. For example, you can have a Set Values button that fills in normal findings for items in a physical exam. Use custom lists with action connections Add and print handouts The EMR application custom lists display a group of related items such as problems or medications. Custom lists are the easiest way to quickly add a new problem, medication, or order. Newmed, Newproblem, and Neworder action connections require custom lists, which greatly reduces the number of items from which a provider must choose. A form user can merely type the first few characters of the desired item, and the list automatically scrolls to that item. For example, on a form for an asthma visit, you might use custom lists of asthma medications and asthma problems. Then the provider won t have to scroll through the entire list of medications or problems to find appropriate choices for the asthma visit. Find the names of medication and problem custom lists 1 Open the EMR application. 2 From the Go menu, select Setup, then Settings. 3 Select Chart > Medication (or Problem) Custom Lists. 4 Note the name of the list you want to use. You ll find orders custom lists from the Setup menu. Click Settings, then Orders. You can now select and print appropriate educational handouts directly from an Encounter form, using the New Handout action connection. You will 2027167-002 Rev B 2006 General Electric Company 33

Creating Clinical Content for Centricity Physician Office - EMR 2005 Connections example need to create a a custom list containing selected patient education or other custom handouts. From Setup, click Settings, then Handouts. You ve created a list of items you want to collect information for on your form. Next, you add connection information for each item. Note which items connect to temporary variables, and which are stored as observations. Also notice the varieties of observation connections. You can use the Centricity Physician Office Term Finder to determine which observations to connect to. Your list now includes a new item, Flow Rate for Home O2 Treatment. You don t want this item to show unless the patient is receiving home oxygen. Form items Referral source History from Reason for visit Chief complaint Current symptoms Current treatment Diet Home oxygen Flow rate Compliance with treatment regime Comments E & M evaluation Connections Temporary variable Temporary variable Temporary variable New observation [Chief Cmplnt] Temporary variable None Notes: This is a heading New Obs (Default Prev) [Diet Plan] Notes: This will display the diet plan if one has already been assigned to the patient. A new one can be entered. New Obs (Default Prev) [O2 Treatment] Notes: Make this a yes/no and display/collect flow rate if yes. New Obs (Default Prev) [Oxygen Flow] Connection: New Observation [Meds Review] Notes: Use good, fair, poor radio buttons. Temporary variable New Observation [HPI level] Notes: Use radio buttons for brief (1 3 items) and extended (4+ items). Might need to add some explanatory text. 34 2006 General Electric Company July 2006

Choose form items Choose form items Use library items After you list your information items and choose their connections, the next step is to decide which onscreen form items you ll use to collect and display the data. Before you start making your list, you ll want to become familiar with the items that you can use in forms. You may also want to view and use several of the form components provided with the EMR application. Three types of form items are available. See the following sections for details. Library items are pre-formatted items or groups of items used for specific purposes, such as collecting family history or vital signs. Custom items are form items that you build yourself, specifying their labels, properties, and connections. Formatting items are items that don t actually appear on the screen. They control the placement of other items on the screen. For more information, see Formatting items on page 46. Creating forms using library items and item groups is much faster and easier than building custom items. GE has prepared a set of items commonly used in forms. The items already display correctly on the screen and work with the EMR database. Encounter Form Editor contains two types of library items: Individual items such as Chief Complaint and Preventive Care Reminders Grouped items such as Family and Social History and Vital Signs When you choose form items, first check the library contents to see if an item or group will meet your needs. As you find library items that match the type of information you want to collect or display, note them on your item list. You can always add custom items to the form in addition to the library items. Some library items and groups supply a sample format. You can insert them in your form and modify them by changing their connections. You can also create your own item and item group libraries. See Work with item and item group libraries on page 81. 2027167-002 Rev B 2006 General Electric Company 35

Creating Clinical Content for Centricity Physician Office - EMR 2005 Here s a table of the items and groups supplied with Encounter Form Editor. For descriptions and pictures, see Library items on page 299, and Library groups on page 301. Items Assess or update problems Chief complaint Clinical list subset (example) Disposition Family History HPI Past Medical History Preventive Care Reminders Social History Groups Add allergy Add directive Add medication Add problem Active Problems and Meds Calculate Body Mass Index (cm-kg) Calculate Body Mass Index (in-lb) Calculate body surface area (cm-kg) Calculate body surface area (in-lb) Calculate Estimated Delivery Date Family and Social History Multiple form items to one observation Narrative style text translation Visibility controlled by observation Visibility controlled by radio button Vital Signs (one-line translation) Use custom form items If none of the library items meets your needs, you can create custom items for your form. Each type of form item is useful for different purposes. For example: List Boxes are groups of check boxes for items with more than one possible selection. A pain characterization list might have choices of mild, moderate, severe, ache, stabbing, throbbing. Drop-Down lists work well when there are a number of choices, but only one can be selected, such as for temperature site. Radio Buttons are used for yes/no or normal/abnormal, for small groups of mutually exclusive choices, and for controlling visibility. Edit Fields are good for collecting small pieces of data, recording dates, or displaying the results of a calculation. Multiline Edit Fields are good for collecting comments or other free-form text that can be lengthy. The following table lists form items. As you choose each item, note it in your list of items. For more information on form items and their properties, see Appendix A, Form item and connection reference. 36 2006 General Electric Company July 2006

Choose form items Not all form items can store values as observations or display all types of data. Carefully review the item connections to make sure you pick an appropriate form item. Form item Purpose and use Heading Display: Single line of text in large bold font, although you can change the font size and style Use: Titles for form sections or subsections Limits: Can t be edited on the form Properties: Text of heading, Begin Suppression Block (suppresses text translation of headings associated with items for which no data is entered) Text Display: One or more lines of text in label font (Arial 8 point) Use: Labels, for instructions to the user, and to create blank space on the form Limits: Can t be edited on the form Properties: Text, Number of Lines Data Display Display: Patient-specific information already entered in the EMR application Use: Display patient information, clinical lists, previous observations, and other previously entered data Write MEL expressions to customize the display or to create dynamic labels Properties: Label, Connect To, Number of Lines, Comma-Delimited List, Border and Scrollbar Connections: Patient Attribute, Clinical Function, Previous Observation, Prev Obs with Date, or MEL expression Edit Field Display: Single-line edit field Use: For brief text entries, numeric-only entries, dates, and displaying calculation results Example: Can use as a date field with onscreen calendar to select date Properties: Label, Connect To, Maximum Character Length, Numeric Mask, Date Field Connections: Temporary Variable, New Observation, or New Obs (Default Prev) 2027167-002 Rev B 2006 General Electric Company 37

Creating Clinical Content for Centricity Physician Office - EMR 2005 Form item Purpose and use Drop-Down List Display: A drop-down list (menu) of choices with an optional edit field Use: Provide a single choice among several options Can restrict user to choosing an item from the list or allow text input in an edit field Alternate list contents can be specified dynamically using a MEL expression when the Dynamic Choice box is checked Properties: Label, Connect To, Choice List, Limit Entry to Choice List Additional properties: Numeric Mask, Maximum Character Length (if choice not limited to list) Connections: Temporary Variable, New Observation, or New Obs (Default Prev) Multiline Edit Field Display: A text input field with more than one line Use: For text notes and to insert text components Properties: Label, Connect To, Number of Lines, Can Insert Templates, Tab to Colon Connections: Temporary Variable, New Observation, or New Obs (Default Prev) Radio Buttons Display: Presents a set of mutually exclusive choices Use: For yes/no and abnormal/normal or small groups of mutually exclusive choices User selects one or none of the choices; the text of the selected radio button is stored as the value Properties: Label, Connect To, Choice List, Arrange Horizontally Connections: Temporary Variable, New Observation, or New Obs (Default Prev) Check Box Display: A single item that can be checked on or off Use: Note a single, independent data item; text value is saved only if checked Properties: Label, Connect To, Statement (check box text) Connections: Temporary Variable, New Observation, or New Obs (Default Prev) 38 2006 General Electric Company July 2006

Determine item properties Form item Purpose and use List Box Display: Offers multiple items with no limit on the number the user can check Use: Permit multiple choice selection; associate multiple items in one observation or variable Properties: Label, Connect To, Choice List, Number of Lines Connections: Temporary Variable, New Observation, or New Obs (Default Prev) Action Button Display: A button that initiates an action when clicked Use: Update problems, medications, observations, allergies, directives, or orders; add problems or medications from a specified custom list; run a calculation or an external program; or set values for other items; open or add form; print handout; add clinical list item Properties: Label, Connect To, additional properties depending on connection Connections: Determined by type of action Flowsheet View Display: flowsheet view of observations over time Use: Display multiple observations over time to show changes, such as weight or blood pressure Properties: Label (not displayed on form), Connect To, Flowsheet Path Name, Number Of Lines Connections: Predefined flowsheet views in the EMR application Determine item properties Each type of form item has specific properties which you can use to set a wide variety of characteristics. Each type of form item or formatting item has different properties. Here are some of the things you can do with properties: Appearance. Adjust the appearance of an item on your form, such as the number of lines for a Multiline Edit Field or data display Text. Specify text for headings and labels Heading suppression. Determine whether the heading will be suppressed if no data is collected for the items that follow it List values. Specify the values used in a drop-down list, a list box, or a set of radio buttons Data type. Restrict the type of data that can be entered 2027167-002 Rev B 2006 General Electric Company 39

Creating Clinical Content for Centricity Physician Office - EMR 2005 Design for text translation Visibility. Specify visibility conditions Appendix A, Form item and connection reference, lists properties for each type of form item. Using your list, enter appropriate properties for each item, noting any specific values and options. Library items and groups already have their properties set as listed in Appendix A. You can modify their properties after you place them in your form. Text translation: A text version of the information in an form component As the provider fills in form items, the EMR application creates a text translation in the chart document. Encounter Form Editor automatically creates this text translation for you, but you may want to customize the translation. For example, you need to plan ahead to suppress headings for items that the user does not enter on your form. Heading suppression is discussed in the following section. For more information about customizing text translations, see Customize text translations on page 131. Heading suppression Go through your list of items and note any headings that you don t want to appear in the text translation if no data is entered in the items underneath them. In the text translation, the EMR application automatically suppresses the labels for these items. However, you may also want to suppress the heading you used for that group of items, because a heading with no data looks like the item wasn t assessed by the provider. In fact, the provider may choose not to assess some items, and it s better not to have the headings appear at all. Suppress a heading for a group of items 1 Check the Begin Suppression Block property for the heading item in the Edit Item window. This prevents the heading from showing up in the text translation if no data is entered for items that follow the heading. Suppression stays in effect until you add an End Suppression Block item. 2 Insert an End Suppression Block item to mark the end of the group of items you want to suppress. Each heading that is marked for suppression must have a corresponding End Suppression Block item. 40 2006 General Electric Company July 2006

Design for text translation Example Nested suppression blocks You might have a section with the heading Diabetic Labs. If no labs are entered during the encounter, you want to suppress the Diabetic Labs heading in the chart note. To accomplish this, you check the Begin Suppression Block property for the Diabetic Labs heading. After all the items for collecting lab data, you add an End Suppression Block item. You can also nest suppression blocks. You can set a heading to be suppressed, and underneath it have subheadings that will be suppressed independently if no data appears in their items. Using the Diabetic Labs example, you might have two labs that appear under their own subheading, such as Blood Tests. If the Blood Tests subheading has its Begin Suppression Block property enabled, it will be suppressed if no data is entered for these two labs (see following illustration). Suppression of the Diabetic Labs heading will only occur if no data is entered for any of the items beneath it, including Blood Tests. The following illustration shows how nested heading suppression works. Diabetic Labs is suppressed if data items 1 through 9 contain no entries Text cannot be suppressed and always appears in the text translation Urinalysis appears regardless of entries in the data items Blood Tests is suppressed if data items 6 and 7 contain no entries Diabetic Labs (begin suppression block) Data item 1 Data item 2 Data item 3 Text Urinalysis Data item 4 Data item 5 Blood Tests (begin suppression block) Data item 6 Data Item 7 End suppression block Data item 8 Data item 9 End suppression block Example Returning to our example, we can now add form items and their properties to our list. We ll also add Headings and End Suppression Block items where appropriate and some explanatory text. 2027167-002 Rev B 2006 General Electric Company 41

Creating Clinical Content for Centricity Physician Office - EMR 2005 At this point, it s useful to start thinking in terms of a list of form items that you can enter into Encounter Form Editor. Notice that we have changed our list to reflect this. You can put your list on paper, in a word-processing file, or start working directly in Encounter Form Editor. If you start working directly in Encounter Form Editor, you must add a Begin Section as your first item. Form item Heading Edit Field Drop-Down List Drop-Down List Drop-Down List Heading List Box List Box End Suppression Block Properties Label: History of Present Illness-Heart Failure Notes: Enable heading suppression. This heading suppressed only if all items under it are not filled in. Label: Referral source: Connection: Temporary Variable Label: History from: Values: patient, spouse, mother, father, son, daughter, caregiver, other Notes: Allow free data entry Connection: Temporary Variable Label: Reason for visit: Values: new referral, routine follow-up, medication refills, see chief complaint Notes: Allow free data entry Connection: Temporary Variable Label: Chief Complaint: Values: shortness of breath, palpitations, syncope, edema Notes: Allow free data entry Connection: New Observation [Chief Cmplnt] Label: Current Symptoms Notes: Enable heading suppression (nested). This heading is suppressed when neither of the following items are filled in. Choice list: none, fatigue, cough, dyspnea, orthopnea, PND Number of lines: 6 Connection: Temporary Variable Choice list: palpitations, tachycardia, chest pain, edema, abdominal pain, cold intolerance Number of lines: 6 Connection: Temporary Variable Ends suppression of the Current Symptoms heading 42 2006 General Electric Company July 2006

Design for text translation Form item Heading Edit Field Label: Current Treatment Notes: Enable heading suppression (nested) for this sub-heading. Label: Diet Connection: New Obs (Default Prev) [Diet plan] Notes: This will display the diet plan if one has already been assigned to the patient. A new one can be entered. Radio Buttons Label: Home 02 Choice list: yes, no Connection: New Obs (Default Prev) [O2 Treatment] Notes: Make this a yes/no and display/collect flow rate if yes. Drop-Down List Text Radio Buttons End Suppression Block Multiline Edit Field Text Properties Label: Flow rate Choice list: 1l/min, 2l/min, 3l/min, 4l/min Notes: Allow free data entry Connection: New Obs (Default Prev) [Oxygen Flow] Notes: Display previous flow rate. A new one can be entered. Only display this item if Home O2 is yes. Label: Compliance with tx regime: Number of lines: 1 Choice list: good, fair, poor Connection: New Observation [Meds Review] Ends suppression of the Current Treatment heading Label: Comments: Number of lines: 3 Can insert templates: Yes Tab to colon: No Connection: Temporary Variable Label: For E&M evaluation, indicate level of detail Number of lines: 2 2027167-002 Rev B 2006 General Electric Company 43

Creating Clinical Content for Centricity Physician Office - EMR 2005 Form item Radio buttons Text End Suppression Block Properties Choice list: brief (1-3 elements), extended (4 or more elements) Connected to: New Observation [HPI Level] Label: HPI elements: location, quality, severity, duration, timing, context, modifying factors, and associated signs\symptoms Number of lines: 2 Ends suppression of the History of Present Illness: Heart Failure heading Create preliminary form design Visual design characteristics Your form should be readable and easy to use on the screen. Good visual design will help users complete the form quickly and accurately. Before you use Encounter Form Editor, it s a good idea to sketch out how you want your form to look. You can use pencil and paper, a white board, or a computer drawing program. Some form designers draw items on sticky notes to make it easier to move them around. Library items are pre-formatted to look good on the screen. When you use library items, it s easy to make the form attractive. Visibility region: A form item or group that appears in response to certain conditions Thinking about these visual design characteristics will help you design the form: Order. You have probably already arranged your items to follow the normal clinical workflow for this type of encounter. Appendix E, Style guide. contains a suggested clinical workflow on page 350. Grouping. Group related items together. For example, all items for collecting vital signs should be close together. You can place a group box around all the items in a section by checking the Group Box property for a Begin Section or Column Break item. Visibility. You can make items appear on your form only when certain conditions are met by using visibility regions. For example, you can have specific exam items appear depending on whether the patient is male or female. In our example, the Drop-Down List for the Home O2 flow rate appears only if the provider selects the Yes radio button for Home O2. Visibility regions can overlap each other. Creating effective visibility regions requires careful specification of the region and its conditions. For more information about visibility regions, see Plan for visibility regions on page 47 and Use visibility regions on page 116. 44 2006 General Electric Company July 2006

Create preliminary form design Page and form navigation. Pages in form components appear as different tabs. Users go from one page to another by clicking on the tabs. You can also use action buttons to open another form component from within a form or to jump to a specified page within a form when certain conditions are fulfilled. See Action Button on page 286. In many cases you can avoid multi-page forms by breaking long forms into smaller components. Multi-page forms are appropriate for some uses, however, such as physical exams. See the forms included with the EMR application for examples. Page names. Page names appear on the page tab. Page names can be up to 30 characters, but you need to make sure the name fits on the page tab. Tab sizes vary according to how many pages the form has, so the more pages, the shorter your names must be to fit on the tabs. Each page name must be unique in the form component. That is, you can t have two pages with the same name in a single form, although you can have two separate form components that each include a page with the same name. Columns. If your form items don t take up much horizontal space, you may want to put them in two or more columns. You specify the number of columns for a section in the Begin Section item properties. Use a Column Break item to make the next item appear in the next column. Use a Begin Section to start a new set of columns. For example, current problem and medication lists usually appear together on a form. Because each needs only about half the width of the form, problem and medication lists work well in a two-column section. You specify the proportional width of columns. For example, the first column might take up 25 percent of the width of the form and the second column the remaining 75 percent. When you specify a number of columns, make sure you use the same number of Column Breaks, minus one, in that section. Headings. Use headings to set off sections and subsections and to clearly indicate the purpose of a group of form items. You can suppress printing of the heading on the chart note if items underneath the heading aren t filled in. For more information, see Heading suppression on page 40. Explanations or instructions. Use a text item to put information helpful to form users on your form. Multi-item rows. You can specify a number of items that should appear next to each other horizontally. For example, you might create a multi-item row of action buttons. You set a property for the multi-item row that determines the proportion of horizontal space that each item takes. 2027167-002 Rev B 2006 General Electric Company 45

Creating Clinical Content for Centricity Physician Office - EMR 2005 The HPI-Heart Failure form uses several formatting techniques: Heading Two column section with group boxes Visibility region Multi-item row Explanatory text Formatting items Encounter Form Editor supplies formatting items that help you lay out your form the way you want. Formatting item Purpose and use Begin Section Function. Starts a new section on the form Use. Group related items, start a new page, create a multicolumn section, or end a columnar section Every form must have a Begin Section as the first item The section title is used as the page name if the Start New Page property is checked Properties. Percentages List (sets column proportions), Number of Columns (1 to 8), Start New Page, Group Box for First Column Column Break Function. Starts a new column Use. Make following items fall into the next column Can be used only in a section with more than one column Properties. Group Box for This Column Begin Multi-item Row Function. Causes the specified number of following items to be placed in a horizontal row Use. Line up several small objects horizontally The items in the multi-item row must be form items, not formatting items You can specify the horizontal percentage of the column that each item takes Properties. Number of Items, Percentages List 46 2006 General Electric Company July 2006

Create preliminary form design Formatting item Purpose and use Begin Visibility Region Function. Denotes an item or group of items that appear on the form in response to certain conditions, such as a form selection or a patient attribute Use. Maximize form space, prevent irrelevant items from appearing, show different items depending on patient sex or the contents of another form item Must be paired with an End Visibility Region item. See following section You can stack visibility regions as long as you make sure only one displays at a time Each group of visibility regions that shares the same space on the form must have a corresponding End Visibility Region item Properties. Visibility Controlled By End Visibility Region Denotes the end of one or more visibility regions Text and Heading Not strictly formatting items, but can be used with no Label property to create blank space Plan for visibility regions When you design a form, consider how you can use visibility regions portions of your form that only appear when conditions that you specify are met. Here are some things you can do: Use visibility regions. Shorten your form to a single page by stacking two or more visibility regions. Data can be collected from several visibility regions in a single form. For example, you can display different visibility regions based on a selection from a set of radio buttons. Display based on observations. You can display certain items depending on previous observations. The previous observation must appear on the same page of the form, however. For example, you can have items related to obesity controlled by the condition OBSPREV("BMI") > 30, which displays the items only if a patient s body mass index is greater than 30. Display based on patient characteristics. You can display items based on a patient s sex, age, or other attributes. For example, you can display different items for a child or adult sore throat visit. Use Action Buttons. You can have Action Buttons appear when a check box is checked. 2027167-002 Rev B 2006 General Electric Company 47

Creating Clinical Content for Centricity Physician Office - EMR 2005 In planning your form, note where you can use visibility regions on your list of items so you ll know where to start and stop the region. Make sure you describe clearly the condition you ll use to make the region visible. This sample Review of Systems form shows items for one system at a time, depending on which radio button the provider chooses. The radio buttons on the left control the visibility of the items on the right. Visual design tips For more information about visibility regions, see Use visibility regions on page 116. Here are some tips to help you design your forms: Blank space. Use blank Heading or Text items to create blank space on the form. Columns. Use column percentages to place items in specific places on the form. Each column can be a different width. Remember that a column does not have to contain any form items. You can also put blank text in a column. Multi-item rows. Use Multi-item Rows to place several small objects in a line. You can use a blank Text or Heading item within the multi-item row to create space. Visibility regions. Use visibility regions to stack items on top of each other to save form space or to display items only when needed. Preview. Use Preview frequently to see how the form looks. Click the Preview button on the Edit Form window to view your form while you re working on it. To learn how to use Preview, see Preview a form on page 79. 48 2006 General Electric Company July 2006

Create preliminary form design Style guidelines Example If you are designing several forms, you should create some basic style guidelines and try to apply them consistently. Style guidelines specify how different items should look on the screen. Using a consistent style makes your forms look familiar so it s easier for users to complete them. Some of the style guidelines used by GE are in Appendix C. The items and sections in the libraries conform to these guidelines. We ve created a sketch of what we want our form to look like. This illustration was created with a word processing program. You may find it easier to use pencil and paper or other methods. History of Present Illness - Heart Failure Referral source: Reason for visit: Chief Complaint: History from: Current Symptoms none fatigue cough dyspnea orthopnea PND palpitations tachycardia chest pain edema abdominal pain cold intolerance Current Treatment Diet: Home O2: no yes Flow rate: Compliance with tx regime good fair poor Comments: For E&M evaluation, indicate level of detail brief (1-3 elements) extended (4 or more elements) HPI elements: location, severity, duration, timing, context, modifying factors, and At this point, you probably want to start working in Encounter Form Editor so you can preview your design. Chapter 3, Use Encounter Form Editor, shows you how. You can print out a list of your items, connections, and properties at any time. See Print an item report on page 80. 2027167-002 Rev B 2006 General Electric Company 49

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CHAPTER 3 Use Encounter Form Editor Start Encounter Form Editor 51 Exit Encounter Form Editor 52 Work with forms 53 Edit a form 55 Customize form appearance 66 Save a form as a clinical kit 72 Preview a form 79 Print an item report 80 Work with item and item group libraries 81 Compact the database 89 Start Encounter Form Editor Supply registration information This chapter tells you how to use Encounter Form Editor s basic features. You can create very useful forms using these features along with Encounter Form Editor defaults. If you need to create more complicated forms, you may want to use Encounter Form Editor s advanced features. For more information, see Chapter 4, Use advanced features. To start Encounter Form Editor, click the Start button on your Windows desktop. Select the Programs menu, then the Encounter Form Editor program group, and finally Encounter Form Editor. The first time you start Encounter Form Editor, it asks for your site number and validation code. To obtain this information, contact Centricity Physician Office Services at 800.957.6837. Each copy of Encounter Form Editor is registered to a single user. Do not use somebody else s validation code. 2006 General Electric Company

Creating Clinical Content for Centricity Physician Office - EMR 2005 Write down your registration information and put it in a safe place. You will need it if you reinstall Encounter Form Editor. View Encounter Form Editor s main window Once you have supplied registration information, you see Encounter Form Editor s main window. Enter the name, description, and EMR path for your form Enter screen size and spacing information Set default font and style here Click Help for help on this screen Exit Encounter Form Editor To quit using Encounter Form Editor, click Exit on the main window.!!! Always use the Exit button rather than in the top right-hand corner of any window to exit Encounter Form Editor. If you don t use the Exit button, you won t be given a chance to save your form as a clinical kit, although it will stay in the database. If you do exit using, Encounter Form Editor will ask you if you want to recover your form next time you open it. Answer Yes to continue working and you won t lose any data. 52 2006 General Electric Company July 2006

Work with forms Work with forms Clinical kit: A set of files that contain related forms, observation terms, templates, and other EMR components Encounter Form Editor holds the form you re working on in its database. Because it uses a database, Encounter Form Editor automatically stores changes you make to a form while you re working on it. However, you must explicitly save, or export, the form before you can do anything with it, such as post it to the KnowledgeBank (http://knowledge.medicalogic.com/) or import it into the EMR application. When you save a form, Encounter Form Editor creates a set of files that make up a clinical kit. It is the clinical kit that you import into the EMR application or submit to the KnowledgeBank (http://knowledge.medicalogic.com/). See Understand encounter form files on page 75 for more information about all of the files that make up a form component clinical kit. You can work on only one form component at a time. Before creating a new or opening an existing form, be sure to save work you ve done previously into a clinical kit. See Save a form as a clinical kit on page 72. Create a new form Provide basic form information To create a new form, click New. If you have already been editing a form, Encounter Form Editor will ask you if you want to discard the current form. To save your previous work, click No, and then click the Save button on the main window. To discard any work you ve done, click Yes. Opening a new form clears the filename and description, and resets the style settings to their defaults. When you create a new form, you need to enter basic information about the form on the main window. You can also review and set style settings. Provide the following information: Form Name. Type a descriptive name for your form. This is the name providers see in the EMR application. Description. Type a description of the form s purpose or the information it will collect. You should include a version number so you can keep track of form revisions. If you attempt to import a form into the EMR application that would replace one with the same name, the EMR application shows you both form s description. EMR Path. The form s folder location in the EMR application. Enter the folder names separated by backslashes. (\). 2027167-002 Rev B 2006 General Electric Company 53

Creating Clinical Content for Centricity Physician Office - EMR 2005 Open an existing form The path you enter depends on how you organize forms in the EMR application. To view the folder hierarchy in the EMR application, go to Setup Settings and select Chart Documents > Form Components. If you don t specify an EMR path, the form is stored at the Enterprise level after its clinical kit is imported into the EMR application. Screen Size. Select Small, Medium, or Large. This setting determines how much of the screen a form takes up. Large forms occupy the entire screen. Default font and style. Set the default font and text style for your chart note text translations. You can customize the style and size of individual form items as you add them. However, the font selection applies to the entire note translation. Spacing. Enter the amount of space between form items on the screen. Leave these settings at 4 vertical pixels and 8 horizontal pixels unless you have special requirements. To open an existing form, click Open. Use the Open File window to choose a form description file to edit. Form description files have a.fd extension. You see the form name, description, style settings, and filename in the main window. 54 2006 General Electric Company July 2006

Work with forms Edit a form Click Edit to begin working with form items. You ll do much of the work of building a form in the Edit Form window. Selection pointer Item number Action buttons If you are creating a new form, an Edit Item window appears in front of the Edit Form window because you must first add a Begin Section item. Type a section name and click Close. The Edit window has several action buttons at the bottom. Here are the things you can do: This set of buttons... Enables you to... Select Find items by searching for a word, phrase, or item number Move the selection pointer to the top or bottom of the item list Move the selection pointer through the list one item at a time For Current Item First select an item on which to perform the action. Edit an item s properties Customize an item s appearance, text translation, or printed form text Delete an item Move an item up or down in the list 2027167-002 Rev B 2006 General Electric Company 55

Creating Clinical Content for Centricity Physician Office - EMR 2005 This set of buttons... Insert First select the item that will follow the inserted item. Save First select the item or beginning item in a group to save. Enables you to... Insert a new custom item Insert an item from the item library Insert an item group from the item group library Save the currently selected item in the item library Save the selected item and following items in the item group library; you specify the last item in the group General View a help screen for the Edit Form window Preview your form s layout Close the Edit Form window and return to the main window Understand the item list Select a form item The item list contains several kinds of information: Item Type lists the type of form item, such as Check Box, Edit Field, or Begin Section. ID # lists a unique number for each item. Encounter Form Editor reports errors by item number when you save the form. Use the ID # to locate items. Labels are labels or options associated with the item, such as the choices in a list or the number of columns in a section. Some options do not appear in this section but are visible in the Edit Item window for the item. Connection indicates what the item is connected to an observation, action, or view, for example as well as the connection type. Additional information about the connection may also appear, such as an observation term, patient attribute, clinical function, or action. The temporary variable connection is selected by default for items that support this connection in the Connect Item Finder. The selection pointer indicates the currently selected item. Encounter Form Editor acts on only one item at a time. To select a form item, click anywhere in its description or click the up and down arrows to move the selection pointer. 56 2006 General Electric Company July 2006

Work with forms To move the selection pointer to the top of the list, click the top arrow. To move it to the bottom of the list, click the bottom arrow. Find a form item You can search the list of form items for any text associated with the item. The text can be from the type of item, its item ID number or label, its list of choices, its connection type, or its associated observation, action, or clinical function. Find a form item 1 Click Find in the Edit Form window. You see the Find window. 2 Type a word, part of a word, an item number, or a phrase. 3 Click Find First to highlight the first occurrence of the item. You may need to move the Find window out of the way to see the highlighted item. 4 To find subsequent occurrences, click Find Next. 2027167-002 Rev B 2006 General Electric Company 57

Creating Clinical Content for Centricity Physician Office - EMR 2005 The Find window has several options that can speed up your search: Use this option... Search To do this... Control the search direction: Up searches from the selection pointer to the top of the list. Down searches from the selection pointer to the bottom of the list. All searches the entire list. Match Search Only Current Field Match Case Specify where to find the search term: Any Part of Field means that the characters can occur in any position. Searching for bin finds hemoglobin and bilirubin. Whole Field means that the characters you type must exactly match the entire field. Searching for Add New Problem finds Add New Problem; searching for Add doesn t find anything. Start of Field means that the characters must appear at the beginning of the field. Searching for uri finds Urinalysis and Urine culture, but doesn t find Hgb urine. Restrict the search to the column (Item, ID #, Labels, Connection) that you click in before opening the Find window. Then check Search Only Current Field before clicking Find First. Find only items that exactly match the capitalization of the search term. Searching for Temperature site finds Temperature site, but not Temperature Site or temperature site. Add form items Use the item list you created, such as the one on page 22, to help you break your form into sections or pages and add items. Be sure to check the libraries to see if you can save time by using any of the predefined items. For example, the library contains items for Chief Complaint and Family History and an item group for Vital Signs. Work down through your list, adding each section or item in sequence. You can rearrange the items later, if you need to. See Rearrange items on page 66. 58 2006 General Electric Company July 2006

Work with forms Add a new form item Add a new form item 1 Click Edit in the main window. You see the Edit Form window. 2 Select the item that will follow the new item To insert an item at the end, select the blank item at the end of the list. new item is added ween Begin Section Heading 1 In the Edit Form window, click New Item under Insert. You see the Item Finder window. 2 Select the type of item you wish to add and click OK. You see the Edit Item window, which is different for each item. 2027167-002 Rev B 2006 General Electric Company 59

Creating Clinical Content for Centricity Physician Office - EMR 2005 3 Specify the item properties. Use your item list and the information in Appendix A, Form item and connection reference. 4 If you want a connection other than Temporary Variable, click Connect To to specify them. You see the Connect Item Finder window. Temporary Variable is selected by default. Some items, such as Begin Section, Column Break, Begin Multi-Item Row, End Suppression Block, Function/MEL Expression, Heading, and Text, do not have connections. You don t see the Connect To button and field for these items. For items without connections, skip to step 7. 60 2006 General Electric Company July 2006

Work with forms Add a new section To create the connection: a b Select a connection type and click OK. The window you see next depends on the item and connection type. Select an observation, patient attribute, clinical function, action, flowsheet view, or MEL expression to connect to. You do not need to select anything to connect to for a temporary variable. 5 To add another item without returning to Edit Form, click New Item. 6 Repeat steps 4 though 9 for each item you want to add. 7 When you re finished adding items, click Close in the Edit Item window. Each form must start with a Begin Section item. You use subsequent Begin Section items to start new pages (tabs) and change the number of columns and column widths. Before you add a new section, think about these things: Do you want the following items to be on a new page (tab) or do you want to continue the current page? Do you want the following items to appear in columns? How many columns? What is the proportion of columns? Are they all the same size or different sizes? Add a new section 1 Add a new Begin Section item. You see the Edit Item window for Begin Section. 2027167-002 Rev B 2006 General Electric Company 61

Creating Clinical Content for Centricity Physician Office - EMR 2005 Add an item from the item library 2 Type a Section Name. If you start a new page with this section, you see the name on the tab. Make sure it s not too long to fit. If you don t start a new page, you don t see the name on your form, but it s helpful for organizing your item list. 3 If your section has columns, type the column proportions as percentages. The numbers must add up to 100 percent. For example, if you have three equal columns, the percentages are 33, 33, 34. If you have two columns, the percentages could be 60, 40. You can leave this blank if you don t want columns in this section. 4 Enter the number of columns. The number of columns must match the number of percentages. For example, if you specified 60, 40, you must type a 2 for the Number of Columns. 5 Specify if the section starts a new page. If you check New Page, you see subsequent form items on a new tab in the form. 6 Specify if the first column has a group box. This property puts a beveled box around items in the first column. 7 Click OK. To start new columns in your section, insert a Column Break item. Make sure that the number of column breaks in the section is one less than the number of columns in the section. For example, if you specify a three-column section, you can t have more than two column breaks. The items in Encounter Form Editor s item library have appropriate properties and are already connected to observations, clinical functions, or patient attributes. For a complete list of library items, see Appendix A, Form item and connection reference, beginning on page 283. You can also create your own item libraries. See Work with item and item group libraries on page 81. Once you ve added a saved item to your form, it is no longer connected to the copy in the item library. You can change its properties, connections, or label without affecting the library item. Add an item from the item library 1 Click Edit in the main window. You see the Edit Form window. 62 2006 General Electric Company July 2006

Work with forms 2 Select the item that will follow the saved item, or place the selection pointer at the end of the list. 3 In the Edit Form window, click Saved Item under Insert. You see the Insert From Item Library window. 4 Select an item and click OK. Encounter Form Editor adds the item to your item list. Add an item group from the item group library Item groups are even more powerful tools than items. You can insert a whole series of items into your form rather than inserting them one by one. For a list of item groups, see in Appendix A, Form item and connection reference, beginning on page 283. You can also create your own item and item group libraries. See Work with item and item group libraries on page 81. Once you add an item group to your form, it s no longer connected to the copy in the library. You can add or delete items or change their properties without affecting the library group. Add an item group from the group library 1 Click Edit in the main window. You see the Edit Form window. 2027167-002 Rev B 2006 General Electric Company 63

Creating Clinical Content for Centricity Physician Office - EMR 2005 2 Place the selection pointer below where you want to add the items. Items will be inserted above Heading 3 Click Saved Group under Insert in the Edit Form window. You see the Insert From Item Group Library window. 4 Select a group and click OK. In the Edit Form window, you see the items in the saved group appear above your selection pointer. Use Centricity Physician Office Term Finder You can use Centricity Physician Office Term Finder to find observation terms for your form by either searching or browsing. Search for observation terms 1 In Encounter Form Editor, insert or select an item that can be connected to an observation, such as an edit field. 64 2006 General Electric Company July 2006

Work with forms 2 Click Connect To and select New Observation, Previous Observation, or Previous Observation with Date. You see the Centricity Physician Office Term Finder. Click the Search tab if necessary. Type a keyword here to search for an Observation terms that meet the Click the Search button to start your search 3 Type a keyword in the Search For field and click Search. You see the list of observations that have that keyword. 4 To further refine your search, type additional key words in the Search For field. Use as many keywords as necessary to limit your search 2027167-002 Rev B 2006 General Electric Company 65

Creating Clinical Content for Centricity Physician Office - EMR 2005 Edit an existing form item Rearrange items You can change properties or connections for existing form items. To edit an existing form item, select it in the Edit Form window by clicking on it or by moving the selection pointer. Click Edit. You see the Edit Item window, where you can change the item s properties or connection. If you select a blank item and click Edit, you automatically see the Item Finder window. You can edit several items without returning to the Edit Form window. Click Next Item and Previous Item on the Edit Item window to move back and forth through the list of items. Delete an item You can rearrange the items in your item list. Form items should be ordered by the clinical workflow of the visit. For information about clinical workflow, see Appendix E, Style guide, beginning on page 349. To move a form item, select the item on the Edit Form window, then click Move Up or Move Down until the item is in the desired position. Customize form appearance To delete an item, select it in the Edit Form window, then click Delete. You can customize the way text appears on your form. Encounter Form Editor s default settings conform to the style guidelines GE uses for font, alignment, style, and size when designing forms. If your organization has developed its own style guidelines for forms, you will want to customize the settings. Style and size customization also helps you adjust the proportions of labels, fields, and other form items on your form. You may want to experiment with the Horizontal % setting to line up items. Customize form appearance 1 In the Edit Form window, select the item you want to customize. 2 Click Customize under For Current Item. 66 2006 General Electric Company July 2006

Customize form appearance You see the Customize Item window. Customize the appearance of form items with these settings Edit MEL expressions to customize the text translations 3 Use the controls to customize the selected item. The contents of the window vary, depending on the item you re customizing. 4 To customize additional items, click Next Item or Previous Item to move back and forth through your list of items. You can set style and size characteristics separately for labels and items: For Label settings apply to the label associated with the item. For Item settings apply to the text associated with an item, such as the text entered in an input field or the text associated with a radio button. Some items, such as Headings and Text, do not have labels. For these items, you see the settings for the item in the For Label row. Chart Update and Printed Form translations You can also customize how form items will appear in the chart note after the form is closed or when it is printed. The MEL expressions providing the default format for these translations are displayed in the Chart Update Translation and Printed Form Translation windows of the Customize Item window. You can: Clear the text in the text window. Edit the expressions by typing in the text window. Reset an edited expression to the default translation. 2027167-002 Rev B 2006 General Electric Company 67

Creating Clinical Content for Centricity Physician Office - EMR 2005 Text alignment Zoom to a larger view of the text area by clicking the + button or pressing Shift+ F2. This will open the MEL Expression Builder window. For more about editing MEL expressions in the Chart Update Translation and Printed Form Translation windows, See Customize text translations on page 131. Refer to the following sections for details on style and size settings for form items. For information about default style and size settings for form items, see Appendix A, Form item and connection reference, For a sample style guide, see Appendix E, Style guide. Right-aligned Left-aligned Centered text The alignment setting determines how text is aligned. You cannot set the alignment of Edit Fields, Multiline Edit Fields, or Data Display items. To change alignment, select Center, Left, or Right from the Alignment drop-down list. Encounter Form Editor automatically right-aligns labels. All other text elements are left-aligned. You can use alignment to achieve a variety of effects: Align left. The default setting for labels is Right, but you can line up your labels on the left. Align right. You can put text information in the right side of a form column. Align center. You can center text above a section or column. Font The font setting specifies the font used for the on-screen label or text. By default, Encounter Form Editor uses standard Windows fonts: Arial and Courier, in several point sizes and in regular, bold, italic, and bold italic styles. 68 2006 General Electric Company July 2006

Customize form appearance In Encounter Form Editor s Font drop-down list, the font name appears first, followed by point size and a code for the font style. Some examples: Arial:8 Arial 8 point Arial:10:B Arial 10 point bold Courier 12:ICourier 12 point italic Courier:10:BICourier 10 point bold italic To change a font, select a font description from the Font drop-down list. Here are some things you can do with fonts: Vary size of headings. You can change the font setting to indicate headings at various levels. For example, a form title might be in Arial 10 point bold, while major section titles are in Arial 8 point bold. Set style instructions. You can set a different font and size instructions to the user. GE s style guide recommends Arial 8 point italic for instructions. Form title Major section title Subsection title Label Instructions If you use a large font, you may need to change the pixel height per line so it will display correctly. See Pixel height per line on page 72. Changing the font changes its appearance in the form. It does not affect the text translation. Text color Text color specifies the color of the text used for a label or an item. You ll want to use black text on your forms most of the time, although you may want to make major headings a different color. You can use a color such as red to call attention to instructions or to a field that must be filled in. The complete list of colors includes: black blue brown purple white yellow green blue-green red pink dark blue dark grey lime green turquoise olive light grey 2027167-002 Rev B 2006 General Electric Company 69

Creating Clinical Content for Centricity Physician Office - EMR 2005 To change text color, select a color from the Text Color drop-down list.!!! Keep in mind that many people have impaired color vision and may not be able to distinguish colors. Back Color Back color controls the color of the text s background. The following colors are available: transparent blue brown purple white yellow green blue-green red pink dark blue dark grey lime green turquoise olive light grey To change background color, select a color from the Back Color drop-down list. Here are some tips for selecting background colors: Labels. For labels, the background is usually transparent so that the background color of the form shows through. The form s background color depends on the user s system settings but is usually grey. White vs. transparent. In general, a white background indicates that data can be entered, while a transparent background (form color showing) indicates information or data that can be read but not changed. For example, Edit Fields have a white background to indicate that data can be entered. Data Display items have transparent backgrounds to indicate that the data is for display only and can t be changed. 70 2006 General Electric Company July 2006

Customize form appearance While using the EMR application, it is likely that some of your form s colors may be affected by the display settings of the workstation: If the workstation display is set to 16-bit (high) color (or higher), all colors display properly. If the workstation is set to 256 colors, yellow appears as dark beige, red as brown, and brown as dark burgundy. MetaFrame workstations must be set to 256 colors, and some clinics may have resource-limited equipment that also limits the display to 256 colors. When you design a form, make sure you know what type of workstations it will be used on. If you plan to share the form on the KnowledgeBank (http://knowledge.medicalogic.com/), avoid using these colors for text or backgrounds. Horizontal percentage The horizontal percentage adjusts the proportion of horizontal column space given to an item compared to its label. You can use this customization feature to adjust the layout of form items. The settings are relative to the column widths that you set in the preceding Begin Section item. For information about creating columns, see Add a new section on page 61. To change the horizontal percentage, enter the desired percentage for the item. The percentage for the label adjusts automatically. Here are some tips for setting horizontal percentages: Adjust for short labels. For example, the normal setting for an edit field is 40 percent for the label and 60 percent for the item. If you have a very short label, you might want to adjust the percentage to 10 percent for the label and 90 percent for the item. Example. Here s how two edit fields would look in a 50% column and in a 33% column. The field labeled Comments has 60 percent for the item, while the field labeled 1 has 90 percent for the item. 50% column section 33% column section Adjust for no label. Horizontal percentage applies only to those items that have a label property. (For example, Edit Fields and Data Displays have labels, while Action Buttons do not.) The percentage applies even if the label is blank. If you aren t using a label, you might want to 2027167-002 Rev B 2006 General Electric Company 71

Creating Clinical Content for Centricity Physician Office - EMR 2005 Pixel height per line customize the item to take up 100 percent of the horizontal space in a column. Defaults settings have been established for most form items. Here are some common settings: Most items default to 40 percent for label, 60 percent for data Multiline Edit Fields and List Boxes default to 20 percent for label, 80 percent for data. Check Boxes allow 5 percent for label, 95 percent for data, because Check Boxes rarely have labels. (The text following a Check Box is the Check Box statement.) Pixel: A single picture element or dot on a computer screen Pixel height per line sets the line height in pixels for each line of text. You can use this feature to control vertical spacing of headings, labels, and other text elements. The default is 16 pixels. Here are some things you can do with pixel height: Set off a heading. You can increase the pixel height to set off a heading. The extra space appears below the heading. Extra pixels below heading Make sure all of a large font shows. If you ve used a large font, characters may not show entirely unless you increase the pixel height per line. Default setting Pixel height adjusted Save a form as a clinical kit Create empty space on your form. You can create an empty space on your form by creating a Text item with no text specified. Use a small pixel height per line to create a short blank space; use a larger pixel height to create a tall blank space. When you save your form, Encounter Form Editor checks all of the form items and their connections and points out any errors you need to correct. Saving the form creates the clinical kit files that you import into the EMR application to make the form component available to EMR users. Exported files include formats needed by the Encounter Editor for updates (*.FS and *.FD files) and other files needed by the EMR application to generate the form. See Understand encounter form files on page 75. 72 2006 General Electric Company July 2006

Save a form as a clinical kit Save a form for the first time or with a different filename 1 If necessary, click Close to exit the Edit Form window and return to the main window. 2 Click Save if it s the first time you ve saved the form. Click Save As to save the form with a different filename. You see the Save File window. 3 Enter a filename and click Save. Form files must have an.fd extension. If you don t type the extension, the program supplies it for you. You see the Save window. This window shows progress and information about the form as Encounter Form Editor prepares your form for import into the EMR application. 4 Review the Save window. If any errors occur, you see the number of errors and the Print Errors button. 2027167-002 Rev B 2006 General Electric Company 73

Creating Clinical Content for Centricity Physician Office - EMR 2005 5 Click Close. If Encounter Form Editor finds certain errors, such as three column breaks in a two-column section, it cannot save the form. You must correct the errors before you can save the form. Use the item number shown in the error window to locate and correct the error. For more information, see View and correct errors on page 74. Save a form using the existing name 1 Click Close to exit the Edit Form window and return to the main window. 2 Click Save. View and correct errors 3 In the Save window, click Close. Encounter Form Editor checks for errors as you build your form and will catch most of them. Some errors, such as an inappropriate number of columns, prevent you from saving the form. Some errors do not prevent saving, but Encounter Form Editor notes them when the form is saved. Moving items or changing item type without correctly specifying new properties usually cause these errors. You see the number of errors in the Save window, as shown in the following illustration. Number of errors Click to view and print error list 74 2006 General Electric Company July 2006

Save a form as a clinical kit View and correct errors 1 In the Save window, click Print Errors. The list of errors includes the number of the form item that produced the error, as well as a description of the error. 2 Print the error report by clicking the Print button, or note the errors and item numbers. 3 Close the View Errors window. 4 Close the Save window and return to Encounter Form Editor s main window. 5 Click Edit to return to your list of items. 6 Use the item numbers (ID #) to locate the items with errors. You can use the Find button, if necessary. 7 Correct each item. 8 Click Close on the Edit Form window and save your form again. If you encounter more errors, repeat the process. Understand encounter form files When you save a form, the form editor creates several files. These files make up the clinical kit. You must have all of these files together in one place to import them into the EMR application. This file... form.fd form.fs form.efm, form.ef2, form.ef3, etc. Contains this... Global information about the form, including the form name. You can open form.fd files with Encounter Form Editor if form.fs is also present. An item-by-item form description. Must be present to open a form.fd file in Encounter Form Editor. These files contain on screen information about each page of the form. form.efm contains page 1 of the form, form.ef2 contains page 2, and so on. 2027167-002 Rev B 2006 General Electric Company 75

Creating Clinical Content for Centricity Physician Office - EMR 2005 This file... form.ckt form.pef form.lst form.xlt form.txt form.xlw Contains this... Clinical kit file ready for import into the EMR application. The clinical kit contains all the files in this table. An ASCII text file that describes the printed version of the form. The list of all files contained in the clinical kit form.ckt. An ASCII text file that contains the form s text translation. It contains many symbols, expressions, and functions that are evaluated when the form is used in the EMR application. A text file containing a list of EMR components used by the form, including observation terms, flowsheet views, and problem and medication custom lists. Optional. A list of MEL expressions that re-evaluate if one of their values changes. File size limits Observation terms in files The EMR application has a file size limitation of 64K on encounter forms files. This is true in the case of forms that work with the Single-User Training and Oracle databases. However, previous versions of the EMR application had a Single-user file size limit of 32K. Encounter Form Editor checks the observation terms against the contents of the terms files that you received with Encounter Form Editor or downloaded from the KnowledgeBank (http://knowledge.medicalogic.com/). These files are named TERMS.FOT and TERMS.FGR. Local terms files are named with your site number. If you download new observation terms from the KnowledgeBank, be sure to import the terms clinical kit into the EMR application as well as into Encounter Form Editor. If you use newer terms in the form but don t import them into the EMR application, the application won t recognize them. If you want to work on a form on another workstation, be sure to transfer both the form.fd and form.fs files. You may also need your observation term files, including KEYWORDS.TXT. Save a form in an existing clinical kit Encounter Form Editor enables you to save a form into an existing kit, which can contain other form components, custom lists, reports, appointment types, and other components. This means you can download clinical kits 76 2006 General Electric Company July 2006

Save a form as a clinical kit from the KnowledgeBank (http://knowledge.medicalogic.com/), edit the forms in them, and save your changed forms back into the original kit. When you edit a form in an existing kit that contains other components, you see the following message when you save the form. Click Yes to save the form into the kit, or click No to create a new kit containing only the form. Rename a form and form description files You can rename a form in Encounter Form Editor s main window. If you rename the form but leave the same filename (shown at the bottom of the main window), Encounter Form Editor asks you if you want to rename the files that describe the original form. You may need to rename existing files because Encounter Form Editor uses the kit name when creating the form description files, and because you may have more than one form in the same kit.!!! If you don t rename the files, you won t be able to edit the original form again. The form description files are named filename.fd and filename.fs. 2027167-002 Rev B 2006 General Electric Company 77

Creating Clinical Content for Centricity Physician Office - EMR 2005 Click Yes if you are creating a new form and want to be able to edit the old form. Click No if you just want to change the name of an existing form. If you click Yes, Encounter Form Editor renames the original form description files as follows: If the last character in the filename is a letter, it changes to the next letter in the alphabet. If the last letter is z, it changes to a. If the last character in the filename is a number, it changes to the next higher number. If the last character is 9, it becomes a. Here are some examples: This filename EYEEXAM.FD RISK FACTORS.FD ANGINA6.FS SORE THROAT9.FD Becomes this EYEEXAN.FD RISK FACTORT.FD ANGINA7.FS SORE THROATA.FD View the form.txt file The file, form.txt contains information about EMR components used by the form. You ll find this file especially useful if you re downloading kits and forms from the KnowledgeBank (http://knowledge.medicalogic.com/). Although the EMR application includes a standard set of observation terms and other components, some forms may use newer terms or depend on custom components, such as flowsheet views or custom lists. Flowsheet views and custom lists needed for a form are usually included in the form s clinical kit, but if a form uses a component you don t have, you may need to change the form before you can use it. Here s the file HPICHF.TXT, created from the History of Present Illness - Congestive Heart Failure form included with Encounter Form Editor: CLINICAL KIT: C:\CLINICAL TOOLS\HPICHF.ckt FORM NAME: HPI - Heart Failure This form uses the following observation terms: Short Name Description ---------- --------- Chief Cmplnt chief complaint Diet plan diet plan HPI level HPI service level 78 2006 General Electric Company July 2006

Preview a form Meds review O2 Treatment oxygen flow Compliance with medical treatment oxygen treatment oxygen flow rate This form uses the following observation terms not included in your Encounter Form Editor: <<NONE>> This form uses the following flowsheet views: <<NONE>> This form uses the following problem custom lists: <<NONE>> This form uses the following medication custom lists: Preview a form <<NONE>> You can preview how your form will look while you are working on it. The preview does not look exactly as it will in the EMR application, but it is very useful while you are designing the form. The preview shows the form items, their connections, and their position on the form. Visibility regions appear with red crosshatching and a red dotted line around the form shows the screen size. Preview does not show colors, fonts, font styles (bold, italic), or font sizes of text. 2027167-002 Rev B 2006 General Electric Company 79

Creating Clinical Content for Centricity Physician Office - EMR 2005 Print the preview To preview the form, click Preview in the Edit Form window. You see the Preview Form window. Close the preview window View additional pages Print an item report Always use the Close button to close the Preview Form window. If you click, you ll exit Encounter Form Editor. If you do accidentally exit Encounter Form Editor, just restart it. It will ask if you want to recover the form you were working on. You can print a report of the items in your form at any time. Use the report to compare the items with your specification and to review items, properties, connections, and values. 80 2006 General Electric Company July 2006

Work with item and item group libraries To print an item report, click Print Items in the main window. You see the Print Items window. Print the item list Zoom in or out Close the Print Items window View additional pages Note. Always use the Close button to close the Print Items window. If you click, you ll exit Encounter Form Editor. Work with item and item group libraries Item and item group libraries are very powerful tools for creating forms. By creating and using libraries, you can significantly reduce the amount of time it takes to create forms. Encounter Form Editor includes one item library (EFEDIT.ILB) and one item group library (EFEDIT.GLB). The libraries contain items and groups customized for specific purposes. Many of the items and groups can serve as templates. You can insert them and them connect them to different observations or make other adjustments. For more information about the libraries, see Appendix A, Form item and connection reference, You can also create your own item and item group libraries for specific purposes or to hold frequently used items and groups. Encounter Form Editor can work with only one item library and one item group library at a time. As you work with forms in Encounter Form Editor, you can import different item and group libraries as needed. 2027167-002 Rev B 2006 General Electric Company 81

Creating Clinical Content for Centricity Physician Office - EMR 2005 GE recommends that you use the blank libraries supplied to create your own libraries rather than modifying the standard item and item group libraries. If you do want to modify them, make a copy first. See Import and export libraries on page 87. Add and delete items from an item library You can easily add an item to an item library from the form you are working on. You can also use a library to save items from one form to use in another form. Before you start adding items to a library, make sure the appropriate library is open in Encounter Form Editor. To view the contents of a library, go to the Edit Form window and click Saved Item under Insert. Decide if you want to add the item to the current library, or if you should import a blank one (BLANK.ILB) or a different library. The library s file name is not visible, so you have to determine which library is loaded by looking at the list of items. Add an item to a library 1 In the Edit Form window, select the item. The item must have a label in order to be saved. The item library uses the label as the name of the item. Library item names must be unique within the library, so make sure the item s label hasn t already been used in the library. 2 Click Current Item. 82 2006 General Electric Company July 2006

Work with item and item group libraries You see the Add Item to Library window with information about the selected item at the top. 3 Click Add. The item is added to the current library in alphabetical order. Delete an item from an item library 1 In the Edit Form window, click Saved Item under Insert. You see the Insert From Item Library window. 2027167-002 Rev B 2006 General Electric Company 83

Creating Clinical Content for Centricity Physician Office - EMR 2005 2 Click Advanced. You see the Advanced: Item Library Management window. 3 Select the item to delete and click Delete Item. 4 Confirm the deletion by clicking OK. 5 Click Back to return to the Insert From Item Library window. 6 Click Close to return to the Edit Form window. Add and delete groups from an item group library You can add groups consisting of several commonly used items to an item group library from the form you are working on. Before you start adding groups to a library, check to make sure the appropriate item group library is open in Encounter Form Editor. To see which library is open, go to the Edit Form window and click the Saved Group button. If you need to, import a blank library (BLANK.GLB) or another library. The library s file name is not visible, so you have to determine which library is loaded by looking at the list of item groups. Add an item group to an item group library 1 Select the first item in the group you want to save. 84 2006 General Electric Company July 2006

Work with item and item group libraries 2 Click Item Group under Save. You see the Choose Last Item in Group window. It lists all the items that follow the item you selected. 3 Select the last item you want in the group and click OK. You see the Add To Item Group Library window with information about the first and last items at the top. 2027167-002 Rev B 2006 General Electric Company 85

Creating Clinical Content for Centricity Physician Office - EMR 2005 4 Click Add. You see the Save To Item Group Library window. 5 Type a name and click OK. Delete an item group from a library 1 Open the Edit Form window. 2 Click Saved Group. You see Insert From Item Group Library window. 86 2006 General Electric Company July 2006

Work with item and item group libraries 3 Click Advanced. You see the Advanced: Item Group Library Management window. Import and export libraries 4 Select the item group to delete and click Delete, then click OK to confirm the deletion. 5 Click Back to return to the Insert From Item Group Library window. 6 Click Close to return to the Edit Form window. Encounter Form Editor allows you to have open only one item library and one item group library at a time. To use items or groups from another library, you need to import the library. Item libraries have a file extension of.ilb, such as EFEDIT.ILB. Item group libraries have a file extension of.glb, such as EFEDIT.GLB. If you ve made changes to a library that you want to save, you must export the current library before importing another library. Import a library 1 In the Edit Form window, do one of the following: For an item library, click Saved Item. For an item group library, click Saved Group. 2 In the resulting window, click Advanced. 3 In the Advanced window, click Import File. 2027167-002 Rev B 2006 General Electric Company 87

Creating Clinical Content for Centricity Physician Office - EMR 2005 Create a new library 4 Confirm that you want to replace the current library, if necessary. When you import a library, it replaces the current library. If you have made any changes in the current library, you ll be asked if you re sure you want to write over the current library. Click No if you ve made changes you want to save. Click Export File to save the current library before importing the new one. Click Yes if you don t want to save the changes you made to the library. 5 Select the desired library from the Import Item Library or Import Item Group Library window and click Open. You see the new items or item groups. Export a library 1 In the Edit Form window, do one of the following: For an item library, click Saved Item For an item group library, click Saved Group. 2 In the resulting window, click Advanced. 3 In the Advanced window, click Export File. 4 Supply a name for the library file and click Save. The.ILB or.glb extension is appended automatically if you don t type it. You can have as many item and group libraries as you wish. When you create libraries, give them names that indicate their contents. You may find it useful to arrange them by specialty, by problem, or by another classification that suits your needs. For example, you might create item and group libraries that contain items for asthma visit forms. You would use this library when designing forms for asthma visits, but not when designing a form for a sprained ankle visit. You might call these libraries ASTHMA.ILB and ASTHMA.GLB. GE supplies two blank libraries with Encounter Form Editor: BLANK.ILB and BLANK.GLB. GE recommends you import these blank libraries, which clear the existing libraries, before you create new libraries. 88 2006 General Electric Company July 2006

Compact the database Create a new library 1 In the Edit Form window, do one of the following: For an item library, click Saved Item or Current Item in the Edit Form window. For an item group library, Saved Group or Item Group. 2 Click Advanced. 3 Click Import File. Compact the database 4 In the Import Item Library or Import Item Group Library window, select BLANK.ILB or BLANK.SLB. 5 Add items or groups to the library. For more information, see Add and delete items from an item library on page 82. 6 Click Export to save the library. 7 In the Export Item or Export Item Group window, type a descriptive name and click Save. Encounter Form Editor was built using Microsoft Access, a database program. Because of the way Access works, the Encounter Form Editor database file, EFEDIT.MDE, becomes larger and larger as you work with forms. You should compact the database frequently, especially if you experience unusual errors. Compacting the database makes Encounter Form Editor run faster and repairs problems with the database. If you re using Encounter Form Editor heavily, you should compact the database at least twice a day. Compact the database 1 Close Encounter Form Editor. 2 Click Start on your Windows desktop. 3 Select Programs, then Encounter Form Editor, and finally Encounter Form Editor Compact Database. 2027167-002 Rev B 2006 General Electric Company 89

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CHAPTER 4 Use advanced features About advanced features 91 About MEL and data symbols 92 Use the MEL Expression Builder 110 Create Data Display items 112 Use visibility regions 116 Use Set Values Action Buttons 121 Use MEL Function/Expression items 125 Write calculations 126 Customize text translations 131 Customize printed form translations 137 Execute MEL scripts at close/traversal of forms 142 About advanced features You can create useful forms using basic Encounter Form Editor features and accepting the defaults for text and printed form translations. However, you may have special needs that require more complex forms. You can use the EMR application s built-in programming language, MEL, within the Encounter Form Editor to further customize your forms. Here are some of the things you can do with MEL: Create dynamic labels that change in response to item entries or other conditions. See Create Data Display items on page 112. Define visibility regions to display relevant content only when it is needed. See Use visibility regions on page 116. Use a Set Values connection for Action Buttons to fill in form values with a single button click. See Use Set Values Action Buttons on page 121. Create MEL Expression/Function items to perform complex or repetitive tasks. See Use MEL Function/Expression items on page 125. Calculate and display values based on form input and patient data. See Write calculations on page 126. 2006 General Electric Company

Creating Clinical Content for Centricity Physician Office - EMR 2005 Customize form translations. See Customize form translations on page 119 and Customize printed form translations on page 137. Link data from multiple items to one observation. See MEL functions on page 104. Execute user-defined MEL scripts at the close/traversal of the encounter forms. See Execute MEL scripts at close/traversal of forms on page 142. About MEL and data symbols Syntax: Keywords, punctuation, and logical structure used in a programming language Expression: A set of instructions that your computer can execute to produce a result MEL is a programming language you can use to customize EMR documents and forms. It includes built-in functions and data symbols and a special syntax you can use to write your own MEL expressions. Using Encounter Form Editor s advanced features requires you to write special instructions to your computer using MEL. However, you can do many things with relatively simple expressions. Even if you don t have any programming background, you can learn what you need to write MEL in Encounter Form Editor. And if you do have some programming background, you ll be able to create custom forms with highly specialized functions. This chapter contains basic information about using MEL in Encounter Form Editor. Data symbols and MEL are documented more thoroughly in Chapter 7, Use data symbols. About data symbols Function: A small program performing a set of tasks which can be called by other MEL expressions or functions Return: To store or display the result of an expression In MEL, you perform comparisons and calculations using built-in data symbols, data symbol functions, MEL utility functions, and functions that you create (user-defined functions). Data symbols represent information stored in the EMR database. You ve already used data symbols if you ve ever connected a form item to a patient attribute, clinical function, or flowsheet view. Most data symbols retrieve data for a particular patient, document, user, or location of care: PATIENT.LABELNAME displays the patient s full name, formatted for a mailing label. DOCUMENT.SUMMARY displays the one-line summary for the current document. LOC.ADDRESS1 prints the first line of the location of care s address. USER.PHONE displays the current user s phone number. Data symbol functions do more than retrieve and display data. They typically manipulate data in specified ways before they return the result. 92 2006 General Electric Company July 2006

About MEL and data symbols Argument: Information needed by a function to perform its defined task. An argument can be text, numbers, or the value returned by another function Many functions require additional information, called arguments, to perform their defined task. The arguments appear in parentheses, after the function name, and are often enclosed in quotes, as in the following examples: This line: OBSNOW("weight") displays the patient s weight only if it has been changed in the current update. This line: MEDS_AFTER("list") displays active medications, including changes from the current update, in a list format. User-defined functions are functions you write in MEL to manipulate clinical data. Utility functions help you perform common tasks as you write MEL expressions. Example: This line: {fmt("comments:", "B")}, applies bold formatting to the label and returns: Comments: Here are some common types of data symbols and functions that you can use directly as connections in Encounter Form Editor: This symbol type... Does this Example Clinical function Patient attribute Action Displays problems, assessments, medications, allergies, directives, orders, observations changed, prescriptions, and protocols. Displays patient information, such as name, address, phone number, sex, or race. Performs specific actions when connected to a button, such as opening dialog boxes to add new problems or medications. MEDS_AFTER("LIST") PATIENT.DATEOFBIRTH ADD_PROBLEMS 2027167-002 Rev B 2006 General Electric Company 93

Creating Clinical Content for Centricity Physician Office - EMR 2005 This symbol type... Does this Example Flowsheet view Observation, previous observation, or previous observation with date Temporary variable Displays on the encounter form a particular flowsheet view previously set up in the EMR application. Displays previously recorded observations or collects new observations. Holds data from an encounter form until it is stored in a signed chart note. ACTIVE_OBSERVATION( ) OBSNOW("Weight") OBSANY("Weight") LASTOBSDATE("BP_ systolic") DOCUMENT.TEMP_59464 262_1_535841. The last set of digits is assigned by Encounter Form Editor when the connection is created. The first and second numbers are a time date stamp and your site number, respectively. About MEL syntax For more information about the symbols and functions built into Encounter Form Editor see, Chapter A, Form item and connection reference. There are many data symbols and functions you can use in MEL expressions in your form components. For a complete list of symbols and functions, see Using data symbols in EMR or Encounter form Editor online help. Syntax: Keywords, punctuation, and logical structure used in a programming language String: Literal text that does not include any symbols or functions Like all programming languages, MEL has its own syntax, or grammar. When you write MEL, you must follow the syntax rules exactly. Any deviation will prevent the EMR application from executing the MEL expression or produce inaccurate results. Here are some rules for writing MEL expressions: Enclose expressions in braces. Each expression is enclosed within braces {expression}. This tells the EMR application that it should execute (evaluate) the statements within the braces. Enclose text arguments in quotes. Many arguments are text strings enclosed in quotes within the parentheses following the function name. {OBSNOW("weight")} {ORDERS_NEW("list", "t")} {ADDDATES("3/1/97","2","0","0")} You may also enclose arguments within single quotes: {OBSNOW('weight')} 94 2006 General Electric Company July 2006

About MEL and data symbols Most data items used as arguments are strings of alphanumeric text. MEL syntax requires that all text be enclosed in quotes. When data symbols or data symbol functions are used as arguments, however, they do not need to be enclosed in quotes. For example: {LISTSUBSET(OBS_LIST_CHANGES (), "LIST", "#", "CONTAINS", "ANY")} Match argument value type. If you use a data symbol as an argument in a function that returns a value type different than the value the function expects, you will get an error. For example, ADDDATES expects the date argument to be a string. If you use PATIENT.DATEOFBIRTH as the argument, you need to convert it from a date to a string first. See Chapter 12, Values and variables. to learn more about working with value types in MEL. Enclose text inside expressions in quotes. Inside expressions, any text, blank lines, or spaces you want to display should be enclosed within double quotes. The EMR application ignores spaces not enclosed in quotes, so you can use them to can make the expression easier to read. Example: {if PATIENT.SEX == 'M' then "Dear Mr. " else "Dear Ms. " endif} Include spaces and punctuation in expressions that contain both text and data symbols. In the preceding example, the MEL expression includes a space after Ms. and Mr. so there will be a space between the title and the patient s last name. Display text is plain. Displayed text outside expressions does not have to be enclosed in quotes. Concatenation. To join items of quoted text or to join text with the value represented by a data symbol, use a plus sign (+). Example: This line: "Dear Ms. " + PATIENT.LASTNAME + ":" returns this value: Dear Ms. Jones: Text to be displayed ("Dear Ms. " and ":") is always enclosed in quotes, but a data symbol returning text (PATIENT.LASTNAME) is not. 2027167-002 Rev B 2006 General Electric Company 95

Creating Clinical Content for Centricity Physician Office - EMR 2005 MEL operators MEL is case-insensitive. In most cases it doesn t matter whether you use uppercase or lowercase letters in data symbols, functions, or observation terms. Text items outside of expressions retain the case you give them. MEL expressions often instruct the EMR application to insert different information depending on certain conditions. In the following expression, the EMR application checks for a condition the patient s sex to determine which title to display. {if PATIENT.SEX == 'M' then "Dear Mr. " else "Dear Ms. " endif} In this example, the operator (==) tells the EMR application to check whether the PATIENT.SEX equals M (male). Conditional expressions like this one use relational operators to evaluate data and return a value of True or False. The following table lists the most common relational and arithmetic operators. For more about MEL operators and operator precedence, see Chapter 11, MEL syntax basics. This operator Does this For example == Checks values for equality = Assign a value See following note. if PATIENT.SEX == "F"... {OBSNOW("BMI") = OBSNOW("Weight") / OBSNOW("Height")} <> Checks for inequality if PATIENT.SEX <> "F"... > Compares values to see if the first is greater < Compares values to see if the first is smaller >= Compares values to see if the first is greater than or equal to the second <= Compares values to see if the first is less than or equal to the second if OBSPREV("BMI") > 30... if OBSPREV("BMI") < 20... if OBSPREV("cholesterol") >= 230... if OBSPREV("cholesterol") <= 230... AND Both conditions must be met for the statement to be true if OBSPREV ("Weight") > 150 AND OBSPREV("Height") < 55... 96 2006 General Electric Company July 2006

About MEL and data symbols This operator Does this For example OR NOT Either condition can be met for the statement to be true The condition must be false for the statement to be true if OBSPREV ("Weight") > 150 OR OBSPREV("Height") < 55... if NOT (PATIENT.AGEINMONTHS > 420 AND OBSPREV("BP") > 120)... Note. This expression is the same as: if PATIENT.AGEINMONTHS <= 420 OR OBSPREV ("BP") <=120... + Add or concatenate 2 + 2 "Weight: " + (OBSNOW("Weight") - Subtract 10.5-4.8 * Multiply 2 * 2 / Divide {OBSNOW("BMI") = OBSNOW("Weight") / OBSNOW("Height")} () Defines operator precedence (do this part first) 3 + (8 * 9) The = operator assigns or changes a value. To prevent changes to the database, Encounter Form Editor does not permit the use of this operator with items that should not change data. For example, you cannot assign a value in a MEL expression connected to a Data Display item or in a visibility condition. If you inadvertently write a visibility condition as PATIENT.SEX = "M" rather than as PATIENT.SEX == "M", the EMR application will not change the patient s sex. Write conditional MEL expressions Often you want a form to display or insert different information depending upon certain conditions. You can use a conditional if-then-else expression to insert different information depending on conditions that you set. 2027167-002 Rev B 2006 General Electric Company 97

Creating Clinical Content for Centricity Physician Office - EMR 2005 The if-then-else expression has the following logical structure: if conditional statement is true, then execute action statement else (if conditional statement is false) execute alternate action statement endif (end if expression) Here s a typical expression used in a text translation: {if OBSNOW("Chief Cmplnt") == "" THEN "" else "Chief Complaint: " + OBSNOW("Chief Cmplnt") +" " endif} This translation says: If there is no new observation for Chief Complaint, display nothing in the chart note. Otherwise, if there is a new observation, display the heading Chief Complaint: followed by the observation, then start a new line. Example Here is a simple example of an if-then-else expression: {if PATIENT.SEX =="M" then "This patient is male." else if PATIENT.SEX =="F" then "This patient is female." else "This patient s sex is undetermined." endif endif} The table shows how MEL syntax was used to create the expression with MEL statements on the left and their meaning on the right. This part of the expression... Means this... { Begin expression if PATIENT.SEX =="M" then "This patient is male." else if PATIENT.SEX =="F" then If (it s true that) the patient is male, then... Display This patient is male. Otherwise, if the patient is not male, continue Begin nested if statement: if (it s true that) the patient is female, then... 98 2006 General Electric Company July 2006

About MEL and data symbols This part of the expression... endif else "This patient is female." "This patient s sex is undetermined." endif Understand if-then-else syntax Means this... Display This patient is female. } End expression Otherwise, if the patient isn t documented as female or male... Display This patient s sex is undetermined. End of nested if condition statements End outer if condition statements Here are some basic rules for writing if-then-else expressions: Use braces correctly. The expression must be enclosed in braces {}. However, don t use braces inside an if-then-else expression. Double-check your conditions. Make certain that the condition you set up in your if statement can be evaluated by the EMR application. If the EMR application cannot accurately evaluate the values you give it, you may get an incorrect result. For more about evaluating conditions, see When to evaluate data symbols on page 179. Don t forget ENDIF. Each if statement must be closed at some point by an endif. Example: { if PATIENT.SEX == 'M' then "Dear Mr. " + PATIENT.LASTNAME + ":" else if PATIENT.SEX == 'F' then "Dear Ms. " + PATIENT.LASTNAME + ":" else "Dear " + PATIENT.FIRSTNAME + " " + PATIENT.LASTNAME + ":" endif endif} Use spaces or tabs to indent the text in an if-then-else expression. This helps you keep track of how many if lines there are so you can include the right number of endif lines. Concatenate all text and data symbols to be displayed. To print a label and data, use the + operator to connect the items: "Label: " + symbol. 2027167-002 Rev B 2006 General Electric Company 99

Creating Clinical Content for Centricity Physician Office - EMR 2005 Understand rich text formatting (fmt and cfmt) The Encounter Form Editor s default translations are created using the MEL fmt and cfmt functions. You can use these MEL functions to apply rich text formatting to the output of your MEL expressions in on-screen and printed form translations. You can apply the following properties to text strings: Bold Italic Underline Font size (from 4 to 72 points) fmt vs. cfmt These two functions have different properties and uses. Use fmt to format simple text strings. The text argument can be plain text or a MEL expression that returns text. Use fmt for small, discrete items and printed form translations. For example, this line: {fmt("comments:", "B")} returns: Comments: Use cfmt to format values and text conditionally. You can also specify text to precede and follow the formatted item with cfmt. Use this function in place of conditional (if-then-else) expressions. The EMR application displays the formatted value and text only if it is not blank. cfmt is especially useful for chart update text translations, which only display form item labels when a value is entered. For example, this line: {cfmt(obsany("weight"), "", "Weight: ", "B")} returns: Weight: 155 fmt syntax The syntax used by fmt is: fmt (expression, [format_code,...]) expression is any MEL expression that results in a string. This includes text you type, the result of a data symbol or function, or a combination. Format codes are as follows: B, BOLDBold I, ITALICItalics U, UNDERLINEUnderline n, -nthe number of points to increment or decrement the font size Examples This line: {fmt(obsany("height"), B )} returns: 65 100 2006 General Electric Company July 2006

About MEL and data symbols This line: {fmt(obsany("height"), "B, I")} returns: 65 This line: {fmt(obsany("height")), "B, 2")} returns: 65 This line: {fmt("comments:", "B")} returns: Comments: Point size increments or decrements from the 10-point default size. Thus, "B,2" returns 12-point text. Syntax rules Observe argument order. Within the function parentheses, the first argument is the expression to be formatted, the second is the format code. If you mix up the order, you may not get the result you expect. Enclose text arguments in quotes, separated by commas. Enclose literal text to be formatted in quotes, but not data symbols or other functions returning text. Enclose the format code(s) in quotes. Place multiple formatting codes within a single set of quotes, separated by commas. (See the following example.) Detailed fmt example The following expressions come from the printed form translation for a form component comment field. (The temporary variables are generated by Encounter Form Editor to hold the text entered by the user, if any.) {fmt("comment: ", "B")} {if DOCUMENT.TEMP_71183708_1_542091 = "" then fmt("..", "B,U") else fmt(document.temp_71183708_1_542091, "B,U") endif} The first expression displays a bold label. The second expression, prints a line if there is no comment value or the value bold and underlined: Weight: 150 or Weight:.. This part of the expression... Means this... { Begin MEL expression fmt("comment: ", "B") Print the word Comments: in bold } End MEL expression { Begin next MEL expression 2027167-002 Rev B 2006 General Electric Company 101

Creating Clinical Content for Centricity Physician Office - EMR 2005 This part of the expression... if DOCUMENT.TEMP_71183708_1_542091 = "" then fmt(". cfmt syntax cfmt uses the following syntax: cfmt(expression, format_code, [pretext, pretext format_code, posttext, posttext format_code]) expression is any MEL expression that results in a string. That includes literal text you type, the results of a data symbol or function, or a combination. pretext is optional text that appears before the value, usually a label. posttext is optional text that appears after the value, for example, a measure such as lb. or in. Examples: This line: {cfmt(obsany("weight"), "", "Weight: ", "B")} returns: Weight: 155 This line: {cfmt(obsnow("weight"), "", "Current weight: ", "B", "lb", "B"} returns: Current weight: 155 lb This line: {cfmt(obsnow("weight"), "B,-2", "Your weight is ", "", "lb")} returns: Your weight is 155 lb Syntax rules.", "B,U") else fmt(document.temp_71183708_1_54 2091, "B,U") endif Means this... If the temporary variable does not contain anything... Then print a period followed by several spaces and then another period in bold and underlined (this creates a line to enter comments on the printed form) Otherwise, if the variable does contain data, print the data bold and underlined End if condition } End second MEL expression Observe argument order. Within the function parentheses, the first argument is the expression to be formatted, the second is the format code(s), followed by optional pretext and codes and posttext and codes. Enclose text arguments in quotes separated by commas. Enclose literal text to be formatted in quotes, but not data symbols or other functions returning text. Enclose the format code(s) in quotes. Place multiple 102 2006 General Electric Company July 2006

About MEL and data symbols formatting codes within a single set of quotes, separated by commas. (See following example.) Use placeholders for unused arguments. Use a pair of quotes as a placeholder for arguments you don t use in the expression. For example, if you want to display text after the formatted expression but not before it, your expression should contain two pairs of quotes to indicate no preceding text and no formatting. You do not need placeholders for unused arguments at the end of the expression. For example, if your expression has no following text, you can omit the placeholders for this argument and its format code. Detailed cfmt example This translation example comes from an Edit Field used to collect height information: {cfmt(obsany("height"), "", "Height: ", "B", " inches ", "")} If the value stored for the patient s height is 65 inches, this translation displays: Height: 65 inches This part of the expression Means this... { Begin MEL expression cfmt(obsany("height"), If a value for the observation exists, print it, otherwise print nothing " ", Format the observation as normal text "Height: ", "B", "inches ", Print Height: before the observation Format Height: in bold Print inches and include a hard return after the observation value "" Print inches as normal text (this argument and the preceding comma could have been omitted) ) End of arguments for cfmt } End of MEL expression 2027167-002 Rev B 2006 General Electric Company 103

Creating Clinical Content for Centricity Physician Office - EMR 2005 MEL functions In addition to writing MEL expressions, you can also define new functions in MEL. A function is a small set of instructions that can be called (executed) by other MEL expressions and functions, including those used for the following: Text and printed form translations Data display expressions Visibility conditions Action Buttons with Set Values and Calculation connections MEL Expression/Function items Functions are handy when you need to carry out a series of tasks repeatedly or to make complex calculations. Once defined, the function can be called by simply typing its name into your MEL expression and, where appropriate, specifying its arguments. The basic syntax for defining a function is: { fn function name ([arg1, arg2,...]) {expression to execute} } When you define a function, you are essentially giving it a name, identifying any arguments it will need, and then listing the instructions you want it to carry out. If you want to write your own MEL functions, it helps to have experience with other programming languages. For more information about writing functions in MEL, see Chapter 14, MEL functions. Examples The Review of Systems form included with Encounter Form Editor uses two functions: ListBoxResult and ListBoxTranslation. These functions work with the form s basic format of two list boxes and one comment field for each system. The functions are called for each system. Note the comments used to explain the code in the following example. Comments are enclosed within slash-asterisk pairs, like this /* comment*/; this tells the EMR application that the comments are not part of the coded instructions. Including comments in your MEL programs helps you remember what you did when you review them later; it also supports others who may need to modify your work. 104 2006 General Electric Company July 2006

About MEL and data symbols This part of the expression... {fn ListBoxResult ListBoxResult(complainStr, denystr, otherstr) The function ListBoxResult combines the text from the Complains of, Denies, and Other items for display as sentences in the chart note. For example: Complains of cough, excessive sputum, wheezing. Denies dyspnea, hemoptysis. Here is the function definition for ListBoxResult: {fn ListBoxResult(complainStr,denyStr,otherStr) { local fullstr = "" /*complainstr is the "complains of" text*/ if (size(complainstr) > 0) then fullstr = "Complains of " + complainstr + ". " endif /*denystr is the "denies" text*/ if (size(denystr) > 0) then fullstr = fullstr + "Denies " + dstr + ". " endif /*otherstr is the "additional comments" text*/ if (size(otherstr) > 0) then fullstr = fullstr + otherstr endif return fullstr }} The table below shows the MEL syntax used to create this function definition, with MEL statements on the left and their meaning on the right: Means this... Begin function definition expression Define function name ListBoxResult and its arguments, complainstr, denystr, and otherstr. { Begin function expression, which will define the tasks ListBoxResult will perform. local fullstr = "" /*"complainstr is the "complains of text*/ Define a local variable fullstr with a value of "" (empty) to hold the combined observations. A comment. if (size(complainstr) > 0) then If the size of the Complains of string is greater than 0 (not empty), then... Note. The MEL function size() is used to test for the presence of an observation in the Complains of item. 2027167-002 Rev B 2006 General Electric Company 105

Creating Clinical Content for Centricity Physician Office - EMR 2005 This part of the expression... fullstr = "Complains of " + complainstr + ". " endif /*denystr is the "denies" text*/ if (size(denystr) > 0) then fullstr = fullstr + "Denies " + denystr + ". " endif /*otherstr is the "additional comments" text*/ if (size(otherstr) > 0) then fullstr = fullstr + otherstr endif return fullstr } } Means this... fullstr now contains a sentence that begins with "Complains of" followed by the observation from the form item, a period, and a space. End of the first if statement. A comment. If the size of the Denies string (denystr) is greater than 0 (not empty), then... fullstr now contains the Complains of sentence (if any), plus a new sentence that begins with Denies, followed by the observation from the form item, a period, and a space. Ends the second if statement. A comment. If the size of the Other string (otherstr) is greater than 0 (not empty), then... fullstr now contains the two previously created sentences, plus whatever text has been typed into Other. Ends the third if statement. Return (display in the list box) the complete text of fullstr. Close the function statements expression. Close the function definition expression. Each set of form items calls the ListBoxResult function with a MEL Function/Expression item. Here s a sample from the general systems review: {OBSNOW("ROS:General", ListBoxResult(DOCUMENT.TEMP_62769891_1_57509, DOCUMENT.TEMP_62769891_1_57511,DOCUMENT.TEMP_627698 91_1_57531))} The three DOCUMENT.TEMP variables are the ListBoxResult arguments complainstr, denystr, and otherstr. They provide the text strings from the Complains of, Denies, and Other form items that will be combined by the function. In this expression, the result returned by ListBoxResult is used as an argument in the function OBSNOW. In OBSNOW the first argument is the name of the observation and the second argument is the new value for the observation. 106 2006 General Electric Company July 2006

About MEL and data symbols ListBoxTranslation The ListBoxTranslation function, defined in the same form item, is similar. It combines the information from the three items with a label for text translation and formats them using the cfmt function. Here s what the translation looks like: Respiratory: Complains of cough, excessive sputum, wheezing. Denies dyspnea, hemoptysis. Here s the function definition: {fn ListBoxTranslation(label,complainStr,denyStr, otherstr) {local fullstr = ListBoxResult(complainStr, denystr,otherstr) return cfmt(fullstr, "", label + ": ", "B", " ") } } The table below shows the MEL syntax used to create this function definition, with MEL statements on the left and their meaning on the right: This part of the expression... {fn ListBoxTranslation(label, complainstr,denystr,otherstr) Means this... Begin function definition. Define the function name ListBoxTranslation and its arguments label,complainstr, denystr,otherstr. { Begin function expression, which will define the tasks ListBoxTranslation will perform. local fullstr = ListBoxResult(complainStr,denyStr, otherstr) return cfmt(fullstr, "", label + ": ", "B", " ") } } Define local variable fullstr and assign to it the value returned by ListBoxResult (the observations in sentence form). Display the observations, preceded by bold label name and a colon, and followed by a hard return (inserted between a pair of quotes). Close the function expression. Close the function definition. Notice that this function has four arguments: the label to be displayed and the three form items. Here s the text translation expression for the General Systems Review that calls the ListBoxTranslation function: {ListBoxTranslation("General",DOCUMENT.TEMP_6276989 1_1_57509,DOCUMENT.TEMP_62769891_1_57511, DOCUMENT.TEMP_62769891_1_57531)} 2027167-002 Rev B 2006 General Electric Company 107

Creating Clinical Content for Centricity Physician Office - EMR 2005 For more examples of functions, see the Item Group library and the forms included with the EMR application. See also Chapter 14, MEL functions. Evaluating MEL expressions in forms When you use MEL in forms, it may be evaluated at different times, depending on where the expression or function is used and what it does. When MEL is evaluated, it is translated into its resulting text Cache: To store retrieved or calculated values for quick access.!!! MEL caches values when functions are executed (evaluated). If a variable changes later, MEL may return its cached value instead of reevaluating. It is important to be aware of when your expressions and functions are evaluated. Here are some basic rules for evaluation: Evaluate on form open (!). If an expression starts with an exclamation point (!), the EMR application evaluates the MEL expression when the user opens the page of the form containing the expression. In other words, any expressions preceded by! are evaluated when the EMR application draws the page on the screen. If a user redisplays a page, the EMR application reevaluates the expression. Exclamation points do not work if they are embedded in a function. Document variables and observations. When a user opens a form, all document variables (temporary variables) are created with UNDEFINED values, or if they already exist, their values are retrieved. If an observation is evaluated and has no value, it returns an empty string. If a document variable or any observation value changes while the form is in use, the EMR application reevaluates the expression. For example, in the expression: Watcher: An expression set to re-evaluate whenever any of its variables change {DOCUMENT.TEMP2 * OBSNOW("height")} a change to DOCUMENT.TEMP2 or to any observation value will cause the expression to reevaluate. This is an example of a watcher expression. See About watchers and triggers on page 109. Functions. MEL automatically executes any expressions containing function definitions when a form is opened: { fn test() { statements } } Executing this expression merely defines the function test. The function itself does not execute when the form opens unless it is set to 108 2006 General Electric Company July 2006

About MEL and data symbols evaluate at that time. You can explicitly evaluate functions by connecting them to Action Buttons. To prevent a MEL expression containing observations from reevaluating automatically whenever any observation is changed, put it into the body of a function. You can then connect the function to an Action Button to evaluate when the button is clicked. About watchers and triggers Trigger: An event that causes an expression to be evaluated Temporary variables and watchers Observations and watchers The EMR form system supports the notion of triggers for causing watcher expressions to be reevaluated. Observations and temporary document variables both trigger watcher expressions but function somewhat differently. Temporary (document) variables. If the variable changes, all watcher expressions that refer to that temporary variable are re-evaluated. Observations. If one observation changes, all watcher expressions that reference any observation are re-evaluated. When a watcher expression contains a temporary variable that changes, only that expression (or others that reference the same temporary variable) are re-evaluated. Watcher expressions that do not reference that temporary variable are not re-evaluated. For example, a form contains two separate watcher expressions with T1 and T2 as temporary variables: {OBSNOW("height", T1 + T2)} {OBSNOW("weight", T2)} When T1 changes, only the first watcher expression re-evaluates. When T2 changes, both watcher expressions re-evaluate. When any observation changes, all watchers that contain observations are re-evaluated, regardless of what the observation is. For example, your form contains two separate watcher expressions with OBS1 and OBS2, which are two observation terms. {OBSNOW("ROS",OBSNOW("OBS1") + OBSNOW("OBS2"))} {OBSNOW("HPI", OBSNOW("OBS1"))} When either OBSNOW("OBS1") or OBSNOW("OBS2") changes, both watcher expressions are re-evaluated. The user may see flickering of the form component because all fields on the form associated with observations will be re-drawn. 2027167-002 Rev B 2006 General Electric Company 109

Creating Clinical Content for Centricity Physician Office - EMR 2005 Use global variables Global variable: A variable that holds an assigned value until the EMR application exits or the document containing it is put On Hold, Cancelled, or Signed. To prevent all observations from being reevaluated when one value changes, associate the observation value with a global variable and then reference the variable in a watcher expression. Then, when the observation changes, the global variable will change, triggering re-evaluation of only those watcher expressions that reference the global variable. This construction is the best way to build forms that don t flicker. For example, your form contains a MEL expression that assigns two observations to global variables G1 and G2. Note that the global variable assignments are in a separate watcher expression. {global G1 = OBSNOW("OBS1")globalG2=OBSNOW("OBS2")} {OBSNOW("ROS",G1 + G2)} {OBSNOW("HPI", G1)} Now, when OBSNOW("OBS2") changes, G2 changes, triggering only the expression {OBSNOW("ROS",G1 + G2)}. Use the MEL Expression Builder In most places in Encounter Form Editor where you can write MEL, you have access to the MEL Expression Builder. (It s also known as MELBA, the MEL building area.) The Expression Builder provides you with a larger text space as well as buttons to help you insert symbols and observations. You can use the Expression Builder wherever you see a button with a plus sign on it. Clicking the button opens the MEL Expression Builder window. Click here to insert an observation Click here to insert a symbol You can use Insert Symbol to find and insert data symbols and functions or type your own MEL expression in the text area. You can use Ctrl + X, Ctrl + C, and Ctrl + V for cut, copy, and paste. 110 2006 General Electric Company July 2006

Use the MEL Expression Builder Insert a symbol You can insert a symbol into the Expression Builder by clicking the Insert Symbol button. In this context, available symbols include temporary document variables and the patient attribute data symbols. Insert a symbol 1 In the MEL Expression Builder, click Insert Symbol. You see the Insert Symbol dialog box. Click here to choose the type of symbols to view 2 From the Symbol Types list, choose one of the following: Symbols on page. Displays all of the document variables on the current page. Patient attributes. Displays all patient attributes. Symbols in form. Displays all document variables on all pages of the form. 3 Select the symbol or document (temporary) variable you want to insert in your MEL expression. 4 Click OK. Insert an observation term You can insert an observation term into the Expression Builder by clicking the Insert Obs button. Insert an observation 1 In the Expression Builder, click Insert Obs. 2027167-002 Rev B 2006 General Electric Company 111

Creating Clinical Content for Centricity Physician Office - EMR 2005 You see the Centricity Physician Office Term Finder dialog box. 2 Locate the term you want using one of these methods: On the Search tab, type part of a term or description and click Search. On the View Folders tab, browse for the term by category. 3 Select the term and click OK. Create Data Display items Data Display items are dynamic labels or other data items that can change in response to changes on the form. You use MEL expressions to define the conditions that trigger the change. Here are some things you can do with dynamic data displays: Display labels conditionally. Display different labels depending on the patient s gender. Display form help conditionally. Use MEL expression to display explanatory text only when necessary. Example. You can create a form with several types of blood pressure measurements on it, each with a check box and a set of data fields to record the measurement. When a certain measurement type is checked, the form displays instructions for taking the measurement. Visually track progress. Provide indications on the first page of a form about items entered on other pages or in regions that are no longer visible. This reminds the provider that part of the form has been filled out. 112 2006 General Electric Company July 2006

Create Data Display items Visibility region: Any group of items on a form may have a MEL expression attached to it that controls its visibility to the user when the form is opened Example. The Review of Systems form included with Encounter Form Editor uses visibility regions extensively one for each system. When the provider moves on to the next system, a red X appears next to the previous system if the provider documented anything. The Xs are implemented as dynamic labels. This Data Display expression is evaluated when the page is opened and whenever any of the variables changes. It says: If any of the three variables contains a value (is not empty), display X. Otherwise, display nothing. {!if DOCUMENT.TEMP_62769891_1_57509 <> "" OR DOCUMENT.TEMP_62769891_1_57511 <> "" OR DOCUMENT.TEMP_62769891_1_57531 <> "" THEN "X" ELSE "" ENDIF} Change labels based on form entry. Example. The Review of Systems form also displays a different label depending on which radio button the provider chooses. In this case, the label displays the contents of the temporary variable associated with the set of radio buttons. {DOCUMENT.TEMP_62769891_1_320935} Display recent data. Example. You can use a dynamic label to display the last date that the patient s medical history was updated, as is done in the Past Medical History form included with the EMR application. Notice the (!) at the beginning of the expression that causes it to be evaluated whenever a user displays that page of the form. This expression says: If the past medical history observation is not empty, then print Last updated: followed by the last signed date, otherwise print nothing. {!if OBSPREV("past med hx") <> "" THEN "Last updated: "+ LAST_SIGNED_OBS_DATE("past med hx") ELSE "" ENDIF} Create a dynamic data display 1 Add a Data Display item to your form. 2 Click Connect To and select MEL Expression. 3 In the MEL Expression field, type in the MEL expression that defines the text as well as the condition for changing. Click the + button to use the MEL Expression Builder, if needed. Be sure to precede the MEL expression with a! if you want the expression to be evaluated whenever the page it s on is displayed. If the 2027167-002 Rev B 2006 General Electric Company 113

Creating Clinical Content for Centricity Physician Office - EMR 2005 expression contains data symbols, it may also re-evaluate whenever one of the symbols changes. See About watchers and triggers on page 109. Create dynamic drop-down/list boxes Like dynamic labels, dynamic drop-down lists are lists that change in response to changes on the form. You use MEL expressions to define the conditions that trigger the alternate list contents. Create a dynamic drop-down/list box 1 Add a drop-down list item to your form. You see the Edit Item dialog box. 2 Check the Dynamic Choice list box. Check this box to dynamically populate the drop down list through a user-defined MEL expression You see the MEL Expression area and the + button which opens the MEL Expression Builder window. 3 In the MEL Expression area, type in the MEL expression that defines the alternate lists as a string, as well as the conditions for switching them. List items are included in the expression separated by commas. If an individual list item contains commas, precede each comma you want to appear as text with a back slash (\,). 114 2006 General Electric Company July 2006

Create dynamic drop-down/list boxes Example The following sample dynamic drop-down list is from the KnowledgeBank (http://knowledge.medicalogic.com/). This form is used to capture information about drug use. There are two items in the form component, a radio button and a dynamic dropdown list. The contents of the dynamic dropdown list are controlled by which item the user selects from the radio button options. If the user selects Current, then the contents of the dynamic drop-down list will show a list of drugs. If the radio button is changed to Previous, the contents of the list change to show a list of time periods. If a selection is made from the first list, and the radio button is changed and a selection is made from the second list, the value in the text translation is changed. The sample is built by adding a radio button item to the form with a choice list of Current, Previous or Never. Next, a Drop-Down list item is added to the form, the Dynamic choice list box checked. The following MEL statement, resulting in 3 different choice lists is then typed in the MEL Expression Builder field: {if DOCUMENT.TEMP_137655242_1_1198558 == "current" then "marijuana, cocaine, heroin, pharmaceuticals, other, multiple" else if DOCUMENT.TEMP_137655242_1_1198558 == "previous" then "1-6 months ago, 6-12 months ago, 12-24 months ago, 2-5 years ago, 5+ years ago" else if DOCUMENT.TEMP_137655242_1_1198558 == "never" then "none" endif endif endif} This part of the expression Means this... { Begins MEL expression if DOCUMENT.TEMP_137655242_1_1198558 == "current" then "marijuana,cocaine,heroin, pharmaceuticals,other,multiple" If the Radio Button item selected is current then... Show these items as choices in the drop-down list 2027167-002 Rev B 2006 General Electric Company 115

Creating Clinical Content for Centricity Physician Office - EMR 2005 Use visibility regions This part of the expression else if DOCUMENT.TEMP_137655242_1_1198558 == "previous" then "1-6 months ago, 6-12 months ago, 12-24 months ago,2-5 years ago,5+ years ago" else if DOCUMENT.TEMP_137655242_1_1198558 == "never" then "none" endif endif endif Means this... If the previous statement is not true... If the Radio Button item selected is previous then... Show these time periods as choices in the drop-down list. If the previous two statements are not true... If the Radio Button item selected is never then... Then show none in the drop-down list. End each of the nested if statements } End the MEL expression. Stacked visibility region: A set of mutually exclusive items or groups of items that appear in the same place on the form Visibility regions help you use form space more effectively by displaying appropriate information only when it is needed. Before you create a visibility region, here are some things you need to decide: Which items do you want to display conditionally (place in the visibility region)? How many items do you want to display conditionally? Do you want a single item to appear in a blank space on the form, or do you want to use stacked visibility regions? What conditions must be met for the region to appear? Here are some rules for using visibility regions: Single visibility region. Each visibility region begins with a Begin Visibility Region item. For a simple region, sandwich the items in the region between a Begin Visibility Region item and an End Visibility Region item. Example. In the HPI - Congestive Heart Failure form, the Oxygen Flow Rate edit field appears only if the provider chooses the Yes radio button for Home O2. Stacked visibility regions. If you want two or more visibility regions to appear in the same place on your form, start each group with a new Begin Visibility Region item. At the end of the regions you want to stack, insert a single End Visibility Region item. 116 2006 General Electric Company July 2006

Use visibility regions Example. The Review of Systems form included with Encounter Form Editor displays a set of radio buttons on the left side. As a provider chooses a radio button, the corresponding items for that system appear on the right. The set of form items for each system starts with a Begin Visibility Region. A single End Visibility Region item follows the set of items. Create a visibility region 1 In the Edit Form window, select the spot where you want to start one or more visibility regions. 2 Click New Item. 3 In the Item Finder dialog box, select a Begin Visibility Region item 4 Type the condition in the Visibility Controlled By field. You may want to wait to define the condition until after you ve specified all the form items. See Write visibility conditions on page 118. 5 If you haven t already done so, add the items you want in the visibility region. 6 Do one of the following: After the last item, insert an End Visibility Region item. For stacked visibility regions, insert another Begin Visibility Region. 7 For stacked regions, repeat steps 4 5 until you ve added all the regions. Then insert an End Visibility Region item. By default, Encounter Form Editor makes each new visibility region the size of the last one in the stack. To avoid visibly overlapping regions on the form, make all your visibility regions the same size or make the last one the longest. You can also add blank text items to a region to pad its length. 2027167-002 Rev B 2006 General Electric Company 117

Creating Clinical Content for Centricity Physician Office - EMR 2005 Write visibility conditions You control whether the user sees a visibility region by specifying a condition that must be met for the form items to appear. The condition is written as a MEL expression, similar to the expressions Encounter Form Editor generates for text translations. Conditions for visibility can include whether a particular radio button is selected or a check box is checked, or the content of an observation. Visibility can also be determined by patient attributes. Visibility condition format Most visibility conditions are very simple, such as this: DOCUMENT.TEMP_30648606_1_57529 == "Gastrointestinal" In the sample Review of Systems form, this code fragment tests whether the radio button labeled Gastrointestinal is selected. If the statement is true, the relevant visibility region is displayed in the form. More complex expressions can incorporate more than one condition, such as this: DOCUMENT.TEMP_30648606_1_57529 == "Genitourinary" AND PATIENT.SEX == "F" This statement tests whether the radio button labeled Genitourinary is selected and the patient s sex is female. The relevant visibility region is displayed only when both conditions are true. Visibility condition limitations When you write visibility conditions, you can use the Choose Symbol to Insert dialog box to insert data symbols or functions that are already on the form as conditional expressions; you can also type in or select other data symbols understood by Encounter Form Editor, such as patient attributes. Make certain that the conditions for the visibility regions in a stack are mutually exclusive, which means that only one of them can apply at any time. If more than one visibility region can appear in the same place at the same time, the results are unpredictable. Example The following example, based on the Review of Systems form, displays list boxes for the Genitourinary system when the Genitourinary radio button is clicked. In addition, the form shows different list boxes based on patient sex. It uses two visibility regions. The procedure walks you through the steps to write the visibility condition. 118 2006 General Electric Company July 2006

Use visibility regions Before you write visibility conditions in Encounter Form Editor, write a simple statement that describes the condition. For example, Display these boxes if the Genitourinary radio button is chosen and if the patient is male. Write a visibility condition 1 Gather any information you need to write the condition. In this example, you want the condition to depend on a radio button choice, so write down the item ID # for the Radio Button item that controls visibility (57529). You can view this number in the Edit Form window. Also make a note of the exact spelling of radio button choice in this case it s Genitourinary. The ID numbers will be different in your version of the form. Item ID # 2 In the Edit Form window, click the Begin Visibility Region item prior to the first list box labeled Genitourinary. List box labeled Genitourinary 3 Click Edit. 4 In the Edit Item dialog box, click the + button to display the MEL Expression Builder. 2027167-002 Rev B 2006 General Electric Company 119

Creating Clinical Content for Centricity Physician Office - EMR 2005 5 Click Insert Symbol. Select the temporary variable with the item ID # 57529 and click OK. 6 In the MEL Expression Builder, type: == "Genitourinary" AND This associates Genitourinary with the button and indicates that another condition is required ( AND ). 7 Click Insert Symbol again and select Patient Attributes (ALL) from the drop-down list at the bottom of the dialog box. 8 Select PATIENT.SEX and click OK. Patient attributes selected 9 In the MEL Expression Builder, after the patient attribute, type: == "F" This indicates that the patient sex must be female. It should look like this: The temporary variable name in your form will be different. 120 2006 General Electric Company July 2006

Use Set Values Action Buttons 10 Click OK to close MEL Expression Builder. Because the visibility region for the male genitourinary review of systems depends on the same temporary variable and patient attribute, you can copy this condition and paste it into the Edit Item dialog box for the Begin Visibility Region associated with the male-oriented list boxes. Then simply change the == "F" to <> "F". More examples Here are more examples of visibility region condition expressions. Visibility based on a patient attribute: PATIENT.AGEINMONTHS <= "48" Visibility based on an observation: OBSANY("O2 Treatment") == "yes" Visibility based on a Radio Button or Drop-Down List choice DOCUMENT.TEMP_61064700_1_535154 == "Angina" Visibility based on the existence of a specific problem or problems, based on ICD code. You can use PROB_PRIOR, PROB_NEW, or PROB_AFTER. For one problem: match(prob_prior("list"),"(icd-123.3)")>0 The match function searches for the code in the patient s problem list. For two problems (both must be present): (match(prob_prior("list"),"(icd-123.3)") AND match(prob_prior("list"),"(icd-345.3)"))>0 Make inserting visibility regions one of the last things you do when creating your form. Use Begin Section items with a new page to see your entire form in Preview before you start adding visibility conditions. Remove the Begin Sections when you put in the visibility regions. Use Set Values Action Buttons You can use a Set Values connection for Action Buttons to fill in form items with the click of a button. The Set Values connection specifies values for data collection items on the same page of the form as the button. When a user clicks the button in the EMR application, all the values are filled in automatically. Set Values Action Buttons help providers complete forms quickly. 2027167-002 Rev B 2006 General Electric Company 121

Creating Clinical Content for Centricity Physician Office - EMR 2005 Here are some things you can do with Set Values Action Buttons: Fill in form items with predefined values, such as normal observations. Insert alternate values in the form item using a MEL expression, such as different data for male and female patients Automatically select other buttons, including other Set Values buttons Clear form items You can set values for the following form items: This form item Edit Field and Multiline Edit Field Non-editable Drop-Down List, Radio Buttons, Check Box Editable Drop-Down List Can have these values Any text Results of MEL expression <clear value>, which clears any value already in the field One of the choices provided when the item was created Results of MEL expression (evaluates to one of the choices) <clear value>, which clears any value already in the field One of the choices provided when the item was created Any text Results of MEL expression <clear value>, which clears any value already in the field List Box The list of choices that specify the values to be checked in the list box Results of MEL expression Action Button <click the button> Superbutton: A Set Values Action Button that clicks other Set Values Action Buttons You can specify whether clicking a Set Values button overrides, leaves unchanged, or appends to previously entered values. For example, you might have a button that clicks all the Negative buttons in an ROS section but doesn t override any items entered by the user. The user enters data for some systems, then clicks the button. Text for negative findings is displayed in the remaining fields. Here are some places to use Set Values Action Buttons: Review of systems. You can use a Set Values button labeled Negative to fill in the text for negative findings for each system in a ROS. A superbutton can click all of the Negative buttons on the page. 122 2006 General Electric Company July 2006

Use Set Values Action Buttons Add a Set Values Action Button Past, family, and social history. You can use a Set Values button to indicate that the histories were reviewed during the encounter or to bring forward previous history information. Physical exam. You can use a Set Values button to fill in normal findings in a physical exam. Clear all. You can use a Set Values button to clear values from a group of items. A Set Values Action Button acts only on items on the same page as the button. Before you add a Set Values Action Button to your form, make sure that all items that you want to set values for are on the page where you re adding the button. By default, Set Values buttons do not overwrite previously entered data, so providers can enter abnormal data, then click a Set Values button to fill remaining fields with normal values. However, you can enable Set Values buttons to insert data into fields that have already been filled out. If you use this type of button, make sure you educate users of your form to use the Set Values button first, then override the data if necessary. You can use the append capability to build up standardized text into a single multiline edit field. For example, you could define a series of buttons, each of which adds additional information to the field. Use this technique to enable non-typers to generate text or to create a narrative. The following procedure describes how to add a Set Values button. As an example, it uses the Basic Practice kit s Review of Systems, No Visibility form, which contains several Set Values buttons. The button sets negative findings for a general review of systems. Add a Set Values Action Button 1 Select the item before which you want to add the button. 2 Click New Item. 3 In the Item Finder dialog box, select an Action Button item and click OK. 4 Enter a label for the button. For example, type Negative. 5 Click Connect To and select SETVALUES. Click OK. You see the Set Values Action Button dialog box. 2027167-002 Rev B 2006 General Electric Company 123

Creating Clinical Content for Centricity Physician Office - EMR 2005 6 Fill in the appropriate values. Select from the drop-down list or type new data. Be sure to fill in only those items that should respond to the Set Values button. For example, type: denies fevers, chills, sweats, anorexia, fatigue, malaise, weight loss, Set values for items here. Enter values only for those items that should respond to the Set Values button. Choose whether to overwrite or append to existing values. 7 If you need to write complex conditions for setting values, click the + button to the side of the value and write a MEL expression. 8 Choose whether to overwrite or append to existing data. This option applies to all values set by this button. 9 Click OK, then click Close.!!! Once you ve set a button s connection to Set Values, you can t change the connection to anything else. To change the connection, you must delete the Action Button and insert a new one. With Set Values buttons you can place inappropriate data into form items. For example, you could put text into a date field. Make sure you specify to users the appropriate type of data for the form item. About superbuttons Superbuttons are Set Values buttons that click other Set Values buttons. For example, the Basic Practice kit s ROS-Complete, No Visibility form contains a superbutton that clicks all of the other Set Values buttons on the form. Because the superbutton doesn t overwrite existing data, a provider can enter any positive findings, then click the Normal Unless Otherwise Specified button to fill in negative findings for all other systems. 124 2006 General Electric Company July 2006

Use MEL Function/Expression items!!! When you save an item group with superbuttons into a library, the superbutton connections are severed. When you insert the item group in a form, you must re-connect the superbuttons to the Set Values buttons. The following illustration shows the Set Values Action Button dialog box for the superbutton. Notice that the form s author has used MEL expressions to insert different negative findings for male and female patients for the genitourinary system. Use MEL Function/Expression items Use the MEL Expression/Function item to insert expressions and functions in your form. Here are some ways you can use MEL Function/Expression items in encounter forms: Calculations. See Use MEL Expression/Function items for calculations on page 128. Combine data from two or more items into one observation. You can write a function or a simple expression to do this. For an example of a function to do this, see MEL functions on page 104. You can also write a simpler expression, such as: {OBSNOW("HPI assoc sxw", DOCUMENT.TEMP1 + DOCUMENTTEMP.2)} This expression combines whatever is entered in two separate form items into one observation. See Using data symbols in EMR online help for detailed description of the function OBSNOW and its arguments. Watchers. A watcher is a MEL expression that watches a value and changes another value in response. Many of the expressions you write can be considered watchers. See About watchers and triggers on page 105. 2027167-002 Rev B 2006 General Electric Company 125

Creating Clinical Content for Centricity Physician Office - EMR 2005 Write calculations You can use MEL to write calculations for your forms. The calculation can be an expression that executes when you click a button, or it can be carried out a MEL function called by a text translation, printed form translation, or form item. Here are some common uses for calculations: Estimated delivery dates Target heart rate for exercise Body mass index The item group library contains calculations for body mass index and estimated delivery date. You can write calculations in almost any place in Encounter Form Editor that you can use MEL. Calculations can be relatively simple, such as computing a target heart rate, or complex, such as an estimated delivery date. You can write simple calculations as MEL expressions; for more complicated calculations, use a MEL function. See MEL functions on page 104. For more information about writing functions, see Chapter 14, MEL functions. Use the Action Button calculation connection You can incorporate calculations in your forms by using the calculation connection for an Action Button. This connection runs the calculation when a user clicks the button; the result is placed in another form item. Example For example, you want to create a very simple form component that calculates a person s target heart rate for exercise and includes it in the chart note. The calculation uses the following formula: (220-patient s age) *.75 Create the target heart rate form 1 Start Encounter Form Editor and click New to start a new form. 2 Name the form Target Heart Rate and type in a short description. 3 Click Edit. You see the Edit Item dialog box for a Begin Section. 4 In the Section Name field, type: Target Heart Rate 5 Click the New Item button and then click Begin Multi-Item Row. 126 2006 General Electric Company July 2006

Write calculations 6 In the Edit Item dialog box, set the percentages to 70 and 30. 7 Click the New Item button again and add an Edit Field item. For its label, type: Target heart rate for exercise: 8 Click the New Item button again and select Action Button from the Item Finder dialog box. You see the Edit Item dialog box. 9 In the Button Label field, type: Calculate 10 Click the Connect To button and select Calculation from the Action Finder dialog box. 2027167-002 Rev B 2006 General Electric Company 127

Creating Clinical Content for Centricity Physician Office - EMR 2005 11 Click OK. You see the Select Target Item for Calculation Result dialog box. If the form contained more items, this dialog box would display all Edit Fields and Data Display items in the form. Here the single item is already selected. 12 Select the item that will display the calculation result and click OK. Select the Edit Field labeled Target Heart Rate for Exercise. You see the Calculation Action Button dialog box. 13 Type in the MEL expression that performs the calculation and click OK. If you need to use the MEL Expression Builder, click the + button. Use MEL Expression/Function items for calculations If you have a complex calculation, it s best to put it in a function. Then you can call the function from an Action Button or from elsewhere in your form. 128 2006 General Electric Company July 2006

Write calculations Use a MEL Expression/Function item for calculations 1 In the Edit Item dialog box, insert a MEL Expression/Function item and enter the function. 2 Add an Edit Field or other item to display the calculation result. 3 Do one of the following: Add an Action Button item with a calculation connection, typing the name of the calculation function in the Calculation dialog box. Write a watcher expression to trigger the calculation when a value changes. Examples For examples of MEL functions used as calculations with action buttons, see the item group library included with Encounter Form Editor. Here are some examples: BMI LB-IN and BMI Metric: Calculate body mass index. BSA LB-IN and BSA Metric: Calculate body surface area. EDD: Records the date of the patient s last menstrual period and calculates an estimated delivery date. The function associated with this item group is a good example of a complex calculation implemented as a function. Calculation using a watcher expression A good example of a calculation that uses a watcher expression is the Body Mass Index calculation in the Vital Signs - Extended form. You can find this form in <FOLDER WHERE THE EMR APPLICATION IS INSTALLED>\CLINKITS\SPECLTY\CARDIO\ITEMS\FORMCOMP\VITALS\VITALSEX.FD. In the following sections, several examples from the Body Mass Index calculation are presented: A MEL expression that assigns variable names to observations for height (previous and current) and weight. A watcher expression that places the value in an observation. A MEL function that performs the actual calculation. Assign variable names This MEL Expression/Function item assigns observations used in the calculation to variables to prevent the flicker on the form caused when all observations are automatically reevaluated. Because this is an expression, it is evaluated when the form opens and any time one of the observations 2027167-002 Rev B 2006 General Electric Company 129

Creating Clinical Content for Centricity Physician Office - EMR 2005 changes. However, it does not cause all observations on the form to be re-evaluated. {global gheight = OBSNOW("Height") global gweight = OBSNOW("Weight") global gheightprev = OBSPREV("Height")} Watcher expression The following MEL Expression/Function item watches to see when one of the values changes. To reduce flicker when a value changes, it calls the function that calculates BMI, using the global variables as arguments instead of observations. The DOCUMENT.TEMP variable here refers to the edit field in which the result of the BMI calculation appears. { DOCUMENT.TEMP_76930175_1_502183 = str(calcbmiconv(gheight,gheightprev,gweight))} In this expression, the str() function is used to convert the values returned by the CalcBMIConv calculation to text strings. Calculation function The following function performs the calculation using the values for height, previous height, and weight (gheight, gheightprev, gweight) passed in from the watcher function. These global variables, which hold the actual observation values, become the heightnow, heightprev, weightnow variables used in the function. {fn CalcBMIConv(heightnow,heightprev,weightnow) { local heightval = "" cond case heightnow <> "" heightval = heightnow case heightprev <> "" heightval = heightprev else heightval = "" endcond if weightnow == "" or heightval == "" then return "" endif if heightval == 0 then return str(0) endif return str((weightnow / 2.2) / ((heightval / 39.4)^2)) }} 130 2006 General Electric Company July 2006

Customize text translations This part of the expression... {fn CalcBMIConv(heightnow,heightpre v,weightnow) Means this... Begin function definition. Name the function and its arguments. When the function is called the global variables gheight, gheightprev, and gweight holding the observation values will be passed into the function as its arguments. { Begin the function statements local heightval = "" cond case heightnow <> "" heightval = heightnow case heightprev <> "" heightval = heightprev else heightval = "" endcond if weightnow == "" or heightval == "" then return "" endif if heightval == 0 then return str(0) endif return str((weightnow / 2.2) / ((heightval / 39.4)^2)) } } Declare a local variable heightval (to be used within this function) with a starting value of empty. Begin a series of conditional cases... If heightnow is not empty, the temporary value heightval is assigned the value of heightnow. if heightprev is not empty, heightval is assigned the value of heightprev. Otherwise, heightval remains empty. End conditional statements. if either weightnow or heightval are empty, then display nothing in the form box. End if statement If heightval equals zero, then return 0 as text. End if statement Display the result of the calculation as text. Close function expression. Close function definition. Customize text translations Encounter Form Editor automatically creates text translations for you. When you open a form you can specify default fonts and styles for the form s chart note text translation. However, you may want to customize the formatting and layout of the translation, by editing the MEL expressions that generate the default formatting 2027167-002 Rev B 2006 General Electric Company 131

Creating Clinical Content for Centricity Physician Office - EMR 2005 Change text translation To change the content or look of the automatically generated translations, use the Customize Item dialog box. Customize the text translation by modifying this text Click to restore the default translation Click to edit in the MEL Expression Builder Change a text translation 1 Display the Customize Item dialog box by doing one of the following: In the Edit Form dialog box, select an item and click Customize. In an Edit Item dialog box, click Customize. 2 Edit the chart update translation. Click the + button to use the MEL Expression Builder. 3 Click Close. You can also click Next Item or Previous Item to move through your list of items. Click the Edit button to return to the Edit Item dialog box for this item. Store frequently used translations in a text file for easy access. You can cut and paste into both the text translation box and the MEL Expression Builder.!!! Be careful about clicking the Reset button. It will overwrite the current translation, even if you have customized it. If you want to save the translation, use NotePad or another text processor to save it as a text file. 132 2006 General Electric Company July 2006

Customize text translations Ways to customize text translations Here are some ways you can use MEL to customize a text translation to improve its readability: Indent items. You can indent text translations for specific items or for a group of items. Indenting helps to show the relationship between a heading and its associated items or between grouped items. Example. To indent an item under a heading, simply type a few spaces at the beginning of the text translation for the item. To indent several items, make sure that you type in the same number of spaces in the text for each item. You cannot use tabs in a text translation. Indenting looks best with a monospaced font, such as Courier. Add or delete vertical space. You can type or delete line breaks to adjust vertical space between items. Add or delete explanatory text. You can add text to the translation for any item or delete the entire text translation for items that shouldn t appear in the chart note. Example. You have placed text on your form that provides instructions to the person using the form. Because the instructions have no relevance to the chart note, delete the text translation for the text item. Add rich text formatting. Using the MEL functions fmt() and cfmt(), make your text translations bold, underlined, or italic. Change the font size. Example. Highlight high cholesterol values in the chart note by underlining values over 220. By default, text translations use bold for labels; however, you can apply formatting to any part of a text translation. Combine data from two or more items into one translation. Sometimes it makes more sense to have the translation for two or more items in one phrase. Example. Combine the data from a Temperature item and a Temperature Site item into one translation phrase that appears on the same line. You can also use this technique to combine translations for a text item and a data item. See Combine two items on page 135. Make the text translation layout different from the form layout. Example. The default translation puts each item on its own line, but you can put all the vital signs collected by the form on a single line in the chart note. See Change the layout on page 136. Create a more narrative note. You may want to include more text than just the label. 2027167-002 Rev B 2006 General Electric Company 133

Creating Clinical Content for Centricity Physician Office - EMR 2005 Example. Add text to the translation to give the note a narrative quality rather than the standard complains/denies format. See Narrative style on page 137. A good example of this style is the Flexible Sigmoidoscopy form in <FOLDER WHERE THE EMR APPLICATION IS INSTALLED>\CLINKITS\SPECLTY\GASTRO\ITEMS\FORMCOMP\FLEXSIG.FD. In this form, most of the items don t have text translations. Instead, information is gathered from several items and woven into a narrative. About default translations The default text translation for form items depends on the item type. Formatting items, such as Begin Section and Column Break, do not have text translations. The following table shows default text translations. For more information on default translations, see Appendix A, Form item and connection reference. These items... Text Heading Action Button Flowsheet View MEL Function Formatting items Data display (MEL connection) All other data collection and display items Have these default translations Displays text in normal font. Displays heading text in bold, two points larger. No translation. If no data is recorded, displays nothing. If data is recorded, displays the label in bold text followed by the data in normal text and starts a new line. Data Display information is formatted according to the type of connection. Expression format The default text translation for data collection items uses the cfmt (conditional format) function to format the text: {cfmt(obsnow("weight"), "", "Weight ", "B", " ")} The cfmt expression prints the text, data, and a line break only if data is recorded for the item. 134 2006 General Electric Company July 2006

Customize text translations Customized text translation examples The easiest way to understand text translations is to look at some examples. Referral source (connected to a temporary variable) {cfmt(document.temp_59464262_1_535841, "", "Referral source: ", "B", " ")} This expression says: If no data is entered in the Referral Source edit field, include nothing; otherwise, include the label Referral Source:, format it as bold, and display the data entered in the Referral Source edit field. The line break between the last two quote marks moves the cursor down to the next line, ready for data from the next item. The chart note looks like this: Referral Source: Dr. Harry Winston Combine two items This example from the HPI - Heart Failure form places the information from two list boxes that collect symptom data on a single line. It uses two translations to accomplish this. The first list box text translation is as follows: {cfmt( DOCUMENT.TEMP_60244561_1_542089, "", "CHF symptoms: ", "B")} {if DOCUMENT.TEMP_60244561_1_542089 == "" AND DOCUMENT.TEMP_60244579_1_542090 <> "" then fmt("chf symptoms: ", "B") else "" endif} This translation includes two expressions. The first formats the label and displays the data for the list box. Then it checks if the first list box is empty but items are checked in the second. If so, it displays the label and formats it in bold. 2027167-002 Rev B 2006 General Electric Company 135

Creating Clinical Content for Centricity Physician Office - EMR 2005 The next list box has the following translation: {if DOCUMENT.TEMP_60244561_1_542089 <> "" AND DOCUMENT.TEMP_60244579_1_542090 <> "" then ", " else "" endif} {cfmt(document.temp_60244579_1_542090, "","",""," ")} {if DOCUMENT.TEMP_60244561_1_542089 <> "" AND DOCUMENT.TEMP_60244579_1_542090 == "" then " " else "" endif} The first expression in the translation says: If both list boxes contain data, then print a comma and a space. The next expression displays the data collected by the second list box followed by a line break. The third expression says: If the first list box is not empty, and the second is empty, insert a line break, otherwise, don t do anything. Change the layout Checking two items in each list box translates as follows: CHF symptoms: fatigue, cough, palpitations, chest pain Another example from the same form places the Home O2 observation on the same line as the flow rate observation: {cfmt(obsany("o2 Treatment"), "", "Home O2: ", "B")}{if OBSANY("O2 Treatment") <> "" AND OBSANY("oxygen flow") == "" then " " else if OBSANY("oxygen flow") == "" then "" else "" endif endif} The text translation appears as follows: Home O2: yes Flow rate: 2l/min The Vital Signs form included in the EMR application s Basic Practice kit places all the vital signs on the same line of the chart note by eliminating the line breaks from the default translations for each item. Spaces are inserted instead. Vital Signs Ht: 71 in. Wt: 197 lb. T: 98.4 deg F. T site: oral P: 81 Rhythm: regular R: 16 BP: 112/78 136 2006 General Electric Company July 2006

Customize printed form translations Narrative style Retain customized translations This example provides expanded text for a drop-down list with the choices of Better, Worse, Unchanged. Although not absolutely necessary, extra text can make your chart note easier to read. You can also provide explanatory information that doesn t appear on the form. {cfmt(document.temp_66545961_1_509236, "", "The symptoms are ", "", " since the last visit. ")} The translation is as follows: The symptoms are unchanged since the last visit. When you change an item s properties, Encounter Form Editor remakes the item description, including its text translation. If you ve customized the text translation, you can choose between your customized translation and the one Encounter Form Editor creates automatically. In the example below, Encounter Form Editor asks whether it should update the text translation. If you wanted to keep this heavily customized translation, you would answer No. Changing an item type or connection requires that a new text translation be generated. In this case, you cannot save any customizations to the translation. Customize printed form translations The EMR application can print a paper copy of your encounter form. The printed form is used by providers when it s inconvenient to use the computer. A provider can collect the data on the printed form and enter the data into the patient s chart in the EMR application at a later time. The primary goals of a printed form are to facilitate data collection and to provide clear data for later entry into the EMR application. 2027167-002 Rev B 2006 General Electric Company 137

Creating Clinical Content for Centricity Physician Office - EMR 2005 Printed form contents Each printed form contains the patient s name, age, sex, and other demographic information at the top of the page. The form also has the problem, medication, directive, and allergy lists for the patient and a list of any services due. All of this information is included in the printed form automatically; you do not need to customize the printed form translation to include it. The printed form also includes any information previously collected in the onscreen form as long as it is printed from the same workstation where the data was collected. For example, if a nurse has filled in blood pressure readings and then printed the form for a doctor to use, the form will include the new blood pressure readings. About default printed form translations Encounter Form Editor s default printed form translations print any data already collected for the form item. They also format printed form translations in rich text so they are easier to read. Headings and Text For Heading items, the translation formats the text in bold and increases the point size by two points. {fmt("vital Signs ", "B,2")} Vital Signs For Text items, the translation is simply the text. Record the patient s height and weight before calculating BMI. Data Display For Data Display items, the EMR application checks to see if data exists. If not, it prints nothing. If it does, it prints the label in bold. The data appears on the same line for single-line data displays, but below the label if it is a multi-line data display. {cfmt(listrxnew(), "", "New Medications ", "B", " ")} New Medications SULFASALAZIN TAB 500MG 2 po bid 10/31/1998 #200 x 1 : Kelly G. Starr MD 138 2006 General Electric Company July 2006

Customize printed form translations Data collection items For items that collect data, including Edit Fields, Check Boxes, List Boxes, Drop-Down Lists, and Radio Buttons, the translation includes the label and a place to enter data on the paper form. If a user has entered data before printing the form, the data is printed. The information is bold and underlined to indicate that it has already been entered. Edit Fields Edit Field translations print the label and a blank line, unless data has already been recorded for the item. {fmt("referral source: ", "B")}{if DOCUMENT.TEMP_73645697_1_579832 =="" then fmt("..", "B,U") else fmt(document.temp_73645697_1_579832, "B,U") endif} Referral source:.. Drop-Down Lists and Radio Buttons The translations for Drop-Down Lists and Radio Buttons print the label in bold. If any data has been collected, it is printed in bold and underlined. Then the choices appear, each preceded by a set of parentheses. Parentheses indicate that only one item can be chosen. If the choice is not limited to the list, as with some Drop-Down Lists, the translation also prints a blank line. {fmt("chief Complaint: ", "B")}{cfmt(OBSNOW("Chief Cmplnt"), "B,U")} ( )shortness of breath ( )palpitations ( )syncope ( )edema ( ){fmt("..","b,u")} Chief complaint: shortness of breath ( )shortness of breath ( )palpitations ( )syncope ( )edema ( ).. List Box The List Box translation prints the label, any data that has been collected, and the list of choices preceded by square brackets [ ]. The square brackets mean that more than one item can be checked. {fmt("chf Symptoms: ", "B")}{cfmt(DOCUMENT.TEMP_73646442_1_542090, "B,U")} [ ]fatigue [ ] cough [ ]dyspnea[ ]orthopnea [ ]PND[ ]palpitations [ ]tachycardia [ ]chest pain [ ]edema [ ]abdominal pain [ ]cold intolerance CHF Symptoms: fatigue, cough, palpitations, chest pain [ ]none [ ]fatigue [ ] cough [ ]dyspnea[ ]orthopnea [ ]PND [ ]palpitations 2027167-002 Rev B 2006 General Electric Company 139

Creating Clinical Content for Centricity Physician Office - EMR 2005 [ ]tachycardia [ ]chest pain [ ]edema [ ]abdominal pain [ ]cold intolerance Items connected to previous observations For items that show existing data, such as Data Display items or other items connected to New Obs (Default Prev), the translation prints the label, any existing data, and the date it was recorded. Previously recorded data appears in italics. This expression: {fmt("height: ", "B")}{if OBSNOW("Height") = "" then fmt("..", "B,U") else fmt(obsnow("height"), "B,U") endif + cfmt(obsprev("height"), "B,I", " (Previous: ", "I", " on " + LAST_SIGNED_OBS_DATE("Height") + ")", "I")} returns: Height:.. (Previous: 62 on 11/01/1998) Ways to customize printed form translations You customize the printed form to increase its readability and usability. Here are some things you might customize: Delete the printed form translations for items that you don t want on the printed form, such as onscreen instructions to the user. You should also delete printed form translations for Data Display items connected to clinical lists (problem, medication, allergy, directive) because those lists are automatically printed on the form. Add blank lines before or after items to separate them on the printed form. Delete blank lines to group items together. Add or delete spaces to make a data collection space longer or shorter. Indent items to group them with their headings. Move the printed form translation for an item to a different item. Add instructions for the paper form user. Change a printed form translation expression To change the content or look of the automatically generated translations, you use the Customize Item dialog box. 140 2006 General Electric Company July 2006

Customize printed form translations Customize the printed form by modifying this text Change a text translation 1 Display the Customize Item dialog by doing one of the following: In the Edit Form dialog box, select an item and click Customize. In an Edit Item dialog box, click Customize. 2 Change the printed form translation. Click the + button to use the MEL Expression Builder dialog box. 3 Click Close. You can also click the Next Item or Previous Item buttons to move through your list of items. Click the Edit button to return to the Edit Item dialog for this item. Store frequently used translations in a text file for easy access. You can cut and paste into both the text translation box and the MEL Expression Builder.!!! Be careful about clicking the Reset button. It will overwrite the current translation, even if you have customized it. If you want to save the translation, use NotePad or another text processor to save it as a text file. 2027167-002 Rev B 2006 General Electric Company 141

Creating Clinical Content for Centricity Physician Office - EMR 2005 Retain printed form customizations When you change an item s properties, Encounter Form Editor remakes the item description, including its printed form translation. If you ve previously customized the printed form translation, you can choose between your customized translation and the one Encounter Form Editor creates automatically. In the example below, we added a space between the brackets and the items. Because we want to keep the space, we would click No. Execute MEL scripts at close/traversal of forms Encounter Form Editor 6.0 allows you to define MEL expression scripts that are executed when end-users (for example, care providers like nurses or doctors) traverse through or close encounter forms. The MEL expression scripts perform functions like checking for missing data (for example, the patient weight field cannot be left blank) or data validation (for example, a temperature value should be a value between 90 degrees and 110 degrees Fahrenheit). The user-defined MEL expression scripts are executed when any of the following encounter form actions occur: At the click of the Close button. At the click of the Next Form button. At the click of the Previous Form button. At the press of the Esc key on the keyboard When a form tab change is performed in a multi-page encounter form. You can define these MEL scripts in the PageClose MEL Function Definition area in the Encounter Form Editor. Each page of an encounter form contains 142 2006 General Electric Company July 2006

Execute MEL scripts at close/traversal of forms a Begin section Edit Item. This is where the PageClose MEL Function Definition area is present. Double click this line to bring up the Properties dialog box. The Properties dialog box for the Begin section Edit Item contains an area to define the MEL script. Defining MEL expression scripts in the PageClose MEL Function Definition area, provides the following functionality: Performs a centralized validation in the encounter form. Notifies the user of missing fields. Dynamically controls what fields are checked. Certain fields are conditional components, which mean that they require data only if another field is entered. Provides for range checking and other types of field validation. 2027167-002 Rev B 2006 General Electric Company 143

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CHAPTER 5 Create E&M Advisor forms About E&M Advisor 145 About HCFA guidelines 147 E&M Advisor requirements 150 View existing E&M form components 153 About E&M Advisor observation terms 154 Design E&M form components 155 About E&M Advisor How E&M Advisor works Evaluation and Management (E&M) Advisor helps providers meet HCFA (Health Care Financing Administration) coding guidelines which specify what must be documented to bill for a given level of service. E&M Advisor helps code patient visits in two ways: Suggests. It quickly analyzes form components in an encounter and suggests the CPT code for the level of service currently documented. Advises. If a CPT code has been specified, E&M Advisor tells the provider if the current documentation supports that code. If not, it tells what additional items must be documented. Document template: A reusable tool that includes the form and text components needed to document a specific type of encounter E&M Advisor uses a special form component that can analyze an encounter. The form counts special E&M observations and other data, such as number of problems assessed and complexity of decision making, from form components used during the encounter. For each type of encounter, you create a document template that contains form components that meet the documentation requirements for several levels of patient visits. For example, the EMR application includes a document template for a Cardiology/Heart Failure visit. It includes the following form components: ENTERPRISE\MEDICALOGIC\HISTORY OF PRESENT ILLNESS\HPI - HEART FAILURE ENTERPRISE\MEDICALOGIC\PAST MEDICAL HISTORY\HISTORIES ENTERPRISE\MEDICALOGIC\PAST MEDICAL HISTORY\RISK FACTORS 2006 General Electric Company

Creating Clinical Content for Centricity Physician Office - EMR 2005 ENTERPRISE\MEDICALOGIC\REVIEW OF SYSTEMS\ROS COMPLETE ENTERPRISE\MEDICALOGIC\EXAM\VITAL SIGNS - EXTENDED ENTERPRISE\MEDICALOGIC\EXAM\PHYSICAL EXAM - CARDIOLOGY ENTERPRISE\MEDICALOGIC\ASSESSMENT-PLAN\ASSESSMENT/PLAN - CARDIOLOGY ENTERPRISE\MEDICALOGIC\OTHER\E&M ADVISOR ENTERPRISE\MEDICALOGIC\PRESCRIPTIONS The provider fills in the form components during the encounter, then opens the E&M Advisor form component. After adding information about medical decision-making, the type of exam, and the type of patient, the provider optionally selects a CPT code and clicks the Advise button. Provider must fill in these items Click the question mark buttons for further Provider may choose a CPT code E&M Advisor results Choose the exam type here Click here to get advice E&M Advisor analyzes the forms in accordance with the HCFA guidelines for the type of patient, medical decision-making, and type of exam (Cardiology). It either suggests a CPT code or indicates whether or not the current documentation is adequate for a selected CPT code. You cannot edit the E&M Advisor form component. However, you can create or edit the form components that the E&M Advisor form component analyzes. 146 2006 General Electric Company July 2006

About HCFA guidelines About HCFA guidelines About CPT coding levels E&M Advisor implements the documentation guidelines proposed by the Health Care Financing Administration (HCFA) and the American Medical Association (AMA) in May 1997. The guidelines provide information about what items must be documented for a given type of patient encounter at a certain CPT coding level. You will need to use the guidelines to develop form components that work with E&M Advisor. You can retrieve them from the HCFA Web page at www.hcfa.gov/medicare/mcarpti.htm. Download Documentation Guidelines for Evaluation and Management Services. The guidelines specify what must be documented for a certain level of service in the following areas: History Examination Medical decision-making Counseling Coordination of care Risk of complications or morbidity/mortality Time The key components in determining the level of service for a visit are history, examination, and decision making. (For counseling visits, time is the key factor.) To achieve a particular level of service, all components must be documented equally: you cannot document the exam at the highest level and the history at the lowest level and still code the visit at the highest level. Keep this in mind as you design form components and make sure that you include all items so that providers can document fully. The HCFA guidelines address five coding levels each for new patients, established patients, and consultations. E&M Advisor can evaluate encounter documentation for each of these coding levels. The provider specifies on the E&M Advisor form component if the visit is for a new or established patient or a consultation. E&M Advisor then analyzes the encounter for that type of patient. The five CPT coding levels are brief, limited, intermediate, extended, and comprehensive visits. Understand buckets and bullets HCFA guidelines use the concept of buckets and bullets for documentation. The guidelines suggest that a certain number of items or bullets (also referred 2027167-002 Rev B 2006 General Electric Company 147

Creating Clinical Content for Centricity Physician Office - EMR 2005 to in the HCFA guidelines as elements) must be documented for each part of the encounter (buckets), such as history or examination. E&M Advisor determines the coding level for the visit by analyzing the form components to see how many bullets have been completed in each bucket. Each bullet corresponds to a specific observation term in the EMR application. Here are some examples: History of present illness (HPI) bucket. It has eight bullets: location, quality, severity, duration, timing, context, modifying factors, and associated signs and symptoms. If one to three bullets of the HPI are described, it is considered a brief HPI. If four or more bullets are included, it is considered an extended HPI. Respiratory system bucket. Its bullets include inspection of chest, respiratory effort, percussion of chest, chest palpitation, auscultation of lungs, and chest inspection. Each specialty exam has its own bucket and bullet requirements. Here s a comparison of the bullets in the respiratory system bucket for three types of specialty exams: Cardiovascular Respiratory system Skin respiratory effort auscultation of lungs respiratory effort chest inspection chest palpitation auscultation of lungs percussion of chest None When you design forms, review the guidelines carefully to make sure you ve identified all of the buckets and bullets you need. The coding level for exams depends on both the type of exam and the number of bullets documented. The requirements become more stringent at higher coding levels: A problem-focused (lowest coding level) cardiology exam requires documentation of one to five bullets. A comprehensive (highest coding level) cardiology exam requires documentation of all bullets for some systems (e.g., respiratory, cardiovascular) and documentation of at least one bullet for others (eyes, skin). ORs and ANDs Counting bullets for exams is not always straightforward. In some cases, E&M Advisor counts only one bullet, even if two bullets (observations) are documented. In other cases, two or more observations are counted as one bullet. The count depends on the type of specialty exam. 148 2006 General Electric Company July 2006

About HCFA guidelines ORs. For some exams, you have the choice of documenting one bullet OR another. E&M Advisor will count only one of them, even if you have both documented. For example, a respiratory specialty exam must include two bullets from the gastrointestinal area. For one of those bullets, you can document either an abdominal inspection or an abdominal palpitation. Another example is observations for vital signs. You can document both height and height (cm), but E&M Advisor counts them as one bullet. ANDs. For some exams, two or more observations must be recorded to fulfill the requirement for a bullet. For example, a neurology specialty exam requires reviewing the strength of the patient s right and left upper and lower extremities (four separate observations) to meet the requirement for that bullet. The tables in this chapter and in Appendix C, E&M Advisor observations and exam requirements, show an OR between two bullets (observations) that can be used to meet the same requirement. Where two or more observations are required, the tables show an ampersand (&) between the bullets. Special considerations The Vital Signs component of an examination requires that three of the following seven items are documented: Sitting or standing blood pressure Supine blood pressure Pulse rate and regularity Respiration Temperature (in Fahrenheit or Celsius) Height (in inches or centimeters) Weight (in pounds or kilograms) The Physical Exam - Cardiology form included with the EMR application implements some special guidelines. You need to be aware of these guidelines if you design forms to document the same information. The Gastrointestinal exam section includes a check box for considering thrombolytic or anticoagulant therapy. If this box is checked, the exam must include a stool check for occult blood to meet the CPT code for a comprehensive exam. The Cardiovascular exam section includes a check box labelled indication exists, which is to be checked when appropriate. If the check box is checked, at least two blood pressure readings in different locations must be entered on the Vital Signs - Extended form to meet the documentation requirements for a comprehensive exam. 2027167-002 Rev B 2006 General Electric Company 149

Creating Clinical Content for Centricity Physician Office - EMR 2005 E&M Advisor requirements E&M Advisor counts E&M observations and evaluates complexity of medical decision making. The following table lists E&M Advisor requirements for each CPT code. Keep this table handy when you design form components. To meet particular coding requirements, you must make sure your form components provide opportunities for providers to document all of the requirements. This table lists the HCFA guidelines for general exams. For specialty exam requirements, see Appendix C, E&M Advisor observations and exam requirements. CPT code History ROS Patient, family, social history Physical exam Medical decisionmaking Time, min 99201 New patient Chief complaint, one element from history None None One element Two areas of minimal decision making 10 99202 New patient Chief complaint, one element from history One area from ROS None At least six bullets from exam sections Two areas of minimal decision making 20 99203 New patient Chief complaint, either four or more elements from history OR assess three or more chronic (existing) problems Two or more areas from ROS Either PMH, family, OR social history For general, need at least six areas (buckets) with two or more bullets each OR twelve or more total bullets from at least two buckets. For eye, psych, at least nine bullets. For other specialty exams, at least 12 bullets. Two areas of limited decision making 30 99204 New patient Chief complaint, either four or more elements from history OR assess three or more chronic (existing) problems Ten or more areas from ROS PMH, family, AND social history For general, need at least nine areas (buckets) with two or more bullets each. For specialty exams, see Appendix C, E&M Advisor observations and exam requirements. Two areas of moderate decision making 40 150 2006 General Electric Company July 2006

E&M Advisor requirements CPT code History ROS Patient, family, social history Physical exam Medical decisionmaking Time, min 99205 New patient Chief complaint, either four or more elements from history OR assess three or more chronic (existing) problems Ten or more areas from ROS PMH, family, AND social history For general, need at least nine areas (buckets) with two or more bullets each. For specialty exams, see Appendix C, E&M Advisor observations and exam requirements. Two areas of extensive decision making 60 99211 established patient No specific guidelines No specific guidelines No specific guidelines No specific guidelines No specific guidelines 5 99212 established patient Chief complaint, one element from history None None One element Two areas of minimal decision making 10 99213 established patient Chief complaint, one element from history One area from ROS None At least six bullets from exam sections Two areas of limited decision making 15 99214 established patient Chief complaint, either four or more elements from history OR assess three or more chronic (existing) problems Two or more areas from ROS Either PMH, family, OR social history For general, need at least nine areas (buckets) with two or more bullets each OR twelve or more total bullets from at least two buckets For eye and psych, at least nine bullets. For other specialty exams, at least 12 bullets. Two areas of moderate decision making 25 2027167-002 Rev B 2006 General Electric Company 151

Creating Clinical Content for Centricity Physician Office - EMR 2005 CPT code History ROS Patient, family, social history Physical exam Medical decisionmaking Time, min 99215 established patient Chief complaint, either four or more elements from history OR assess three or more chronic (existing) problems Ten or more areas from ROS PMH, family, AND social history For general, need at least nine areas (buckets) with two or more bullets each. For specialty exams, see Appendix C, E&M Advisor observations and exam requirements. Two areas of extensive decision making 40 99241 consultation Chief complaint, one element from history None None One element Two areas of minimal decision making 15 99242 consultation Chief complaint, one element from history One area from ROS None At least six bullets from exam sections Two areas of minimal decision making 30 99243 consultation Chief complaint, either four or more elements from history OR assess three or more chronic (existing) problems Two or more areas from ROS Either PMH, family, or social history For general, need at least nine areas (buckets) with two or more bullets each OR twelve or more total bullets from at least two buckets For eye and psych, at least nine bullets. For other specialty exams, at least 12 bullets. Two areas of limited decision making 40 99244 consultation Chief complaint, either four or more elements from history OR assess three or more chronic (existing) problems Ten or more areas from ROS PMH, family, AND social history For general, need at least nine areas (buckets) with two or more bullets each. For specialty exams, see Appendix C, E&M Advisor observations and exam requirements. Two areas of moderate decision making 60 152 2006 General Electric Company July 2006

View existing E&M form components CPT code History ROS Patient, family, social history Physical exam Medical decisionmaking Time, min 99245 consultation Chief complaint, either four or more elements from history OR assess three or more chronic (existing) problems Ten or more areas from ROS PMH, family, AND social history For general, need at least nine areas (buckets) with two or more bullets each. For specialty exams, see Appendix C, E&M Advisor observations and exam requirements. Two areas of extensive decision making 80 View existing E&M form components You can design your own form components to work with E&M Advisor, or you can modify the form components included with the EMR application. You should examine several of the E&M form components before you start designing your own. Determine if an EMR form component is E&M compliant 1 In the EMR application, from the Go menu, select Setup> Settings. 2 From the folder list, select Chart Documents > Form Components. 3 Select Enterprise > MedicaLogic > Exam. Use the appropriate path to locate the component you want to check. 4 Choose a form from the list and click the Details button. The description tells you if the form component works with E&M Advisor The information comes from the Description text box in Encounter Form Editor. When you create an E&M-compliant form, be sure to note it in the description. 2027167-002 Rev B 2006 General Electric Company 153

Creating Clinical Content for Centricity Physician Office - EMR 2005 About E&M Advisor observation terms E&M Advisor counts only certain observations when evaluating the documentation for an encounter. When you create forms to work with E&M Advisor, you must use these observation terms. Your form can contain other observations or temporary variables that help you document an encounter, but E&M Advisor will not count them. Locate E&M Advisor observation terms The observation terms that E&M Advisor counts are listed in Appendix C, E&M Advisor observations and exam requirements. You can also use the Centricity Physician Office Term Finder in Encounter Form Editor to search for E&M terms. Search for E&M observation terms 1 In Encounter Form Editor, select an item that can be connected to an observation. 2 For Connect To, select New Observation, Previous Observation, or Previous Observation with Date. You see the Centricity Physician Office Term Finder. Click the Search tab if necessary. Type E&M here to search for E&M observation terms Observation terms that meet the search criteria appear here Click the Search button to start your search 3 In the Search For text box, type E&M and click Search. You see the list of observations terms that E&M Advisor can count. 154 2006 General Electric Company July 2006

Design E&M form components 4 To further refine your search, type additional keywords in the Search For text box. Use as many keywords as necessary to limit your search Design E&M form components Designing E&M form components is just like designing other form components, except that you have to connect items to observation terms that E&M Advisor recognizes. This section describes each part of the E&M analysis and explains what E&M Advisor needs to correctly analyze a patient encounter. As you design E&M form components, remember that you re not limited to E&M observation terms. Include whatever information will help document the encounter even though E&M Advisor will count only the E&M observation terms. Document history HCFA guidelines require that history include the patient s chief complaint, history of present illness (HPI), review of systems (ROS), and past, family, and social history (PFSH). HCFA guidelines specify that all three elements must be incorporated to qualify for a specific type of history, as shown in the table below. Type of history HPI ROS PFSH Problem-focused Brief N/A N/A 2027167-002 Rev B 2006 General Electric Company 155

Creating Clinical Content for Centricity Physician Office - EMR 2005 Type of history Expanded problem-focused HPI ROS PFSH Brief Problem-pertinent N/A Detailed Extended Extended Pertinent Comprehensive Extended Complete Complete Make several form components to collect history information. Chief complaint and HPI All coding levels except 99211 require a chief complaint. The history type for HPI is determined by the number of elements for HPI and by assessments of existing problems, as shown in the table on page 150. Encounter Form Editor includes observations terms for each of the eight HPI elements. You can create a form that has items for those observations, and E&M Advisor will count the number of HPI observations; or you can ask the provider to determine the HPI type, as shown in the HPI - Heart Failure form component. In this case, the form uses an observation for HPI type. You can locate HPI observations in the Centricity Physician Office Term Finder by searching on E&M HPI. Provider determines HPI level Problem assessment For some codes, history requirements can be met by assessing chronic problems. In this case, the provider uses the standard Update Problems 156 2006 General Electric Company July 2006

Design E&M form components dialog box. You do not need to design a form component. E&M Advisor automatically counts problem assessments. ROS The guidelines specify how many systems must be reviewed for each CPT E&M coding level. You can determine the observation for a review of each system in the Centricity Physician Office Term Finder by searching on E&M ROS. Both the ROS forms included with the EMR application use these observations. Past, Family, and Social History Past, family, and social histories are required for higher coding levels. Mid-level coding requires one of the histories. It is sufficient to note that the history was reviewed. Separate observations are available for the histories themselves and for review of history. Search on E&M history. The Past Medical History form component included with the EMR application enables providers to collect, update, and review past, family, and social history. Document physical exams The HCFA guidelines specify four types of examinations: Problem-focused Expanded problem-focused Detailed Comprehensive 2027167-002 Rev B 2006 General Electric Company 157

Creating Clinical Content for Centricity Physician Office - EMR 2005 The level assigned by E&M Advisor depends on how extensive the exam is. Documentation for physical exams relies on buckets and bullets for each body system. HCFA guidelines specify different requirements for general multi-system exams vs. specialty examinations. Each type requires different buckets and bullets to meet coding levels. The following table lists the requirements for general multi-system examinations. This exam level... Problem-focused Expanded problem-focused Detailed examination Comprehensive examination Requires this... One to five bullets in one or more organ systems or body areas (buckets). At least six bullets in one or more organ systems or body areas. At least six organ systems or body areas, with at least two bullets in each. or At least twelve bullets in two or more organ systems or body areas. At least nine organ systems or body areas. For each system/area, all bullets unless indicated otherwise. At least two bullets must be documented for each system/area. For specialty examinations, the number of buckets and bullets depends on the system or body area. See the HCFA guidelines for detailed descriptions of these requirements. For E&M Advisor to properly evaluate specialty examinations, the provider must use one of GE s specialty exam forms or choose the specialty on the E&M Advisor form component. If the provider uses a specialty form, it automatically sets the exam type on the E&M Advisor form. However, providers can override the value and choose a different exam type on the E&M Advisor form. The coding level is determined by both the number of systems (buckets) covered and the number of items (bullets) addressed in each one. Depending on the type of exam (respiratory, cardiovascular, etc.), different buckets and bullets are required to meet various coding requirements: A general system exam must include bullets from all systems except head/face. A musculoskeletal exam requires bullets from general constitutional (vital signs), cardiovascular, lymphatic, MSK, skin, neuro, and psychiatric. A genitourinary exam requires bullets from general constitutional (vital signs), neck, respiratory, cardiovascular, chest (breasts), gastrointestinal, genitourinary, lymphatic, skin, and psychiatric. 158 2006 General Electric Company July 2006

Design E&M form components Encounter Form Editor includes observations for each bullet listed in the HCFA guidelines. You can search for E&M system_name to locate them. For example, E&M skin finds all E&M observations that have to do with skin. When you design forms for exams, make sure you include observations for all required bullets. The EMR application includes E&M-compliant exam form components for a general systems exam as well as exams for all specialties as defined by HCFA. The exam forms are set up to document the correct buckets and bullets. You can use these as examples for designing your own forms. Some of the bullets are fulfilled by observations recorded by the Vital Signs form components, which are considered part of the exam. The rest of this section shows two examples. General system exam The form component for a general system exam includes all body systems. Buttons make it easy to include normal findings, and drop-down lists present common findings. Providers are also free to type text into the form component. Each item is connected to a specific E&M observation. 2027167-002 Rev B 2006 General Electric Company 159

Creating Clinical Content for Centricity Physician Office - EMR 2005 Musculoskeletal exam This form component includes the systems that must be documented for a comprehensive MSK exam. It includes many more bullets in the MSK area than does the general exam form. Document medical decision-making According to HCFA guidelines, the level of medical decision-making is determined by the following elements: The number of diagnoses or management options The amount and/or complexity of data to be reviewed The risk of complications and/or morbidity or mortality E&M Advisor uses a combination of encounter analysis and provider input to assign one of the following levels to decision-making: straightforward, low complexity, moderate complexity, or high complexity. The guidelines specify that two of the three elements must be met or exceeded to achieve a specific level of decision-making. For example, if the number of diagnoses is multiple and the amount of complexity of data is moderate, E&M Advisor assigns a decision-making level of moderate complexity regardless of the level for risk of complications. Each of the elements can be considered a bucket which contains a certain number of bullets. To determine the number of bullets in each bucket, E&M 160 2006 General Electric Company July 2006

Design E&M form components Advisor evaluates several factors and calculates a numerical score that corresponds to the decision-making level for each of the three elements. Number of diagnoses or management options E&M Advisor evaluates the number of diagnoses or management options by examining the following factors: The number of problems assessed. (1 point each) The number of new problems recorded. Up to two minor diagnoses are counted. Additional minor diagnoses are not counted. (1 point each) Whether an additional workup is planned for new problems. (1 point) When designing form components to collect this information, you should add an action button to assess or update problems which brings up the Update Problems dialog box. Providers can assess existing problems and add new ones from this dialog box. You can also add a check box for Additional Workup Planned to your Assessment/Plan forms. This check box would be connected to the special E&M observation term Workup Plan. For examples, see the forms included with the EMR application. E&M Advisor uses the following point scale for this factor: This number of points... 0, 1 Minimal 2 Limited 3 Multiple 4 or more Extensive Provides this level for number of diagnoses... Amount and complexity of data to be reviewed Another factor in determining the level of medical decision-making is the amount and complexity of data reviewed by the provider. E&M Advisor analyzes this factor using provider input in check boxes on the E&M Advisor form component. Here are the factors considered and the point value assigned: Review/order clinical lab tests (1 point) Review/order radiology tests (1 point) Review/order other diagnostic or treatment interventions (1 point) Discuss test results with performing MD (1 point) Obtain old records or history from another person (1 point) Review and summarize old records (2 points) 2027167-002 Rev B 2006 General Electric Company 161

Creating Clinical Content for Centricity Physician Office - EMR 2005 Independent review of data, e.g., image or specimen (2 points) Each of these items must be further documented in the chart note. See the HCFA guidelines for more information. You cannot add these factors as items on your form components or change the point values assigned. The provider must use the check boxes in the E&M Advisor form component to record this information. E&M Advisor uses the following point scale for this factor: This number of points... 0, 1 Minimal 2 Limited 3 Moderate 4 or more Extensive Risk of complications, morbidity, and/or mortality E&M Advisor uses provider input on the E&M Advisor form component to evaluate the risk of complications, morbidity, and/or mortality. The provider must determine the level of risk and assign a value of minimal, low, moderate, or high. Determining the level of risk is complex. The HCFA guidelines provide a table that includes many clinical examples that can assist providers in assigning risk levels. You ll want to make this information available to providers who use E&M Advisor. In addition to assigning a level, the chart note must also include documentation of the factors that led to the assigned risk level. Document counseling and coordination Provides this level for amount and complexity... If a patient visit is primarily for counseling and/or coordination, the determining factor for coding is the amount of time spent rather than the history, exam, and medical decision-making. 162 2006 General Electric Company July 2006

Design E&M form components The E&M Advisor form component includes a check box to indicate that the visit is primarily counseling/coordination. When it s checked, the provider can use a list to indicate the amount of time spent. The chart note must include documentation of the counseling/coordination activities. Encounter Form Editor does not include observations for counseling/coordination and time. Providers must use the E&M Advisor form component to record this information for evaluation. 2027167-002 Rev B 2006 General Electric Company 163

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CHAPTER 6 Import and test forms Import the form into the EMR application 165 Test the onscreen form in the EMR application 166 Review text and printed form translations 169 Use MEL tracing 170 Before you release your form component for provider use or upload it to the KnowledgeBank (http://knowledge.medicalogic.com/), you need to test it thoroughly. To test and revise the form, have both Encounter Form Editor and the EMR application running on your workstation. Having both programs available makes it much easier to test incremental changes.!!! When testing forms, use the training database provided with the EMR application. Do not test forms in a real patient database. Import the form into the EMR application When you save a form component in Encounter Form Editor, it creates the files that make up a clinical kit. See Understand encounter form files on page 75. If you need to move the clinical kit to a different workstation, be sure you move all of the files that make up the kit. Import a form into the EMR application 1 Start the EMR application using the Single-User Training database. You can log in as kstarr. The password is password. 2 Go to Setup Settings. 2006 General Electric Company

Creating Clinical Content for Centricity Physician Office - EMR 2005 3 Select System > Import Clinical Kits. Click the System folder to see the list of system tasks Then click Import Clinical Kits 4 Click the Import Clinical Kit button. 5 Use the Import Clinical Kit dialog box to locate and select the.ckt file for your form component. Click Open to import the kit. You can usually find the clinical kit in the CLINICAL TOOLS folder. The file is named form.ckt. If you don t specify an EMR path for your form, it is imported at the Enterprise level. Test the onscreen form in the EMR application Once you ve imported your form, the next step is to view it in the EMR application and make sure it works correctly. The following procedure briefly lists the steps to bring a form into a patient chart. For more information on using form components, see the online help in the EMR application. 166 2006 General Electric Company July 2006

Test the onscreen form in the EMR application View a form component in the EMR application 1 Click Chart on the toolbar. You see the Find Patient dialog. If a chart is open, you see the chart skip to step 4. 2 Click Search to find all patients in the training database. 3 Select Don Bassett and click OK. You see the chart. 4 Click the Update button. You may see a dialog box indicating that an update is already in progress. GE recommends that you choose a patient for whom there are no unsigned documents. 5 In the Update Chart dialog box, click OK. 6 Right-click in the notes area and select Insert > Component. Review form design 7 Select the form component you imported and click OK. You see the form. Examine your onscreen form for design problems. Make a note of any problems so you can fix them in Encounter Form Editor. Does the form follow normal clinical workflow for the encounter? Does the form collect all data needed for this type of encounter? Does it look attractive? Are the form items lined up properly? Is everything spelled correctly? 2027167-002 Rev B 2006 General Electric Company 167

Creating Clinical Content for Centricity Physician Office - EMR 2005 Test the form Do the headings clearly delineate sections of the form? Are the font styles and sizes consistent and do they conform to your style guidelines? Test your form to make sure it is performing correctly. Note any problems that occur. Here are some tips on testing a form. Before you start testing, use your Item Report to list the observations and clinical lists that can be changed by the form. EMR database items. Review form items that display information from the EMR database. Check to make sure they correctly show clinical information, such as problem, medication, or allergy lists. If Data Display items display observations, check to make sure the correct observations are displayed. Check Flowsheet View items to ensure the correct flowsheet view is displayed. Previous observations. For items connected to a previous observation, make sure previous data is displayed. Data entry. Enter information into the form. If you ve placed restrictions on the type of data, such as limiting data to positive integers or a date, try entering data that doesn t meet the requirements. Changes to clinical lists. After entering data in form items that are connected to observations, end the update and check the changes to the clinical lists to confirm that the correct observations were used. Drop-downs and radio buttons. Try each choice available on the form. For example, try all Drop-Down List choices and all Radio Button choices. Action Buttons. Click any Action Buttons on the form to verify that they work correctly. If the button has a Calculation connection, make sure the calculation was performed properly. Verify that the Set Values buttons fill in form items correctly. Visibility regions. Test the conditions that make the region appear and disappear. Make sure stacked visibility regions don t overlap in the onscreen form. MEL expressions. Verify the functionality of hidden form items, such as MEL expressions and functions. Tab order. Check to make sure the tab order is correct by opening your form and pressing Tab to move through the data entry items. Encounter Form Editor uses the same tab order as the order of the item list. 168 2006 General Electric Company July 2006

Review text and printed form translations Review text and printed form translations It is especially important to review the form s text translation because this text becomes the chart note, which is a permanent part of the patient record. Check each item translation. As you fill out the form, examine the text translation for each form item. Note any text translation problems for correction in Encounter Form Editor. You can click and drag to move the form out of the way so you can easily view the onscreen text translation. Review text translations for heading suppression. Test with and without values under the heading so you can make sure the suppression blocks work correctly. Review printed form. Print out the form and review the printed form translation for format and accuracy. Try printing the form after entering some information on it and check to make sure the information prints. You must print from the workstation where you entered the data for the data to print on the form. Review the text and printed form translations 1 From within a EMR chart update, click Print. You see the Print dialog box. 2 From the Print Topics list, select Documents. 3 From the Print Items list, select Selected Document. 4 Choose Chart Document View and click Print. The EMR application prints the chart note. 5 Repeat Steps 1 3, then choose Template/Component View and click Print. The EMR application prints the printed form translation, including any data already entered. 2027167-002 Rev B 2006 General Electric Company 169

Creating Clinical Content for Centricity Physician Office - EMR 2005 Use MEL tracing Examine the chart note and printed form for problems. Note any changes that you want to make in Encounter Form Editor. Was previously collected data printed correctly? Are major section divisions made obvious by blank lines and/or indenting? Are the data entry areas an appropriate size? Are instructions to the user clear? Does the form encourage the user to collect data in the correct way for entry into the EMR application? For example, does it indicate items that must contain a date or a numeric value? Does it list appropriate units? If your form contains complicated text translations or MEL expressions and functions, you can use MEL trace to help you find out what s going wrong. A trace shows the MEL program that is being executed, each individual step, and any intermediate results of program execution. While you re tracing, all the information is recorded in a file called C:\TRACEMEL.TXT. You can examine this file to see exactly what your MEL programs are doing. Turn tracing on and off in EMR 1 Press Ctrl + Alt + M to turn tracing on. You see MEL Tracing in the EMR status bar. You cannot set a MEL trace on a form that is open. Be sure to start tracing after you load the form you want to test into an update but before you open the form. 2 Press Ctrl + Alt + M to turn tracing off. The user s name reappears on the EMR status bar.!!! All traces are added to the end of the TRACEMEL.TXT file in the C:\ directory on the local workstation. This file can grow overly large, especially if you forget that tracing is turned on. 170 2006 General Electric Company July 2006

Part II Using MEL Using MEL is for EMR users who want to customize their EMR application for use in a clinic. MEL (MedicaLogic Expression Language) is a programming language you can use to customize EMR documents and forms. Chapter 7 introduces the MEL programming language, data symbols, and functions. Chapters 8-11 explain basic concepts for working with MEL and common MEL tasks. This part of the book is appropriate for EMR users with no previous experience with a programming language. Chapters 12-17 provide details of the MEL programming language and additional techniques you can use in writing MEL programs. 2006 General Electric Company

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CHAPTER 7 Use data symbols What is MEL? 173 About data symbols 174 About functions 174 About MEL 175 Where to use MEL and data symbols 177 Use the Insert Symbol dialog box 177 When to evaluate data symbols 179 Types of data symbols 181 Using data symbol functions with arguments 183 Look up observation terms 188 This chapter introduces the MEL expression language, data symbols, and functions. It describes how they work and defines their characteristics. It also explains how to use the Insert Data Symbol dialog box in the EMR application and how to use observations with data symbol functions. What is MEL? Expression: A set of instructions that your computer can execute to produce a result Function: A small program performing a set of tasks which can be called by other MEL expressions or functions MEL (MedicaLogic Expression Language) is a programming language you can use to customize EMR documents and forms. You can create MEL expressions that tell the EMR application how to perform simple tasks, such as customizing patient banners and letterheads. As you become more proficient with MEL, you can create complex letter and text components. You can also write your own MEL functions for use in form components. In MEL, you perform comparisons and calculations using built-in data symbols, data symbol functions, MEL utility functions, and functions that you create (user-defined functions). Data symbols retrieve patient information and clinical data from the EMR database. Example: PATIENT.DATEOFBIRTH Data symbol functions manipulate data from data symbols. Example: OBSNOW User-defined functions are functions you write in MEL to manipulate clinical data. 2006 General Electric Company

Creating Clinical Content for Centricity Physician Office - EMR 2005 Utility functions help you perform common tasks as you write MEL expressions. Example: get(string) About data symbols Data symbols represent information stored in the EMR database. Most data symbols retrieve data for a particular patient, document, user, or location of care. For example: PATIENT.LABELNAME displays the patient s full name, formatted for a mailing label. DOCUMENT.SUMMARY displays the one-line summary for the current document. LOC.ADDRESS1 prints the first line of the location of care s address. USER.PHONE displays the current user s phone number. The part of a data symbol name before the period (.) identifies a category of information stored in the database, For example, USER.PHONE refers to information pertaining to the EMR users. The part of the name after the period identifies a specific data item within that category, in this case the user s phone number. An item of stored information is also referred to as a value. Types of values that are stored and manipulated in the EMR application include text (a string of characters), numbers (values used in calculations), and dates (a special value that displays a date). Return: To store or display the result of an expression When the EMR application evaluates a data symbol, it determines which data item to return based on where the symbol is used in the EMR application. Symbols associated with documents, locations of care, and users retrieve data for the current document being viewed, the location of care set up for printing, and the user who s currently logged in. In this example, USER.PHONE returns the number of the user logged in to the workstation. Similarly, when you use a data symbol representing a patient name, address, or referring physician, for example, it retrieves that data for the patient whose chart is open on the work station. About functions Data symbol functions, as well as functions you define, typically do more than retrieve and display data. They manipulate data in specified ways and can even execute other functions. 174 2006 General Electric Company July 2006

About MEL Argument: Information needed by a function to perform its defined task. An argument can be text, numbers, or the value returned by another function A function is handy when you need the EMR application to carry out a complex calculation or a long series of tasks repeatedly.you define a function by giving it name and listing the instructions you want it to carry out. Then the function can be called (executed) simply by typing its name into your program and, in some cases, specifying the data you want it to manipulate. A function consists of a descriptive name followed by a pair of parentheses, which tells the EMR application that the name refers to a function. The data symbol function OBS_LIST_CHANGES(), for example, tells the EMR application to find and display in list form all observations entered, changed, or removed during the current update. Most data symbol functions require you to specify the type of data you want to retrieve or manipulate, and sometimes the format you wish to see it displayed in. These data items and other information required by the function are called its arguments; they are usually enclosed in quotes and inserted between the parentheses following the function name. For example OBSANY(), takes any observation short name as its argument. For example, OBSANY("HEIGHT") retrieves the most recently recorded height for the current patient. INS_ADDR("S") shows the address of the current patient s secondary insurance carrier. If no argument is inserted, the primary insurance address is displayed. LASTOBSVALUE("WEIGHT") shows the last recorded weight for the current patient. PROB_PRIOR("LIST") lists the patient s problems prior to the current encounter. Some data symbol functions do not require arguments. For example, ALL_ACTIVE() requires no additional information; it finds and lists all active allergies. Nevertheless, you must always include the parentheses () when using a function. About MEL Syntax: Keywords, punctuation, and logical structure used in a programming language The MEL programming language was created to work with the EMR application. MEL consists of a vocabulary of unique keywords reserved for use in MEL and a special syntax grammatical rules for writing instructions a computer can interpret and carry out. Even if you have no experience with other programming languages, you can do many things with relatively simple MEL expressions. And if you do have some programming experience or the desire to learn, you can learn to write more complex MEL expressions. 2027167-002 Rev B 2006 General Electric Company 175

Creating Clinical Content for Centricity Physician Office - EMR 2005 A single data symbol is a simple but complete MEL expression. This symbol retrieves PATIENT.SEX and displays the sex of the patient: {PATIENT.SEX} Here s another expression that combines MEL keywords, plain text, and special operators with the function REGGUARANTOR() in a series of conditional statements: {if REGGUARANTOR() == "" then "" else "Guarantor: " + REGGUARANTOR() endif} REGGUARANTOR() is a function that retrieves and displays the patient s guarantor if any has been entered at registration. You can read this expression like a sentence. It tells the EMR application the following: if the function finds no guarantor in the patient s registration information... then print nothing. else (otherwise) print the text Guarantor: followed by the guarantor name retrieved by the function. endif In this "sentence," MEL keywords if, then, else, and endif and special operators (==) and (+) give the expression its logical structure. You ll learn more about writing MEL expressions in Chapter 8, Write MEL expressions. MEL is a dynamic programming language. This means that MEL can update values based on changes to other values as a spreadsheet does. For example, a MEL expression representing a patient s clinical data can be continually re-evaluated by the EMR application to reflect new chart updates. 176 2006 General Electric Company July 2006

Where to use MEL and data symbols Where to use MEL and data symbols You can use data symbols and MEL expressions when entering chart notes and to create or format a variety of chart documents: To learn about MEL and data symbols for... Customizing patient banners Modifying headers for chart documents, handouts, and letters Creating text components for chart notes and templates for letters and handouts Defining quick text shortcuts Entering directly into chart notes Creating encounter form components Read this... Create patient banners on page 216 Headers for letters, handouts, and chart documents on page 218 Text components and templates for letters and handouts on page 220 Quick text on page 229 Chart notes on page 231 Form components on page 231 Use the Insert Symbol dialog box You ll use EMR s Insert Symbol dialog box to insert data symbols into templates, headers, banners, chart notes, and quick text definitions. The Insert Symbol dialog box lists data symbols so you can browse or search for them. In some parts of the EMR application, Insert Symbol also lets you Type characters to search for and click Search Choose when to evaluate the symbol Select the symbol to insert and click OK View symbol types specify when symbols are evaluated. See Types of data symbols on page 181. 2027167-002 Rev B 2006 General Electric Company 177

Creating Clinical Content for Centricity Physician Office - EMR 2005 Insert a symbol You can use the Insert Symbol dialog box in the following places in the EMR application: RTF editor for text components and letter and handout templates RTF editor for patient banner, letter, handout, and chart document headers Define Quick Text dialog box Chart Update tab (right click in note) 1 Do one of the following: In RTF editor or Define Quick Text dialog box, click Insert Symbol. On the Chart Update tab, right-click and select Insert Symbol. 2 Select the symbol to insert. 3 If appropriate, choose to evaluate the symbol Continuously or When Inserted in Note. For more information about evaluating symbols, see When to evaluate data symbols on page 179. 4 Click OK. 5 If necessary, edit the inserted symbol.!!! Once you ve inserted a data symbol or function, you may need to adjust the syntax. For example, Insert Symbol inserts an item as a separate expression, enclosed in braces. If you insert a data symbol or function into another MEL expression, you need to remove the extra braces to prevent compiler errors. See About MEL syntax on page 193. Finding symbols and functions The Insert Symbol dialog box displays different sets of data symbols depending on where it appears. For example, location of care symbols (LOC.ADDRESS1, LOC.ZIP) appear only in the RTF editor for letter and handout headers. For more information about Insert Symbol options in different RTF editors, see Chapter 9, Use data symbols with MEL in EMR. 178 2006 General Electric Company July 2006

When to evaluate data symbols Some symbols should be used in certain contexts even though they appear in the Insert Symbol dialog box. For example, inserting data symbol functions that do not have default arguments in the chart note will cause compiler errors. See Using data symbol functions with arguments on page 183. It may be quicker to search for a data symbol than to scroll the list looking for it. Search for a symbol 1 Open the Insert Symbol window. 2 Type a few characters from in the symbol you re searching for. For example, if you re searching for a symbol related to orders, type in ord. 3 Indicate where these characters appear in the name: To match characters at the start of a symbol name, select From Start of Name. To match characters anywhere in the symbol name, select Anywhere in Name. 4 Click Search. You see symbols that match your search criteria. When to evaluate data symbols When you insert symbols used in chart notes, such as those used in quick text or text components, you need to tell the EMR application how often to 2027167-002 Rev B 2006 General Electric Company 179

Creating Clinical Content for Centricity Physician Office - EMR 2005 update the data they represent based on new chart information. You do this in the Insert Symbol dialog box. Choose one of these options for evaluating symbols When inserted in note. This is the default setting. The data symbol is evaluated once when you first insert it.the value the data symbol has at that instant is saved in the chart note and doesn t change. The data symbol is inserted as an expression, enclosed in braces, like this: {PATIENT.LASTNAME} Many data symbols do not need to be evaluated continuously, such as those for information that doesn t change often, like addresses, names, and insurance information. Continuously. The data symbol is inserted in the note and displayed in red to note that it can change. Values may change until the chart document is signed, even if it has been put On Hold. The time of evaluation is important when you are using functions that involve frequent changes in patients conditions. When you insert a text component that contains data symbols while an update is In Progress, the information in the chart can continue to change until the update is signed. If a data symbol is only evaluated at the time it is inserted, you may not see the most recent changes from this chart update or from others. Data symbols to be evaluated continuously are enclosed in single quotes within a second pair of braces like this: {'{OBS_LIST_CHANGES()}'} This syntax tells the EMR application to keep evaluating the symbol until the note is signed. 180 2006 General Electric Company July 2006

Types of data symbols Types of data symbols Don t evaluate symbols continuously unless it s important to see the latest possible data. Continuously evaluated symbols can cause the EMR application to run slower. Data symbol reference pages in Data Symbols Help (available from the EMR application and Encounter Form Editor) recommend when each symbol should be evaluated. See also Chapter 16, Advanced topics. for detailed discussion of when and how data symbols are evaluated in the EMR application. Sometimes it s important to know what type of value is returned by a data symbol or function, because values are not always interchangeable. In the Insert Symbol dialog box, each symbol is assigned a type: text, number, Boolean, function, or date. The type helps you determine how to use the symbol. For data symbols, the type indicates the type of value returned: text, date, number, or Boolean (true or false). For data symbol functions, the type simply indicates that the item is a function. This reminds you that the function may need additional arguments to work properly. For more about value types in MEL, see About value types on page 206. 2027167-002 Rev B 2006 General Electric Company 181

Creating Clinical Content for Centricity Physician Office - EMR 2005 Text symbols String: A text value consisting of one or more alphanumeric characters Text symbols return a string of letters or numbers, such as a name or other information about a patient, document, location of care, or user. Here are some examples: Data symbol Value returned Sample value PATIENT.LASTNAME Patient s last name Sanders DOCUMENT.ACTIVESUMDESC PATIENT.EMPLSTATUS LOC.CITY PATIENT.ZIP Summary description of active document Patient s employment status City of the location of care selected for printing Code of five or ten characters (five digits, a hyphen, and a four-digit extension) Office procedure Self-employed Portland 97021 Number symbols Boolean symbols Number symbols return numeric values. Only two symbols listed in the Insert Symbol dialog box have the type Number. However, while these two symbols, PATIENT.REFMDID and PATIENT.RESPPROVID, initially retrieve a numeric ID, they actually return a text string containing the provider s name associated with the ID number. Boolean symbols return True or False. The Insert Symbol dialog box lists only one Boolean symbol. Data symbol PATIENT.SENSITIVECHART Question Is the patient s chart marked sensitive? 182 2006 General Electric Company July 2006

Using data symbol functions with arguments Date symbols Date symbols return a date in the format mm/dd/yyyy. Here are some examples: Data symbol Description Sample value PATIENT.DATEOFBIRTH Patient s date of birth 07/03/1956 DOCUMENT.CLINICALDATE The clinical date and time for the current document 02/06/1999 3:59 PM._TODAYSDATE The current date 06/12/1999 Certain data symbol functions return dates as simple text strings that look like date values, for example, DATESTAMP, SUBTRACTDATES, and LASTNOTEDATE. Using data symbol functions with arguments Data symbol functions represent more complex data than the other types. Special rules govern their use. Many data symbol functions require you to use arguments additional information that describes how to interpret or display the data represented by the symbol. Arguments include observation term short names, formatting instructions (such as comma or list), the type of insurance, and other codes. For more information about using data symbol functions with arguments, see Data Symbols Help in the EMR application or Encounter Form Editor. 2027167-002 Rev B 2006 General Electric Company 183

Creating Clinical Content for Centricity Physician Office - EMR 2005 Syntax for arguments Here are some examples of data symbol functions: Data symbol function What it does... Format Sample value LASTOBSVALUEDATE MEDS_AFTER INS_ADDR Displays the last observation and the date and time it was made for the specified term. Displays active medications after the current update is finished. Can be formatted as a list or comma-separated. Displays in address label format the name and address of the patient s primary, secondary, other, or inactive insurance company. {LASTOBSVALUEDATE ("cholesterol")} {MEDS_AFTER("LIST"} {INS_ADDR("P")} 200 (04/01/99 1:00:00 PM) INDOCIN CAP 25MG 1 tid A-HYDROCORT INJ 250MG Best Insurance 825 NE Roosevelt Portland, OR 97312 When you use data symbol functions, you need to know what arguments and syntax are required. You can find the syntax, arguments, and other options for each symbol in Data Symbols Help in the EMR application or Encounter Form Editor. Here are some basic rules for formatting data symbols functions: Enclose text arguments in quotes. Many arguments are text strings enclosed in quotes within the parentheses following the function name. {LASTOBSDATE("WEIGHT")} {ALL_PRIOR("LIST")} Separate arguments by commas. If the function requires more than one argument, enclose each argument in quotes and separate arguments with commas. {ADDDATES("2/1/1999", "2", "0", "0")} Don t quote functions used as arguments. If you use another data symbol or function as an argument, don t enclose it in quotes. If it requires arguments, include them in parentheses, within quotes. {ADDDATES(DATESTAMP(OBSANY( pap smear ),"2","0", "0")} {LISTSUBSET(OBS_LIST_CHANGES(), "list", "#", "contains", "any")} {OBSNOW("Height",OBSPREV("Height"))} 184 2006 General Electric Company July 2006

Using data symbol functions with arguments Always include function parentheses. Some functions do not require arguments, or may default to a specific argument if none is supplied. For these symbols, you must nonetheless include parentheses, because they tell the EMR application to treat the symbol as a function. {DATESTAMP()} {ALL_PRIOR()} defaults to {ALL_PRIOR("LIST")} Match argument value type. If you use a data symbol as an argument in a function that returns a value type different than the value the function expects, you will get an error. For example, ADDDATES expects the date argument to be a string. If you use PATIENT.DATEOFBIRTH as the argument, you need to convert it from a date to a string first. See About value types on page 206. Use observation terms as arguments Observation term: The short name of an observation used to retrieve its value Several data symbol functions require the short name of an observation term as an argument so that the functions can return a specific observation. This section explains how to use observation terms as arguments. EMR observation terms include a short name, a longer description, and other information. To use an observation with a data symbol, you must use the short name, which is always 12 characters or less. The following table lists data symbol functions that use observation terms: This data symbol ACTIVE_OBSERVATIONS LASTOBSDATE LASTOBSDATETIME LASTOBSVALUE LASTOBSVALUEBYLOC LASTOBSVALUEBYUSER LASTOBSVALUEDATE Shows this Connects to a flowsheet view on an encounter form. Shows all signed observations. Does not include observations entered during the current encounter. The date of the most recent observation, including the current update. The date and time of the most recent observation, including the current update. The most recent observation entered, including the current update. Returns the last signed observation value entered in a document that shares the same location of care as the current document. Returns the last observation value signed by the currently logged in user for the specified observation term. The most recent observation and the date and time it was entered, including in the current update. 2027167-002 Rev B 2006 General Electric Company 185

Creating Clinical Content for Centricity Physician Office - EMR 2005 This data symbol LAST_SIGNED_OBS_DATE LAST_SIGNED_OBS_DATETIME LAST_SIGNED_OBS_VALUE LAST_SIGNED_OBS_VALUEDAT E LIST_OBS LISTOBSVALUEBYLOC LISTOBSVALUEBYUSER OBS_LIST_CHANGES OBSANY OBSMODIFIERANY OBSTAGANY OBSNOW OBSMODIFIERNOW OBSTAGNOW OBSPREV OBSMODIFIERPREV OBSTAGPREV Shows this The date of the last signed observation, not including the current update. The date and time of the last signed observation, not including the current update. The last signed observation, not including the current update. The last signed observation and the date and time it was entered, not including the current update. Lists all observation values and dates or values for a specified observation term. Returns a list of signed observation values entered in documents that share the same location of care as the current document Returns a list of signed observation values signed by the currently logged in user for the specified observation term. Lists all observations entered, changed, or removed during the current update. The most recent observation, observation comment, or observation tag. If there is a new one for the current chart update, the symbol shows it. Otherwise, the symbol shows the most recent one. The observation, comment, or tag entered during the current chart update. If there was no entry for this observation during this update, the symbol returns nothing. The most recent observation, comment, or tag entered before the current chart update. If there is no observation, comment, or tag for a previous update, the symbol returns nothing. Doesn t reflect changes in the current update. 186 2006 General Electric Company July 2006

Using data symbol functions with arguments This data symbol OBSUNIT POTENT_OBSERVATIONS SUM_ACTIVE_OBSERVATIONS Shows this The unit of measurement used for an observation term. Connects to a flowsheet view on a form component. Shows all signed observations and unsigned observations. Connects to a flowsheet view on an encounter form. Shows only the latest values for signed observations. Does not include observations entered during the current encounter. The EMR application includes thousands of observation terms. Updates containing the latest observation terms are always available on the Centricity Physician Office Services Web site in the EMR KnowledgeBank (http://knowledge.medicalogic.com/). Sample function with an observation term name argument In the following example, a data symbol function in a text component takes as its argument the observation term short name Weight to retrieve the patient s current weight. Enter an observation term with a data symbol 1 Go to Setup Settings and select Chart Documents > Text Components. 2 To create a new text component, click New in the right column. You see the Text Component RTF editor. 3 In the text entry area, type: Weight: 4 Right-click and select Insert Symbol. 5 In the Insert Symbol window, search for and select the OBSANY data symbol. 6 For Evaluate Symbol, choose Continuously. 7 Click OK. The Insert Symbol dialog box closes, and the inserted text and expression looks like this: Weight: {'{OBSANY()}'} 8 Click between the function parentheses and type: "Weight" (including the quotation marks) The resulting text and expression should look like this: Weight: {'{OBSANY("Weight")}'} 2027167-002 Rev B 2006 General Electric Company 187

Creating Clinical Content for Centricity Physician Office - EMR 2005 When the text component is used in a chart note, the EMR application displays the label Weight:" followed by the latest observation for the patient s weight. When the value changes, so does the chart note, until it is signed. It does not matter whether you type observation terms in uppercase or lowercase. For more information about the formatting of data symbols and MEL expressions, see About MEL syntax on page 193. Look up observation terms When you insert a data symbol function that requires an observation term, you must type in the observation term you want the function to display. Here are some options for finding the term you need: Look up the term in Inquiries/ Reports. Print a report of observation terms from Inquiries/Reports. Use Centricity Physician Office Term Finder in Encounter Form Editor. Search in Inquiries. Search in Setup under Flowsheet Views. The Centricity Physician Office Term Finder in Encounter Form Editor has several features to help you locate observation terms, including keyword searching. If you have installed Encounter Form Editor, it may be easier to use the Centricity Physician Office Term Finder than to look up observations in the EMR application. For more information, see Creating Encounter Forms. Look up observation terms in EMR In the EMR Inquiries/Reports module, you can search for an observation term, write it down, then type it into Insert Symbol elsewhere in the EMR application. View the list of observation terms 1 Click Reports, then click the Inquiries tab. 2 In the Find list, select Patients. 3 In the Where list, select <Observation>(any entry). 188 2006 General Electric Company July 2006

Look up observation terms You see the Select Observation window. 4 In Search For, type a word or part of a word that will help you find the observation term. The EMR application searches for names or descriptions that start with those letters. 5 In the Search On list, select Name or Description. 6 Click Search. 7 To close the Select Observation window, click OK or Cancel. Example To find the observation term for Serum Cholesterol, you might type cho in the Search text box. When you click the Search button and search on Description, you see a short list of items that include cho. Find the term that you want and write it down. For example, "Cholesterol" is the observation term for serum cholesterol. 2027167-002 Rev B 2006 General Electric Company 189

Creating Clinical Content for Centricity Physician Office - EMR 2005 Tips on searching for observation terms Use wildcards With wildcards, you can search for observation terms or descriptions based on partial words. Use this wildcard... To do this... % Match any characters. For example, type %immu and select Search on Description to find all observation terms with immu anywhere in the description. This search would find: chicken pox immunization immunization for measles but not: flu vaccine _ (underscore) Match any single character anywhere in the line. For example, enter a_b to find all observation terms that begin with a, any single character, and then b. This search would find: AFB STAIN albumin but not: abdomen exam Search using observation term description If you don t remember how to spell an observation term, you can search for its description with partial spellings. To find Electrocardiogram, use the Search On list and select Description. In the Search field enter %elec to search for all descriptions that contain the letters elec. To locate all terms for hepatitis immunizations, you can enter multiple wildcards. In the Search On list, select Description. 190 2006 General Electric Company July 2006

Look up observation terms In the Search For field, enter %hep%immu, to search for all descriptions that contain those characters anywhere in the description. You see all terms for hepatitis immunizations, as shown. Print a report of observation terms Use the following procedure to print a report of all observation terms in the EMR application. Print the list of observation terms 1 In the main toolbar, click Reports, then select the Reports tab. 2 Select one of these reports: Observation Terms, by Abbreviation Observation Terms, by Category Observation Terms, by Description The Observation Terms, By Category report is probably most useful. It is a lengthy report of 500+ pages. 3 Click Print or Preview to review the report online. 2027167-002 Rev B 2006 General Electric Company 191

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CHAPTER 8 Write MEL expressions About MEL syntax 193 Write if-then-else expressions 196 Use MEL operators 202 Use case expressions 204 Use mathematical operators 205 About value types 206 Use MEL rich text formatting functions 207 About MEL syntax In this chapter you will learn about: The syntax for MEL expressions Writing expressions in MEL long and short forms Writing conditional MEL expressions using operators and value types, and making calculations Using special MEL utility functions to format text MEL expressions must be written in a specific syntax so that the EMR application can interpret your instructions correctly. Here are some rules for writing MEL expressions: Enclose expressions in braces. Each expression is enclosed within braces {expression}. This tells the EMR application to execute (evaluate) the statements within the braces. Choose when to evaluate. When a note template is inserted, it is immediately evaluated once. It has the value that was returned at that point in time. This line: {OBSANY("Weight")} returns the patient s weight currently stored in the EMR database. This does not apply to form translations. Expressions included in text translations will automatically re-evaluate if information changes. 2006 General Electric Company

Creating Clinical Content for Centricity Physician Office - EMR 2005 To evaluate the same expression continuously, place it between single quotes within a second set of braces. This syntax tells the EMR application to reevaluate the expression whenever its value changes. {'{OBSANY( Weight )}'} is reevaluated each time a new value for this patient s weight is entered in the EMR application. Example. Additional braces and quotes may be required as the expression becomes more involved. For example, blood pressure consists of two observations, BP Systolic and BP Diastolic, represented by two separate expressions. To display them together, use the following formats: Evaluate when inserted in note {OBSANY("BP systolic")}/{obsany("bp diastolic")} This expression gives a result like this: 120/80 In this case, the EMR application evaluates and displays the result of the first expression, then the slash, and then evaluates and displays the second expression. Evaluate continuously {'{OBSANY("BP systolic")}/{obsany("bp diastolic")}'} Notice that in this case the outer set of braces and quotes goes around the combination of systolic and diastolic blood pressures in this case. This tells the EMR application to evaluate both expressions within the outer braces should be evaluated whenever either of the BP values is updated. Enclose text arguments in quotes. Within the function parentheses, enclose text string arguments in single or double quotes, separated by commas. {OBSNOW("weight")} {ORDERS_NEW("list", t )} {ADDDATES("3/1/97","2","0","0")} {OBSNOW('weight')} Don t quote functions used as arguments. If you use another data symbol or function as an argument, don t enclose it in quotes. If it requires arguments, include them in parentheses, within quotes. {ADDDATES(DATESTAMP(OBSANY("pap smear"),"2","0", "0")} Alternate single and double quotes when nested. The EMR application looks for matching pairs of quotes when evaluating expressions. When an expression contains nested sets of quotes, you should alternate single and double quotes to avoid confusion. {"{OBSNOW('Weight')}"} evaluates correctly because the outer double quotes and inner single quotes match each other. {"{OBSNOW("Weight")}"} does not evaluate correctly, because the EMR application tries to match the first double quote to the double quote before Weight. 194 2006 General Electric Company July 2006

About MEL syntax Enclose text inside expressions in quotes. Inside expressions, any text, blank lines, or spaces you want to display should be enclosed within quotes. The EMR application ignores spaces not enclosed in quotes, so you can use them to make the expression easier to read. Example: {if PATIENT.SEX == 'M' then "Dear Mr. " else "Dear Ms. " endif} Include spaces and punctuation in expressions that contain both text and data symbols. In the preceding example, the MEL expression includes a space after Ms. and Mr. so there will be a space between the title and the patient s last name. The subsequent expression displays the patient s name followed by a colon (:) at the end of the line. Display text is plain. Displayed text outside expressions does not have to be enclosed in quotes. {OBSANY("BP systolic")}/{obsany("bp diastolic")} The slash between the two expressions is automatically displayed. Concatenation. To join items of quoted text, or to join text with the value represented by a data symbol, use a plus sign (+). Example: This line: {"Dear Ms. " + PATIENT.LASTNAME + ":"} returns this value: Dear Ms. Jones: Text to be displayed from within an expression, for example, "Dear Ms. " or ":", is always enclosed in quotes, but a data symbol returning text (PATIENT.LASTNAME) is not. Case insensitivity. In most cases it doesn t matter whether you use uppercase or lowercase letters in data symbols, functions, or observation terms. Text items outside of expressions retain the case you give them. When evaluating equality with text values, it is safest if both values being compared are the same case, especially if you are not certain about the return value. See Test for returned values on page 200. For the syntax of each data symbol and function, see Using data symbols in EMR help or Encounter Form Editor help. 2027167-002 Rev B 2006 General Electric Company 195

Creating Clinical Content for Centricity Physician Office - EMR 2005 Write if-then-else expressions Often you want to tell the EMR application to insert different information depending on certain conditions. You can use if-then-else expressions to insert different information depending on conditions that you set. An if-then-else expression has the following logical structure: if conditional statement is true, then execute action statement else (if conditional statement is false) execute alternate action statement endif (end if expression) You can write if-then-else expressions using a long form or a short form. Long form MEL syntax is verbose but easier to understand. The long form is also used in complex expressions. Short form MEL syntax is terse and compact. Short form is most often used in formatting text and other simple MEL expressions. Once you become comfortable using the long form, you can switch to the short form syntax for simple expressions. The following is a simple example of a long-form if-then-else expression: {if PATIENT.SEX == 'M' then "This patient is male." else "This patient is female." endif} Logical operator: Unlike numerical operators used in calculations, logical operators compare values and return a value of True or False. This expression uses the logical operator (==)which means "equal to". For more on logical operators, see Use MEL operators on page 202. The table below shows how MEL syntax was used to create this expression, with MEL statements on the left and their meaning on the right. This part of the expression... Means this... { Begin expression if PATIENT.SEX =='M' then "This patient is male." else If it s true that this patient s sex is male, then... Insert This patient is male in the note, letter, or handout However, if the statement is false, then... 196 2006 General Electric Company July 2006

Write if-then-else expressions This part of the expression... "This patient is female." endif Means this... Insert This patient is female in the note, letter, or handout End of if-then-else conditional statements } End expression Rules for long form if-then-else expressions Here are a few basic rules for writing long form if-then-else expressions. Use braces correctly. The if-then-else expression must be enclosed in braces {}. However, don t use braces inside an if-then-else expression. When you insert a data symbol using the Insert Symbol dialog box, the symbol is inserted as an expression and enclosed within braces. If you insert a data symbol into an expression, you must remove the braces around the symbols. Example: This symbol reference causes an error in if-then-else expressions: {if {PATIENT.SEX} == 'M'...} After if, the EMR application expects to see a statement comparing two values that evaluates to true or false. However, the expression {PATIENT.SEX} cannot be compared to the value M. The value returned by PATIENT.SEX can be compared to the value M. Use double (") or single quotes (') around the value to which the data symbol is compared. Example: if PATIENT.SEX == 'M' then... If you use double quotes, be sure you use the double-quote character ("), not two single-quote characters in a row. Double-check your conditions. Make certain that the condition you set up in your if statement can be evaluated by the EMR application. If the EMR application cannot accurately evaluate the values you give it, you may get an incorrect result. For example, use only data symbols and functions that return short values in the if portion of an if-then-else expression, especially if you are using the == operator. Data symbol functions that return a list of words or phrases may not evaluate as equal to a single item. Example: if ALL_AFTER("comma") == "Penicillin VK"... This statement is not true unless Penicillin VK is the patient s only allergy, which may not be the case. Here s a statement that would accurately test for Penicillin VK in the patient s allergy list: if match(all_after("comma"), "Penicillin") > 0... 2027167-002 Rev B 2006 General Electric Company 197

Creating Clinical Content for Centricity Physician Office - EMR 2005 Here the match function looks for the text "Penicillin" in the list generated by ALL_AFTER(). It returns the starting location of the first instance of penicillin in the list. If the value is greater than 0, we know that penicillin is in the list. You can use a function that returns a list of values in the if portion of the expression in the following circumstance: {if PROB_PRIOR() <> "" then "Patient has a problem list." else "Please create a problem list for this patient." endif} This expression uses the logical operator <>, which means "not equal to". For more about logical operators, see Use MEL operators on page 202. In this case, you are not asking the EMR application to compare the list with a value, only to test whether it is empty. For more about evaluating conditions, see Test for returned values on page 200. It s fine to use a data symbol that returns a list of values in the then-else portion of the expression. In the following example, if the patient s cholesterol level is over 240, the EMR application lists current problems: { if OBSANY("Cholesterol")>240 then PROB_AFTER("LIST") endif } Don t forget ENDIF. Each if line must be concluded at some point with an endif line. Example: {if PATIENT.SEX == 'M' then "Dear Mr. " + PATIENT.LASTNAME + ":" else if PATIENT.SEX == 'F' then "Dear Ms. " + PATIENT.LASTNAME + ":" else "Dear " + PATIENT.FIRSTNAME + " " + PATIENT.LASTNAME + ":" endif endif} Use spaces or tabs to indent the text in an if-then-else expression. This helps you keep track of how many if lines there are so you can include the right number of endif lines. 198 2006 General Electric Company July 2006

Write if-then-else expressions Long form vs. short form MEL syntax Simple if-then-else expressions can be written using either the long or short forms. Here s a typical long form expression: {if OBSNOW("Chief Cmplnt") == "" then "" else "Chief Complaint: " + OBSNOW("Chief Cmplnt") + " " endif} This expression says: if there is no new observation for Chief Complaint, include nothing in the chart note; if there is a new observation, include the label; Chief Complaint: and the observation, then a hard return. The EMR application will display a new line if you type a quote, press Enter, and then type another quote. This will not work, however, in data displays on a form. Here s the same example rewritten in short form MEL syntax: {if OBSNOW("Chief Cmplnt") == "", "", "Chief Complaint: "+ OBSNOW("Chief Cmplnt")+ " "} Notice that the first and second commas are substituted for the keywords then and else, and endif is omitted. Here s a detailed breakdown of the short form syntax for this expression: This part of the expression... Means this... { Begin MEL expression if OBSNOW( Chief Cmplnt )=="", then... If there is no entry for Chief Complaint... display nothing..., else... "Chief Complaint: "+ OBSNOW("Chief Cmplnt") + " Display or print Chief Complaint: followed by the observation and a hard return. "} End of MEL expression Using short form syntax The short form syntax helps save space when you have many lengthy text items to display. The following example is a fragment of a chart note with a short form if-then-else expression. 2027167-002 Rev B 2006 General Electric Company 199

Creating Clinical Content for Centricity Physician Office - EMR 2005 GU: {if PATIENT.SEX =='M',"denies hematuria, frequency, urgency or dysuria","denies menstrual irregularity, vaginal discharge, frequency, urgency, or dysuria"} This expression displays denies hematuria, frequency, urgency or dysuria if the patient is male, and denies menstrual irregularity, vaginal discharge, frequency, urgency, or dysuria if the patient is female or the patient s sex is unspecified. The short form format can also handle multiple expressions. The following example prints a short remark about the patient s cholesterol level: {if (OBSANY("cholesterol"))=="", "no test", if (OBSANY("cholesterol"))>240,"high", if (OBSANY("cholesterol"))>200,"borderline high","low"} Rules for short form if-then-else expressions Test for returned values Here are the rules that apply to short form if-then-else syntax: Use braces correctly. Like long-form expressions, the short-form expression must be enclosed in braces { }. Use commas instead of key words.the first comma after the if stands for then; succeeding commas stand for else, until the next if. Be careful to enclose any commas you want used as text inside quotes. Otherwise the EMR application may interpret the comma as part of an if statement. Don t use ENDIF. Endif is not used with short form syntax. For if-then-else expressions to work, they must test for the correct value. Here are a few more rules for special cases: Test for the presence of data. Always test in your if-then-else expression whether the observation data you are using as your condition actually exists. If no data exists, the expression may return an incorrect value. To test for the presence of data, use the following expression format. The two quotes represent an empty string (no value) and must be placed together with no spaces in between. For example: {if (OBSANY("cholesterol") == "" then "No cholesterol test was performed." } 200 2006 General Electric Company July 2006

Write if-then-else expressions Although both the assignment operator (=) and the Boolean operator (==) can be used to test for equality, = is also used to assign, or change, values. It s safer to use the Boolean operator (==), because it compares the values and returns True or False. If you use the assignment operator and your syntax is incorrect, you may inadvertently change data or receive an invalid result. In Encounter Form Editor, you should always use == to test for equality. Comparison: An expression that compares two items using the operators <, >, =<, =>, =, ==, or <> Check shorthand value names. Certain data symbols return either a short or long form of their value, depending on where they are used. When used in if-then-else expressions to make comparisons, the short value is used. The data symbols that return short values in comparison expressions are PATIENT.SEX, PATIENT.PSTATUS, PATIENT.MARITALSTATUS, PATIENT.RACE, and PATIENT.EMPLSTATUS. For example, in the case of a female patient, this line: {"This patient is " + PATIENT.SEX} returns the full value Female because no comparison is made. This line: {if PATIENT.SEX == "F" then "girl" else "boy" endif} returns girl because a comparison is made and the short value F is used. This line: {if PATIENT.SEX =="Female" then "girl" else "boy" endif} returns boy. Since the shorthand is used for comparisons, the value of PATIENT.SEX is "F", not Female. This comparison yields an inaccurate result. Check the case of values. Be sure to specify the value you're testing for in the proper case. Although you can use mixed case for symbol names and arguments, when comparing to returned values the case must match exactly. For example, the expression: {if PATIENT.SEX == "m"... } is always false, because the symbol returns M. 2027167-002 Rev B 2006 General Electric Company 201

Creating Clinical Content for Centricity Physician Office - EMR 2005 Use MEL operators If you are unsure about the case of a return value, you can convert all characters to upper or lower case to ensure an accurate comparison. For example, the following expression will give an accurate comparison, regardless of the case used to type in the last name. {if toupper(patient.lastname) == "SMITH...} For more information about using MEL utility functions toupper or tolower to convert text to upper or lower case, see Using data symbols in EMR help or Encounter Form Editor help. Watch out for typing errors in conditions. Make sure you type returned values exactly as they are returned by a data symbol. For example, the expression: {if PATIENT.SEX == " M"...} is always false, because the returned value does not include spaces before it. The if-then-else expressions included so far have used the logical operators (==) and (<>). Logical operators compare values and return a value of True or False. Numerical operators are used in calculations and return numbers. You can use any logical or numerical operator in a MEL expression. The following table lists the most common operators. Some additional operators are available; for a complete list, see Operators on page 244. This operator... Means this... == Equal to <> Not equal to > Greater than < Less than >= Greater than or equal to <= Less than or equal to + Add, or concatenate - Subtract * Multiply / Divide = Assign value // Not an operator. Indicates programming notes or comments. 202 2006 General Electric Company July 2006

Use MEL operators Make complex comparisons The following example shows how to use other MEL operators to make comparisons in an if-then-else expression involving the patient s cholesterol. Always test for the presence of data. In some cases the EMR application may assume that the last conditional statement in your expression is true if the data doesn t exist. You can test for the presence of data by typing two double quotes together to represent an empty value. Don t separate them with a space. This part of the expression... Means this... { Begin MEL expression if OBSANY("cholesterol")=="" then "No cholesterol test was performed." else if (OBSANY("cholesterol"))>240 then "Your cholesterol is " + OBSANY("cholesterol") + ", which is in the high range (over 240)." else if (OBSANY("cholesterol"))<200 then "Your cholesterol is " + OBSANY("cholesterol") + ", which is in the normal range (under 200)." else "Your cholesterol is " + OBSANY("cholesterol") + ", which is borderline high (between 200 and 240)." endif endif endif If there is no cholesterol observation for the patient, then... Display No cholesterol test was performed. But if the patient s cholesterol is greater than 240, then... Display Your cholesterol is [value,] which is in the high range. But... If the patient s cholesterol is less than 200... Display Your cholesterol is [value,] which is in the normal range (under 200). Otherwise, if the patient s cholesterol isn t either of the above... Display Your cholesterol is [value,] which is borderline high (between 200 and 240). End of third if condition End of second if condition End of first if condition } End of MEL expression 2027167-002 Rev B 2006 General Electric Company 203

Creating Clinical Content for Centricity Physician Office - EMR 2005 Use case expressions Another way to include conditional statements in your MEL expression or function is to use a case expression. A case expression is a shorter form that saves space when you have three or more possible conditional values, or cases to test. Syntax for case expressions Case expressions have the following simple syntax rules: Use braces. Like other expressions, the case expression must be enclosed in braces { }. Use case expression format. A set of case condition statements begins with cond and ends with endcond. Enclose text in quotes. As in other expressions, text to be displayed or printed must be enclosed in quotes. Variable: a symbol or name that represents a value. To streamline your code, you can define variables at the beginning of the expression to represent the values returned by functions or calculations. This reduces the amount of text in your expression. Example. The following example is an alternate version of the cholesterol example on page 200 using a case expression. Note that the first part of the expression defines a variable chol to hold the value returned by the function OBSANY("cholesterol"). {chol=(obsany("cholesterol") cond case chol="" "no test performed" case chol>240 "high" case chol>200 "borderline high" case chol<=200 "normal" endcond } For more about variables, see Chapter 12, Values and variables. This part of the expression... Means this... { Begin expression chol = (OBSANY("cholesterol")) cond The variable chol is defined as (OBSANY("cholesterol")) to save typing later Begin case conditional statements. If one of the conditions takes place, execute the action 204 2006 General Electric Company July 2006

Use mathematical operators Use mathematical operators Example This part of the expression... case chol="" "no test performed" case chol>240 "high" case chol>200 "borderline high" case chol<=200: "normal" endcond You can also use operators to add, subtract, multiply, or divide numerical values. Use these operators only with observations such as Height, Weight, and Cholesterol, which have numerical values. The EMR application will convert some non-numerical values to numerical values if used with the operators. This is called implicit conversion. However, some values don t make sense as numbers and aren't converted. For example, you can t add the value 2 to the value high. Sometimes you need to explicitly convert numerical values to text strings or vice versa. The str and val functions accomplish this. For more information about converting values, see Convert values using val and str on page 207. Calculations proceed from left to right and follow standard rules of operator precedence: 1 Calculations enclosed in parentheses 2 Items with exponents 3 Multiply and divide operations 4 Add and subtract operations Means this... If chol has no value, then Display no test performed If chol is greater than 240, then Display high If chol is greater than 200, then Display borderline high If chol is less than or equal to 200, then Display normal End case conditional statements } End of expression Here is a sample expression that calculates a patient s target exercise heart rate range. The expression uses the data symbol PATIENT_AGE, which does not appear in the Insert Symbol dialog box, but you can type it in. 2027167-002 Rev B 2006 General Electric Company 205

Creating Clinical Content for Centricity Physician Office - EMR 2005 About value types Parentheses are used to subtract the patient s age from 220 before multiplying the result by.6 or.8. Here s the code fragment: Your target heart rate while exercising should be between {220 - PATIENT_AGE() *.6} and {220 - PATIENT_AGE() *.8} beats per minute. This part of the expression... Your target heart rate while exercising should be between Means this... Displayed before the calculation. {(220 - PATIENT_AGE()) Subtract the value returned by PATIENT_AGE from 220. *.6} Then multiply the result by.6 and return the result. and Display this text between the calculated values. { (220 - PATIENT_AGE()) Subtract the value returned by PATIENT_AGE from 220. *.8} Multiply the result by.8 and insert the result. beats per minute. Display this text after the calculation. If you used this example for a 61-year old patient, the letter or patient handout would read: Your target heart rate while exercising should be between 95.4 and 127.2 beats per minute. Most values returned by data symbols are strings. A handful are numbers or dates. All MEL functions are designed to manipulate one type of value or another. If you use the wrong type of value as an argument, some functions try to convert it to a value they can use. Many others do not, so you should check in EMR help ( Using data symbols ) or Encounter Form Editor help to determine the required value. String value. A string is one or more characters of text. Strings can include letters, spaces, numbers, dates, and characters such as slashes and quotation marks. Even if a string contains a number, MEL still sees it as a string. MEL converts strings to numbers when they are used with mathematical operators. Number value. A number is a mathematical value that can be used in a calculation. MEL recognizes it as a number rather than as a string or a date. 206 2006 General Electric Company July 2006

Use MEL rich text formatting functions Convert values using val and str Date value. A date is a special value displayed in the form 01/01/2000. PATIENT.DATEOFBIRTH and DOCUMENT.CLINICALDATE return dates. However, the data symbol functions ADDDATES, SUBTRACTDATES, and DURATIONDAYS expect their date arguments to be strings. You cannot use a symbol that returns a date value as an argument with these functions; you must convert their results to strings first using the str function. You can convert values to strings or numerical values using the MEL functions val and str. In the following example, str converts a date to a string so it can be used with ADDDATES. {ADDDATES(str(PATIENT.DATEOFBIRTH), "2", "0", "0")} The value returned is a date two years after the patient s date of birth. See Using data symbols in EMR help or Encounter Form Editor help to learn more about ADDDATES, str, and val. Use MEL rich text formatting functions fmt vs. cfmt With two special MEL functions, fmt and cfmt, you can apply rich text formatting (RTF) to the output of your MEL expressions. Rich text formatting includes font styles bold, italic, and underlined, and variable font sizing from 4 to 72 points. fmt syntax These two functions have different properties and uses. Use fmt to format simple text strings. The text can be a MEL expression or plain text. Use fmt for small, discrete items and printed form translations. Use cfmt to format values and text conditionally. You can also specify text to precede and follow the formatted item. Use it in place of ifthen-else expressions. The EMR application displays the formatted value and text only if it is not blank. cfmt is especially useful for chart update text translations, which only display form item labels when a value is entered. The Encounter Form Editor s default translations use fmt and cfmt functions. fmt (expression, format_code) expression can be any MEL expression that returns a string. This includes text you type, the result of a data symbol or function, or a combination. 2027167-002 Rev B 2006 General Electric Company 207

Creating Clinical Content for Centricity Physician Office - EMR 2005 Format codes include: B, BOLD Bold I, ITALIC Italic U, UNDERLINE Underline n or -n The number of points to increment or decrement the font size, for example, 2, -1 The default font is Arial 10 pts. Examples Syntax rules fmt examples This line: {fmt(obsany("height"), "B"))} returns 65 This line: {fmt(obsany("height"), "B, I")} returns 65 This line: {fmt(obsany("height"), "B, 2")} returns 65 This line: {fmt("comments:", "B")} returns Comments: Observe argument order. Within the function parentheses, the first argument is the expression to be formatted, the second is the format code. If you mix up the order, you may not get the result you expect. Enclose arguments in quotes, separated by commas. Enclose arguments in quotes, unless it is a data symbol or another function. Enclose the format code(s) in quotes. Place multiple formatting codes within a single set of quotes, separated by commas. (See the following example.) The following expressions come from the printed form translation for a form component comment field. (The temporary variables are generated by the Encounter Form Editor to hold the text entered by the user, if any.) {fmt("comments: ", "B")} {if DOCUMENT.TEMP_71183708_1_542091 = "" then fmt("..", "B,U") else fmt(document.temp_71183708_1_542091, "B,U") endif} 208 2006 General Electric Company July 2006

Use MEL rich text formatting functions The first expression displays a bold comments label. The second expression, prints a line if there is no comment or the comment text bold and underlined: Comments: worse with exertion or Comments:.. This part of the expression... Means this... { Begin MEL expression fmt("comments: ", "B") Print the word Comments: in bold } End MEL expression { Begin next MEL expression if DOCUMENT.TEMP_71183708_1_542091 = "" then fmt("..", "B,U") else fmt(document.temp_71183708_1_54209 1, "B,U") endif If the temporary variable does not contain anything... Then print a period followed by several spaces and then another period bold and underlined (this creates a line to enter comments on the printed form) Otherwise, if the variable does contain data, print the data bold and underlined End if condition } End second MEL expression cfmt syntax cfmt ((expression, format_code, [pretext, pretext_format_code, posttext, posttext_format_code]) expression is any MEL expression that results in a string. That includes text you type, the results of a data symbol or function, or a combination. pretext is optional text that appears before the value, often a label. posttext is optional text that appears after the value. Format codes include: B, BOLD Bold I, ITALIC Italic U, UNDERLINE Underline n or -n The number of points to increment or decrement the font size, for example, 2, -1 The default font size is 10 pts. 2027167-002 Rev B 2006 General Electric Company 209

Creating Clinical Content for Centricity Physician Office - EMR 2005 Examples: Syntax rules This line: {cfmt(obsany("weight"), "", "Weight: ", "B")} returns Weight: 155 This line: {cfmt(obsnow("weight"), "", "Current weight: ", "B", "lb", "B"} returns Current weight: 155 lb This line: {cfmt(obsnow("weight"), "B,-2", "Your weight is ", "", "lb")} returns Your weight is 125 lb Observe argument order. Within the function parentheses, the first argument is the expression to be formatted, the second is the format code(s), followed by optional pretext and codes and posttext and codes. Enclose arguments in quotes, separated by commas. Enclose arguments in quotes, unless it is a data symbol or another function. Enclose the format code(s) in quotes. Place multiple formatting codes within a single set of quotes, separated by commas. (See the following examples.) Use placeholders for unused arguments. Use a pair of quotes as a placeholder for arguments you don t use in the expression. For example, if you want to display text after the formatted expression but not before it, your expression should contain two pairs of quotes to indicate no preceding text and no formatting. You do not need placeholders for unused arguments at the end of the expression. For example, if your expression has no following text, you can omit the placeholders for this argument and its format code. 210 2006 General Electric Company July 2006

Use MEL rich text formatting functions cfmt examples The following expression comes from the Clinical Lists Update text component: {'{cfmt(prob_list_changes(),"","problems: ","B,1","","")}'} This part of the expression {'{ cfmt ((PROB_LIST_CHANGES(), Means this... Begin MEL expression and evaluate it continuously If a value for PROB_LIST_CHANGES exists, display it and the preceding and following text; otherwise don t display anything "", Don t format the value PROB_LIST_CHANGES, print as normal text "Problems: ", "B,1", Display Problems: before the value of PROB_LIST_CHANGES and insert a return Format Problems: in bold and one point size larger "","" Don t display formatted text after the value (you may leave these arguments out since they are at the end of the expression) ) End of arguments to cfmt }'} End of MEL expression Use cfmt and fmt in EMR form editors EMR RTF editor. RTF formatting is available through the toolbar in some parts of the EMR application. Where available, it can be used to format the output of a single data symbol or a simple numerical expression. However, you should use fmt and cfmt functions to format text whenever: Your MEL expression contains an if-then-else expression. You want the value returned by the MEL expression to be evaluated continuously. You want to format the output of any function or calculation. 2027167-002 Rev B 2006 General Electric Company 211

Creating Clinical Content for Centricity Physician Office - EMR 2005 Using the RTF editor to format the output of a MEL function can cause the function to break. Quick text. RTF formatting is not available. Encounter Form Editor. RTF formatting is not available through a toolbar in the Encounter Form Editor. However, you can use fmt and cfmt. See Chapter 9, Use data symbols with MEL in EMR, to learn more about using the RTF editor in the EMR application. 212 2006 General Electric Company July 2006

CHAPTER 9 Use data symbols with MEL in EMR Use the rich text format (RTF) editor 213 Create patient banners 216 Headers for letters, handouts, and chart documents 218 Text components and templates for letters and handouts 220 Quick text 229 Chart notes 231 Form components 231 You can use MEL and data symbols in many places in the EMR application to create and customize clinical content, including headers, banners, letter, handout and text templates, form components, and other items. This chapter tells you what you can do in each area and presents examples and tips for using MEL in the EMR RTF editors. Use the rich text format (RTF) editor Text components, letter and handout templates, headers, patient banners, and chart notes are all created using the RTF editor. The editor is a simple text tool like Microsoft WordPad, with spell-checking and basic text formatting features such as fonts and styles, text alignment, and lists. 2006 General Electric Company

Creating Clinical Content for Centricity Physician Office - EMR 2005 The RTF editor also provides access to the Insert Symbol dialog box so you can easily find and insert symbols, text components and forms. RTF editor options In the RTF editor, you can: Check spelling Set font, font size, and font style (bold, italic, underline) Set paragraph formatting, such as bullets, text alignment, and tabs Set margins (in Letters only) Apply borders and shading Insert graphics in letters Insert data symbols, dictation placeholders, form components, and document templates Write MEL expressions In addition to standard text formatting, the following options are available in certain EMR contexts. In this context... Use these options... Change header Insert symbol Insert page Set tabs Text component Insert symbol Handout Insert symbol 214 2006 General Electric Company July 2006

RTF editor options In this context... Use these options... Letter Insert symbol Set margins Document template Insert form Insert text component Chart note Insert form, insert text component Insert symbol Insert dictation Insert document template RTF editor tips Here are some tips for working with the RTF editor. For more information, press F1 for online help while using the RTF editor. Click here to insert a data symbol Use this toolbar to format your text Click here to set tabs (headers/banners only) Inserting symbols. The Insert Symbol dialog box offers different sets of symbols depending on what you are editing. For example, the RTF editor for the chart update and letter and handout headers includes the location of care (LOC) symbols. These symbols do not work in other contexts. Adjusting spacing. It is often difficult to adjust spacing correctly in the RTF editor, because data symbols and MEL statements can take more or less space than the text they produce. To work around this, create a draft component using sample data in place of symbols, then adjust the tabs and spacing to look the way you want it. Then replace the sample data with symbols and MEL expressions. Be sure to check the results with several different patients from the training database. Importing from other applications. You can paste text from other applications that support rich text format into the RTF editor, including WordPad and Microsoft Word. If you re more comfortable working in these tools, create your text in them and then paste it into the RTF editor. 2027167-002 Rev B 2006 General Electric Company 215

Creating Clinical Content for Centricity Physician Office - EMR 2005 Text copied from Word documents using macros or sophisticated formatting may cause problems when pasted into EMR documents. Using tables. You can also paste text that contains tables, indented paragraphs, or other formatting. Most of this formatting is retained in the RTF editor, although you may not be able to change it in the editor. Using graphics. You can copy graphics from another application and paste them into the RTF editor, but each graphic occupies its own vertical space. That means that you can t have a graphic with more than one line of text beside it. Graphics make sense for letterheads, but not patient banners, so be careful where you use them. They cannot be used in chart updates. See Headers for letters, handouts, and chart documents on page 218 for an example of graphics used in a header. To display or print a graphic with several lines of text next to it, use a table created in Microsoft Word. Place your graphic in one table cell and the text in another. Then paste the table into the RTF editor. Formatting symbols. You can apply formatting directly to data symbols and very simple MEL expressions using the RTF editor toolbar. Select the entire expression, including the braces, then click the style or format button to apply the formatting. Do not select and format functions or data symbols that evaluate continuously or functions that involve dates or calculations. The formatting codes inserted by the editor may cause errors. Create patient banners You can customize patient banners to show the information most useful to a provider during a patient encounter. Each user can set a preference for the banner they wish to use, or you can set preferences for a group or the entire enterprise. The patient banner can display up to three lines of text on the screen at legible font sizes. If your banner uses more lines, a scroll bar appears on the right side of the banner. Generally, you should avoid putting information in the banner that can t be seen on the screen, unless it is accessed infrequently. Before you create or modify banners, take some time to view the examples included with the EMR application. Included are banners that show protocols and the patient s responsible provider. 216 2006 General Electric Company July 2006

Create patient banners Create or modify a patient banner 1 Go to Setup Settings and select Chart > Patient Banner. 2 Do the following: To modify a banner, select an existing patient banner and click Change. To create a new banner, click New. You cannot create a new patient banner by opening an existing banner and changing its name. To create a banner based on an existing one, open the banner you want to use and copy its contents into a new banner. 3 In the RTF editor, add data symbols, MEL statements, and text to the banner. 4 If you are creating a new banner, type a name for the banner in the Name field. 5 To save the banner, click OK. View the patient banner 1 Log in to the EMR application as hwinston, password asdf. 2 Go to Setup Preferences and select Chart > Patient Banner. 3 Select the patient banner you created. 4 Return to the Desktop and open a chart or registration information for a patient. Do not use data symbols that push information, such as MEL_ADD_PROBLEM, in a banner. You will not be able to sign it or associate it with a document later. Examples Here are some examples of patient banners with the MEL code that produced them. In these examples, formatting has been added using the RTF editor format buttons. This variation on the default patient banner includes the guarantor s name if one exists. No phone numbers have been entered for Benjamin, so none appear in the banner. 2027167-002 Rev B 2006 General Electric Company 217

Creating Clinical Content for Centricity Physician Office - EMR 2005 {PATIENT.LABELNAME}Guarantor: {If REGGUARANTOR() = "" then "None" else REGGUARANTOR() endif}home: {if PATIENT.ALTPHONE = "" then "None" else PATIENT.ALTPHONE endif} Work: {if PATIENT.WORKPHONE = "" then "None" else PATIENT.WORKPHONE endif} {PATIENT.FORMATTEDAGE} {PATIENT.SEX} (DOB: {Patient.DateOfBirth})Patient ID: {PATIENT.PATIENTID} Insurance: {INS_PLAN()} Group: {INS_GRP()}Insurance: {INS_PLAN()} This banner displays an external ID number. You could use this banner if your clinic uses a separate practice management system. {PATIENT.LABELNAME}PM ID: {PATIENT.EXTERNALID} Home: {if PATIENT.ALTPHONE = "" then "None" else PATIENT.ALTPHONE endif} Work: {if PATIENT.WORKPHONE = "" then "None" else PATIENT.WORKPHONE endif} {PATIENT.FORMATTEDAGE} {PATIENT.SEX} (DOB: {Patient.DateOfBirth})Patient ID: {PATIENT.PATIENTID} Insurance: {INS_PLAN()} Group: {INS_GRP()} Headers for letters, handouts, and chart documents Each letter, handout, document or chart you print from the EMR application has a header that appears at the top of the page. Typically, the header includes information such as the clinic s name, address, and telephone number. For chart documents, it also contains information about the patient as well as insurance information. Although you can use headers to create letterheads in the EMR application, you can t use color, print down the left side of the page, or place graphics wherever you want. If you have preprinted clinic letterhead that you wish to use, you can print directly on it. Simply load the letterhead into a printer and select that printer when you are printing letters and chart documents. You may need to adjust the margins of your templates. Do not use data symbols that push information, such as MEL_ADD_ORDER, in headers. You will not be able to sign it or associate it with a document later. 218 2006 General Electric Company July 2006

Headers for letters, handouts, and chart documents About location of care symbols A special set of symbols with the prefix LOC. is available for use in headers. These symbols, available only for printing, retrieve details about locations of care, such as address, phone number, and fax number. The particular location used depends on what you re printing and other settings: Printable items. For many printable items, you can select the location of care from the Print dialog box. Handouts. For handouts, the location of care is the document location, which is usually the same as the user s current location. Chart documents. For items printed from a patient chart, such as form and text components, chart documents, and registration summaries, you can set a default to use the user s current location or the patient s home location. In Setup Settings, select System > Locations of Care Printing Defaults. Letter templates. For letter templates, you choose from the following when you create the template: Enterprise Name, Patient s Home Location, User s Home Location, User s Current Location, Responsible Provider s Home Location. Change a chart document, letter, or handout header 1 Go to Setup Settings and select one of the following: Chart Documents > Header Letters > Header Handouts > Header 2 Click Change Header. 3 In the RTF editor, add data symbols, MEL statements, and text to the header. 4 To save the modified header, click OK. View a letter or chart document header 1 Log in to the EMR application as hwinston, password asdf. 2 Open a chart. 3 On the main toolbar, click Print and select a letter or chart document to print. 4 To print the item, click Print; to view it, click Preview. View a handout header 1 Open a chart. 2027167-002 Rev B 2006 General Electric Company 219

Creating Clinical Content for Centricity Physician Office - EMR 2005 Header examples 2 On the main toolbar, click Handouts and select a handout to print. 3 To print the handout, click Print; to view it, click Preview. Here are two examples of headers. Header with graphic above the text. We found a simple graphic in a clip art collection, pasted it into the RTF editor, and set a centered tab at 3.5 inches. Here s what it looks like in the RTF editor: Header with names of clinic providers Here we set a left tab at 3.5 inches and a right tab at 6.5 inches, and typed in the provider s names. The point size of the names is reduced to to 8 point. Here s what it looks like in the RTF editor: Text components and templates for letters and handouts To send the same letter to several patients, you could type in each patient s name, address, and the date. Or you can create a letter template by combining data symbols with the text of the letter. This allows you to reuse the same letter for many different patients. 220 2006 General Electric Company July 2006

Text components and templates for letters and handouts You can use data symbols to create letter and handout templates with patient-specific information. You can also create text components, which are used to insert common text items into chart notes. We ll refer to letter templates, handout templates, and text components collectively as templates. You can create your own templates or you can modify one of the many included with the EMR application. When you create or modify templates, the new templates are seen by everyone in your clinic after you import them into your clinic database. Check with EMR Manager before you begin. To test your templates before making them available to the clinic, see Chapter 11, MEL syntax basics. View sample templates One way to understand how text components and templates work is to look at the ones included with the EMR application. You can also download templates from EMR KnowledgeBank (http://knowledge.medicalogic.com/). View a template 1 Go to Setup Settings and select one of the following: Chart Documents > Text Components Letters > Letter Templates Handouts > Handout Templates 2027167-002 Rev B 2006 General Electric Company 221

Creating Clinical Content for Centricity Physician Office - EMR 2005 2 Select a folder, then select a component or template name from the list. 3 To view the template, click Change. You see the Letter, Handout, or Text Component window with the template in it.!!! To avoid accidentally changing the template, click Cancel when you ve finished viewing. 222 2006 General Electric Company July 2006

Text components and templates for letters and handouts Create a new letter template The following is a sample letter template, followed by the result when it is evaluated. Letter template with these data symbols {DATESTAMP} {PATIENT.LABELNAME} {PATIENT.LABELADDRESS} Dear {PATIENT.TITLE}{PATIENT.LASTNAME}: Displays May 4, 1999 Harriet Fleming 1846 SW 153rd Ave. Beaverton, OR 97006 Dear Ms. Fleming: You can create your templates in the EMR application, or you can use WordPad or a word processor to create the text and then copy and paste it into the EMR application. If your template is relatively simple, create it directly in the EMR application. If you want to include sophisticated tabs or tables in your template, create a version with sample data in Microsoft Word or other application that uses RTF. The EMR application may not support complex tables. For example, if you create a text component with tables that contain continuously evaluated symbols, you ll get a compiler error. You can use symbols in tables if they are set to be evaluated when inserted in the note. Part 1: Create a draft template Use the Single-User Training or Network Training database to create and test components and templates. When you re satisfied with your template, you can import it to the clinic database, where it will be available to everyone. The following procedure explains how to create a letter template. As an example, it shows how to create a letter template that provides information about a cholesterol level. You ll follow the same process to create text components and handout templates. Draft your template without using actual data symbols. Decide what you want to use it for and what information you want it to display. Use UPPERCASE letters to represent information that s different for each patient. This information will be represented by data symbols in your final template. 2027167-002 Rev B 2006 General Electric Company 223

Creating Clinical Content for Centricity Physician Office - EMR 2005 Create a draft template 1 Go to Setup Settings and select Letters > Letter Templates. 2 Click New and type a name for your template. For this example, use Cholesterol Results. 3 Select a letterhead type. 4 Click in the text portion and type your template text. Because the EMR application automatically prints on letterhead, you don't need to include the clinic address. (See the following example.) 5 Click OK to save your template. Part 2: Copy existing template elements whenever possible Other letters have data symbols for date, patient address, and a salutation based on patient sex. It s easier to copy this information than it is to re-create it. If you have combinations of text, symbols, and MEL expressions that you use frequently, such as symbols for a salutation, you can keep them in a text file, then copy and paste the expressions into your template. Copy information from another template 1 Go to Setup Settings and select Letters > Letter Templates. 2 Select a template or component from the list and click Change to open it. 224 2006 General Electric Company July 2006

Text components and templates for letters and handouts 3 Select the text and symbols that you want to copy. 4 Right-click and select Copy. 5 Open the template or component you re working on. 6 Right-click and select Paste. Example Open the template Recall Letter and copy the following: {._TODAYSDATE} {PATIENT.LABELNAME} {PATIENT.LABELADDRESS} Dear {if PATIENT.TITLE == "" then cond case PATIENT.SEX == "M" " Mr." case PATIENT.SEX == "F" " Ms." else "" endcond else PATIENT.TITLE endif} {PATIENT.FIRSTNAME} {PATIENT.LASTNAME}, Then paste it into your template, replacing the first four lines of your draft. Part 3: Insert data symbols and MEL statements Now you are ready to decide which symbols can replace the temporary (uppercase) information in the body of your letter template. Look through the symbols by category list in Using data symbols in EMR help or Encounter Form Editor help. Then replace the text with symbols by typing them into the template or by using the Insert Symbol dialog box. For information on using the Insert Symbol dialog box, see Use the Insert Symbol dialog box on page 177. Insert template text 1 To write the MEL statement that tells the patient that their cholesterol level is high, borderline high, or normal, insert the following expressions in the body of your letter: Thank you for coming in to have your cholesterol checked. Your cholesterol level was {OBSANY("cholesterol")} which is {if (OBSANY("cholesterol"))>240, "high", if (OBSANY("cholesterol"))>200, "borderline high", "normal"}. Sincerely yours, {PATIENT.RESPROVID} 2027167-002 Rev B 2006 General Electric Company 225

Creating Clinical Content for Centricity Physician Office - EMR 2005 2 When your letter template looks the way you want it, click OK to save it. Part 4: Test your template or component It s important to test your templates in Single-User Training before you put them in your EMR database. This part describes a short procedure for doing this. For more information on testing templates, see Chapter 11, MEL syntax basics.. You can test the letter using the patient Walter Caldwell from the training database. Test a letter template 1 Click the Chart button. 2 If necessary, click Find Patient. 3 In the Find Patient window, search for and select Walter Caldwell. 4 Click Print. 226 2006 General Electric Company July 2006

Text components and templates for letters and handouts 5 In the Print window, select your letter template. 6 To view your letter onscreen, click Preview. 7 If the letter contains any errors, go back and adjust it and repeat the test. For information on troubleshooting data symbols and MEL, see Troubleshoot MEL and data symbols on page 239. 8 Test the letter with several other patients. For more information on testing templates, see Guidelines for testing clinical content on page 233. Selecting data symbols for letter and handout templates Which symbols and functions you use in your letters and handouts depends on when you expect the documents to be printed. When used in letters and handouts, clinical list symbols with the suffixes _AFTER, _LIST_CHANGES, _, _NEW, _PRIOR, and _REMOVED, as well as DOCUMENT.*, only show data if EMR user prints the letter during a chart update. 2027167-002 Rev B 2006 General Electric Company 227

Creating Clinical Content for Centricity Physician Office - EMR 2005 If you use these symbols in letters and handouts, educate users to print them only during an update. Template and component examples Following are two examples of templates: a consultant letter and a vital signs text component. Consultant letter This letter template is designed to be printed during an update and sent back to a referring physician. Note the extensive use of symbols to bring in clinical lists and observation data. Note also how conditional if-then-else expressions are used to display different text depending on the clinical information documented for the patient. Read more about conditional expressions in Chapter 8, Write MEL expressions. {DATESTAMP} Dear Dr. {PATIENT.REFMDID}: I am writing to report my evaluation of {PATIENT.FIRSTNAME} {PATIENT.LASTNAME}, a {PATIENT.FORMATTEDAGE} {PATIENT.SEX} on whom I consulted {LASTNOTEDATE()}. When I saw the patient the Chief Complaint was "{LASTOBSVALUE('Chief Cmplnt')}". At that time the history of the present illness was as follows: {LASTOBSVALUE('HPI')}. {PATIENT.FIRSTNAME}'s Past Medical History at the time of my evaluation was notable for: {PROB_NEW, ('comma')}. {if LASTOBSVALUE('Past Med Hx')=="" then "" else "Other history is as follows: " + LASTOBSVALUE('Past Med Hx') + ". " endif}{if OBSANY('Family Hx')=="" then "There is no documented family history. " else "The family history is notable for: " + OBSANY('Family Hx')+ ". " endif}{if OBSANY('Social Hx')=="" then "There is no documented social history. " else "The social history is notable for: " + OBSANY('Social Hx') + ". " endif} I have attached a copy of my clinic note to the end of this letter which details the review of systems and physical examination for your review. My assessment at that time was as follows: {LASTOBSVALUE('Impression')}. The plan at that time was as follows: {LASTOBSVALUE('Plan')}. {if PROB_ACTIVE()== "" then "There are no active problems at this time. " else PATIENT.FIRSTNAME + "'s active problems now include: " + PROB_ACTIVE() endif} {if MEDS_ACTIVE()== "" then "There are no active medications at this time." else "The medication list includes: " + MEDS_ACTIVE() endif} {if ORDERS_AFTER('LIST') == "" then "There are no active orders at this time. " else "Active Orders include the following: " + ORDERS_AFTER('LIST') endif} 228 2006 General Electric Company July 2006

Quick text Vital signs text component Quick text I will send copies of the results of the above investigations as they become available to your office if you wish. The most recent office note and chart summary are attached. Thank you for the opportunity to participate in the care of {PATIENT.FIRSTNAME} {PATIENT.LASTNAME}. Yours truly, {USER.REALNAME} This text component collects and displays vital signs. Notice the use of the fmt function to format the vitals observations. {fmt("vital Signs", "B,2")} {fmt("height (in):", "B")} {OBSANY('Height')} {fmt("weight (lb):", "B")} {OBSNOW('Weight')} {fmt("temperature (deg F):", "B")} {OBSNOW('Temperature')} {fmt("temperature site:", "B")} {OBSNOW('Temp site')} {fmt("pulse rate:", "B")} {OBSNOW('Pulse rate')} {fmt("pulse rhythm:","b")} {OBSNOW('Pulse rhythm')} {fmt("respirations:", "B")} {OBSNOW('Resp rate')} {fmt("blood Pressure:", "B")} {OBSNOW('BP systolic')}/{obsnow('bp diastolic')} Quick text is another area of the EMR application where you can use MEL and data symbols. Quick text lets you assign a typing shortcut to text phrases and data symbols you use frequently. When you re in a chart note or customizing a letter, you can type two or three characters, and quick text fills in the rest. Quick text shortcuts are often preceded by a period (.) to distinguish them from other acronyms, but the period is not required. Quick text offers you a way to insert symbols that take arguments directly into your chart note. Here are some examples from the quick text included with the EMR application: This code... Places this in the chart note... Which does this....oc {'{ORDER_LIST_CHANGES}'} Displays a continuously updated list of orders added during the current encounter. 2027167-002 Rev B 2006 General Electric Company 229

Creating Clinical Content for Centricity Physician Office - EMR 2005 This code... Places this in the chart note... Which does this....wnl within normal limits Inserts the text within normal limits..ic {INSERT_FORM_COMP} Opens the Insert Form Component window..pf {PATIENT.LABELNAME}, a {PATIENT.FORMATTEDAGE} Displays Kevin S. Gelner, a 24 Year Old. Not all symbols and functions work with quick text. For example, you can t use the MEL functions fmt and cfmt to produce formatted quick text. See Use MEL rich text formatting functions on page 207. Create and test quick text 1 From the Options menu, select Quick Text. 2 In the Define Quick Text window, Choose whether to make the text Type a quick text shortcut in here Type the text or expression or insert a symbol to replace the code here available to everyone using the EMR application or to reserve it for personal use. 3 In the Replace field, type a shortcut. 4 In the With field, do the following: Type the text you want the EMR application to insert. Click Insert Symbol if you want to include a data symbol or function. 5 To save the quick text shortcut, click Add, then Close. 6 Go to Chart. If necessary, find a patient first. 7 Click Update. 8 Type the quick text shortcut into the chart note. If the quick text does not appear or appears incorrectly, go back and adjust the expression you typed in the With field, and retest. 230 2006 General Electric Company July 2006

Chart notes Chart notes You can insert some data symbols directly into a chart note, where they can be evaluated continuously or when you insert them in the note. Not all data symbols are appropriate for direct use. Here are some general rules: You must insert the symbol using the Insert Symbol dialog box. You can t type symbols directly into the chart note. You can use data symbols that display text, such as PATIENT.LASTNAME or USER.PHONE, or a date, such as PATIENT.DATEOFBIRTH. You can also use function data symbols that don t take an argument or that default to an argument. Examples include REGPHARMACY and ALL_PRIOR. You can t use data symbol functions that require one or more arguments, such as ADDDATES. Insert a data symbol into a chart note 1 In the chart note, right-click and select Insert > Symbol. 2 Follow the instructions for using Insert Symbol on page 177. You can also insert text and form components containing MEL expressions directly into the chart using Insert > Component. Form components MEL and data symbols are used extensively in creating encounter form components. For more information about using MEL in forms, see Creating Encounter Forms and Using data symbols in EMR help or Encounter Form Editor help. 2027167-002 Rev B 2006 General Electric Company 231

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CHAPTER 10 Test and deploy clinical content Guidelines for testing clinical content 233 Deploy your created content 236 Build a library of MEL functions 238 Troubleshoot MEL and data symbols 239 In the EMR application, we refer to headers, banners, letter, handout and text templates, form components, and other items as clinical content. Clinical content is imported into and exported from the EMR application using a format called a clinical kit, which consists of a set of files. You also have the ability to create a usrlib.txt file that can store a set of MEL functions that you can use in both an Encounter form and a patient banner. This chapter tells you how to test your clinical content and how to import and export it from the EMR application. It also explains how to create the usrlib.txt file. The chapter concludes with information on how to troubleshoot MEL and data symbols Guidelines for testing clinical content You should always test new clinical content with sample data before using it with real patient data. You can test your work most easily using Single-User Training. If you didn't create your template or text component in the training database, you ll need to export it from the clinic database and import it into the training database. Follow the instructions about exporting and importing starting on page 236. Create patient data to test conditions Test templates by creating patient data that meets the various conditions of your expression, then view the results in the EMR application. 2006 General Electric Company

Creating Clinical Content for Centricity Physician Office - EMR 2005 Example Follow this procedure to test each condition in the sample if-then-else expression on cholesterol in the Cholesterol Results letter detailed on page 219. Select a patient who has no previous cholesterol observations. Test your expression with sample data 1 In Chart, begin a chart update. 2 To see if the correct text for no cholesterol test performed appears in the letter, click Print. 3 In the Letters folder, select the letter you re testing (Cholesterol Results). 4 Click Print Preview to view the letter without printing, and click Close when you re done. Use Print Preview to test letter or patient handout templates, so you don t have to send each test to a printer. 5 Click Flowsheet and select a flowsheet containing cholesterol. 6 In the Update Flowsheet window, click New. 7 In the New Observations window, enter a cholesterol value of 260, and click OK. 8 Click OK again to close Update Flowsheet. 9 To see if the correct text for a cholesterol of 260 appears in the letter, click Print, and in the Letters folder select the letter you re testing (Cholesterol Results). 10 To confirm that the correct text appears, click Preview. 11 Repeat steps 4-8 to add a new cholesterol observation with a value of 190. Then repeat steps 8-10 to preview the letter again. 12 Add another observation with a cholesterol value of 230. Preview the letter again to verify the correct text appears. 234 2006 General Electric Company July 2006

Guidelines for testing clinical content If you do not get the results you expect, refer to Troubleshoot MEL and data symbols on page 239. Test text components in a chart update Test new text components by inserting them in a chart update and then entering or changing observations corresponding to the data symbols you are using in the component. Test a text component 1 In Chart, begin a chart update. 2 Right-click in the note area and select Insert > Component. 3 In the Find Component window, select a folder and then a component name to insert. Click OK. In the chart note area, you see the text component. 4 Click Flowsheet to enter or change observations that correspond to the data symbols in the component you are testing, such as Height, Weight, Temperature, or Cholesterol. Depending on what you are testing in the template, you may need to update other clinical lists to add or change problems, medications, allergies, or directives. 5 As you change observations and update lists, verify that the data you entered appears correctly in the template. 2027167-002 Rev B 2006 General Electric Company 235

Creating Clinical Content for Centricity Physician Office - EMR 2005 Deploy your created content Once you ve got your content working in the training database, you can import it into your clinic database. To do this, you ll export the item from the training database as a clinical kit, then import it into the clinic database. Use the same procedure to export and import patient banners, headers, text components, form components, letter and handout templates, and quick text. Export item from the training database Once you re satisfied that an item works correctly, export it as a clinical kit. Then you can import it into your clinic database. When you create a clinical kit for export, it can include different types of clinical content. If you ve created several new items, you can export and import them as a package. Export a clinical content item 1 Begin in the training database, in Setup. 2 Go to Setup Settings and select System > Export Clinical Kits. 3 From Available Components, select the type of item you are exporting. 4 Click Add. 236 2006 General Electric Company July 2006

Deploy your created content 5 Select the item to export, and click OK. 6 Repeat steps 3-4 to place additional items in the clinical kit. 7 Click Export Clinical Kit. 8 In the Export Clinical Kit window, enter a descriptive name for the kit, using up to eight characters. The EMR application supplies the.ckt filename extension for you. 9 If necessary, change the location where the EMR application places the clinical kit folder. Click OK. By default, the EMR application creates a folder in the local EMR folder with the same name as the clinical kit file, and places the clinical kit file in that folder for example, C:\<FOLDER WHERE THE EMR APPLICATION IS INSTALLED>\CHO\CHO.CKT. Import item into your clinic database You'll need to import the clinical kit containing the custom item to make it available to everyone who uses your clinic database. Import a clinical kit 1 Go to Setup Settings and select System > Import Clinical Kits. 2 Click Import Clinical Kit. 3 In the Import Clinical Kit window, locate the folder you exported the kit to. For example, locate C:\<FOLDER WHERE THE EMR APPLICATION IS INSTALLED>\CHO\CHO.CKT. 4 Open the folder containing the kit, and select the.ckt file to import. 5 Click OK. The EMR application imports the clinical kit containing the template. 2027167-002 Rev B 2006 General Electric Company 237

Creating Clinical Content for Centricity Physician Office - EMR 2005 When you are testing, you may be warned that an item already exists in the folder. Click Yes to replace the item, otherwise you will not see your changes. Build a library of MEL functions You can create a usrlib.txt file that is a library of MEL functions that you can use in multiple clinical content files. For example, if you have a MEL function that you would like to use in an Encounter form, patient banner, and letter you can store the function in a usrlib.txt file and give it a name. To insert the function into a clinical content file, you insert the function name referenced in the usrlib.txt file (instead of the entire MEL expression). You create usrlib.txt using Notepad or any other text editor. Once you have typed in your MEL expression, save the file with the name usrlib.txt to the EMR directory on the local workstation. Create a usrlib.txt file 1 Open Notepad or any other text editor. 2 Type your MEL expression. When adding MEL functions to usrlib.txt, you must format MEL correctly and use the correct syntax. If the MEL functions in the file are not formatted correctly, you will get a MEL compiler error when the EMR application starts and you will not be able to login. GE recommends that you first test your MEL functions in a text component or quick text prior to adding them to the usrlib.txt. The usrlib.txt file cannot exceed 64K if it does, you will not be able to start the EMR application. Therefore, you need to make careful decisions about what to place in the usrlib.txt and what to place inside your EMR application clinical content. 3 Save the text file as USRLIB.TXT. When the EMR application starts, it reads the contents of the usrlib.txt file and stores the MEL functions in memory the functions then can be called from anywhere in the EMR application that uses MEL. Once the usrlib.txt has been fully tested on a single workstation, the jobs.txt function can be used to copy the file to all EMR workstations. 238 2006 General Electric Company July 2006

Troubleshoot MEL and data symbols The file, MELLIB.TXT, has the same purpose as USRLIB.TXT; however, MELLIB.TXT is reserved for use by the EMR application to distribute MEL functions. Do not use MELLIB.TXT file for your own functions. With each new release, the EMR application overwrites the existing MELLIB.TXT file. Any customization you have done will be lost. In addition, editing or removing this file can break EMR functions and existing clinical content. Troubleshoot MEL and data symbols Several kinds of errors typically happen with MEL expressions and data symbols. In most cases, errors are caused by small syntax errors. If you don t get the results you expected, or if you see an error message, first verify that your MEL expressions and symbols are formatted correctly. To check syntax rules for individual data symbols and functions, see Using data symbols in EMR help or Encounter Form Editor help. For additional MEL errors, see Chapter 17, Troubleshooting MEL. Here are some troubleshooting tips: Expression in output. If you see the entire expression in the final output rather than the expected return value, be sure there is a left brace at the beginning of the expression and a right brace at the end. Also check for missing endif lines. No output. When the expression doesn t produce any output at all, it may mean either of these things: No data exists for this patient for the type of data referred to by the expression. For example, if the expression is about cholesterol and no cholesterol observations are entered for this patient, there is no output from the expression. There is an error in the expression s construction. Check for missing plus signs between concatenated data symbols and missing quotes around text within expressions. Too few arguments. If you see an error like this: { OBSANY() <-TOO FEW ARGUMENTS TO FUNCTION } It means that you must give OBSANY an observation term as an argument. You may see these errors for other data symbol functions that take arguments, such as MEDS_AFTER or ADDDATES. Too many arguments. You see an error like this: {LISTRXNEW("weight") <-TOO MANY ARGUMENTS TO FUNCTION } It means that you used an argument with LISTRXNEW, which doesn t need one. For details on which symbols require arguments, see Using data symbols in EMR help or Encounter Form Editor help. 2027167-002 Rev B 2006 General Electric Company 239

Creating Clinical Content for Centricity Physician Office - EMR 2005 Format codes in output. If you see formatting codes, such as \b or \i, you ve probably selected a data symbol in the RTF editor and applied formatting without selecting the braces. Select the symbol or expression, remove the formatting, then reselect the symbol, taking care to include the braces in your selection. Incorrect value. If your expression returns unexpected values, check to see whether you have used the RTF editor to format data symbols or functions that involve calculations or dates. This places additional formatting codes inside the expression that the MEL compiler may interpret incorrectly, resulting in an inaccurate value. Error Codes. Some data symbols that add data to the database, for example MEL_ADD_ORDER, use error codes to return information about problems with the MEL. The error codes provide feedback about incorrect or missing arguments in a MEL function. The error codes can be captured in the MEL code and combined with USERYESNO or USEROK to display messages to the user alerting them to missing or incorrect information. For information on specific error codes see Using data symbols in EMR help. For additional tips on troubleshooting, see Chapter 17, Troubleshooting MEL. 240 2006 General Electric Company July 2006

CHAPTER 11 MEL syntax basics Keywords 241 Comments 244 Operators 244 MEL expressions 245 Multiple statements 246 This chapter describes the basic building blocks for MEL, including keywords, comments, operators, and expressions. Keywords In MEL certain terms, called keywords, are reserved for use in the MEL language and cannot be used by programmers to refer to any other value or function. Keywords are not case-sensitive. The following table lists each MEL keyword, its purpose, and an example. Keyword Purpose Example AND Logical AND operator if PATIENT.SEX == "F" AND OBSNOW("Weight") < 100 then "discuss nutrition" endif break case Transfers control out of an enclosing conditional statement, for loop, or while loop and continues Begins a single conditional statement in a case expression while x < 5 do obslist = obslist + "," + obs[x] if obs[x] == then break endif x = x + 1 endwhile case OBSNOW("Height") == "" return "no height available" case OBSNOW("Height") > 65 return "tall" 2006 General Electric Company

Creating Clinical Content for Centricity Physician Office - EMR 2005 Keyword Purpose Example cond const, constant continue do else endcond Begins a series of related conditional statements in a case expression Defines a variable whose value cannot be changed Transfers control to the end of an enclosing for or while loop (stop here and return to the beginning of the loop) Specifies the action to perform while the conditions of a for or while statement are met Specifies the action to perform when the condition of an if-then-else statement is not met Ends a series of conditional statements in a case expression cond case OBSNOW("Height") == "" return "none available" case OBSNOW("Height") > 65 return "tall" endcond const normtemp = 98.6 while x < 5 do if y[x] < 0 then continue endif total = total + y[x] x = x + 1 endwhile see while or for if PATIENT.SEX =="M" then "This is a male patient" endif See cond endfor Ends a for loop See for endif Ends an if-then-else expression See if endwhile Ends a while loop See while for Begins a for loop for i=1, i<=size(names), i=i+1 do if names(i) == Smith then found = true endif endfor fn, function global Identifies a function definition Identifies a global variable definition {fn lastvalue () {... }} global lastname = PATIENT.LASTNAME 242 2006 General Electric Company July 2006

Keywords Keyword Purpose Example if local NOT OR return then TRUE, FALSE UNDEFINED VOID while YES, NO Begins an if-then-else statement Identifies a local variable definition Logical NOT operator (reverses the Boolean value of the following expression) Logical OR operator (if either item is true, then whole expression is true) Specifies a value to be returned; ends a function Indicates the statement to execute when the condition in an if statement is met Boolean values for logical equality or inequality A special value indicating a null value A special value indicating a generic error Indicates the start of a while loop (while these conditions are true, do the following) Alternate Boolean values for true and false if PATIENT.SEX == "M" then "This is a male patient" endif local startcount = 1 if NOT(PATIENT.SEX == "U") then... if OBSNOW("BG Random")<100 OR OBSNOW("BG Random")>300 then "Recheck Blood Glucose" endif case OBSNOW("Height") == "" return "no height available" if PATIENT.SEX =="M" then "This is a male patient" endif For patient Don Bassett: PATIENT.SEX =="M" evaluates to TRUE PATIENT.SEX =="F" evaluates to FALSE See UNDEFINED on page 252 while x < 5 do total = total + y[x] x = x + 1 endwhile See TRUE, FALSE 2027167-002 Rev B 2006 General Electric Company 243

Creating Clinical Content for Centricity Physician Office - EMR 2005 Comments Adding comments to your code helps others understand your program. There are two ways to include comment lines in MEL. For single-line comments, precede the text with two forward slashes (//). For example: // This is a single line comment For multiline comments, use /* to start the comment and */ to end the comment. For example: /* this comment begins on one line and ends on the next line */!!! When writing MEL functions, do not use apostrophes in multiline comments text, for example in words like can t or won t. The compiler may evaluate an apostrophe as part of the function and return an error. Operators Operators compare values or change values. They can also change combinations of values into new values. MEL evaluates operators that are at the same level of precedence from left to right. Parentheses may be used to override precedence. The following table lists the operators recognized by MEL, their purpose, and their order of precedence. Operator Purpose Example ( ) Controls precedence (do this operation first). Gets the value of a field in a table [ ] Indicates the position of an element in an array or string + or - Indicates the sign of a number (3 + 8) * 9 PATIENT.LASTNAME lastname[1] local num = -100 NOT AND Reverses the Boolean value of the following expression Says that both conditions must be met to be true NOT (PATIENT._AGEINMONTHS > 420 AND OBSPREV("BP") > 120) This expression is the same as: PATIENT._AGEINMONTHS<=420 OR OBSPREV("BP")<=120 if OBSPREV("Weight") > 150 AND OBSPREV("Height") < 55 then... 244 2006 General Electric Company July 2006

MEL expressions Operator Purpose Example OR ^ Says that if either condition is true, the whole expression is true Exponentiates (raises to the power of) if OBSPREV("Weight") > 150 OR OBSPREV("Height") < 55 then... 2^3 * Multiplies 24*5 (3.5 * 1.1) / Divides 100/3 + Adds 5 + 3 - Subtracts 6.6-2.4 + Concatenates This expression: "Weight: " + (OBSNOW("Weight") returns Weight: 180 > Greater than {if OBSPREV("BMI") > 30 then...} < Less than {if OBSPREV("BMI")< 20 then...} == Compares for equality {if" PATIENT.SEX == "F...} = Assigns a value local x = OBSNOW("Weight") / OBSNOW("Height") <= Less than or equal if OBSPREV "cholesterol") <= 230 then... >= Greater than or equal if OBSPREV("cholesterol") >= 230 then... <> Not equal {if PATIENT.SEX <> "F" then...} " or Marks the beginning and end of text within expressions This expression: "Weight: "+ (OBSNOW("Weight") returns Weight: 180 MEL expressions In a MEL expression operators, variables, control constructs, data symbols, and functions are enclosed within braces { }. MEL evaluates each expression and returns its results. For example, the following expression returns false as its result: { 5 <= 3 } In the next example, the expression returns Dr. Winston. { "Dr." + " Winston" } More complex expressions can be assembled in MEL using variables, scoping, functions, and control flow. Examples of these are given in later chapters. 2027167-002 Rev B 2006 General Electric Company 245

Creating Clinical Content for Centricity Physician Office - EMR 2005 Multiple statements A MEL expression that spans multiple lines does not add lines in the displayed result. For example, this expression: {"Dr." + " Winston"} returns Dr. Winston. The EMR RTF editor can process text and execute MEL expressions. You can combine MEL expressions with plain text, for example: The patient s age is {PATIENT_AGE()}. When evaluated, this displays: The patient s age is 28. Text combined with expressions can be typed directly into the RTF editor, however, any text to be returned as part of the result of a MEL expression must be enclosed in quotes inside the expression: Your weight: {cfmt(obsany("weight"), "", "(clothed)", "", "lbs.")) This expression returns Your weight: (clothed) 125 lbs. Multiple MEL expressions can be defined and combined with text. For example: The value {1 + 2} is equal to {4-1} This example contains two MEL expressions. It returns the following: The value 3 is equal to 3 Multiple statements can be combined within one MEL expression: {"Patient " + "age: " 20 + 5} Bear in mind, however, that the result of evaluating everything within a single set of braces is always the value of the last statement MEL evaluates. MEL first executes the statement "Patient " + "age: " and then executes the statement 20 + 5. In this case MEL would yield 25 as a result of executing this expression. To display both values, enclose each statement in braces separately. This line: {"Patient " + "age: "}{20 + 5} returns Patient age: 25 246 2006 General Electric Company July 2006

CHAPTER 12 Values and variables Dynamic typing in MEL 247 MEL values 247 Simple values 248 Complex values 249 Assignment behavior 251 UNDEFINED 252 Special operators 253 Errors 253 Dynamic typing in MEL This chapter explains dynamic typing, why it is used in MEL, and its impact on simple and complex values, including strings and arrays. It also explains the behavior of MEL variables, including assignment using simple and complex values and the special value UNDEFINED. It details the special behavior of certain operators, depending on the values they operate on, and explains the difference between runtime and compile errors. MEL is a dynamically typed programming language. This means that you don t have to declare a variable before using it, nor do you have to declare its type. Dynamic typing in MEL makes it easy to write simple, powerful expressions in an environment where the type of value assigned to variables may not be known until runtime. In MEL, values are typed (long, string, double, etc.), but variables are not. MEL values MEL expressions retrieve, manipulate, and store values using operators, data symbols, functions, and control structures such as if-then-else expressions. There are two categories of values in MEL: simple and complex. Simple value. A simple value can be changed only by assignment as a whole. A number is an example of a simple value. It has no parts that can be changed. Complex value. A complex value can be changed by assignment either as a whole or in parts. An array is an example of a complex value, because 2006 General Electric Company

Creating Clinical Content for Centricity Physician Office - EMR 2005 Simple values it consists of parts that can be assigned values individually. An entire array s value can be changed, or individual elements. Complex values can contain both simple and complex values. For example, a single element in an array can contain a simple value like a number or string, or a complex value like another array. The following table describes the simple value types in MEL. Value Description Example Boolean String Double Long A value indicating logical equality or inequality A sequence of ASCII characters delimited by single or double quotes A double-precision floating point (decimal) number An integer. Long refers to the amount of space allocated to the value type in memory TRUE, FALSE, YES, NO "weight" '185' Patient presents with 10678.992 573 Date A value representing a date 11/10/98 ASCII is a code for representing characters as numbers, with each letter assigned a number from 0 to 127. For example, the ASCII code for uppercase M is 77. Most computers use ASCII codes to represent text, which makes it possible to transfer data from one computer to another. String The string is a simple value with many uses in MEL. A string is defined by enclosing a series of characters within single or double quotes in a MEL expression: { local stra = "a String" } { global strb = 'a String ' + and + 'another string.' } The string of characters and spaces enclosed in quotes in each example is the value that MEL creates. Strings may contain special characters like: \n Newline \t Tab \ \ A single backslash \" Embedded double quote \' Embedded single quote 248 2006 General Electric Company July 2006

Complex values Complex values Since strings are simple values, they cannot be changed directly by assignment. However, MEL provides functions and operators you can use to manipulate string values using a copy of the original string. MEL string utility functions include: copy, eval, find, get, getfield, insert, match, remove, set, size, sub, tolower, toupper, and val. See Using data symbols in EMR help or Encounter Form Editor help for more information about MEL string utilities. Most MEL data symbols and data symbol functions return a simple string value. A few return numbers and dates. The following table describes the complex value types in MEL. Value Description Example Array Variables and data symbols An array of MEL values Each array element can contain any value and can be manipulated independently of other elements Named MEL variables and data symbols {global linearray = getfield (PROB_AFTER("delimited"), " ","") global itemarray = getfield(linearray[1],"^","") itemarray[2]+ ","+itemarray[4]} returns CONGESTIVE HEART FAILURE, pt. also has family hx of CHF See note below. mylist patient.labelname OBSANY() In this example, the function getfield creates an array of substrings from the string returned by PROB_AFTER("delimited"). Then, a second array is created using selected elements from the first. For more information about using getfield, see Using data symbols in EMR help or Encounter Form Editor help. Array An array is a complex value with many uses in MEL. An array can be created using the array() function: { local testarray = array("testing","02/08/75", OBSANY(),"200")} This creates an array with four elements. Notice that the array elements have different value types. Array elements start with the first element at 1 and the last element equal to the size of the array. For instance element 1 in the previous example is testing, and element 4 is 200. 2027167-002 Rev B 2006 General Electric Company 249

Creating Clinical Content for Centricity Physician Office - EMR 2005 Variables An array element can be manipulated via the index [ ] operator, or by using the set, get functions. To learn more about using get(array) and set(array), see Special operators on page 253, and Using data symbols in EMR help or Encounter Form Editor help. Unlike the characters in a string, the values of individual array elements can be changed directly. Functions that manipulate arrays change the original array, not a copy, as string functions do. See Assignment behavior on page 251, and set(array) in Using data symbols in EMR help and Encounter Form Editor help. Data symbols Named variables are values you create to hold any MEL value so it can be used for processing, comparison, or manipulation. When a variable is referred to, it returns the value it has been assigned. For instance: {fn myfunction() {local x = 2... } When this function is evaluated, it assigns the value 2 to variable x. The keyword local tells the EMR application that a variable x is being defined for use within this function. A local variable is created and holds its assigned value only while the function in which it is defined is active or processing. The following example assigns to x an array value with elements 1,2,3: { global x = array(1,2,3) } This expression tells the EMR application that the variable x has array of three values (1,2,3). The keyword global indicates that its lifespan (how long it exists) and scope (where it can be seen and used) depend on where it is used in the EMR application. Inside a document, for example, a global variable holds its assigned values until the document is put On Hold, cancelled, or signed. If a global variable is used anywhere other than a document, it holds the assigned values until the end of the current EMR session. For more about variable lifespan and scope, see Chapter 15, Scoping of variables. A data symbol is similar to a global variable, in that it can hold any MEL value for a life span determined by where it is used. The difference is that a data symbol uses either a MEL expression or C++ program built into MEL for use in the EMR application. As with other variables, when a data symbol is referenced, it returns its current value. For instance, the following data symbol, used in Mary Smith s chart, returns Dear Mary Smith: Dear {PATIENT.LABELNAME} 250 2006 General Electric Company July 2006

Assignment behavior A data symbol can be used in MEL just like a variable, however you can t assign values directly to a data symbol. The ability to define new data symbols is not currently supported. Assignment behavior It is not possible for two or more variables to refer to the same simple value. So when MEL assigns a simple value to a variable, the value is copied. This is called assignment by value. For example: This part of the expression.. Does this... { global x = 1 Creates variable x and assigns it the value 1 global y = x Creates variable y with value of x y = 0 Assigns y a new value of 0 x } Returns 1 because y is stored separately from x Because x is a simple value, y is assigned a copy of the value of x. When y is assigned a new value of 0, the value of x remains 1. When MEL assigns a complex value to a variable, the value is not copied because multiple copies of a complex value could take up a lot of space in memory. Complex values are assigned by reference, which permits two or more variables to refer to the same complex value. For example: This part of the expression.. Does this... { global x = array(1,2,3) Creates variable x as an array and assigns it the values 1, 2, and 3 global y = x y[1] = 0 x } Creates variable y with value of x Assigns the first element of y the new value 0 Returns 023, because x and y refer to the same value Since x has a complex value, when it is assigned to y, the value is not copied. Both variables y and x now refer to the same value. When the value of y[1] is changed, this also changes the value referred to by x[1]. Now x and y both refer to an array whose value is 023. 2027167-002 Rev B 2006 General Electric Company 251

Creating Clinical Content for Centricity Physician Office - EMR 2005 UNDEFINED The value UNDEFINED is similar to the numerical value 0 or an empty string and represents a null value, or the absence of a value or entry. The value UNDEFINED behaves differently in MEL depending on its operators. For example: Operator Action Example Returns if Acts like TRUE if UNDEFINED then "Dr. Winston" ELSE "Dr. Janoff" endif Dr. Winston + Acts like 0 1 + UNDEFINED 'Dr. Winston' + UNDEFINED UNDEFINED + UNDEFINED -, *, / Acts like 0 1 - UNDEFINED UNDEFINED - UNDEFINED 1 * UNDEFINED UNDEFINED * UNDEFINED 1 / UNDEFINED UNDEFINED / UNDEFINED 1 Dr. Winston UNDEFINED 1 0 0 0 Divide by zero Error Divide by zero Error >, <, >=, <=, <>, == Acts like 0 0 > UNDEFINED 0 < UNDEFINED 0 >= UNDEFINED 0 <= UNDEFINED 0 <> UNDEFINED 0 == UNDEFINED FALSE FALSE TRUE TRUE FALSE TRUE AND UNDEFINED AND FALSE UNDEFINED AND TRUE UNDEFINED AND UNDEFINED FALSE UNDEFINED UNDEFINED OR UNDEFINED OR FALSE UNDEFINED OR TRUE UNDEFINED OR UNDEFINED UNDEFINED TRUE UNDEFINED NOT NOT UNDEFINED UNDEFINED An UNDEFINED is returned as as an empty string. The following expression also returns an empty string: { UNDEFINED } The ok() function can be used to determine if an argument is UNDEFINED. For more about using ok(), see Using data symbols in EMR help or Encounter Form Editor help. 252 2006 General Electric Company July 2006

Special operators Special operators The following operators behave differently depending on the values they operate on. Operator Example Result Explanation [ ] global a = "hi" a[1] [ ] global a = "zi" a[1] = "h" [ ] global a = array(0,2,3) a[1] [ ] global a = array(0,2,3) a[1]=1 + "hi" + " there" "h" ERROR String index used to access a part of a simple value You can t directly change a simple value. Instead, we use the set function, which returns a copy. 0 Array index (1, 2, 3) Array index used to assign a single array element "hi there" String concatenation + "hi" + "123" "hi123" String concatenation + "11/10/1997" + "1/11/2000" "9/22/3998" Date addition >,<,>=,<=, ==,<> >,<,>=,<=, ==,<> >,<,>=,<=, ==,<> "11/10/97" <> "1/11/00" -,*,/ val("456") - val("123") Boolean TRUE String comparison "456" <> "123" Boolean TRUE String comparison "456" >"hi" ERROR Not a valid comparison 333 Numeric operation - "456" -"hi" ERROR Not a valid operation Errors In MEL, two types of errors can occur: compile and runtime errors. A compile error usually indicates a syntax error, such as a missing brace or parenthesis. 2027167-002 Rev B 2006 General Electric Company 253

Creating Clinical Content for Centricity Physician Office - EMR 2005 Compile errors A runtime error is an error in logic that appears when the EMR application actually evaluates the expression. It indicates an error that prevents the program from executing properly. Runtime errors When a compile error occurs, MEL displays the offending MEL expression along with the error. For example, if you insert a form containing a compile error into an update, you may see unexpected text followed by an error message. For instance, in the following MEL expression, the programmer has inadvertently omitted a closing parenthesis: { OBSNOW("weight" } The compiler displays this error: { OBSNOW("weight" }<-COMPILER ERROR: Expect COMMA OR RIGHT PARENTHESIS. Instead had RIGHT CURLY BRACE after STRING When a compile error occurs, the offending MEL expression is not executed. When a runtime time error occurs, MEL displays an error message and terminates the MEL expression. Runtime error messages are most often seen in TRACEMEL.TXT files and occasionally in form edit fields. For instance, the following MEL expression: { global x = array(1,2,3) x[4]... } displays this error: global x = array(1,2,3) x[4] <-BAD VALUE In this case, MEL begins executing the expression but stops when it encounters the attempt to access a nonexistent array element. The global variable x is assigned, but attempting to access the non-existent element [4] causes the expression to stop. Any statements after the error are not executed. For more information about common error messages and MEL error tracing, see Chapter 17, Troubleshooting MEL. 254 2006 General Electric Company July 2006

CHAPTER 13 Flow control Conditional statements 255 Loop statements 258 Break statement 259 Continue statement 260 Conditional statements If statement In MEL, the order in which your instructions to the EMR application are executed is controlled by MEL s flow control features, such as branching conditional statements like if and case, looping statements like for and while, and the continue statement. MEL provides two types of conditional statement for controlling program flow: the if and case statements. The syntax of an if statement is: if condition then statement 1 statement 2... endif condition should be an expression that evaluates to TRUE or FALSE. If the condition evaluates to TRUE, MEL executes the statements following then. Otherwise, none of the statements are executed. The flow of control continues after endif. 2006 General Electric Company

Creating Clinical Content for Centricity Physician Office - EMR 2005 The if statement also supports an optional else clause. The else clause is useful, because it provides a default condition if none of the others is satisfied.the else syntax is: if condition then statement 1 statement 2... else statement 3 statement 4... endif If condition evaluates to FALSE, MEL evaluates the statements following else. Otherwise, it executes the statements following then. Control flow continues after endif. Example Short form if statement The reading is { if x > 5 then "high" else "low" endif } If x > 5 is TRUE, the text returned is: The reading is high Otherwise, if x > 5 is FALSE, the text returned is: The reading is low A condition can have several statements as long as they evaluate to TRUE or FALSE, for example: if (j == 1) AND (gexamsection == "") then... For more information about if statements, see Rules for short form if-then-else expressions on page 200. MEL has a short if statement for specifying small conditional test cases. The syntax of the short if statement is: if condition, true_expression condition should be an expression that evaluates to TRUE or FALSE. If the condition evaluates to TRUE, MEL executes true_expression. Otherwise, nothing happens, and control flow continues after true_expression. The short if statement also supports an optional else clause. The syntax is: if condition, true_expression, false_expression 256 2006 General Electric Company July 2006

Conditional statements If the condition evaluates to TRUE, MEL executes true_expression. Otherwise, MEL executes false_expression, and control flow continues after false_expression. In the short if statement, commas are substituted for then and else and endif is not required. The first comma after if stands for then, and succeeding commas stand for else, until the next if. When using the short form, be careful to enclose in quotes any commas you want used as text. Otherwise the EMR application may interpret the commas as part of an if statement. Case statement The case statement is a way to create a multi-option if-then-else expression. The syntax of the case statement is: cond case condition1 statements case condition2 statements case condition3 statements else statements endcond MEL executes the set of statements associated with the first condition that evaluates to TRUE. After that, no other conditions are checked, and processing continues after endcond. The statements following else are only executed when no case condition evaluates to TRUE. For example: {global a = 2 global b = 3 cond case a == b "they are equal" case a > b "a is bigger" else "b is bigger" endcond } Like the if-then-else expression, case expressions return a value. In the previous example, the expression returns: b is bigger 2027167-002 Rev B 2006 General Electric Company 257

Creating Clinical Content for Centricity Physician Office - EMR 2005 Loop statements While statement A colon (:) or the keyword return may be used between a condition and statements to enhance readability. For example: cond case a == b: "they are equal" case a > b: "a is bigger etc. cond case a == b return "they are equal" case a > b return "a is bigger etc. MEL contains two looping statements for controlling program flow: the while and for statements. For statement The syntax of the while loop is: while condition do statement1 statement2... endwhile condition is an expression. As long as condition evaluates to TRUE, MEL repeatedly executes the statements between do and endwhile. When condition evaluates to FALSE, processing continues after endwhile. A break statement can be used at any point within the loop. This statement is used to transfer control out of the loop. Processing continues after endwhile. For more information, see Break statement on page 259. A continue statement can be used to transfer control to the bottom of a loop to avoid unnecessary processing, but not out of the loop. For more information, see Continue statement on page 260. The syntax of the for loop is: for initial, condition, iteration do statement1 statement2 258 2006 General Electric Company July 2006

Break statement Break statement... endfor MEL executes the initial statement once when it encounters a for loop. The initial statement establishes an initial value from which to begin counting iterations of the loop. MEL evaluates condition before it begins a loop iteration. If condition evaluates to TRUE, MEL executes the statements following do, and then completes the loop by executing the iteration statement (to increment/decrement the condition value). The for loop repeats until condition evaluates to FALSE. Then processing exits the loop and continues after endfor. MEL executes the following loop 5 times: { global n global x= 0 for n = 1, n <= 5, n = n+1 do x = x + 2 endfor x } This expression returns 10. MEL provides a break statement to permit the program flow to exit from an innermost enclosing cond statement, for loop, or while loop. The syntax for the break statement is: break The following example uses break to terminate a for loop early when the variable is the desired value: { global month = "" for counter=1, counter<=5, counter = counter+1 do month = month + " MONTH " + counter if counter == 3 then break endif endfor month} This returns: MONTH 1 MONTH 2 MONTH 3 2027167-002 Rev B 2006 General Electric Company 259

Creating Clinical Content for Centricity Physician Office - EMR 2005 Continue statement The continue statement is used to transfer control to the bottom of a for or while loop but not out of the loop. The syntax for the continue statement is: continue The following example uses continue to avoid some inner loop processing: { global month = "" for counter=1, counter<=5, counter = counter+1 do if counter == 3 then continue endif month = month + " MONTH " + counter + " " endfor month} This returns MONTH 1 MONTH 2 MONTH 4 MONTH 5 260 2006 General Electric Company July 2006

CHAPTER 14 MEL functions Define MEL functions 261 Call functions 262 Define arguments 262 Return statement 263 Define MEL functions This chapter explains how to define and call functions in MEL, including how to define arguments for your functions and using return statements.. With MEL, you can package operators, symbols, flow control features, and functions in a function definition. The basic syntax for defining a function is: { fn function name ([arg1, arg2,...]) {expression to execute} } When you define a function, you are essentially giving it a name, identifying any arguments it will need, and then listing the instructions you want it to carry out. Here is an example of a function definition expression: { fn hi() { "hello" } } When this expression is executed, it defines a simple function called hi(). MEL now knows about this function. From now on { hi() } returns hello when it evaluates. All functions must be defined before they are executed. If MEL tries to execute a function that has not been previously defined, MEL returns an error indicating the function is not executable.!!! Using special characters (!,@,#,$,%,^,&, and so on) in the name of a function will generate an error. 2006 General Electric Company

Creating Clinical Content for Centricity Physician Office - EMR 2005 Call functions Define arguments A MEL expression can call a function to perform the steps in its definition. For example the function definition { fn hi() { "hello" + " there" } } displays hello there when its name called in an expression: {hi()}. After the function executes, it returns the value of the last expression it executed: hello there A function can have zero or more arguments as part of its definition. For example: { fn hi(a) { if a <> "" then a + " there" else "none" endif} } After this expression executes, MEL knows about a function named hi that has one argument, the value a. When this function is called, a value representing a should be passed to the function. For example: { hi("hello") } When this expression is executed, it passes "hello" as its argument and assigns a the value of hello. The function then executes: a + " there" This evaluates to: hello there Since this is the value of the last expression, the function returns: hello there Arguments with simple values Changing an argument variable that has been assigned a simple value inside a function only affects the local copy of the variable. Here is an example: This expression... Does this... { global x = 5 } Declares global variable x with the value 5 262 2006 General Electric Company July 2006

Return statement This expression... {fn test(a) { a = 0 }} For more about assignment to simple values, see Assignment behavior on page 251. Arguments with complex values Does this... Defines test and gives its argument the value 0 { test(x)} Calls test with x as its argument. Passes a copy of x to test, and test changes the value of x inside the function to 0. { x } Since x has a simple value, it is not changed when a is assigned the value of 0 inside the function. The value returned by this expression is 5. Return statement Changing an argument variable with a complex value such as an array will affect any variable that refers to the complex value, whether that variable is inside or outside the function. Here is an example: This expression... {global x = array(1,2,3)} {fn test(a) {a[1] = 0}} Does this... Declares x as an array of three values Defines test and gives its argument s first element a[1] the value 0 { test(x)} Passes array x into test() and assigns the first element of x to 0 { x } Since x has a complex value, it is changed when a is assigned the value 0 The value returned is 023 For more about assignment to complex values, see Assignment behavior on page 251. A return statement transfers control out of a function and returns a value at any point within the function. Without a return statement, a function will return the value of the last statement executed. The syntax for the return statement is: return expression where expression evaluates to any MEL value. 2027167-002 Rev B 2006 General Electric Company 263

Creating Clinical Content for Centricity Physician Office - EMR 2005 { fn hi(a) { if a == "" then return "none" endif return a + " there" } } Once a return statement has been executed, nothing further in the expression is evaluated. Return statements are often added in other contexts to enhance readability, but are generally not required. 264 2006 General Electric Company July 2006

CHAPTER 15 Scoping of variables Individual scoping 265 Community scoping 266 Variable summary 269 Individual scoping Global scoping The lifespan of a variable is the period during which the EMR application knows that the variable exists. The scope of a variable includes all the contexts in which its value can be accessed by a MEL expression. This chapter explains how variables are scoped in MEL. MEL controls the lifespan and visibility of variables in two ways: Individual scoping for variables that are seen by a single user Community scoping for variables that are seen by multiple users This category of scoping applies to variables that are seen by a single EMR user and not by multiple users. Global variables can be declared in the following ways: In this expression... declared like this... { fn test1() { global test...} } Within a function definition { global test2... } As part of an expression { global test3 =...} While being assigned a value { test4 = 7...} Undefined variables are global by default The lifespan of a global variable depends on where the MEL expression defining it is executed. If it is executed from inside a document, the variable will expire when the document is put On Hold, Canceled, or Signed. If the variable is used anywhere else, it is removed when the user exits the EMR application. 2006 General Electric Company

Creating Clinical Content for Centricity Physician Office - EMR 2005 Local scoping Community scoping Variables declared as local inside a function definition have a lifespan which lasts from when the function is called to when it exits. For example: { fn test() { local a = 1 } } { test() } The variable a is not defined until test is called. It disappears when test exits. In the EMR application, the following syntax is allowed in expressions: { local x = 1 } Document-scoped variables The variable x is defined only while this expression is executing. MEL has a second category of scoping not found in other systems: document scoped variables. This category facilitates simultaneous multiuser access to variables used in chart documents. It also retains variable values while a document is On Hold. MEL has a set of DOCUMENT.* variables that come into existence when a document is active and cease to exist when the document is signed. The life of a DOCUMENT variable is the period the document remains unsigned. Unlike a global variable whose life ends when the EMR application is closed or the document is put on hold, a DOCUMENT variable can exist across multiple EMR sessions as long as the document remains unsigned. DOCUMENT variables are visible across more than one user workstation. This allows users on different workstations to access the same instance of a DOCUMENT variable. Multiple users (a doctor and nurse, for example) can work on the same document at the same time. For more information about DOCUMENT variables and multiple users, see Multiuser considerations on page 267. A set of DOCUMENT variables may be tied to a form component. The same form component may appear in different documents. This means that the EMR application must allow different instances of the same DOCUMENT variable name to exist without interfering with each other. Multiple simultaneous sets of DOCUMENT variables can be active at any point in time. MEL DOCUMENT variables are referred to as temporary variables in the context of Encounter Form Editor. For more information, see Creating Encounter Forms. 266 2006 General Electric Company July 2006

Community scoping Define DOCUMENT variables Use DOCUMENT variables Multiuser considerations As previously mentioned, a set of DOCUMENT variables comes into existence when a document is created and remains in existence until it is signed. DOCUMENT variables are created only when the user opens a page of a form component that contains a DOCUMENT variable. When the page is opened, any DOCUMENT variables on the page that don t yet exist are created but not saved in the database. After a DOCUMENT variable is created, but before it is given a value, its value is UNDEFINED. A DOCUMENT variable is saved in the database when it is given a value. This happens when the user clicks on a button, fills in an edit field, or checks a check box attached to a DOCUMENT variable. DOCUMENT variables are used in form components and text translations. For example: The patient has {if DOCUMENT.TEMP_161462143_1_1517847 == 1 then 'a fever' else 'no fever' endif } The MEL expression refers to a DOCUMENT variable (DOCUMENT.TEMP_161462143_1_1517847) that is attached to a check box. If the user checks the box, the text translation of this is: The patient has a fever If the user leaves the box unchecked, the translation is: The patient has no fever Unchecking a check box sets the corresponding DOCUMENT variable to UNDEFINED and removes any previously saved value from the database. The variable returns to a value of UNDEFINED. Sometimes MEL expressions refer to DOCUMENT variables that do not yet exist, because the user has not opened the page that creates the DOCUMENT variable. In this case, the reference is treated as though it were a freshly created variable with a value of UNDEFINED. In the previous example, if DOCUMENT.TEMP_161462143_1_1517847 had not been created, its value would be UNDEFINED. Comparing UNDEFINED with 1 produces FALSE, and the else statements in the if statement are executed. Notice that no special checking is required in MEL expressions to guard against variables that don t exist or have UNDEFINED values. This feature simplifies writing MEL expressions. Access to the same variable by different users could give rise to undesired behavior if two or more users changed the same variable at the same time. To prevent this, the EMR application has built-in functionality that only allows one user at a time to update portions of the chart where this behavior could occur. To prevent this, the EMR application uses optimistic and 2027167-002 Rev B 2006 General Electric Company 267

Creating Clinical Content for Centricity Physician Office - EMR 2005 Database-scoped variables pessimistic locking with a refresh mechanism to keep changes made by users serialized and consistent. It also guarantees that users see the most up-to-date values. Discussion of this mechanism is beyond the scope of this document. PATIENT variables Other sets of variables (PATIENT.*, CLINIC.*) have lifespans that persist as long as the data they contain remains in the database. These variables use the same mechanisms as document-scoped variables to insure consistency and up-to-date values. Observations PATIENT.* variables hold demographic data for each person or patient in the database. These values are retrieved when a user searches with Find Patient. The values for these variables are saved for the person or patient whenever a user makes changes to them using the registration dialog. PATIENT variables must be updated via the registration module or Link Logic; they cannot be changed programmatically using a MEL expression or function. Observations are variables that hold data on a patient which may change over time. These variables are saved for each patient and accessed through a set of data symbol functions that manipulate observations. These include LIST_OBS, OBSNOW, OBSPREV, OBSANY, and similar functions. For example: { OBSNOW('Weight', "130")) } This will set the Weight observation for a patient to 130. Notice that the second argument is a string. For more information about data symbol functions that manipulate observations, see Use observation terms as arguments on page 185. For more information about individual observation data symbols, see symbols listed by category in Using data symbols in EMR help and Encounter Form Editor help. 268 2006 General Electric Company July 2006

Variable summary Variable summary The following table summarizes the categories of variables discussed in this chapter. Scope Where created Lifespan Visibility Global Outside a document Until the EMR application is closed Global Inside a document Until the document is put On Hold, canceled, signed, or until the user closes the EMR application Single user only Single user only Local Inside a MEL function or expression Until the function or expression is finished running Single user only DOCUMENT Inside a document Holds temporary data that goes away when a document is signed Until the document is canceled or signed Anyone who joins the update Only one instance of each DOCUMENT variable per document. Multiple instances can exist for different documents. Observations (unsigned) Inside a document Holds tentative time-varying data on a patient Until the document is canceled or signed Multiple instances per document can exist, but only one observation can have a given timestamp per document Multiple instances can exist for different documents 2027167-002 Rev B 2006 General Electric Company 269

Creating Clinical Content for Centricity Physician Office - EMR 2005 Scope Where created Lifespan Visibility Observations (signed) From an unsigned observation when the document is signed Holds permanent time-varying data on a patient. Permanent part of the patient record Anyone looking at the patient chart and from any document for that patient that was created after the observation was signed PATIENT When the person or patient is created Holds demographic data Permanent part of the patient record until the patient is removed from the database Anyone looking at the person or patient CLINIC When the database is created or from Setup For the lifetime of the database Anyone looking at that database Holds data that is visible to anyone in the clinic 270 2006 General Electric Company July 2006

CHAPTER 16 Advanced topics Evaluating data symbols during chart updates 271 Evaluating data symbols and expressions in forms 273 Data symbol dependency analysis 274 Visibility 274 Watcher expressions 275 When you use MEL expressions or data symbols in forms or chart notes, they may be evaluated at different times, depending on where and how they are used and what they do. This chapter reviews factors that influence evaluation of data symbols in chart updates and encounter forms. It reviews related concepts of data symbol dependency, visibility conditions in forms, and the use of watcher expressions to trigger reevaluation of variables. Evaluating data symbols during chart updates By default, data symbols used in text components, note templates, and letters are evaluated once when they are inserted into a chart note. The value the database has at that instant is retrieved and recorded in the chart note and will not change. Different rules apply to encounter forms. See Evaluating data symbols and expressions in forms on page 273. Data symbols and other MEL expressions can be set to evaluate continuously until the update is signed by enclosing the expression within quotes and a second pair of braces: {'{expression}'} This syntax tells the EMR application to keep evaluating the symbol until the note is signed. Rules for evaluating data symbol functions Certain types of data symbols should always be set to evaluate continuously: Date-driven functions. Continuously evaluate any data symbols containing AFTER, ANY, NOW, NEW, and REMOVED such as ALL_AFTER, OBSTAGANY, OBSNOW, LISTASSESSNEW, and PROB_REMOVED. 2006 General Electric Company

Creating Clinical Content for Centricity Physician Office - EMR 2005 When AFTER, ANY, NOW, NEW, and REMOVED data symbols are evaluated continuously, they return a list of current conditions. If these data symbols are only evaluated when inserted in the note, the list will not show any changes made after the component or symbol was inserted in the note. AFTER and ANY data symbols can include changes recorded in previous visits, plus whatever changes resulted from the current chart update. NEW and NOW data symbols show only changes made during the current chart update. Change-driven functions. Always evaluate continuously the data symbols ALL_LIST_CHANGES, MED_LIST_CHANGES, OBS_LIST_CHANGES, ORDER_LIST_CHANGES, DCT_LIST_CHANGES, and PROB_LIST_CHANGES. These symbols provide a running ticker tape of changes to clinical lists during a patient encounter. Evaluating symbols during multiple updates Pay special attention to data symbols that return data from the current update, which is the update In Progress when the data symbol is used. Even when a data symbol is set to evaluate continuously, users may not see the most recently updated value. When a chart update is In Progress, more than one person can be working on the update. For example, a physician may be entering data on a text component, while a nurse who has joined the update is using a form component. If data symbols are set to evaluate continuously, data entered on the nurse s form component during the update will be included in the physician s text component. If more than one update for a patient is In Progress, however, care must be taken to ensure accurate data. Some symbols return both signed and unsigned data, for example, OBSNOW, OBSANY, PROB_AFTER, MEDS_AFTER, and MED_LIST_CHANGES. If you re evaluating such a symbol continuously and its value changes in another update, you won t see the change until the user signs the other update and you agree to merge the data into your current update. The reason for this potential delay is that only one document at a time can contain unsigned changes to problems, medications, allergies, or directives. Moreover, only one person at a time in any update can change these lists. However, a user can release the lock on the problem, medication, directive, and allergy lists without signing the document by checking the Sign Clinical List Changes check box in the End Update dialog box. This makes the updated values from clinical lists available to users working on other updates for the patient. 272 2006 General Electric Company July 2006

Evaluating data symbols and expressions in forms Example: A single update An update includes a form component to collect vital signs. The nurse enters the data. Meanwhile, the physician is working with a text component that includes data symbols for temperature and respiration rate. If the symbols in the text component are evaluated when the component is inserted, the nurse may not have entered the data yet. In this case, if the text component used OBSANY("temp"), for example, the symbols might return blank observations or observations taken during a previous update, depending on the data symbols used. If the symbols are evaluated continuously, however, the symbols are updated to new values as soon as the nurse enters them on the form component. Example: Two concurrent updates A provider starts an update for a patient. The update includes a form component, and the provider updates the problem list. The provider is called away and places the document On Hold. Another provider starts an update for the same patient. Because the first provider has updated the problems list but not signed the document, the new problem does not appear in the problems list on the form component for the second update. Nor can the problem, allergy, medication, or directive lists be updated until the first provider signs the clinical list changes, signs the entire document, or cancels the update. Evaluating data symbols and expressions in forms In EMR forms, certain types of data symbols and expressions are automatically updated when their values change, while others must be programmed to re-evaluate. Evaluate on form open (!). If an expression starts with an exclamation point (!), the EMR application evaluates the MEL expression when the user opens the page of the form containing the expression. In other words, expressions preceded by! are evaluated when the EMR application draws the page on the screen. If a user redisplays a page, the EMR application re-evaluates the expression. Exclamation points do not work when embedded in a function. Watcher: An expression that is re-evaluated if one of its variables changes Watcher expressions. When a user opens a form, all DOCUMENT variables (also called temporary variables in Encounter Form Editor) are created with UNDEFINED values; or if they already exist, their values are retrieved. If a document variable changes while the form is in use, the EMR application re-evaluates the expression. 2027167-002 Rev B 2006 General Electric Company 273

Creating Clinical Content for Centricity Physician Office - EMR 2005 For example, in the expression: {OBSNOW("height", DOCUMENT.TEMP2 + DOCUMENT.TEMP3)} A change to DOCUMENT.TEMP2 or DOCUMENT.TEMP3 causes the expression to be re-evaluated. This is an example of a watcher expression. For more information, see Watcher expressions on page 275. Functions. MEL automatically executes any expressions containing function definitions when a form is opened: { fn test() { statements } } Executing this expression merely defines the function test. The function itself does not execute when the form opens unless it is set to evaluate at that time. Functions are evaluated only when called explicitly. Their results are cached, and the function is not automatically re-evaluated if one of its internal variables changes. A function will re-evaluate, however, if the value of any of its argument variables changes. You can also explicitly re-evaluate functions by connecting them to Action Buttons in Encounter Form Editor. Data symbol dependency analysis In the EMR application, if any symbol on a form changes, all other values that depend on the value are updated immediately, unless embedded in a function. If an expression controlling visibility of form elements is present on a form page, for example, {OBSNOW('Weight')>50}, its observation value is recalculated immediately if the value is changed from another field, whether the field is visible or not. Similarly, if OBSNOW('Weight') appears on one field, and OBSANY('Weight') is on a different field, changing the OBSNOW('Weight') field should cause the OBSANY('Weight') field to recalculate. Changing any observation value causes all expressions containing observations to be re-evaluated, except in functions. Visibility In the Encounter Form Editor you can define regions of your form whose visibility to the user when the form is opened is controlled by a MEL expression. If the expression returns TRUE, the items in the region will be displayed. If the result is anything else, the region won t be displayed. The following example is a typical expression controlling visibility: {! PATIENT.SEX = 'F' AND (OBSPREV("Temp") > 99.0 OR DOCU- MENT.TMP3 == "fever") } 274 2006 General Electric Company July 2006

Watcher expressions Watcher expressions This expression is evaluated immediately when the page opens and will be re-executed while the form is open to see if the visibility of the field it is attached to has changed. MEL expressions can be used to monitor the values of other data symbols or variables. All MEL expressions containing DOCUMENT variables or observations (except function definitions) are watcher expressions by default. When a variable referred to by the MEL expression is changed (by the user), then the expression automatically executes. For example, changing one field in a form can cause other fields with watcher expressions to automatically recalculate. To execute a watcher expression when a form page is opened, include an exclamation point in the definition: {! statements } If a watcher expression calls a function, and a variable inside that function is changed elsewhere by the user, the watcher expression is not automatically re-evaluated to update that variable. Automatic recalculation only applies to variables that appear at the top level of the watcher definition. For more information about watcher functions, see Creating Encounter Forms. Watcher expression triggers The EMR application supports special trigger variables that cause watcher expressions to re-evaluate. Observations and DOCUMENT variables (temporary variables, such as DOCUMENT.TEMP1) both trigger watcher expressions in different ways: DOCUMENT variables are "registered" so that if the variable changes, all watcher expressions that reference that temporary variable are re-evaluated. Observations are registered so that if one changes, all watcher expressions that reference any observation are re-evaluated. DOCUMENT variables and watcher expressions When a watcher expression contains a DOCUMENT variable that changes, only that expression (or others that reference the same temporary variable) are re-evaluated. Watcher expressions that do not reference that temporary variable are not re-evaluated. 2027167-002 Rev B 2006 General Electric Company 275

Creating Clinical Content for Centricity Physician Office - EMR 2005 For example, a form contains two separate watcher expressions with T1 and T2 as DOCUMENT variables: {OBSNOW("height", T1 + T2)} {OBSNOW("weight", T2)} When T1 changes, only the first watcher expression is re-evaluated. When T2 changes, both watcher expressions are re-evaluated. Observations and watcher expressions When any observation changes, all watcher expressions that contain observations are re-evaluated, regardless of the observation. For example, your form contains two separate watcher expressions, with OBS1 and OBS2 as observation terms. {OBSNOW("ROS",OBSNOW("OBS1") + OBSNOW("OBS2"))} {OBSNOW("HPI", OBSNOW("OBS1"))} When either OBSNOW("OBS1") or OBSNOW("OBS2") changes, both watcher expressions are re-evaluated. The user may see flickering of the form component because all fields on the form associated with observations are redrawn. Watcher function and buttons A function can be defined in MEL and connected to an action button in Encounter Form Editor,so that when a user clicks the button, the function executes and performs some action. The following sections show a bad use and a good use of button functionality. Example 1: Bad use A page on a form component contains three fields: an edit item, a data display connected to a MEL expression dynamic label, and an action connected to RunProcess. The edit item shows TMP1. The data display shows TMP1 as well. The action button when pushed, resets TMP1 to an empty string. This is accomplished with the following definition for the RunProcess MEL expression: { TMP1 = "" } The problem with this is that it acts like a watcher expression. Whenever TMP1 is changed by the user typing a value in the edit item, it immediately resets the value back to the empty string. TMP1 is reset whenever it is changed. This is not desirable behavior. Example 2: Good use The solution to the previous problem is to take advantage of the fact that watcher functions don t watch dependencies beyond the top level. Rewrite the form action to add a function in addition to the edit item, data display, and action button. The edit item and data display are defined as before. 276 2006 General Electric Company July 2006

Watcher expressions Define the action button as follows: { pushed() } The function can now be defined to reset TMP1 as: { fn pushed() { TMP1 = "" } } A user can now enter values for TMP1 without triggering a reset. Only when the button is pushed is TMP1 initialized to the empty string. 2027167-002 Rev B 2006 General Electric Company 277

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CHAPTER 17 Troubleshooting MEL MEL error messages 279 Use MEL tracing 281 MEL error messages This chapter provides a complete list of MEL error messages and explains how to use MEL tracing to locate and log errors. Special character in function name. Using special characters (!,@,#,$,%,^,&, and so on) in the name of a function will generate an error. <-COMPILER ERROR NEARBY: Expect FUNCTION NAME. Instead had IDENTIFIER after FUNCTION KEYWORD before the end of the name of the function. Expression in output. If you see the entire expression in the final output, not the correct return value, be sure there is a left brace at the beginning of the expression and a right brace at the end. Also check for missing endif lines. No output. When the expression doesn t produce any output at all, it may mean either of these things: No data exists for this patient for the condition in the expression. For example, if the expression is about cholesterol and no cholesterol values are entered for this patient, there is no output from the expression. There is an error in the expression s construction. Check for missing plus signs between concatenated data symbols and missing quotes around text within expressions. Too few arguments. You see an error like this: { OBSANY() <-TOO FEW ARGUMENTS TO FUNCTION } You must give OBSANY an observation term as an argument. You may see these errors for other function symbols that take arguments, such as MEDS_AFTER or ADDDATES. 2006 General Electric Company

Creating Clinical Content for Centricity Physician Office - EMR 2005 Too many arguments. You see an error like this: {LISTRXNEW("weight") <-TOO MANY ARGUMENTS TO FUNCTION } You used an argument with LISTRXNEW, which doesn t need one. For details on which symbols require observations, see Using data symbols in EMR help or Encounter Form Editor help. Format codes in output. You see formatting codes, such as \b or \i You ve probably selected a data symbol in the RTF editor and applied formatting without selecting the braces. Select the symbol or MEL expression, remove the formatting, then reselect the symbol, taking care to include the braces in your selection. Incorrect value. If your expression returns unexpected values, check to see whether you have used the RTF editor to format data symbols or functions that involve calculations or dates. This places additional formatting codes inside the expression that the MEL compiler may interpret incorrectly, resulting in an inaccurate value. Incomplete sentences returned. If an if-then-else expression returns incomplete sentences, confirm that: Plus signs (+) connect all text elements to be displayed, including data symbols that return text. All text to be displayed is enclosed in quotes (" or '). Comma errors. If you see an error like this: <-COMPILER ERROR: Expect LITERAL, FUNCTION, OR IDENTI- FIER. Instead had COMMA after PLUS You've probably put a comma in the wrong place. Because the EMR application interprets commas as the next if statement, commas in text cause errors unless they re inside quotes. In the following expression, the comma before which is part of the text. "Your cholesterol is " + OBSANY("cholesterol") + ", which is in the normal range (under 200)." Missing ENDIF. If you see an error like this: <-COMPILER ERROR: EOF was expected after ENDIF KEYWORD The endif that closes a set of conditional statements is probably missing. Make sure each if has a corresponding endif. Argument with wrong value. If you see an error like this: <-INVALID OPERATION OR BAD SYMBOL TYPE You probably used a data symbol as an argument in a function that returns a value type different than the value the function required. For example, ADDDATES expects the date argument to be a string. If you use PATIENT.DATEOFBIRTH as the argument, you need to convert it from 280 2006 General Electric Company July 2006

Use MEL tracing Use MEL tracing a date to a string first. See About value types on page 206 for more information. Error Codes. Some data symbols that add data to the database, for example MEL_ADD_ORDER, use error codes to return information about problems with the MEL. The error codes provide feedback about incorrect or missing arguments in a MEL function. The error codes can be captured in the MEL code and combined with USERYESNO or USEROK to display a message to the user alerting them to missing or incorrect information. For information on specific error codes see Using data symbols in EMR help or Encounter Form Editor help. You can trace the actions of your MEL expression to help you find out what s going wrong. A trace shows each individual step and any intermediate results of expression execution. While you re tracing, all the information is recorded in a file called TRACEMEL.TXT. By default, the file is placed in the C:\ directory. You can examine this file to see exactly what your MEL expressions are doing. To turn tracing on and off Press Ctrl + Alt + M to turn tracing on. Press Ctrl + Alt + M to turn tracing off. You can also turn tracing on programmatically. See debug in Using data symbols in EMR help or Encounter Form Editor help.!!! All traces are added to the end of the TRACEMEL.TXT file. This file can grow large, especially if you forget that tracing is turned on. Make certain you turn tracing off when the expression is finished evaluating, and periodically delete the file. 2027167-002 Rev B 2006 General Electric Company 281

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APPENDIX A Form item and connection reference Formatting items 283 Form items 286 Library items 299 Library groups 301 Connection reference 307 Formatting items Begin Section This appendix lists details about the form and formatting items available in Encounter Form Editor. In addition, it contains pictures of the library items and item groups. The formatting items affect how your encounter form looks on the screen. The MEL Function/Expression item is also detailed in this section. Purpose Starts a new section on your form. Each form must have Begin Section as its first item. Use Start an encounter form definition. Properties Start a new encounter form page. Change the number of columns. Set the width of columns. Surround a group of headings with a group box. Start a group of items to be saved as a section. Begin and end columnar sections. Section Name. Used as a page title if the section begins a new page. Page names must be 30 characters or less. Because page names appear in the form on tabs, shorter names are better. 2006 General Electric Company

Creating Clinical Content for Centricity Physician Office - EMR 2005 Percentages List. Sets the proportional width of the columns in the section. For example, if you have a three-column section with percentages set to 50, 25 and 25, the first item takes up 50% of the screen width. The remaining two items each take 25% of the width. If this property is left blank, Encounter Form Editor sizes the columns equally. Number of Columns. Sets the number of columns for the following form items until another Begin Section. Valid values are 1 8; the default is 1. New Page. If checked, starts a new encounter form page. The page must have a name that is unique in that form component. You can use the same page name in other components. Group Box for First Column. If checked, places a group box around the first column in the section. Restrictions The numbers in the percentages list must add up to 100. Begin Multi-Item Row Purpose Places the specified number of following items in a horizontal row within the current column. Use Line up a group of items horizontally. Place several small objects on the same line to save space. Place form items precisely by specifying the amount of space for each. Create blank horizontal space by using a blank text item for one or more of the items in a multi-item row. Properties Restrictions Column Break Percentages List (Comma Separated). Sets the horizontal percentage of the column occupied by each item in the multi-item row. If left blank, items take up an equal amount of space. For example, if you have a three-item row with percentages set to 50, 25 and 25, the first item takes up 50% of the column width. The remaining two items each take 25% of the width. Number of Items. Sets the number of items to place in a horizontal row. Valid values = 2 20. Default = 2. All items in a multi-item row must be form items. Formatting items (Begin Section, Column Break, Begin Multi-Item Row, and End Suppression Block) cannot be included in a multi-item row. The percentages list must add up to 100% and the number of percentages must match the number of items. Purpose Ends the current column and places the following items in the next column. 284 2006 General Electric Company July 2006

Formatting items Use Properties Restrictions Begin a new column. Group Box for This Column. If checked, places a group box around the column. Use only in a section with more than one column. The number of Column Breaks in a section must not exceed one less than the number of columns specified in the previous Begin Section. End Suppression Block Purpose Marks the end of a set of items for which a previous heading will be suppressed in the text translation if no data is entered for those items. Use Turn off suppression so the heading that began the suppression block is not dependent on subsequent items in determining whether it appears in the chart note text translation. Properties Restrictions Match a previous Heading that has its Begin Suppression Block property enabled. None Each End Suppression Block must have a matching Heading with its Begin Suppression Block property enabled. See also Heading suppression on page 40. Function/MEL Expression Purpose Enables you to include MEL functions and expressions in your form. Use Perform frequently used form functions. Control which information goes into observations. Customize printed form and chart note text translations. Properties MEL function definition Restrictions None See also See Use MEL Function/Expression items on page 125. Begin Visibility Region Purpose Marks the beginning of a set of items that will be displayed only when the visibility condition is met. Use Display certain form items only when needed. Display gender-specific form items. Conserve form space. 2027167-002 Rev B 2006 General Electric Company 285

Creating Clinical Content for Centricity Physician Office - EMR 2005 Properties Restrictions Visibility controlled by You can have several visibility regions that occupy the same space on the form. However, the last set of items must be followed by an End Visibility Region item. See also See Use visibility regions on page 116. End Visibility Region Purpose Marks the end of a set of items, or several sets of items, that will be displayed only when the visibility condition is met. Use To end one or more visibility regions. Properties None Restrictions None See also See Use visibility regions on page 116. Form items Action Button Form items place text or controls on the form. Some form items are for display only, others collect data. The items are listed below in alphabetical order. Purpose Places a button on the encounter form that causes an action when clicked. Properties Use Display the Update Problems, Medications, Allergies, Flowsheet, Orders, or Directives dialog box to modify the clinical lists. Open the New Medication, New Problem, or New Order update dialog box with a specified custom list. Open the Print Education Handout dialog box with a specified custom list. Navigate to other forms or parts of forms Run a program other than the EMR application. Display referral guidelines. Set values in other form items. Run MEL programs. Button Label. The text displayed on the button. 286 2006 General Electric Company July 2006

Form items Connect To. A list of specific actions. See Actions on page 312, for a list of actions you can connect to. Med Custom List or Problem Custom List. The folder pathname for the custom list. This property is available only when the button is connected to New Medication or New Problem. The pathname must be typed exactly as shown, including capitalization. You can determine the pathname from EMR s Setup module. For example: Clinic\Medicine\Pulmonary\Function Problem Prefix. The problem type for the new problem: Diagnosis of, Minor diagnosis of, Hospitalized for, Status post, Rule out, Question of, Risk of, Take note of, or Family history of. This property is available only when the button is connected to New Problem. Path and Arguments. The operating system pathname and command-line options to run a specific program or process that is not part of the EMR application. The process must be executable from the operating system. Executable files typically have extensions of.exe or.bat.this property is available only when the button is connected to Run Process. For example: C:\WINDOWS\CALCULATOR.EXE. Customization options Style and Size Font. Arial 8, 10, 12, and 14 pt. Courier 10, 12, and 15 pt. All fonts available in plain text, bold, italic, and bold italic. Default for button label = Arial 8 pt. Text Color. Black, white, red, lime green, blue, yellow, pink, turquoise, brown, green, dark blue, olive, purple, blue-green, dark grey, light grey. Default for button label = black. Back Color. Transparent, white, red, lime green, blue, yellow, pink, turquoise, brown, green, dark blue, olive, purple, blue-green, dark grey, light grey. This customization affects the background color of the entire button. Default = transparent. Chart Update Translation Printed Form Translation Pixel Height per Line. Default = 16. Action Buttons do not have text translations. Action Buttons do not appear on the printed form. Check box Purpose Displays a single yes/no choice. Use Properties Single, independent data items. Label. An optional text label placed to the left of the Check Box. Check Boxes frequently do not have labels. Maximum number of characters = 255. 2027167-002 Rev B 2006 General Electric Company 287

Creating Clinical Content for Centricity Physician Office - EMR 2005 Connect To. Temporary variable, New Observation, New Obs (Default Prev). Statement. The text to place after the Check Box. If a statement is connected to an observation, the statement is stored as the value of the observation if the check box is checked. Customization options Style and Size Alignment. Left, Center, Right. Default for label = Right. Font. Arial 8, 10, 12, and 14 pt. Courier 10, 12, and 15 pt. All fonts available in plain text, bold, italic, and bold italic. Default for label and item = Arial 8 pt. Text Color. Black, white, red, lime green, blue, yellow, pink, turquoise, brown, green, dark blue, olive, purple, blue-green, dark grey, light grey. Default for label and item = black. Back Color. Transparent, white, red, lime green, blue, yellow, pink, turquoise, brown, green, dark blue, olive, purple, blue-green, dark grey, light grey. Default for label and item = transparent. Horizontal Percentage. Check Boxes rarely have labels, so the default is 95 percent for data. This percentage slightly indents the check box from the left edge of the column. Chart Update Translation Printed Form Translation Pixel Height per Line. Default = 16. Suppresses the label and Check Box statement if the Check Box is not checked. If the Check Box is checked, the text translation includes the label (if any) and the Check Box statement. For example: {cfmt(obsnow("pp BTL cnsnt"), "", "", "B", " ")} Label (if any) in bold plus the check box statement. If data has been collected for this item, it is shown in bold and underlined. {fmt("", "B")} {cfmt(obsnow("pp BTL cnsnt"), "B,U")} [ ] Data display Purpose Displays patient-specific information recorded in the EMR application. Use Display patient information, clinical lists, and other previously recorded information. Display previous observation. Display data that can t be edited on the form. 288 2006 General Electric Company July 2006

Form items Display the result of a MEL expression or function. Properties Label. An optional text label placed to the left of the Data Display. The label may use as many lines as specified by the Number of Lines property. Maximum number of characters = 255. Connect To. Clinical function, patient attribute, Previous Observation, Prev Obs with Date. Number of Lines. The number of lines of data. Valid values = 1 20. Default = 1. Comma-Delimited list. If checked, data is displayed with the items separated by commas instead of each item on its own line. This property is available only if the Data Display is connected to a clinical function that supports this choice. Customization options Style and Size Alignment. Left, Center, Right. Default for label = Right. Font. Arial 8, 10, 12, and 14 pt. Courier 10, 12, and 15 pt. All fonts available in plain text, bold, italic, and bold italic. Default for label and item = Arial 8pt. Text Color. Black, white, red, lime green, blue, yellow, pink, turquoise, brown, green, dark blue, olive, purple, blue-green, dark grey, light grey. Default for both label and item = black. Back Color. Transparent, white, red, lime green, blue, yellow, pink, turquoise, brown, green, dark blue, olive, purple, blue-green, dark grey, light grey. Default for both label and item = transparent. Horizontal Percentage. Default = 60 percent for data. Chart Update Translation Printed Form Translation Pixel Height per Line. Default = 16. Suppresses the label if no data is displayed; other wise includes the label, the data, and a blank line. For example: {cfmt(patient.formattedage, "", "", "B", " ")} Label (if any) in bold + the patient-specific data. For example: {fmt("", "B")}{fmt(PATIENT.FORMATTEDAGE, "B")} Drop-down list Purpose Allows user to select from a list of choices. Can be set to allow choices only, or to allow data entry. Alternate list contents can be specified dynamically using a MEL expression when the Dynamic Choice box is checked. 2027167-002 Rev B 2006 General Electric Company 289

Creating Clinical Content for Centricity Physician Office - EMR 2005 When data entry is not allowed, the Drop-Down List contains a blank item. Users can select the blank item to clear the data entry field. Properties Use Long lists of choices where user can select only one. Takes up less space than radio buttons when there are several choices. Saves space by displaying alternate lists depending the fulfillment of a specified condition, such as patient gender. Allows free data entry when not limited to choices. Label. An optional text label placed to the left of the Drop-Down List. Maximum number of characters = 255. Connect To. Temporary variable, New Observation, or New Obs (Default Prev). Choice List. A comma-separated list of choices. Each choice appears on a line in the Drop-Down List. To include commas within a single item, type a back slash before the comma you want to appear as text. For example, well nourished\,well-hydrated\,no acute distress, diaphoretic, dusky, cachetic The first item in the list appears as well nourished, well hydrated, no acute distress. Maximum Character Length. The number of characters that can be typed. Valid values = 1 2000. Numeric Mask. Restricts data entry to numbers entered in the appropriate format. The default is none. Formats include: Integer: Positive or negative whole numbers (-3, 0, 7) Positive integer: Positive whole numbers (3, 5) Real: Positive or negative whole or fractional numbers (-2.7, 5, 4.85) Positive real: Positive whole or fractional numbers (5, 4.85, 6.2) Limit Entry to Choice List. Creates a Drop-Down List without an edit field. Users must select from the list of choices. Checking Limit Entry to Choice List disables the Maximum Character Length and Numeric Mask properties. A Drop-Down List with this property enabled includes a blank item so users can reset the Drop-Down List to contain no entry. 290 2006 General Electric Company July 2006

Form items Customization options Style and Size Chart Update Translation Printed Form Translation Alignment. Left, Center, Right. Default for label = Right. Font. Arial 8, 10, 12, and 14 pt. Courier 10, 12, and 15 pt. All fonts available in plain text, bold, italic, and bold italic. Default for label and item = Arial 8pt. Text Color. Black, white, red, lime green, blue, yellow, pink, turquoise, brown, green, dark blue, olive, purple, blue-green, dark grey, light grey. Default for item and label = black. Back Color. Transparent, white, red, lime green, blue, yellow, pink, turquoise, brown, green, dark blue, olive, purple, blue-green, dark grey, light grey. Default for label = transparent; default for item = white. Horizontal Percentage. Default = 60 percent for data. Pixel Height per Line. Default = 16. Suppresses the label if the Drop-Down List contains no data. For example: {if DOCUMENT.TEMP_4081010_123_8="" then "" else "History Source: " + DOCUMENT.TEMP_4081010_123_8 + " " endif} Label + the list of choices. If data entry is allowed, a space for additional data appears at the end of the printed form translation. If data has been collected for this item, it is shown in bold and underlined. {fmt("history source: ", "B")}{cfmt(DOCUMENT.TEMP_81777302_1_542378, "B,U")} ( )patient ( )significant other ( )relative ( )friend ( )patient's medical record ( )referral letter ( ){fmt("..","b,u")} Edit field Purpose Provides a single line for data entry. Use Brief text entries. Collect numeric-only data. Date field with calendar. 2027167-002 Rev B 2006 General Electric Company 291

Creating Clinical Content for Centricity Physician Office - EMR 2005 Properties Customization options Style and Size Chart Update Translation Printed Form Translation Show a previous observation but allow new data entry for that observation. Label. An optional text label placed to the left of the edit field item. Maximum number of characters = 255. Connect To. Temporary variable, New Observation, New Obs (Default Prev). Maximum Character Length. The number of characters that can be typed. Valid values = 1 2000. Numeric Mask. Restricts data entry to numbers entered in the appropriate format. Default = none. Formats include: Integer: Positive or negative whole numbers (-3, 0, 7) Positive integer: Positive whole numbers (3, 5) Real: Positive or negative whole or fractional numbers (-2.7, 5, 4.85) Positive real: Positive whole or fractional numbers (5, 4.85, 6.2) Date Field. Adds a calendar object to the field. When clicked, a calendar allows easy date selection. The form user can also type a date, although only numeric characters, -, and / are allowed. Checking Date Field disables Maximum Character Length and Numeric Mask properties. Alignment. Left, Center, Right. Default for label = Right. Font. Arial 8, 10, 12, and 14 pt. Courier 10, 12, and 15 pt. All fonts available in plain text, bold, italic, and bold italic. Default for label and item = Arial 8pt. Text Color. Black, white, red, lime green, blue, yellow, pink, turquoise, brown, green, dark blue, olive, purple, blue-green, dark grey, light grey. Default for label and entry = black. Back Color. Transparent, white, red, lime green, blue, yellow, pink, turquoise, brown, green, dark blue, olive, purple, blue-green, dark grey, light grey. Default for label = transparent; default for entry = white. Horizontal Percentage. Default = 60 percent for data. Pixel Height per Line. Default = 16. Suppresses the label if the Edit Field contains no data. For example: {cfmt(obsnow("pulse rate"), "", "Pulse rate: ", "B", " ")} Label + an area for entering data. If data has been collected for this item, it is shown in bold and underlined. {fmt("pulse rate: ", "B")}{if OBSNOW("Pulse rate") = "" then fmt("..", "B,U") else fmt(obsnow("pulse rate"), "B,U") endif} 292 2006 General Electric Company July 2006

Form items Flowsheet View Purpose Displays a flowsheet view of observations over time. Use Display a particular flowsheet view in the encounter form. When the provider wants to view historical data while filling out the form. Properties Label. The optional label is not displayed in the encounter form. However, you must specify a label if you want to save the Flowsheet View item in the item library. Connect To. A list of flowsheet views, including POTENT_OBSERVATIONS, which displays all signed and current observations (within this update); ACTIVE_OBSERVATIONS, which displays only signed observations; and SUM_ACTIVE_OBSERVATIONS, which displays only the latest signed observations. Flowsheet View Pathname. The EMR folder for the flowsheet view. For example, Enterprise\Family Practice\Risk Factors. The pathname must be typed exactly as shown in EMR Setup, including capitalization. See Flowsheet on page 31. Number of Lines. The number of lines the Flowsheet View item occupies on the form. If the flowsheet contains more items, a vertical scroll bar appears on the form. Customization options Style and Size Pixel Height per Line. Default = 16. Heading Chart Update Translation Printed Form Translation Flowsheet views do not have text translations. Flowsheet views do not appear on the printed form. Purpose Displays a single line of text in a large, bold font. Use Form title, section or subsection title. 2027167-002 Rev B 2006 General Electric Company 293

Creating Clinical Content for Centricity Physician Office - EMR 2005 Display text that can t be edited on the form. Create blank space on the form using a Heading with no text. Properties Text. The text displayed on the form. Maximum number of characters = 255. Begin Suppression Block. If checked, the Heading and following items do not appear in the text translation if no values are entered for items between it and its matching End Suppression Block. Suppression blocks can be nested. See Heading suppression on page 40. Customization options Style and Size Alignment. Left, Center, Right. Default = Left. Font. Arial 8, 10, 12, and 14 pt. Courier 10, 12, and 15 pt. All fonts available in plain text, bold, italic, and bold italic. Increase font size for major section headings. Default = Arial 8 pt bold. Text Color. Black, white, red, lime green, blue, yellow, pink, turquoise, brown, green, dark blue, olive, purple, blue-green, dark grey, light grey. Default = black. Back Color. Transparent, white, red, lime green, blue, yellow, pink, turquoise, brown, green, dark blue, olive, purple, blue-green, dark grey, light grey. Default = transparent. Chart Update Translation Printed Form Translation Pixel Height per Line. Default = 16. A blank line followed by Heading text on the next line. The heading is displayed in bold type, two points larger than normal. {fmt("cardiovascular ", "B,2")} A blank line followed by Heading text on the next line. The heading is printed in bold type, two points larger than normal. {fmt("cardiovascular ", "B,2")} Restrictions Each Heading with its Begin Suppression Block property enabled must have a matching End Suppression Block. List box Purpose Displays a list of choices preceded by check boxes. One or more of the boxes can be checked. The data from all checked boxes in the list can be stored in a single observation or temporary variable. Use Lists of several related items when more than one can be chosen. 294 2006 General Electric Company July 2006

Form items To accumulate several data items into the same observation. Properties Label. An optional text label placed to the left of the list box. Maximum number of characters = 255. The label can occupy as many lines as the Number of Lines property. Connect To. Temporary variable, New Observation, New Obs (Default Prev). Choice List. A comma-separated list of choices. Each choice appears following a check box. Number of Lines. The number of lines the List Box occupies. If the list of choices contains more items, a scroll bar appears at the right side of the List Box. Customization options Style and Size Alignment. Left, Center, Right. Default for label = Right. Font. Arial 8, 10, 12, and 14 pt. Courier 10, 12, and 15 pt. All fonts available in plain text, bold, italic, and bold italic. Default for label and item = Arial 8 pt. Text Color. Black, white, red, lime green, blue, yellow, pink, turquoise, brown, green, dark blue, olive, purple, blue-green, dark grey, light grey. Default for label and item = black. Back Color. Transparent, white, red, lime green, blue, yellow, pink, turquoise, brown, green, dark blue, olive, purple, blue-green, dark grey, light grey. Default for label and item = transparent. Horizontal Percentage. Default = 80 percent for data. Chart Update Translation Printed Form Translation Pixel Height per Line. Default = 16. Suppresses the label and the list of choices if none of the list choices is checked on the encounter form. If one of more of the choices are checked, the text translation includes the label and the text of checked choices. {cfmt(document.temp_81778258_1_542381, "", "Pain occurs: ", "B", " ")}" ENDIF} Label (if present) + the list of choices. If data has been collected for this item, it is shown in bold and underlined. {fmt("pain occurs: ", "B")}{cfmt(DOCUMENT.TEMP_81778258_1_542381, "B,U")} [ ]supine [ ]seated [ ]walking [ ]at night [ ]when coughing/sneezing 2027167-002 Rev B 2006 General Electric Company 295

Creating Clinical Content for Centricity Physician Office - EMR 2005 Multiline edit field Purpose Provides scrolling multiline data entry. Properties Customization options Style and Size Use Longer text entries. Inserting note templates. Label. An optional text label placed to the left of the multi-line edit field. The label can take up the same number of lines specified by the Number of Lines property. Maximum number of characters = 255. Connect To. Temporary variable, New Observation, New Obs (Default Prev). Number of Lines. The number of lines. Valid values = 3 20. Default = 3. Can Insert Templates. If checked, users can click the right mouse button to insert text components that can be filled out by the provider. Checking Can Insert Templates activates the Tab to Colon property. Tab to Colon.If checked, pressing Tab positions the cursor after the next colon rather than transferring focus to the next form item. This feature is particularly useful with text components. Tab to Colon is available only if Can Insert Templates is checked. Alignment. Left, Center, Right. Default for label = Right. Font. Arial 8, 10, 12, and 14 pt. Courier 10, 12, and 15 pt. All fonts available in plain text, bold, italic, and bold italic. Default for label and item = Arial 8 pt. Text Color. Black, white, red, lime green, blue, yellow, pink, turquoise, brown, green, dark blue, olive, purple, blue-green, dark grey, light grey. Default for label and item = black. Back Color. Transparent, white, red, lime green, blue, yellow, pink, turquoise, brown, green, dark blue, olive, purple, blue-green, dark grey, light grey. Default for label = transparent; default for item = white. Horizontal Percentage. Default = 80 percent for data. Pixel Height per Line. Default = 16. Chart Update Translation Suppresses the label if the Multi-Line Edit Field contains no data. For example: 296 2006 General Electric Company July 2006

Form items Printed Form Translation {cfmt(obsnow("mom med hx"), "", "Mother's medical history: ", "B", " ")} Label + an area for entering data. If data has been collected for this item, it is shown in bold and underlined. {fmt("mother's medical history: ", "B")}{if OBSNOW("mom med hx") = "" then fmt("..", "B,U") else fmt(obsnow("mom med hx"), "B,U") endif} Radio buttons Purpose Displays a set of mutually exclusive choices. If one Radio Button is selected, any other is deselected. Users can deselect all of the buttons by clicking on the selected button. Properties Customization options Style and Size Use Short lists of mutually exclusive choices. All choices can be seen on the screen, unlike Drop-Down Lists. Often used for normal/abnormal indicators. Label. An optional text label placed to the left of the Radio Buttons. If the buttons are placed vertically, the label can take up the same number of lines as there are choices. Maximum number of characters = 255. Connect To. Temporary variable, New Observation, New Obs (Default Prev). Choice List. The text placed after each Radio Button. The choices are separated by commas. You should always have at least two choices. Arrange Horizontally. If checked, the Radio Buttons appear next to each other horizontally. If unchecked, the Radio Buttons are stacked vertically. Alignment. Left, Center, Right. Default for label = Right. Font. Arial 8, 10, 12, and 14 pt. Courier 10, 12, and 15 pt. All fonts available in plain text, bold, italic, and bold italic. Default for label and item= Arial 8 pt. Text Color. Black, white, red, lime green, blue, yellow, pink, turquoise, brown, green, dark blue, olive, purple, blue-green, dark grey, light grey. Default for label and item = black. Back Color. Transparent, white, red, lime green, blue, yellow, pink, turquoise, brown, green, dark blue, olive, purple, blue-green, dark grey, light grey. Default for label and item = transparent. 2027167-002 Rev B 2006 General Electric Company 297

Creating Clinical Content for Centricity Physician Office - EMR 2005 Horizontal Percentage. Default = 60 percent for data. Chart Update Translation Printed Form Translation Pixel Height per Line. Default = 16. Suppresses label if none of the radio buttons is selected. If a button is selected, the text translation includes the label and the text of the selected button. For example: {cfmt(document.temp_81779404_1_542383, "", "Affected side: ", "B", " ")} Label + the list of choices. If data has been collected for this item, it is shown in bold and underlined. {fmt("affected side: ", "B")}{cfmt(DOCUMENT.TEMP_81779404_1_542383, "B,U")} ( )right side ( )left side ( )both sides Text Purpose Displays one or more lines of text. Use Display text that can t be edited on the form. Instructions to users. Subsection titles. Multi-line text. Create blank space by specifying a Text item with no text. Properties Text. The text to display. Maximum number of characters = 255. Number of Lines. The number of lines of text. Text wraps according to the width of the Text item. Valid values = 1 20. Default = 1. Customization options Style and Size Alignment. Left, Center, Right. Default = Left. Font. Arial 8, 10, 12, and 14 pt. Courier 10, 12, and 15 pt. All fonts available in plain text, bold, italic, and bold italic. Default = Arial 8 pt. Text Color. Black, white, red, lime green, blue, yellow, pink, turquoise, brown, green, dark blue, olive, purple, blue-green, dark grey, light grey. Default = black. Back Color. Transparent, white, red, lime green, blue, yellow, pink, turquoise, brown, green, dark blue, olive, purple, blue-green, dark grey, light grey. Default = transparent. 298 2006 General Electric Company July 2006

Library items Chart Update Translation Printed Form Translation Pixel Height per Line. Default = 16. Text appears in chart update translation as on form. Text appears in printed form as in onscreen form. Example: EDD =(LMP + 7 days - 3 months = 1 year) Library items Assess or update problems This section shows the library items supplied with Encounter Form Editor in the library file EFEDIT.ILB. Most library items have been customized. If you need to, you can modify the library items in Encounter Form Editor after placing them into your form item list. GE recommends that you create a form with all of the items in the library and then print an item report. The item report will show you the property and customization settings for each item. This Action Button displays the Update Problems dialog box. Chief Complaint This drop-down list is connected to the Chief Cmplt observation. You can easily change the choices in the drop-down list. Clinical list subset This data display is connected to a MEL expression that checks the problem list and displays all problems that contain diab. You could also use ICD codes to display only specific problems. 2027167-002 Rev B 2006 General Electric Company 299

Creating Clinical Content for Centricity Physician Office - EMR 2005 Disposition This drop-down list is connected to the Disposition observation term. You can change the items in the drop-down list. Family History This multiline edit field is connected to the Fam Hx observation as a New Observation (Default Prev). If family history data exists, it is displayed. The provider can add to the information. History of Present Illness This multiline edit field is connected to a New Observation for HPI. You can adjust the number of lines in the edit field. 300 2006 General Electric Company July 2006

Library groups Past medical history This multiline edit field is connected to the observation Past Med Hx as a New Observation (Default Prev). If past medical history exists, it is shown in the field and the provider can add to it. Preventive care reminders This data display item is connected to the clinical function LISTPROTOCOLSHORT. Social history This multiline edit field is connected to the observation Social Hx as a New Observation (Default Prev). Previous data is displayed and the provider can add information. Library groups This section shows item groups s supplied with Encounter Form Editor in the library file EFEDIT.GLB. Many items in these groups have been customized for both form appearance and text translation. GE recommends that you create a form with all of the groups in the library and then print an item report. By examining the report, you can tell which formatting items were added and how the items in each section were laid out on the form. In addition, you can view how the text translations were created. 2027167-002 Rev B 2006 General Electric Company 301

Creating Clinical Content for Centricity Physician Office - EMR 2005 Active Problems/Meds Boxes This item group is formatted so the labels appear above the data displays, allowing more room for data. Add Allergy/Directive/Medication/Problem These item groups, available with the EMR application, permit the user to select from a short list of common allergies, directives, medications, or problems. The library items include starter lists that can be modified in Encounter Form Editor. The user selects an item from the list and then selects or types other pertinent information. Add allergy Using this form, the user can select an allergy from a list, select the date of onset using a calendar, and click radio buttons to note the severity of response. A comment text box is also provided for additional details. Clicking the Add Allergy button adds the allergy information to the patient s allergy list and displays the information added on the form. To check interactions, add an allergy that is not in the list, or change allergies, the user can click Update Allergies to open the EMR Update Allergies dialog box. 302 2006 General Electric Company July 2006

Library groups Add directive Using this form, the user can select a directive from a list and set the date using a calendar. Clicking the Add Directive button adds the directives information to the patient s directives list and displays the information added on the form. To change existing directives, the user can click Update Directives to open the Update Directives dialog box. Add medication Using this form, the user can select a medication from a list, select start and end dates using a calendar, and type in instructions. Clicking the Add Medication button adds the medication to the patient s medications list and displays the information added on the form. To check interactions, add a medication not found on the list, or to change or remove existing medications, the user can click Update Medications to open the Update Medications dialog box. Add problem Using this form, the user can select a prefix and problem from custom lists, select start and stop dates using a calendar, and added a typed comment. Clicking the Add Problem button adds the diagnosis to the patient s problem list and displays the information added on the form. To add a problem not found on the list, or to change or remove existing problems, the user can click Update Problems to open the Update Problems dialog box. 2027167-002 Rev B 2006 General Electric Company 303

Creating Clinical Content for Centricity Physician Office - EMR 2005 Calculations The item group library contains several calculations. Calculations for body mass index and body surface area require the provider to click a button to invoke the calculation. The height fields are connected to a new observation (default prev) and the weight fields are connected to a new observation. Each calculation has an action button that calls a function and places the result in an edit field. The calculation for estimated delivery date uses a date field for the patient s last menstrual period. The provider then clicks a button that calls a function that calculates the estimated delivery date. 304 2006 General Electric Company July 2006

Library groups Family/Social History These multiline edit fields are connected to New Observations for Social Hx and Family Hx. Multiple items stored in one observation This group of items presents an example for recording data from three separate form items into one observation. The function ListBoxResult gets triggered whenever the value of one of the items changes. This function concatenates the information from the three items and stores it in one observation. You can easily change the contents of the list boxes and the observation term for storing the data. This group also contains a Set Values action button. Narrative style This group of items shows you how you can combine information from several items into a natural-sounding narrative for a chart note. Review the 2027167-002 Rev B 2006 General Electric Company 305

Creating Clinical Content for Centricity Physician Office - EMR 2005 text translations to understand how the narrative is put together. You can adapt this style for other types of form items. Visibility controlled by an observation This item group provides an example of a visibility region controlled by an observation. The Flow Rate drop-down list doesn t appear unless an observation of O2 Treatment of yes is recorded. Visibility controlled by radio button This item group displays different items depending on the radio button selection. 306 2006 General Electric Company July 2006

Connection reference Vital Signs The Vital Signs section has been formatted to take up a small amount of space on the form and to put the translation for all of the items on one line in the chart note. Connection reference Observation terms This section lists the connections that you can make between form items and data in the EMR database. It also describes the actions you can connect to an action button. One of the most common connections is to an observation term. You can connect Data Display, Edit Field, Drop-Down List, Multiline Edit Field, Radio Buttons, Check Box, and List Box items to observation terms. Depending on the form item, you can connect to observations in several ways: Previous Observation displays signed data from previous encounters. Prev Obs with Date displays signed data and the date it was entered. New Observation allows you to enter new data. New Obs (Default Prev) displays the last signed observation and allows you to enter new data. The EMR application supplies hundreds of observation terms for use with encounter forms. In addition, your organization may have requested and received additional local observation terms. It s easy to find observation terms in the Centricity Physician Office Term Finder. See Use Centricity Physician Office Term Finder on page 64. You can also print a report of all the terms from within the EMR application. This report is about 30 pages long. Print a list of observation terms 1 Open the EMR application. 2 Click Reports in the toolbar, then click the Reports tab at the top. 2027167-002 Rev B 2006 General Electric Company 307

Creating Clinical Content for Centricity Physician Office - EMR 2005 Clinical functions 3 Select Observation Headings By Category. 4 Click Print. The following table lists the clinical functions to which you can connect Data Display items. This clinical function... ALL_AFTER ALL_LIST_CHANGES ALL_NEW ALL_PRIOR ALL_REMOVED DCT_AFTER DCT_LIST_CHANGES DCT_NEW DCT_PRIOR DCT_REMOVED LISTASSESSNEW LISTPROTOCOLDUE LISTPROTOCOLFULL Produces these results... List of allergies, including changes during current update. Changes made during the encounter are visible in the data display within 30 seconds and appear in the chart note. Changes made to the allergies list during the current update. List of allergies added or changed during current update. Allergies previously in the clinical list are not shown and do not appear in the chart note. List of allergies prior to the current update. Any changes made during the encounter are not reflected in the data display or the chart note. List of allergies removed from allergies list during the current encounter. Only removed allergies are shown in the data display and in the chart note. List of directives, including changes during current update. Changes made during the encounter are immediately visible in the data display and appear in the chart note. Changes made to the directives list during the current update. List of directives added or changed during current update. Directives previously in the clinical list are not shown and do not appear in the chart note. List of directives, prior to the current update. Any changes made during the encounter are not reflected in the data display or the chart note. List of directives removed from directives list during the current encounter. Only the removed directives are shown in the data display and in the chart note. Shows problem assessments (better, worse, the same) made during the current encounter. The data display and chart note show the problem, date, assessment, and responsible provider. List of observations and interventions due per protocol, including details. List of observations/interventions due per protocols, including details. Provides a full list of preventive care actions, how often they are due, the last time they were performed, the last result, and status (due or done). 308 2006 General Electric Company July 2006

Connection reference This clinical function... LISTPROTOCOLSHORT LISTRXNEW LISTRXNEWFULL MED_LIST_CHANGES MEDS_AFTER MEDS_NEW MEDS_PRIOR MEDS_REMOVED OBS_LIST_CHANGES ORDER_LIST_CHANGES ORDERS_AFTER ORDERS_NEW ORDERS_PRIOR PROB_AFTER PROB_LIST_CHANGES Produces these results... List of observations/interventions now due per protocols. The data display and chart note show only the names of preventive care actions currently due for the patient. List of new medications added to the medication list and any refills to prior prescriptions. The name of the medication, date, amount prescribed, and responsible provider s name appear in the data display and the chart note. List of new medications added during this update, including full details. Changes made to the medications list during the current update. List of medications, including changes during current update. Changes made during the encounter are visible within 30 seconds in the data display and appear in the chart note. List of medications added or changed during current update. Medications previously in the clinical list are not shown and do not appear in the chart note. List of medications, prior to the current update. Any changes made during the encounter are not reflected in the data display or the chart note. List of medications removed from medications list during the current encounter. Only the removed medications are shown in the data display and in the chart note. Changes made to observations during the current update. Changes made to the list of orders during the current update. List of orders, including changes during current update. Changes made during the encounter will be immediately visible in the data display and will appear in the chart note. List of orders added or changed during current update. Orders previously in the clinical list are not shown and do not appear in the chart note. List of orders, prior to the current update. Any changes made during the encounter are not reflected in the data display or the chart note. List of problems, including changes during current update. Changes made during the encounter are visible within 30 seconds in the data display and will appear in the chart note. Changes made to the problems list during the current update. 2027167-002 Rev B 2006 General Electric Company 309

Creating Clinical Content for Centricity Physician Office - EMR 2005 This clinical function... PROB_NEW PROB_PRIOR PROB_REMOVED Produces these results... List of problems added or changed during current update. Problems previously in the clinical list are not shown and do not appear in the chart note. List of problems, prior to the current update. Any changes made during the encounter are not reflected in the data display or the chart note. List of problems removed from problems list during the current encounter. Only the removed problems are shown in the data display and in the chart note. Patient attributes This attribute... PATIENT._AGEINMONTHS 240 PATIENT_AGE 50 PATIENT._BLBANNER PATIENT._CASUALNAME PATIENT._IDBANNER The following table lists the patient attributes to which you can connect a Data Display item. Displays this... Age and sex: "35 Year Old Male" Name: "Smith, John D." Formatted ID number: "P-1235" PATIENT._TRBANNER Both phone numbers: "Home: 503-555-1212 Work: 503-555-6789" PATIENT.ADDRESS1 PATIENT.ADDRESS2 PATIENT.ALTPHONE PATIENT.CITY PATIENT.COUNTRY Address (first line) Address (second line) Alternate (home) phone City Country PATIENT.DATEOFBIRTH Date of birth: "04/30/1960" PATIENT.EMAIL PATIENT.EMPLSTATUS PATIENT.ENTITLEMENTS PATIENT.EXTERNALID PATIENT.FAXPHONE PATIENT.FIRSTNAME PATIENT.FORMATTEDAGE Email address Employment status Entitlements: "M.D." External ID Fax number First name Age: "35 Year Old" 310 2006 General Electric Company July 2006

Connection reference This attribute... PATIENT.HOMELOCATIONABB REVNAME PATIENT.HOMELOCATION NAME PATIENT.LABELADDRESS PATIENT.LABELNAME PATIENT.LASTNAME PATIENT.MARITALSTATUS PATIENT.MEDRECNO PATIENT.MIDDLENAME PATIENT.PATIENTID PATIENT.PREFLANG PATIENT.PRINTID PATIENT.PSTATUS PATIENT.RACE PATIENT.REFMDFIRST NAME PATIENT.REFMDID PATIENT.REFMDLAST NAME PATIENT.REGNOTE PATIENT.RESPPROVID PATIENT.SENSITIVECHART PATIENT.SEX PATIENT.SOCSECNO PATIENT.STATE PATIENT.TITLE PATIENT.WORKPHONE PATIENT.ZIP Displays this... Abbreviated version of the home location name. E IM Home location name. Eastside Clinic Internal Medicine. Label address (combines Address1, Address2, City, State, ZIP, Country) Patient name in label format: Mr. Peter J. Bauch, Jr. Last name Marital status Medical record number Middle name Patient ID Preferred language ID used in printing (Patient ID, MRN, External ID) Patient status (Active, Inactive, Deceased, Obsolete) Race Referring physician s first name Referring physician Referring physician s last name Registration note Responsible provider Sensitive chart status Sex Social security number State Title: "Dr." Work phone Zip 2027167-002 Rev B 2006 General Electric Company 311

Creating Clinical Content for Centricity Physician Office - EMR 2005 Actions The following table lists the actions to which you can connect Action Buttons. This action... ADD_ALLERGIES ADD_DIRECTIVES ADD_FLOWSHEET ADD_FORM_COMP ADD_MEDICATIONS ADD_ORDERS ADD_PROBLEMS CALCULATION JUMP_TO_TAB GUIDELINES NEWHANDOUT NEWMED NEWORDER NEWPROBLEM OPEN_FORM_COMP RUNPROCESS SETVALUES Does this... Opens the Update Allergies dialog box to view, add, change, or remove allergies. Opens the Update Directives dialog box to view, add, change, or remove directives. Opens the Update Flowsheet dialog box to view, add, change, or remove flowsheet observations or change the flowsheet view. Adds a form component to an update in specified order without opening it. Opens Update Medications dialog box to view, add, change, remove, or refill medications. Opens Update Orders dialog box to view, add, change, or remove orders. Open Update Problems dialog box to view, add, change, remove, or assess problems. Performs a calculation and sends the result to another form item. Moves to a specified page within a form. Opens the Referral Guidelines dialog box to view guidelines. Opens print education handout dialog box with the specified custom list. Opens the New Medication dialog box with the specified default custom list. Opens Update Order dialog box with specified default custom list. Opens New Problem dialog box with the specified default custom list. Opens a different form component s page. Starts the specified external program with provided command line arguments or executes a MEL program. Sets values for other form items. 312 2006 General Electric Company July 2006

Connection reference Flowsheet views The following table lists the ways you can view flowsheets with a Flowsheet View item. This flowsheet function... POTENT_OBSERVATIONS ACTIVE_OBSERVATIONS SUM_ACTIVE_OBSERVATIONS Displays this... Contains all signed and current observations. Current observations are those entered during the current encounter but not yet signed. Contains all signed observations. Does not reflect observation changes made during the current encounter. Contains only the latest signed observations. Flowsheet labels The EMR application allows you to customize the labels in the Flowsheet view. These are flowsheet labels To customize flowsheet labels 1 Start the EMR application. 2 From the Go menu, select Setup > Settings. 2027167-002 Rev B 2006 General Electric Company 313

Creating Clinical Content for Centricity Physician Office - EMR 2005 3 From the Chart > Flowsheet Views window select the flowsheet view where you want to customize the labels. 4 Click the Change button. 5 In the Change Flowsheet View window, go to the Custom Label column of the observation for which you want to customize the label and type your customized label for the observation. 314 2006 General Electric Company July 2006

Connection reference For example, if you want to change the BP systolic label to systolic blood pressure in the Medicalogic > Vital Signs flowsheet, go to the Custom Label column of BP systolic and type systolic blood pressure there. 6 Click OK. Alternatively, the EMR application allows you to change the label of an observation to its description. Lets say you want to change the PULSE RATE observation label to its description, pulse rate E&M in the Medicalogic > Vital Signs flowsheet.to do this: 1 From the Go menu, select Setup > Settings. 2 From the Chart > Flowsheet Views window select Medicalogic > Vital Signs flowsheet. 3 Click Change. 2027167-002 Rev B 2006 General Electric Company 315

Creating Clinical Content for Centricity Physician Office - EMR 2005 4 Right Click the Description field of the PULSE RATE row and select Copy to Label. 5 Click OK. Check if customized labels are incorporated in the flowsheet 1 Click the Chart on the toolbar. 2 Click the Flowsheet tab. 3 Select the Vital Signs flowsheet from the View drop down and check if the label has changed. 316 2006 General Electric Company July 2006

APPENDIX B Update the EMR forms Update flowsheet views 317 Update text and printed form translations 318 Update MEL functions and Set Values action buttons 319 Use EMR E&M Advisor forms 319 Update flowsheet views Most previously created forms will work in the current release of the EMR application without modification. However, they won t implement new features, such as rich text formatting or printing of previously entered values. Forms that have flowsheet views, Set Values Action Buttons, or MEL functions must be updated for technical reasons. To update forms, you need to have available both the form.fd and form.fs files for the form. Here s a list of the things you can do to update your forms. Only the first two are essential. Update flowsheet view pathnames. You must do this for the 4.6 form to work correctly in the EMR application. Update MEL functions and Set Values action buttons. You must do this for the form to work correctly in the EMR application. Shorten page names. Short page names work better with the new tabbed format for form pages. Break the form into components. It s easier to work with smaller form components, and the current release of the EMR application supports combining several smaller components into document templates. Add formatting to the current translations. You can add rich text formatting to current text and printed form translations without re-setting the translation. Reset translations. You can reset translations to take advantage of rich text formatting and automatic printing of previously entered values. Updating flowsheet views consists of updating the pathnames for where flowsheets are stored in the EMR application. 2006 General Electric Company

Creating Clinical Content for Centricity Physician Office - EMR 2005 Update encounter forms created with previous versions of Encounter Form Editor 1 Open the EMR application and note the correct paths for flowsheet views. To see pathnames, use the Go menu to select Setup Settings. Click Chart > Flowsheet Views to see the folder hierarchy. 2 Start Encounter Form Editor (version 2.1 or newer). 3 Open the form s.fd file and click the Edit button to edit the form. 4 On the Edit Form screen, select a Flowsheet View item. 5 Click the Edit button. 6 In the Edit Item dialog box, type the correct flowsheet view pathname. 7 Repeat steps 4 though 6 until you ve updated all flowsheet view paths. Update text and printed form translations You must manually update text and printed form translations to use rich text formatting and to allow previously entered values to be printed on a printed form. Encounter Form Editor can create default translations for you, but you must redo any customizations in the new format.!!! Following this procedure will eliminate any previous customization of text translations. Make sure you haven t previously customized an item before you click the Reset button. No undo is available. Update default text translations 1 Start Encounter Form Editor (version 2.1 or newer). 2 Open the form s.fd file and click the Edit button to edit the form. 3 On the Edit Form screen, select the first item that has a text translation. 4 Click the Customize button. 5 In the Customize Item dialog box, click the Reset button for Chart Update Translation. 6 Click the Reset button for Printed Form Translation. 7 Click the Next button. 8 Repeat steps 5 through 7 for each item that is translated. 9 Save the form and re-import the clinical kit into the EMR application. 318 2006 General Electric Company July 2006

Update MEL functions and Set Values action buttons Update customized translations 1 Start Encounter Form Editor (version 2.1 or newer). 2 Open the form s.fd file and click the Edit button to edit the form. 3 On the Edit Form screen, select an item that has a customized text translation. 4 Click the Customize button. 5 Review the existing text translation and rewrite it using rich text formatting syntax. 6 Repeat steps 3 through 5 for all items with customized text translations. 7 Save the form and re-import the clinical kit into the EMR application. 8 Test the form to make sure it works properly. Update MEL functions and Set Values action buttons Some MEL functions and Set Values action buttons need to be updated because the current release stores function information in the form.xlt file rather than the form.efm file. Opening and re-saving these forms in Encounter Form Editor 2.1 automatically creates the correct files. Use EMR E&M Advisor forms Update forms with MEL functions and Set Values action buttons 1 Open the form s.fd file in Encounter Form Editor (version 2.1 or newer). 2 Click the Save button to re-make the form s clinical kit. 3 Re-import the clinical kit into the EMR application. You can use the Logician 4.6 E&M Advisor forms with later versions of the EMR application without modifying them. However, you must use them as stand-alone forms, not with the E&M Advisor form component. The EMR E&M Advisor forms store information in temporary variables. When the forms are used by themselves by themselves, they will correctly evaluate the data for meeting HCFA documentation requirements. In the EMR application, any form can work with the E&M Advisor if it uses special E&M observation terms and is evaluated with the E&M Advisor form component. However, if you have forms any that have been created using the Logician 4.6 E&M Advisor, it would be required that you update them using Encounter Form Editor 5.1 or later. 2027167-002 Rev B 2006 General Electric Company 319

Creating Clinical Content for Centricity Physician Office - EMR 2005 Edit EMR 2005 E&M Advisor forms GE recommends that you do not significantly edit the EMR E&M forms. In previous versions of Encounter Form Editor, many items on the forms were protected from modification. The items are no longer protected. It is possible to break the forms or change them so that they don t evaluate correctly. GE recommends that you use these forms as is, or build new ones to work with the E&M Advisor form component included in the current release of the EMR application. Some release 4.6 E&M Advisor forms become too large when updated in Encounter Form Editor. For these forms, you should break them into several form components. You can easily do this by exporting portions to an item group library and then importing selected items into a new form. 320 2006 General Electric Company July 2006

APPENDIX C E&M Advisor observations and exam requirements Observations recognized by E&M Advisor 321 Observation terms by exam focus 333 Comprehensive exam requirements 343 Observations recognized by E&M Advisor The following table provides a quick reference to the observation terms you can use when designing form components to work with E&M Advisor. The table is arranged roughly by exam focus. Name Description Used in Values Exam Focus exam focus E&M, organ system focus for examination Exam, E&M Advisor forms General multi-system, Cardiovascular, ENT, Eye, Genitourinary, Heme/lymph/immuno, Musculoskeletal, Neurological, Psychiatric, Respiratory, Skin Chief Cmplnt chief complaint HPI User-specified All HPI level HPI service level HPI brief (1-3 elements), extended (4 or more elements) HPI context HPI context HPI User-specified All HPI assoc sx HPI associated signs and symptoms All All HPI User-specified All HPI duration HPI duration HPI User-specified All HPI location HPI location HPI User-specified All HPI mod fact HPI modifying factors HPI User-specified All 2006 General Electric Company

Creating Clinical Content for Centricity Physician Office - EMR 2005 Name Description Used in Values Exam Focus HPI quality HPI quality HPI User-specified All HPI severity HPI severity HPI User-specified All HPI timing HPI timing HPI User-specified All ROS:GENERAL ROS general ROS User-specified All ROS EYES ROS eyes ROS User-specified All ROS ENT ROS ENT ROS User-specified All ROS: CARDIAC ROS cardiovascular ROS User-specified All ROS:PULMON ROS pulmonary ROS User-specified All ROS: GI ROS gastrointestinal ROS User-specified All ROS: GU ROS genitourinary ROS User-specified All ROS:MUSCSKEL ROS musculoskeletal ROS User-specified All ROS SKIN ROS skin ROS User-specified All ROS: NEURO ROS neurological ROS User-specified All ROS: PSYCH ROS psychiatric ROS User-specified All ROS ENDO ROS endocrine ROS User-specified All ROS HEME ROS ALLERG PMH reviewed ROS hematologic/lympha tic ROS allergic/immunologi c past medical history reviewed ROS User-specified All ROS User-specified All Past medical history form Past Med Hx past medical history Past medical history form FH reviewed family history reviewed Past medical history form Family Hx family history Past medical history form SH reviewed social history reviewed Past medical history form Social Hx social history Past medical history form User-specified User-specified User-specified User-specified User-specified User-specified Height height Vitals form User-specified All All All All All All All 322 2006 General Electric Company July 2006

Observations recognized by E&M Advisor Name Description Used in Values Exam Focus Height (cm) height in centimeters Vitals form User-specified All Weight weight Vitals form User-specified All Weight (kg) weight in kilograms Vitals form User-specified All Temperature temperature Vitals form User-specified All Temp(deg C) temperature in centigrade Vitals form User-specified All Pulse rate pulse rate Vitals form User-specified All Resp rate respiratory rate Vitals form User-specified All BP Systolic BP sys #2 BP Sys #3 blood pressure, systolic blood pressure, systolic, second observation blood pressure, systolic, third observation BP Site #1 blood pressure #1 site BP Site #2 blood pressure #2 site BP Site #3 blood pressure #3 site BP Sys R Arm BP Sys L Arm BP Sys L Leg BP Sys R Leg Gen appear commun abil hd/face insp blood pressure, systolic, right arm blood pressure, systolic, left arm blood pressure, systolic, left leg blood pressure, systolic, right leg general appearance on examination assessment of ability of communicate inspection of head and face Vitals form User-specified All Extended Vitals form Extended Vitals form Extended Vitals form Extended Vitals form Extended Vitals form Extended Vitals form Extended Vitals form Extended Vitals form Extended Vitals form User-specified User-specified User-specified User-specified User-specified User-specified User-specified User-specified User-specified Exam form User-specified All Cardio Cardio Cardio Cardio Cardio Cardio Cardio Cardio Cardio Exam form User-specified ENT Exam form User-specified ENT 2027167-002 Rev B 2006 General Electric Company 323

Creating Clinical Content for Centricity Physician Office - EMR 2005 Name Description Used in Values Exam Focus face pal/per saliv gland face strengt conjunc insp Funduscopy pupil exam EOM post segment optic disc palpation and percussion of face examination of salivary glands assessment of facial strength inspection of conjunctivae and lids ophthalmoscopic examination examination of pupils and irises assessment of ocular motility inspection of posterior segments inspection of optic disc Exam form User-specified ENT, Heme Exam form User-specified ENT Exam form User-specified ENT Exam form User-specified General, eye, cardio, heme, skin Exam form User-specified General, neuro, eye Exam form User-specified General, eye Exam form User-specified ENT, Eye, Neuro Exam form User-specified Neuro, eye Exam form User-specified Neuro, eye Visual acuit visual acuity testing Exam form User-specified Eye Visual field ocula adnexa corne s-lamp lens s-lamp ant cham s-l ocul pres OD ocul pres OS ext insp ear ex insp nose examination of visual fields examination of ocular adnexae slit lamp exam of cornea slit lamp exam of lens slit lamp exam of anterior chambers intraocular pressure, left eye intraocular pressure, right eye external inspection of ears external inspection of nose Exam form User-specified Eye Exam form User-specified Eye Exam form User-specified Eye Exam form User-specified Eye Exam form User-specified Eye Exam form User-specified Eye Exam form User-specified Eye Exam form User-specified General, ENT Exam form User-specified General, ENT 324 2006 General Electric Company July 2006

Observations recognized by E&M Advisor Name Description Used in Values Exam Focus otoscopy hearing asmt otoscopic examination assessment of hearing Exam form User-specified General, Heme Exam form User-specified General, ENT Nose exam examination of nose Exam form User-specified General, ENT, pulm dent/gums oropharynx Oral exam dent/gum/pal otoscopy air lip-dent-gum phary/pyrifo larynx exam nasophar exm inspection of teeth and gums examination of oropharynx examination of oral cavity (mouth/throat/teeth) inspection of teeth, gums, and palate otoscopic examination with air inspection of lips, teeth and gums inspection of pharyngeal walls and pyriform sinuses examination of larynx examination of nasopharynx Exam form User-specified General, heme, pulm Exam form User-specified General, ENT, heme, pulm, skin Exam form User-specified Cardio Exam form User-specified Cardio Exam form User-specified ENT Exam form User-specified ENT, skin Exam form User-specified ENT Exam form User-specified ENT Exam form User-specified ENT NECK EXAM examination of neck Exam form User-specified General, heme, ENT, GU, pulm Thyroid exam NECK veins resp effort examination of thyroid inspection of neck veins assessment of respiratory effort Exam form User-specified General, heme, ENT, GU, cardio, pulm, skin Exam form User-specified Cardio, pulm Exam form User-specified General, cardio, GU, heme, pulm percus chest percussion of chest Exam form User-specified General, pulm chest palp palpation of chest Exam form User-specified General, pulm 2027167-002 Rev B 2006 General Electric Company 325

Creating Clinical Content for Centricity Physician Office - EMR 2005 Name Description Used in Values Exam Focus auscul lungs auscultation of lungs Exam form User-specified general, cardio, GU, heme, ENT, pulm chest inspec inspection of chest Exam form User-specified ENT, pulm breast insp inspection of breast Exam form User-specified General, GU female breast palp palpation of breast Exam form User-specified General, GU female Carotid exam examination of carotid arteries Exam form User-specified General, Cardio, neuro heart palp palpation of heart Exam form User-specified General, cardio auscul heart auscultation of heart Exam form User-specified General, ENT, GU, Heme, cardio, neuro fem art exam abd aort exm Periph circ pedal pulse Bp2ext flag examination of femoral arteries examination of abdominal aorta examination of peripheral vasculature examination of pedal pulses E&M indication exists for obtaining blood pressure in two extremities Exam form User-specified General, cardio Exam form User-specified General, cardio Exam form User-specified General, ENT, GU, Heme, neuro, MSK, skin Exam form User-specified General, cardio Exam form Checked means yes, unchecked no anticoag flag anticoagulation flag Exam form Checked means yes, unchecked no abd hernias abdom insp abdom palp Rectal exam Hemoccult examination for abdominal hernias inspection of abdomen palpation of abdomen examination of rectum occult blood stool sample Cardio Cardio Exam form User-specified General, GU Exam form User-specified General, GU, heme, pulm Exam form User-specified General, GU, heme, pulm Exam form User-specified General, GU male Exam form User-specified General, cardio, GU 326 2006 General Electric Company July 2006

Observations recognized by E&M Advisor Name Description Used in Values Exam Focus Indhemclexst liver spleen anus/perineu scrotal exam penis exam ProstateExam epididym exm testes exam ureth meatus semin vesic Ext gen exam Hemoccult testing, indication exists examination of liver and spleen inspection of anus and perineum examination of scrotum examination of penis examination of prostate examination of epididymides examination of testes examination of urethral meatus examination of seminal vesicles examination of external genitalia Exam form Checked means yes, unchecked no Exam form User-specified General, cardio, GU, heme, pulm, skin Exam form User-specified Skin, GU male, GU female Exam form User-specified General male, GU male Exam form User-specified General male, GU male Exam form User-specified General male, GU male Exam form User-specified GU male Exam form User-specified GU male Exam form User-specified GU male, GU female Exam form User-specified GU male Exam form User-specified General female, GU female Vagina exam vaginal examination Exam form User-specified General female, GU female urethra exam Cervix exam examination of urethra examination of uterine cervix Exam form User-specified General female, GU female Exam form User-specified General female, GU female uterus palp palpation of uterus Exam form User-specified General female, GU female Uter adn exa examination of uterine adnexa Exam form User-specified General female, GU female bladder palp palpation of bladder Exam form User-specified GU female cervic nodes palpation of cervical lymph nodes Exam form User-specified General Axillary nod Axillary nodes Exam form User-specified General 2027167-002 Rev B 2006 General Electric Company 327

Creating Clinical Content for Centricity Physician Office - EMR 2005 Name Description Used in Values Exam Focus inguin nodes palpation of inguinal lymph nodes Exam form User-specified General LYMPH NODES Lymph node exam Exam form User-specified General, ENT, GU, heme, skin, pulm gait station digit nails head/neck ex trunk exam RUE exam RLE exam LUE exam LLE exam examination of gait and station inspection and palpation of digits and nails inspection, palpation, or percussion of head and neck inspection, palpation, or percussion of spine, ribs, and pelvis inspection, palpation, or percussion of right upper extremity inspection, palpation, or percussion of right lower extremity inspection, palpation, or percussion of left upper extremity inspection, palpation, or percussion of left lower extremity Exam form User-specified General, cardio, MSK, neuro, psych Exam form User-specified General, pulm Exam form User-specified General, MSK Exam form User-specified General, MSK Exam form User-specified General, MSK Exam form User-specified General, MSK Exam form User-specified General, MSK Exam form User-specified General, MSK Back exam examination of back Exam form User-specified Cardio, MSK strengt tone assessment of muscle strength and tone Exam form User-specified Cardio, psych, pulm 328 2006 General Electric Company July 2006

Observations recognized by E&M Advisor Name Description Used in Values Exam Focus digit nails ROM hd/neck ROM LLE ROM LUE ROM RLE ROM RUE ROM trunk stabl hd/nck stabl LLE stabl LUE stabl RLE stabl RUE stabl trunk stren hd/nck stren LLE stren LUE inspection and palpation of digits and nails range of motion of head and neck range of motion of left lower extremity range of motion of left upper extremity range of motion of right lower extremity range of motion of right upper extremity range of motion of spine, ribs, and pelvis stability of head and neck stability of left lower extremity stability of left upper extremity stability of right lower extremity stability of right upper extremity stability of spine, ribs, and pelvis muscle strength and tone of head and neck muscle strength and tone of left lower extremity muscle strength and tone of left upper extremity Exam form User-specified Heme, skin, pulm Exam form User-specified MSK Exam form User-specified MSK Exam form User-specified MSK Exam form User-specified MSK Exam form User-specified MSK Exam form User-specified MSK Exam form User-specified MSK Exam form User-specified MSK Exam form User-specified MSK Exam form User-specified MSK Exam form User-specified MSK Exam form User-specified MSK Exam form User-specified MSK Exam form User-specified MSK, neuro Exam form User-specified MSK, neuro 2027167-002 Rev B 2006 General Electric Company 329

Creating Clinical Content for Centricity Physician Office - EMR 2005 Name Description Used in Values Exam Focus stren RLE stren RUE stren trunk Tone LLE Tone LUE Tone RLE Tone RUE skin sq insp skin sq palp skin sq head skin sq neck skin sq chst skin sq abdo muscle strength and tone of right lower extremity muscle strength and tone of right upper extremity muscle strength and tone of spine, ribs, and pelvis muscle tone of left lower extremity muscle tone of left upper extremity muscle tone of right lower extremity muscle tone of right upper extremity inspection of skin and subcutaneous tissues palpation of skin and subcutaneous tissues inspection and palpation of skin and subcutaneous tissue on head and face inspection and palpation of skin and subcutaneous tissue on neck inspection and palpation of skin and subcutaneous tissue on chest inspection and palpation of skin and subcutaneous tissue on abdomen Exam form User-specified MSK, neuro Exam form User-specified MSK, neuro Exam form User-specified MSK Exam form User-specified Neuro Exam form User-specified Neuro Exam form User-specified Neuro Exam form User-specified Neuro Exam form User-specified General, cardio, GU, Heme, pulm, MSK Exam form User-specified General, cardio, GU, Heme, pulm, MSK Exam form User-specified Skin Exam form User-specified Skin Exam form User-specified Skin Exam form User-specified Skin 330 2006 General Electric Company July 2006

Observations recognized by E&M Advisor Name Description Used in Values Exam Focus skn sq groin skin sq back skin sq LLE skin sq LUE skin sq RLE skin sq RUE skin glands hair exam skin sq trnk Cran Nerve inspection and palpation of skin and subcutaneous tissue on genitalia, groin, and buttocks inspection and palpation of skin and subcutaneous tissue on back inspection and palpation of skin and subcutaneous tissue on left lower extremity inspection and palpation of skin and subcutaneous tissue on left upper extremity inspection and palpation of skin and subcutaneous tissue on right lower extremity inspection and palpation of skin and subcutaneous tissue on right upper extremity inspection of eccrine and apocrine glands inspection of scalp and body hair inspection and palpation of skin and subcutaneous tissue on trunk examination of cranial nerves Exam form User-specified Skin Exam form User-specified Skin Exam form User-specified Skin, MSK Exam form User-specified Skin, MSK Exam form User-specified Skin, MSK Exam form User-specified Skin, MSK Exam form User-specified Skin Exam form User-specified Skin Exam form User-specified MSK Exam form User-specified General, ENT Deep ten rfl deep tendon reflex Exam form User-specified General, MSK, Neuro 2027167-002 Rev B 2006 General Electric Company 331

Creating Clinical Content for Centricity Physician Office - EMR 2005 Name Description Used in Values Exam Focus sensa exam coordination CN II CN V CN VII CN VIII CN IX CN XI CN XII judg insight MSE:orient Disorientat MSE:recall affct-mood examination of sensation examination of coordination examination of second cranial nerve examination of fifth cranial nerve examination of seventh cranial nerve examination of eighth cranial nerve examination of ninth cranial nerve examination of eleventh cranial nerve examination of twelfth cranial nerve assessment of judgment and insight mental status examination: orientation disorientation as to people, time and place mental status examination: recall assessment of mood and affect Exam form User-specified General, MSK, Neuro Exam form User-specified MSK, Neuro Exam form User-specified derived from other exams Neuro Exam form User-specified Neuro Exam form User-specified Neuro Exam form User-specified Neuro Exam form User-specified Neuro Exam form User-specified Neuro Exam form User-specified Neuro Exam form User-specified General, psych Exam form User-specified General, cardio, heme, GU, heme, pulm, skin, eye, MSK, psych Exam form User-specified General, cardio, heme, GU, heme, pulm, skin, eye, MSK, psych Exam form User-specified General, psych Exam form User-specified General, cardio, heme, GU, heme, pulm, skin, eye, MSK Speech speech Exam form User-specified Psych 332 2006 General Electric Company July 2006

Observation terms by exam focus Name Description Used in Values Exam Focus desc thought desc associa description of thought processes description of associations Observation terms by exam focus Exam form User-specified Psych Exam form User-specified Psych Thought Cont thought content Exam form User-specified Psych MSE:attentn language MSE:infrmtn workup plan attention span by mental status examination assessment of language mental status examination: fund of knowledge E&M additional workup planned for new problem flag Exam form User-specified Psych Exam form User-specified Psych Exam form User-specified Psych Exam form Yes, No All The following table lists the observations available for each type of exam. For some exams, providers can choose which of two or more bullets to document. These requirements are indicated by an OR, such as in the Eyes section of the Neuro Exam. For some exams, two or more observations must be recorded to fulfill the requirement for a bullet. These observations are joined with an ampersand (&). For example, the Neuro exam requires reviewing the strength of the patient s right and left upper and lower extremities (four separate observations) to meet the requirement for that bullet. However, in the musculoskeletal exam, each of the observations is considered a bullet. The observations in this table are noted using their names within the EMR application. The names can be somewhat cryptic. You can look up the observation descriptions in the previous table. 2027167-002 Rev B 2006 General Electric Company 333

334 2006 General Electric Company July 2006 Constitutional Head/face Eyes General Exam Gen appear conjunc insp Fundusco py pupil exam Cardiova scular Exam Gen appear conjunc insp ENT Exam Gen appear, commun abil hd/face insp, face pal/per, saliv gland, face strengt EOM Eye Exam Visual acuit, Visual field, EOM, conjunc insp, ocula adnexa, pupil exam, corne s-lamp, lens s-lamp, ant cham s-l, ocul pres OD, ocul pres OS, post segment, optic disc OR funduscopy GU Exam Gen appear Heme/ Onc Exam Gen appear face pal/per conjunc insp MSK - Exam Gen appear Neuro Exam Gen appear post segment, optic disc OR funduscopy Psych Exam Gen appear Respiratory Exam Gen appear Skin Exam Gen appear conjunc insp Creating Clinical Content for Centricity Physician Office - EMR 2005

2027167-002 Rev B 2006 General Electric Company 335 Ears, Nose, Throat Neck Respiratory General Exam ext insp ear, ex insp nose, otoscopy, hearing asmt, Nose exam, dent/ gums, orophary nx NECK EXAM, Thyroid exam resp effort, percuss chest, chest palp, auscul lungs Cardiova scular Exam dent/gum/ pal, oral exam NECK veins, Thyroid exam resp effort, auscul lungs ENT Exam otoscopy air, hearing asmt, ex insp nose & ext insp ear, nose exam, lip-dentgum, orophary nx, phary/pyr ifo, larynx exam, nasophar exm NECK EXAM, Thyroid exam chest inspec, auscul lungs Eye Exam GU Exam NECK EXAM, Thyroid exam resp effort, auscul lungs Heme/ Onc Exam otoscopy, nose exam, dent/ gums, orophary nx NECK EXAM, Thyroid exam resp effort, auscul lungs MSK - Exam Neuro Exam Psych Exam lip-dentgum, oropharynx Respiratory Exam nose exam, dent/ gums, orophary nx NECK EXAM, Thyroid exam, neck veins resp effort, chest inspec, chest palp, auscul lungs, percus chest Skin Exam Thyroid exam Observation terms by exam focus

336 2006 General Electric Company July 2006 Cardiovascular Chest (breasts) Gastrointestina l (Abdominal) General Exam Carotid exam, heart palp, auscul heart, fem art exam, abd aort exm, Periph circ, pedal pulse breast insp, breast palp abd hernias, abdom insp OR abdom palp, Rectal exam, Hemoccult, liver spleen Cardiova scular Exam Carotid exam, heart palp, auscul heart, fem art exam, abd aort exm, Periph circ, pedal pulse, TWO EXTR BP abdom palp, Hemoccult, liver spleen ENT Exam auscul heart, Periph circ Eye Exam GU Exam auscul heart, Periph circ breast insp & breast palp, abd hernias, abdom insp OR abdom palp, Hemoccult, liver spleen Heme/ Onc Exam auscul heart, Periph circ abdom insp OR abdom palp, liver spleen MSK - Exam Periph circ Neuro Exam Carotid exam, auscul heart, Periph circ Psych Exam Respiratory Exam auscul heart, Periph circ abdom insp OR abdom palp, liver spleen Skin Exam Periph circ liver spleen, anus/ perineu Creating Clinical Content for Centricity Physician Office - EMR 2005

2027167-002 Rev B 2006 General Electric Company 337 Genitourinary Male Genitourinary Female General Exam scrotal exam, penis exam, Prostate Exam Ext gen exam, Vagina exam, urethra exam, Cervix exam, uterus palp, bladder palp, Uter adn exa Cardiova scular Exam ENT Exam Eye Exam GU Exam anus/ perineu, scrotal exam, epididym exm, testes exam, ureth meatus, penis exam, Prostate Exam, Rectal exam, semin vesic Ext gen exam, Vagina exam, urethra exam, Cervix exam, uterus palp, Uter adn exa, rectal exam, ureth meatus, bladder palp, anus/ perineu Heme/ Onc Exam MSK - Exam Neuro Exam Psych Exam Respiratory Exam Skin Exam Observation terms by exam focus

338 2006 General Electric Company July 2006 Lymphatic General Exam cervic nodes, Axillary nod, inguin nodes, LYMPH NODES Cardiova scular Exam ENT Exam LYMPH NODES Eye Exam GU Exam LYMPH NODES Heme/ Onc Exam LYMPH NODES MSK - Exam LYMPH NODES Neuro Exam Psych Exam Respiratory Exam LYMPH NODES Skin Exam LYMPH NODES Creating Clinical Content for Centricity Physician Office - EMR 2005

2027167-002 Rev B 2006 General Electric Company 339 MSK General Exam gait station, digit nails, head/ neck ex, trunk exam, RUE exam, RLE exam, LUE exam, LLE exam Cardiova scular Exam back exam, gait station, strengt tone, digit nails ENT Exam Eye Exam GU Exam Heme/ Onc Exam digit nails MSK - Exam gait station, head/ neck ex, ROM hd/neck, ROM LLE, ROM LUE, ROM RLE, ROM RUE, ROM trunk, stabl hd/nck, stabl LLE, stabl LUE, stabl RLE, stabl RUE, stabl trunk, stren hd/nck, stren LLE, stren LUE, stren RLE, stren RUE Neuro Exam gait station, stren LLE & stren LUE & stren RLE & stren RUE, tone LLE & tone LUE & tone RLE & tone RUE Psych Exam strengt tone, gait station Respiratory Exam strengt tone, gait station, digit nails Skin Exam digit nails Observation terms by exam focus

Creating Clinical Content for Centricity Physician Office - EMR 2005 Skin Exam Respiratory Exam General Exam Cardiova scular Exam ENT Exam Eye Exam GU Exam Heme/ Onc Exam MSK - Exam MSK (cont) stren trunk, LLE exam, LUE Exam, RLE exam, RUE exam, trunk exam Neuro Exam Psych Exam 340 2006 General Electric Company July 2006

2027167-002 Rev B 2006 General Electric Company 341 Skin General Exam skin sq insp, skin sq palp Cardiova scular Exam skin sq insp, OR skin sq palp ENT Exam Eye Exam GU Exam skin sq insp, OR skin sq palp Heme/ Onc Exam skin sq insp, OR skin sq palp MSK - Exam skin sq head & skin sq neck, skin sq trnk, skin sq LLE, skin sq LUE, skin sq RLE, skin sq RUE Neuro Exam Psych Exam Respiratory Exam skin sq insp, OR skin sq palp Skin Exam skin sq head, skin sq neck, skin sq chst, skin sq abdo, skn sq groin, skin sq back, skin sq LLE, skin sq LUE, skin sq RLE, skin sq RUE, skin glands, hair exam Observation terms by exam focus

342 2006 General Electric Company July 2006 Neuro General Exam Cran Nerve, Deep ten rfl, sensa exam Cardiova scular Exam ENT Exam Cran Nerve Eye Exam GU Exam Heme/ Onc Exam MSK - Exam coordinat ion, Deep ten rfl, sensa exam Neuro Exam funduscopy & visual acuit & visual field, EOM & pupil exam, CN V, CN VII, CN VIII, CN IX, CN XI, CN XII, coordinat ion, Deep ten rfl, sensa exam, MSE: orient, MSE: recall, affctmood, MSE: attentn, language, MSE: infrmtn Psych Exam Respiratory Exam Skin Exam Creating Clinical Content for Centricity Physician Office - EMR 2005

2027167-002 Rev B 2006 General Electric Company 343 Psych General Exam judg insight, MSE: orient OR Disorientat, MSE: recall, affctmood Cardiova scular Exam MSE: orient OR Disorientat, affctmood ENT Exam MSE: orient OR Disorientat, affctmood Eye Exam MSE: orient OR Disorientat, affctmood Comprehensive exam requirements GU Exam MSE: orient OR Disorientat, affctmood Heme/ Onc Exam MSE: orient OR Disorientat, affctmood MSK - Exam MSE: orient OR Disorientat, affctmood Neuro Exam Psych Exam Speech, desc thought, desc associa, Thought Cont, judg insight, MSE: orient, MSE: recall, MSE: attentn, language, MSE: infrmtn, affctmood MSE: orient OR Disorientat, affctmood Respiratory Exam MSE: orient OR Disorientat, affctmood Skin Exam For a comprehensive specialty examination, the guidelines have specific requirements for exam components. For example, a comprehensive cardiovascular examination requires that the provider document eight elements of the cardiovascular exam, for example, listening to the heart or examining the peripheral pulses. However, the provider is not required to document anything about the genitourinary system. For a comprehensive genitourinary examination, the physician must document 9 or 11 (depending on patient gender) elements of the genitourinary exam, as well as at least one part of the cardiovascular exam. The table in the following page shows the number of bullets required for a comprehensive exam of each specialty system. Required elements are shown in bold, and the provider must document all of the elements. Numbers that are not in bold indicate that the provider must document at least one element in that body area. Comprehensive exam requirements

Creating Clinical Content for Centricity Physician Office - EMR 2005 CPT codes 99204, 99205, 99215, 99244, and 99245 require comprehensive examinations. 344 2006 General Electric Company July 2006

2027167-002 Rev B 2006 General Electric Company 345 Organ System. Const VS- Head Ent Eye Neck Resp CV Abd- GU Male GU Female Lym Msk Skin Neuro CV 1 1 2 1 2 2 8 3 3 1 2 Ent 2 1 4 9 1 2 2 1 1 2 Eye 1 12 2 Gu 1 2 2 2 2 4 9 11 1 1 2 Hem 1 1 1 4 1 2 2 2 2 1 1 1 2 Msk 1 1 1 1 17 4 3 2 Neur 1 1 1 3 3 16 Psy 1 1 2 11 Resp 1 1 3 3 5 2 2 1 3 1 2 Skin 1 1 2 1 1 1 2 1 1 10 2 Psych Comprehensive exam requirements

Creating Clinical Content for Centricity Physician Office - EMR 2005 346 2006 General Electric Company July 2006

APPENDIX D Technical information Uninstall Encounter Form Editor 347 Reinstall Encounter Form Editor 347 Microsoft Access considerations 347 Uninstall Encounter Form Editor If you should ever need to uninstall Encounter Form Editor, go to Start Programs > Encounter Form Editor and click Encounter Form Editor Setup. Follow the on-screen instructions.!!! Before you uninstall Encounter Form Editor, export your libraries so that items you have added will not be overridden during a subsequent installation. Reinstall Encounter Form Editor If you need to reinstall Encounter Form Editor, you should follow the uninstall procedure and then reinstall as described in Install Encounter Form Editor on page 7. Microsoft Access considerations Run-time version There are several things you need to consider if you have other tools that are based on Microsoft Access or if you have a full copy of Access installed on your workstation. When you install Encounter Form Editor, Setup installs a run-time version of Microsoft Access 2003 in a folder called OFFICE. This folder normally gets placed in the ENCOUNTER FORM EDITOR folder. Encounter Form Editor requires the Access run-time to run. If you delete the OFFICE folder from any location, Encounter Form Editor will not work. 2006 General Electric Company

Creating Clinical Content for Centricity Physician Office - EMR 2005 348 2006 General Electric Company July 2006

APPENDIX E Style guide Font, style, and capitalization guidelines 349 Clinical workflow 350 This appendix contains a style guide for creating forms. It is based on the form component style guide used by GE. It provides some guidelines to help you make forms that are consistent, but it does not cover all aspects of form design. You may want to develop your own style guide. Encounter Form Editor supports most of these guidelines with its default properties and customizations. Font, style, and capitalization guidelines These guidelines apply to the way the form looks onscreen. Item Font, size, style Capitalization Notes Form title Use a Heading item Arial 10 point bold Capitalize the First Letter of Each Major Word Make sure the form s purpose is clear. Section title Use a Heading item Arial 9 point bold Capitalize the First Letter of Each Major Word Single-item headings Use the label for the form item Arial 8 point Capitalize the First Letter of Each Major Word Single-item headings are headings for a significant part of the exam, but are followed by only one form item, such as an Edit Field or a Multi-Line Edit Field. Examples: Chief Complaint or History of Present Illness. Place a colon after the label. Subsection title Use a Heading or Text item Arial 8 point Capitalize the First Letter of Each Major Word 2006 General Electric Company

Creating Clinical Content for Centricity Physician Office - EMR 2005 Item Font, size, style Capitalization Notes Label Use the label for the form item Instructions or messages to the user Use a Text item Radio Button choices, Check Box statements, and List Box choices Arial 8 point bold Clinical workflow Arial 8 point italic Arial 8 point A clinical encounter usually follows a specific workflow. While not every encounter includes all parts of the clinical workflow, you should place form items and components in this order. Referral source History source Chief complaint Capitalize only the first word Capitalize the first letter of each sentence don t capitalize any words unless they are Proper Names History of present illness Place a colon after the label. Right-align label in front of data entry field. Place units of measurement after data entry field. Don t enclose instructions in parentheses (). DON T USE ALL CAPS. Use a transparent background for the item. The radio buttons and check boxes themselves are white. Edit Field text Arial 8 point Use a white background for the item. Multi-Line Edit Field text Drop-Down List choices Data Display text Action Button text Arial 8 point Do not use bold. Use a white background. Arial 8 point Arial 8 point or Arial 8 point bold Arial 8 point don t capitalize any words unless they are Proper Names Capitalize the First Letter of Each Major Word Display protocol lists (preventive care reminders) in bold. Display problem, medication, allergy, and directive lists in non-bold. Use a transparent background to indicate that data can t be entered. If the button leads to a dialog box or another application, follow the label with an ellipsis (three periods). 350 2006 General Electric Company July 2006

Clinical workflow Past medical history Current problems and medications Risk factors Family medical history Social history Review of systems Vital signs Physical exam Preventive care reminders Buttons for updating problem and medication lists Impression Plan Return to office Disposition 2027167-002 Rev B 2006 General Electric Company 351

Creating Clinical Content for Centricity Physician Office - EMR 2005 352 2006 General Electric Company July 2006

INDEX Note. In this index, a bold page number indicates where the term is defined. A Access. see Microsoft Access Acrobat Reader 8 Action Buttons 122, 284 connections for 31, 310 customization options for 285 labels for 285 path and arguments for external program 285 problem prefix for problem custom list 285 properties 284 Set Values connection 121 text translations 285 to trigger calculations 126 with medication custom list 285 with problem custom list 285 action connection using custom list with 33 Active Observations flowsheet view 311 Active Problems/Meds boxes, library group 300 Add Allergies action connection 31, 310 Add and print handouts 33 Add Directives action connection 32, 310 Add Flowsheet action connection 32, 310 Add Form Component action connection 32 Add Medications action connection 32, 310 Add Orders action connection 32, 310 Add Problems action connection 32, 310 adding form items 59 item groups to library 84 items to library 82 advanced features about 91 using 91?? alignment, customizing 68 allergies Action Button connection to update 310 Allergies After clinical function 306 AND operator, defined 239 ANDs for E&M Advisor 149 arguments defining in functions 260 observation terms 184 with complex values 261 with simple values 260 arrays, as MEL value types 247 arrow buttons 56 assignment behavior with complex values 261 with simple values 260 Assignment behavior 249 B background color 70 customizing 70 white vs. transparent 70 banners. See patient banners Begin Multi-Item Row number of items 282 percentages list 282 restrictions 282 Begin Section 281 group box 282 new page 282 number of columns 282 percentages list 282 properties 281 restrictions 282 section name 281 Begin Suppression Block 40, 292 Begin Visibility Region 116, 119 defined 47 blank libraries 88 blank space, creating 48 body mass index calculation 302 body surface area calculation 302 bold font 68 in fmt and cfmt expressions 100 bold italic font 68 Boolean symbols 182, 246 braces 94 break, syntax 257 buckets 147 bullets 147 ANDs 149 ORs 149 2006 General Electric Company

Creating Clinical Content for Centricity Physician Office - EMR 2005 button functions 274 button labels 285 C calculations action connection to update 310 common uses 126 defined 32 example 203 in expressions 203 MEL Expression/Function items 128 rules of precedence 203 using Action Buttons for 126 writing 126 call functions 260 case expressions, variables in 110 in custom list pathnames 285 in flowsheet pathnames 291 insensitivity 96 matching in searches of item list 58 style guide for form items 347 case expressions about 202 case statement 255 case insensitivity 193 cfmt compared with fmt 100 syntax rules for 102 usage rules 102 cfmt() compared to fmt() 205 format codes for 207 when to use 205 with quick text 228 chart update translations. see text translations chart updates concurrent 271 single 271 Check Boxes 122, 285 customization options 286 labels for 286 printed form translation 286 properties 285 statements 286 text translations 286 chief complaint 156 library item 297 choice list for Drop-Down Lists 288 for List Boxes 293 for Radio Buttons 295 Cholesterol Results letter 221 choosing connections 26 33.CKT extension 76 clinical content importing into EMR 235 testing 231 clinical functions Allergies After 306 Allergies New 306 Allergies Prior 307 Allergies Removed 307 Allergy List Changes 306 as data symbols 93 Directives After 307 Directives New 307 Directives Prior 307 Directives Removed 307 displaying as comma-delimited list 287 List New Assessments 307 List New Medications 307 List New Medications Full 307 list of Data Display connections 306 List Protocols Due 307 List Protocols Full 307 List Protocols Short 307 Medications After 307 Medications List Changes 307 Medications New 307 Medications Prior 307 Medications Removed 308 Observations List Changes 308 Orders After 308 Orders List Changes 308 Orders New 308 Orders Prior 308 Problems After 308 Problems List Changes 308 Problems New 308 Problems Prior 308 Problems Removed 308 clinical kits about 53 creating 72 exporting 234 files in 75 importing 235, 236 clinical lists updating with Action Buttons 31 clinical workflow 44 style guide for 348 Column Breaks 283 group box for column 283 properties 283 restrictions on using 283 columns about 45 2 2006 General Electric Company July 2006

Index number of property 282 tips for using 48 comma-delimited list for clinical function Data Displays 287 commas, in drop-down list items 288 comments, syntax for 242 community scoping of variables 264 database-scoped 266 document-scoped 264 compacting the database 89 compatibility with operating systems 6 with previously created forms 6 compile errors 278 complex values 245, 247 array 247 data symbols 248 complication risk, evaluated by E&M Advisor 162 components. See text components 226 comprehensive exam requirements 158 concatenation 95, 193 conditional expressions 97 case statement 255 continue statement 258 if statements 253 if-then-else expression 194 loop statements 255, 256 short-form if-then-else 254 Connect Item Finder dialog box 60 connections choosing 26 33 clinical functions 30, 306 example 34 for Action Buttons 31 for Data Displays 29 for storing data 27 list of 305 311 MEL expressions 31 New Obs (Default Prev) 28 New Observation 28 observation terms 306 Prev Obs with Date 29 Previous Observation 29 shown on item list 56 Temporary Variable 28 const variable, defined 240 continue 258 continue statements 258 converting value types 205 correcting errors 75 counseling documentation 162 CPT coding levels 147 crash recovering form component after 52 current field, search only 58 custom form items, about 36 custom lists using with new problem or new medication connection 285 Customize Item dialog box 66 customizing about 91 background color 70 fonts 68 form appearance 66 horizontal percentage 71 pixel height per line 72 printed form translations 137 text alignment 68 text color 69 text translations 131 customizing fonts set syle instructions 69 vary heading size 69 D data dependencies analysis 272 Data Display items about 112 change labels based on form entry 113 creating 112 Data Displays 287 clinical function connections 30 comma-delimited list in 287 connections 29 customization options 287 labels for 287 Previous Obs with Date connection 29 Previous Observation connection 29 text translations for 287 data symbol functions evaluating change-driven functions 270 data-driven functions 269 rules for 269 sample observation term argument 186 using with arguments 182 data symbols about 92, 174 argument syntax 183 as complex values 248 Boolean 182 clinical functions 93 data symbol functions 93 date type 182 errors with 277 evaluating 179 during chart updates 269 2027167-002 Rev B 2006 General Electric Company 3

Creating Clinical Content for Centricity Physician Office - EMR 2005 in forms 271 in multiple updates 270 for Flowsheet Views 94 in quick text 227 in templates 225 inserting into Expression Builder 111 observation term arguments 184 observations as 94 patient attributes 93 searching 178 shorthand values returned 199 temporary variable 94 types 180 using Insert Symbol dialog box 177 values returned by 180 when to evaluate 179 with Action Buttons 93 data, testing for presence of 198 database, compacting 89 databases Network Training Database xv database-scoped variables 266 date field 290 date symbols 182 date, value type 246 default font and style 54 deleting form items 66 library groups 86 library items 83 description of form 53 designing form components 44 direction of search 58 directives, Action Button connection to update 310 disposition, library item 298 document templates with E&M Advisor 145 DOCUMENT variables as triggers 273 defining 265 multi-user considerations 265 using 265 watcher expressions, and 273 document variables evaluating 108 document-scoped variables 264 double, MEL value type 246 Drop-Down Lists 122, 287 choice list 288 customization options 289 dynamic drop-down lists 114 label 288 limit entry to choice list 288 maximum character length 288 E numeric mask 288 printed form translations 289 properties 287 text translations 289 E&M Advisor 145 163 about 145 amount of data 161 Cardiovascular exam considerations 149 complexity of data 161 complication risk 162 designing form components 155 determining EMR form compliance 153 documenting counseling 162 Gastrointestinal exam considerations 149 HPI observation count 156 locating observation terms 153 management options 161 morbidity risk 162 mortality risk 162 number of diagnoses 161 observation terms 153 operation 145 patient history 157 problem assessment 156 requirements 150 special considerations 149 system review 156 viewing form components 153 Edit Fields 122, 289 characteristics 289 customization options 290 date field 290 label 290 maximum character length 290 numeric masks for 290 printed form translation 290 text translations 290 edit window controls 55 editing a form 55 66 EFEDIT.ILB, contents of 297.EFM extension 75 Encounter Form Editor 158 about 5 compatibility with older forms 6 edit window controls 55 exiting 52 files created by 75 installing 6 installing local observation term files 7 item list 56 main window 52 new features in 2.5 5 4 2006 General Electric Company July 2006

Index registering 51 reinstalling 345 starting 13, 51 tutorial 13 uninstalling 345 Encounter Form Info Sheets using for form design 24 Encounter form tips and limitations 8 End Suppression Block 40, 283 properties 283 restrictions on using 283 End Visibility Region 116 error code 279 error codes 238 errors about 74 compile error 252, 278 in Encounter Form Editor program 89 misplaced commas 278 missing + operator 278 missing braces 237, 277 missing quotes 278 no data returned 237, 277 printing list of 75 runtime error 252 too few arguments 237, 277 too many arguments 237, 278 troubleshooting MEL 237 types defined 251 using ID numbers to locate 75 viewing 75 with data symbols 277 estimated delivery date calculation 302 evaluating data symbols 179 continuously 180 during multiple updates 270 in forms 271 when inserted in note 180 evaluating in forms exclamation point 271 on form open 271 watcher expressions 271 exam levels comprehensive 158 detailed examination 158 expanded problem-focused 158 problem-focused 158 exam requirements detailed 158 general system 158 genitourinary 158 musculoskeletal 158 executable file path and arguments 285 existing forms, opening 54 exiting Encounter Form Editor 52 expanded problem-focused exam requirements 158 exporting Encounter Form Editor libraries 88 exporting templates 234 expression evaluating 108 joining text to a data symbol 95 Expression Builder 110 inserting a symbol 111 inserting observation terms 111 expressions arguments in 192 braces in 191 calculations in 203 case expression 202 case insensitivity in 193 comments in 242 concatenation in 193 if-then-else 194, 253 joining text to symbols 193 long-form syntax 195 operators in 200 short-form syntax 197 syntax for 191 when to evaluate 191 external programs Action Button connection to run 33, 311 F FALSE operator, defined 241 family history, library item 298 family/social history, library group 303.FD extension 75 file size limits 76 files created by Encounter Form Editor 75 extensions for Encounter Form Editor files 75 Flowsheet Views 291 active observations 311 customization options 291 data symbols for 94 labels for 291 list of views 311 number of lines shown 291 pathname property 291 potential observations 311 printed form translations 291 properties 291 summary of active observations 311 text translations 291 flowsheets Action Button connection to update 310 fmt 100 compared with cfmt 100 2027167-002 Rev B 2006 General Electric Company 5

Creating Clinical Content for Centricity Physician Office - EMR 2005 syntax rules 101 usage rules 100 fmt() compared to cfmt() 205 when to use 205 with quick text 228 font size specifying in fmt and cfmt expressions 100 fonts customizing 68 styles available 68 for loop 256 for statement 256 form components 229 about 3 action connection to open 311 clinical workflow in 44 creating preliminary design 44 description of 53 design process 11 editing 55 66 editing on another workstation 76 entering basic information 53 errors while saving 74 gathering preliminary information for 22 grouping 44 info sheet for gathering preliminary information 24 naming form components 22 opening existing 54 opening new 53 order of items 25 pages, navigation 45 parts of 3 previewing 79 printed forms 4 recovering after unexpectedly exiting Encounter Form Editor 52 saving 72 spacing 54 style guidelines for designing 49 testing onscreen forms 166 text translations 4 using columns in 45 viewing in EMR 167 visibility in 272 visual design of 44 49 visual design tips 48 form information entering basic information 53 gathering preliminary information 22 form items 284 297 Action Buttons 39, 122, 284 adding 58 64 adding explanations, instructions 45 adding library items 62 Check Boxes 38, 285 choosing 35 Data Displays 37, 286 deleting 66 Drop-Down Lists 38, 122, 287 Edit Fields 37, 122, 289 editing existing 66 Flowsheet Views 39, 291 Headings 37, 291 inserting in list 59 List Boxes 39, 122, 292 moving 66 Multiline Edit Fields 38, 122, 294 printing a report of 80 Radio Buttons 38, 122, 295 rearranging 66 selecting 56 Text 37, 296 form navigation Add Form Component action connection 310 Jump to Tab action connection 310 Open Form Component action connection 311 format codes 100 formatting items 46, 281 284 Begin Multi-Item Row 46 Begin Section 46, 281 Begin Visibility Region 47 Column Breaks 46, 283 End Suppression Block 283 End Visibility Region 47 Headings 47 Text 47 forms inserting expressions or functions 125.FS extension 75 function data symbols about 174 examples of 182 rules for evaluating 269 functions 260, 261 about 104, 174 calling 260 data symbol functions 93 defining 259, 260 evaluating 108 evaluation 272 examples 104 MEL functions 104 passing arguments to 260 syntax 94 watcher 273 with action buttons 274 6 2006 General Electric Company July 2006

Index G gathering form information 22 general system exam example 159 requirements 158 genitourinary exam requirements 158 global scoping of variables 263 global variable, defined 240 global variables 110 graphics, in RTF editor 214 group box for Begin Section item 282 for column 283 group library items, new items 5 grouping form items 44 guidelines action connection 310 H handout printing 5 handouts 218 229 about 218 headers for printing 216 locations of care for headers 217 HCFA buckets 147 bullets 147 document history requirements 155 examination types 157 family history 157 guidelines 147 medical decision-making 160 past history 157 problem assessment 156 ROS forms 156 social history 157 headers 216 218 examples 218 location of care symbols in 217 heading suppression 40 how to specify 40 nesting suppressed headings 41 Headings 291 as formatting items 47 as visual design elements 45 begin suppression block property 292 customization options 292 printed form translation 292 properties 291 restrictions 292 suppressing 40 text translation 292 using for blank space 48 History of Present Illness Heart Failure form 22 library item 299 horizontal percentage, customizing 71 HPI locating observations 156 I ID # in item list 56 using to locate errors 75 if statements 253 short form 254 syntax 253 if-then-else expressions 97, 194 comparison statements 199 long and short forms compared 197 long form rules 195 short form rules 198 testing for returned values 198 using braces with long form 99 importing forms into EMR 165 importing libraries 87 individual scoping of variables 263 global scoping 263 Insert Symbol dialog box 111 removing extra braces 178 searching for symbols 178 using 177 inserting items in list 59 installing Acrobat Reader 8 local observation term files 7 installing Encounter Form Editor 6 reinstalling 345 italic font 68 in fmt and cfmt expressions 100 Item Finder dialog box 59 item group libraries adding groups to 84 contents of library supplied with Encounter Form Editor 36 creating new 89 deleting groups from 86 exporting 88 importing 87 item groups adding item groups to form 63 item libraries adding items from library to form 62 contents of library supplied with Encounter Form Editor 36 creating new 89 deleting items from 83 exporting 88 2027167-002 Rev B 2006 General Electric Company 7

Creating Clinical Content for Centricity Physician Office - EMR 2005 importing 87 item list contents 56 searching 57 item properties, about 39 item report printing 80 item space vs. label space 71 item type 56 J Jump to Tab action connection 32 K keywords, summary table of 239 KnowledgeBank about 6 L labels 56 adjusting horizontal percentage 71 amount of column occupied by 71 changing alignment of 68 changing font and style of 68 changing pixel height per line 72 changing text color 69 customizing 67 display conditionally 112 displaying recent data 113 for Check Boxes 286 for Data Displays 287 for drop-down list 288 for Edit Fields 290 for Flowsheet Views 291 for List Boxes 293 for Multiline Edit Fields 294 for Radio Buttons 295 form instructions 112 Large List Lookup 31 LAST_SIGNED_OBS_DATE 184 LAST_SIGNED_OBS_DATETIME 185 LAST_SIGNED_OBS_VALUE 185 LAST_SIGNED_OBS_VALUEDATE 185 LASTOBSDATE 184 LASTOBSDATETIME 184 LASTOBSVALUE 184 LASTOBSVALUEDATE 184 letterhead using preprinted or creating 216 letters 218 229 headers for printing 216 locations of care for headers 217 libraries 81 adding item groups to 84 adding items to 82 blank libraries supplied with Encounter Form Editor 88 contents of 36 creating new 88, 89 deleting item groups 86 deleting items 83 exporting 88 importing 87 included with Encounter Form Editor 81 library groups Active Problems/Meds boxes 300 Add Allergy, Directive, Medication, or Problem item 300 calculations 302 family/social history 303 multiple items for one observation 303 narrative style 304 visibility controlled by observation 305 visibility controlled by radio button 305 vital signs 305 library groups, descriptions and pictures of 300 305 library item groups adding 63 library items adding 62 assess or update problems item 297 chief complaint item 297 clinical list subset 298 descriptions and pictures of 297 300 disposition item 298 family history item 298 history of present illness item 299 past medical history item 299 preventive care reminders 299 social history item 300 using in form components 35 List Boxes 122, 292 choice list for 293 customization options 293 labels for 293 number of lines shown 293 printed form translation 293 properties 292 text translation 293 ListBoxResult function example 105 ListBoxTranslation function example 107 local observation term files, installing 7 local scoping of variables 264 local variable, defined 241 location of care selecting in print dialog box 217 use in headers 217 locations of care 217 8 2006 General Electric Company July 2006

Index about data symbols for 217 for handouts 217 for letters 217 in handouts 217 Centricity Physician Office Term Finder 187 Centricity Physician Office Term Finder dialog box 112 long, MEL value type 246 loop statements 256 for 256 while 256.LST extension 76 M matching, all or part of field 58 maximum character length for Drop-Down Lists 288 for Edit Fields 290 medical decision-making documentation 160 MedicaLogic Expression Language assigning variable names 129 evaluation 108 Expression Builder 110 functions 104 inserting expressions 125 inserting functions 125 long form syntax 99 operators 96 rich text formatting 100 syntax 94 103 medications action connection to add new 310 action connection to update 310 MEL about 92, 175 array values 247 Boolean values 246 case statements 255 comments 242 complex values in 247 continue statements 258 data symbols 92 date values 246 defining functions in 259 double values 246 dynamic programming language 176 for statements 256 keywords 239 library of functions 236 long values 246 loop statements 256 short form if statements 254 string values 246 syntax 191 198 table of variable scoping 267 tracing errors 279 user-defined functions 93, 173 utility functions 93, 174 values in 245 where to use 176 while statements 256 writing calculations 126 MEL expression evaluating 108 MEL expressions using multiple statements in 244 MEL functions 93 about 104 evaluating 108 MEL tracing 170 MEL value types arrays 247 strings 246 Microsoft Access run-time version 345 mortality risk 162 moving form items 66 multi-item rows 45 see also Begin Multi-Item Row tips for using 48 Multiline Edit Fields 294 can insert templates 294 customization options 294 labels for 294 number of lines shown 294 printed form translations 295 properties 294 tab to colon 294 text translations 294 using note templates with 294 with Set Values button 122 musculoskeletal exam requirements 158 N naming form components 22 narrative style format 304 Nested suppression blocks 41 Network Training Database xv new forms, opening 53 New Handout action connection 32 New Medication action connection 32, 310 New Obs (Default Prev) 28 New Observation 28 New Order action connection 32 new page, specifying with Begin Section item 282 New Problem action connection 33, 310 2027167-002 Rev B 2006 General Electric Company 9

Creating Clinical Content for Centricity Physician Office - EMR 2005 using custom list with 33 NO operator, defined 241 NOT operator, defined 241 note templates, using with multline Edit Fields 294 number of columns in section 282 number of items, Begin Multi-Item Row property 282 number of lines 287 for Data Displays 287 for Flowsheet Views 291 for List Boxes 293 for Multiline Edit Fields 294 for Text item 296 number symbols 182 numeric masks for Drop-Down Lists 288 for Edit Fields 290 O OBSANY 185 observation terms as arguments to data symbols 184 case insensitivity in 186 for use with E&M Advisor 153 inserting into Expression Builder 111 local terms 7 looking up in EMR 187 printing a report 190 printing a report of 306 searching for 64 searching with wildcard characters 189 using as arguments 184 observations 266 as data symbols 94 as triggers 109, 273 as variables 266 associating with global variables 110 capabilities of 26 connections to form items 306 evaluating 108 in Flowsheet Views 311 New Obs (Default Prev) storage connection 28 New Observation storage connection 28 Prev Obs with Date Data Display connection 29 Previous Observation Data Display connection 29 testing for presence of 198, 201 watcher expressions, and 274 watchers, and 109 OBSMODIFIERANY 185 OBSMODIFIERNOW 185 OBSMODIFIERPREV 185 OBSNOW 185 OBSPREV 185 OBSTAGANY 185 OBSTAGNOW 185 OBSTAGPREV 185 OBSUNIT 185 online manuals accessing 5 installing 8 onscreen form components, characteristics of 3 Open Form Component action connection 33 open recent form 5 opening forms existing 54 new 53 operators 96, 242 add 200 divide 200 equal to 200 greater than 200 greater than or equal 200 in if-then-else statements 199 less than 200 less than or equal 200 multiply 200 not equal to 200 relational 96 rules of precedence 203 subtract 200 summary table of 242 using to make comparisons 201 OR operator, defined 241 order of items on form 25 orders,action connection to update 310 ORs 149 P pages in form components 45 naming form pages 45, 281 paper form. see printed form passing arguments 260 Past Medical History form 157 past medical history, library item 299 pathnames for Flowsheet Views 291 for running external programs 285 patient attributes as data symbols 93 list of 308 patient banners 214 216 about 214 examples of 215 patient data creating for testing 231 PATIENT variables 266 using 266 10 2006 General Electric Company July 2006

Index.PEF extension 76 percentages list for Begin Multi-Item Row 282 for Begin Section 282 performance, improving 89 pixel height per line, customizing 72 Potential Observations action connection 311 precedence rules for operators 203 preventive care reminders, library item 299 Preview Form window 80 previewing form 79 printing the preview 80 Previous Obs with Date connection 29 Previous Observation connection 29 printed form translations changing translation expressions 140 customizing 137, 140 default settings 138 printed forms 4 changing translation expressions 140 contents 138 customizing 140 retaining customizations 142 printing form preview 80 item report 80 observation terms list 306 printing a list of observation terms 190 printing handouts 5 problem custom list 285 problem-focused exam requirements 158 problems, action connection to update 310 properties changing after printed form is customized 142 for items 39 specifying 60 Q quick text about 227 and cfmt(), fmt() 228 examples 227 how to create an entry 228??, 228 limitations 228 using data symbols in 227 quitting. see exiting R Radio Buttons 122, 295 arrange horizontally or vertically 295 choice list for 295 customization options 295 labels for 295 printed form translations 296 properties 295 text translations 296 rearranging form items 66 recovering a form 52 referral guidelines. see guidelines registering Encounter Form Editor 51 reinstalling Encounter Form Editor 345 relational operator 96 reports errors 75 list of form items 80 observation terms list 306 return 241 returned values shorthand 199 testing for in if-then-else statements 198 rich text format editor. See RTF editor rich text formatting 100 rich text formatting with MEL 205 RTF editor about 211 adjusting spacing in 213 features 211 graphics, using in 214 Insert Symbol dialog box 213 options in EMR 212 pasting data from other applications 213 tips for using 213 RTF formatting functions 205 Run Process action connection 33, 311 running external programs 33, 285 runtime errors 252 S sample form HPI-History of Present Illness 22 sample templates viewing 219 Save dialog box 73 errors shown in 73 information in 73 saving forms about 72 errors while saving 74 for the first time 73 with a different filename 73 with existing name 74 scope of variables community 264 individual 263 individual user, local scoping 264 Scoping of variables 263 scoping of variables 2027167-002 Rev B 2006 General Electric Company 11

Creating Clinical Content for Centricity Physician Office - EMR 2005 community 264 database 266 DOCUMENT 264 global 263 individual 263 local 264 screen size, selecting 54 searching 57 current field only 58 direction of search 58 for data symbols 178 for observation terms 64 matching all or part of field 58 matching case 58 using wildcard characters 189 section name property, Begin Section 281 selecting form items 56 Set Values Action Buttons adding 123 124 superbuttons 124 using 121 Set Values action connection 33 shorthand values 199 Sign Clinical List Changes check box 270 simple values 245 strings 246 social history, library item 300 spacing, adjusting in RTF editor 213 spacing, setting 54 special operators 251 starting Encounter Form Editor 13, 51 statements break 257 case 255 continue 258 for 256 if 253 loop 256 multiple 244 while 256 statements for Check Boxes 286 storage connections New Obs (Default Prev) 28 New Observation 28 Temporary Variable 28 str() using to convert value types 205 strings as MEL value type 246 manipulating 246 style and size customizations 66 72 alignment 68 background color 70 font 68 horizontal percentage 71 pixel height per line 72 text color 69 style guide for clinical workflow 348 for fonts, styles, and capitalization 347 Summary of Active Observations flowsheet view connection 311 superbuttons 124 suppression blocks 40 begin suppression block Heading property 292 nested 41 symbols. see data symbols syntax 191 198 arguments 183 cfmt 102 fmt 100 for long form MEL 99 format codes for fmt 100 in expressions 191 long and short form syntax compared 197 long-form if-then-else expressions 195 observation term arguments 184 short-form if-then-else expression 197 syntax for MEL 94 T tab to colon property 294 templates consultant letter sample 226 creating a letter template 221 225 exporting from training database 234 guidelines for testing 231 importing into EMR 235 sample templates 219 selecting data symbols 225 tables in 221 text components 226 templates, inserting in Multiline Edit Fields 294 Temporary Variables 94 as triggers 109 connections 28 default selection 56 Temporary variables watchers, and 109 temporary variables evaluating 108 testing for observations 198 form design 167 onscreen forms 166 text translation 169 tips for 168 12 2006 General Electric Company July 2006

Index using the Single-User Training database 231 testing form components 166 Text 296 alignment of 68 customization options for 296 for headings 292 number of lines 296 properties 296 text property 296 using to create blank space 48 text color, customizing 69 text components 218 229 text styles 68 text symbols 181 text translations 4 and heading suppression 40 changing 132 Chart Update and Printed Form 67 combining two items 135 customizing 131 137 default expression format 134 default settings 134 deleting 137 designing for 40 examples 135 narrative style 137 reviewing 169 setting default font and style 54 tracing errors 170 training Network Training Database xv training database, using for testing 165 transferring form compnent files to another workstation 76 triggers observations 109, 273 Temporary Variables 109 temporary variables 273 troubleshooting MEL 237, 277 TRUE operator, defined 241 tutorial 13.TXT extension 76 U UNDEFINED value, defined 241 UNDEFINED, behavior 249 underline font in fmt and cfmt expressions 100 uninstalling Encounter Form Editor 345 updating clinical lists, actions available for 310 usrlib.txt 236 V val using to convert value types 205 value types about 204 arrays 247 Boolean 246 complex 245, 247 converting 205 date 205, 246 double 246 long 246 number 204 simple 245 string 204, 246 variables 248 DOCUMENT 264 in case expressions 110 observations 266 PATIENT 266 scoping 263?? summary table of 267 Variables Summary 267 viewing errors 75 viewing form components in EMR 167 visibility 272 visibility conditions writing?? 121 visibility expression example 118 limitations 118 visibility regions Begin Visibility Region 116 condition format 118 creating 117 End Visibility Region 116 stacked 116 using 116 visual design characteristics 44 tips for 48 vital signs, library section 305 VOID value, defined 241 W watcher expressions 125, 273 calling functions 273 functions and buttons 274 triggers 273 watchers and triggers 109 while loop 256 wildcard characters, using to search 189 workflow, style guide for 348 2027167-002 Rev B 2006 General Electric Company 13

Creating Clinical Content for Centricity Physician Office - EMR 2005 X.XLT extension 76.XLW extension 76 Y YES operator, defined 241 14 2006 General Electric Company July 2006