Allscripts Wand for TouchWorks EHR Version 2.2 User Guide

Allscripts Wand for TouchWorks EHR Version 2.2 User Guide Copyright 2014 Allscripts Healthcare, LLC and/or its affiliates. All Rights Reserved. www.allscripts.com

Published Date: November 06, 2014 for release of For further information about this manual or other Allscripts Healthcare, LLC products, contact Global Product Support Services, as follows: Global Product Support Services Website http://www.allscripts.com/en/client-login.html (Client Support login is required. Contact information varies by product.) Telephone: http://www.allscripts.com/en/support/international-phone-numbers.html The Documentation Center of Excellence welcomes your opinion regarding this document. Please e-mail your comments and suggestions to userdoc@allscripts.com. Proprietary Notice 2014 Allscripts Healthcare, LLC and/or its affiliates. All Rights Reserved. This document contains confidential and proprietary information protected by trade secret and copyright law. This document, the information in this document, and all rights thereto are the sole and exclusive property of Allscripts Healthcare, LLC and/or its affiliates, are intended for use by customers and employees of Allscripts Healthcare, LLC and/or its affiliates and others authorized in writing by Allscripts Healthcare, LLC and/or its affiliates, and are not to be copied, used, or disclosed to anyone else, in whole or in part, without the express written permission of Allscripts Healthcare, LLC and/or its affiliates. For authorization from Allscripts to copy this information, please call Allscripts Global Product Support Services at 888 GET-HELP or 888 438-4357. Notice to U.S. Government Users: This is Commercial Computer Software Documentation within the meaning of FAR Part 12.212 (October 1995), DFARS Part 227.7202 (June 1995) and DFARS 252.227-7014 (a) (June 1995). All use, modification, reproduction, release, performance, display, and disclosure shall be in strict accordance with the license terms of Allscripts Healthcare, LLC and/or its affiliates. Manufacturer is Allscripts Healthcare, LLC, and/or its affiliates, 222 Merchandise Mart Plaza, Suite #2024, Chicago, IL 60654. IMPORTANT NOTICE REGARDING GOVERNMENT USE The software and other materials provided to you by Allscripts include "commercial computer software" and related documentation within the meaning of Federal Acquisition Regulation 2.101, 12.212, and 27.405-3 and Defense Federal Acquisition Regulation Supplement 227.7202 and 52.227-7014(a). These materials are highly proprietary to Allscripts and its vendors. Users, including those that are representatives of the U.S. Government or any other government body, are permitted to use these materials only as expressly authorized in the applicable written agreement between Allscripts and your organization. Neither your organization nor any government body shall receive any ownership, license, or other rights other than those expressly set forth in that agreement, irrespective of (a) whether your organization is an agency, agent, or other instrumentality of the U.S. Government or any other government body, (b) whether your organization is entering into or performing under the agreement in support of a U.S. Government or any other government agreement or utilizing any U.S. Government or any other government funding of any nature, or (c) anything else. is a trademark of Allscripts Healthcare, LLC and/or its affiliates. Allscripts Healthcare, LLC is a trademark of Allscripts Healthcare, LLC and/or its affiliates. All other products are trademarks of their respective holders, all rights reserved. Reference to these products is not intended to imply affiliation with or sponsorship of Allscripts Healthcare, LLC and/or its affiliates. The names and associated patient data used in this documentation are fictional and do not represent any real person living or otherwise. Any similarities to actual people are coincidental. CPT 2013 American Medical Association. All rights reserved. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. CPT is a registered trademark of the American Medical Association. International Statistical Classification of Diseases and Related Health Problems (ICD) is copyright 2009 World Health Organization (WHO). Microsoft Excel and Microsoft Word are either registered trademarks or trademarks of Microsoft Corporation in the United States and/or other countries. Adobe, the Adobe logo, Acrobat, PDF, and Reader are either registered trademarks or trademarks of Adobe Systems Incorporated in the United States and/or other countries. iphone and ipad are trademarks of Apple Inc., registered in the U.S. and other countries.

Table of Contents Chapter 1: Overview...7 Introduction...7 Chapter 2: Getting Started...9 Installation...9 Configuration...9 Updates...10 Login...10 Inactivity timeout...12 Chapter 3: Navigation...13 Areas of functionality...13 Appointments and tasks...13 Appointment list...14 Appointment information detail...17 Task list...19 Progressive information display...21 Patient header...22 Add a patient portrait...24 Add a chart photo to a patient's scanned documents list...25 Create a task...26 Alerts and Review panels...27 Search for a patient...30 Searching in the application...30 Encounter linking...31 Help...31 Chapter 4: Working with Appointments...33 Appointments...33 View a patient appointment...33 Patient Review screen...34 Enable Chief Complaint...34 Vitals...35 Vitals section...35 November 06, 2014 3

Table of Contents Add a vitals reading...40 Alerts and Reminders...42 Alerts and reminders section...42 Problems...44 Problems section...44 Add a problem...47 Verify an unverified problem...49 History...49 History section...49 History Details screen...51 Add a history item...52 Work a history item...53 Medications...54 Medications section...54 Medication Details screen...58 Historical Medication Details screen...61 Add a medication...63 Renew a medication...64 Renew a medication with changes...64 Edit a medication...65 Add a historical medication...65 Search for a pharmacy...66 Work with a medication...67 Allergies...67 Allergies section...67 Add an allergy...70 Edit an allergy...71 Inactivate an allergy...71 Immunizations...72 Immunizations section...72 Immunization Details screen...74 Add a historical immunization...74 Results...75 Viewing results...75 Documents...76 Documents section...76 Display a document...79 Add a chart photo to a patient's scanned documents list...80 Create dictation...81 Create quick note...82 Patient Timeline...84 Patient timeline...84 View a patient timeline...84 Problems Timeline screen...85 Medications Timeline section...85 4 November 06, 2014

Table of Contents Visualizations section...87 Events section...89 Chapter 5: Working with Encounters...91 Encounter-Related Workflows...91 Encounters...91 Encounter screen...92 Switch between encounters...97 Refreshing patient data...99 Medical History...99 Review medical history for an encounter...99 Vitals...103 Enter vitals for an encounter...103 Assessment and Plan...103 Create an assessment and plan...104 Related Screens...106 Drug Utilization Review...131 DUR alert types...132 DUR Alerts screen...133 Encounter-Related Documentation...134 Documents...134 Select or create a document...136 Select a document type...137 Edit a document section...138 Preview and sign a document...139 Text templates...140 Copy forward...143 Work with dictation markers...143 Related Screens...146 Document screen...146 Text Style screen...147 Note Preview screen...149 Signature screen...151 Encounter-Related Charges...153 Introduction to charging in Wand...153 Configuring Wand for charging...153 Generating charges...154 Chapter 6: Working with Tasks...157 Task Details screen...157 Task types and icons...160 Task actions...161 Approve or deny a task...163 November 06, 2014 5

Table of Contents Reassign a task...164 Index...165 6 November 06, 2014

Chapter 1 Overview Contents Introduction...7 Introduction Welcome to Allscripts Wand for TouchWorks EHR, the companion application for Allscripts TouchWorks EHR that runs on the Apple ipad. Allscripts Wand for TouchWorks EHR is a streamlined version of your electronic health record (EHR) base application that you can carry with you all day long. It is designed to let you perform the 20% of standard EHR functions that you use 80% of the time. We've removed the complexity of the base application, improved the user experience, and increased the proficiency of the provider. Allscripts Wand for TouchWorks EHR is intended for use by primary care practitioners, not by specialty providers. Allscripts Wand for TouchWorks EHR functionality has been designed around the key workflows that clinicians like you perform over and over every day: > Reviewing your appointment list > Reviewing patient information > Managing your patient's medications > Resolving tasks > Completing encounters > Completing review of systems > Performing physical exam > Ordering labs and medication during encounters > Creating and signing clinical documenation > Generating visit charges November 06, 2014 7

Chapter 1 Overview 8 November 06, 2014

Chapter 2 Getting Started Contents Installation...9 Configuration...9 Updates...10 Login...10 Inactivity timeout...12 Installation Before you begin Confirm that your ipad device is connected to the Internet. The Allscripts Wand for TouchWorks EHR installation is performed through the App Store on the ipad device. This task has 6 steps. 1. On the ipad device, launch the App Store. 2. In the Search box, type Allscripts. 3. Select Allscripts Wand. 4. Tap Free next to Allscripts Wand. 5. Tap Install App next to Allscripts Wand. 6. Enter your Apple ID password, and then tap OK. The application is installed. Configuration After Allscripts Wand for TouchWorks EHR is installed on the ipad device, some configuration is necessary. This task has 5 steps. November 06, 2014 9

Chapter 2 Getting Started 1. Launch Settings. 2. Under Apps, tap Wand. 3. Under EHR Settings>Server, enter the IP address of the base system. This is entered in the format http://#.#.#.# or https://#.#.#.#. 4. Some organizations might require a Windows username and password to access Unity. If so, enter those in Windows Authentication Settings. 5. Under Connection Settings, Run in connected mode, select On. Results of this task Changes to settings are automatically saved. Press Home to continue. Updates Before you begin Confirm that your ipad device is connected to the Internet. After Allscripts Wand for TouchWorks EHR is installed on your ipad device, you will receive future updates to the application that you must install. The presence of one of these updates is indicated with a red number on the App Store icon. If there is no number, there are no updates to install. 1. Launch the App Store. 2. Tap Updates. 3. Tap Free next to Allscripts Wand. 4. Enter your Apple ID password, and then tap OK. The application is updated, and the number no longer displays on the App Store icon. Login Before you begin Allscripts Wand for TouchWorks EHR must be installed on the ipad device, and connection settings to the base application must be configured. Your Username and Password are the same as your Username and Password for the base application. 1. Tap the Wand icon. 2. Enter your Username and Password, and then tap OK. 10 November 06, 2014

Login 3. Set Remember me to On to have Username default to your username each time you log in to the application. Note: You must enter your password each time you log in or are returned to the Login screen. Important: Allscripts Wand for TouchWorks EHR does not support multiple simultaneous logins for a single user on different devices. When you are done using Wand on one device, log out before logging onto another. November 06, 2014 11

Chapter 2 Getting Started Inactivity timeout Allscripts Wand for TouchWorks EHR automatically ends your session after a period of inactivity. Allscripts Wand for TouchWorks EHR has a 20 minute inactivity timer. If you remain on any screen without taking action on a patient for 20 minutes, the application times out and forces you to log in again. The application displays the message: Error: As a Security precaution, you have been logged out due to inactivity. Tap OK to dismiss the message and log into the application. 12 November 06, 2014

Chapter 3 Navigation Contents Areas of functionality...13 Progressive information display...21 Patient header...22 Add a patient portrait...24 Add a chart photo to a patient's scanned documents list...25 Create a task...26 Alerts and Review panels...27 Search for a patient...30 Searching in the application...30 Encounter linking...31 Help...31 Areas of functionality Appointments and tasks The Allscripts Wand application is designed around two main areas of functionality: patient appointments and tasks. When you are in the Appointments area of Allscripts Wand (including Patient Review, Encounter, and Patient Timeline screens), the application has a green background; when you are in the Tasks area, the background is blue. > To navigate from Appointments to Tasks, tap the Task icon ( ). > To navigate from Tasks to Appointments, tap either the Patient Review icon ( ) or Patient Timeline icon ( ). November 06, 2014 13

Chapter 3 Navigation Appointment list When you tap Appointments, the application displays your Appointments list, from which you can load a patient's information into Patient Review, also referred to as "having a patient in context." The Appointment list includes the following identifying information about each appointment: > Patient picture > Patient name > Appointment time > Reason for visit > Patient status You can also send that patient's chart to another provider or print a copy of the Clinical Summary document for the patient. 14 November 06, 2014

Areas of functionality Change schedule date Allscripts Wand displays the appointment list for the current date by default. You can tap the date to move forward or to a past date. Wand uses the system date on the ipad device to determine the current date, not the server date. Change provider schedule When you are viewing your own appointment list, the Appointment list reads Appointments at the top. However, you can view other providers' appointment lists by tapping that header, and then selecting another provider. Only providers with appointments at the selected location are displayed in the list. The currently selected provider is displayed with a green check mark. Change site While viewing the Appointments list, you can view other sites' appointment lists by tapping the header with the site name, and then selecting another site. Only providers with appointments at the selected site are displayed in the list. The currently selected site is displayed with a green check mark. November 06, 2014 15

Chapter 3 Navigation Logout You can log out of the application by tapping the user name. You must confirm the action. Change appointment day When you are viewing the Appointment list, the application shows today's appointments by default. However, you can tap the Earlier icon ( ) and and Later icon ( ) to move to a different day's list. You can also tap the date. A date spinner is displayed, and you can select a date from one year in the past through one year in the future. View appointment details When you are viewing the Appointment list, tap on a patient's picture to display the Appointment information. From there, you can edit a patient's status and location. 16 November 06, 2014

Areas of functionality Appointment information detail The Appointment Information detail, displayed by tapping on a patient photo on the Appointment List, enables you to view patient demographic information, as well as patient status and location. Patient name (not labeled) The application displays the patient's name in the format Last, First Middle. This is read-only information. Appointment time (not labeled) The application displays the patient's current appointment time beside the patient's name. Date of birth (not labeled) The application displays the patient's date of birth in the format day - month abbreviation - year. This is read-only information. Age (not labeled) The application displays the patient's age using the following conventions: > If the patient is 0-28 days old, the age is displayed as #d, such as 7d to represent 7 days old. > If the patient is 29-days to 3 months, the age is displayed as #w, such as 5w to represent 5 weeks old. > If the patient is 4 months to 2 years, the age is displayed as #m, such as 21m to represent 21 months old. > If the patient is greater than 2 years and less than 18 years, the age is displayed as #y #m, such as 12y 3m to represent 12 years and 3 months old. > If the patient is greater than 18 years, age is displayed as #y, such as 27y to represent 27 years old. This is read-only information. Sex (not labeled) The application displays the patient's sex as either Male or Female. This is read-only information. November 06, 2014 17

Chapter 3 Navigation MRN (not labeled) The application displays the patient's medical record number from Allscripts TouchWorks EHR. This is read-only information. Marital status (not labeled) The application displays the patient's marital status. This is read-only information. Primary language (not labeled) The application displays the patient's primary language. This is read-only information. Insurance The application displays the patient's insurance provider name. This is read-only information. Patient Phone The application displays contact information for the patient. Phone numbers are listed in the following order: home (h), cell (c), and work (w). This is read-only information. Status The application displays the appointment status. You can tap this field to select one of the following statuses: Arrived, Check-Out, Discharged, Nurse Ready, Orders Pending, Provider Ready, Roomed, or Waiting. This field can be left blank. When a status is selected, tap X to clear the entry. Time (not labeled) The application displays the scheduled appointment time. This is read-only information. Location The application displays the patient's location. You can tap this field to select the appropriate location. Available locations are pulled from the Patient Location dictionary in Allscripts TouchWorks EHR. This field can be left blank. When a location is selected, tap X to clear the entry. Important: Status and Patient Location are reflective of the last update, regardless of appointment date. For example, if the patient has appointments for today and tomorrow, when the patient location is updated to Room 1 on today s appointment, 18 November 06, 2014

Areas of functionality should you scroll to tomorrow s appointment, you will see the patient location as Room 1 there as well. This is consistent with Allscripts TouchWorks EHR functionality. Print Clinical Summary icon ( The application generates the Clinical Summary document and prints it based on the document type, site, and provider settings. This process follows automatic printing settings configured in Allscripts TouchWorks EHR. The Clinical Summary document includes patient demographic information, reason for visit, treatment plan, vitals, current medications list, current health issues (problems), allergies, and results, as well as contact information for the provider. Note: When the patient's Clinical Summary Communication Method is set to Declined, this icon is disabled. Scheduling comment (not labeled) The application displays information from Scheduling Comments in Allscripts TouchWorks EHR. Task list When you tap Tasks (or the Tasks icon ( ) on the Appointment List), the application displays your Tasks List, from which you can load information about the task into the Task Details screen. November 06, 2014 19

Chapter 3 Navigation The Tasks List includes the following identifying information about the task: > Task icon > Patient name (or Non-Patient Task for tasks with the type Non Patient Task) > Date the task was added or posted > Task description The tasks are grouped by the following priorities: > Urgent > ASAP > Routine The Tasks List displays tasks from only the past month. 20 November 06, 2014

Progressive information display Progressive information display Allscripts Wand for TouchWorks EHR is designed around the principle that it displays just the amount of information you need to make decisions, and that if you need more, you can get the information with just one tap. Where clinical data is displayed, it is presented in one of three states. Basic view The default view of data on Patient Review and Task Details is the basic view, which includes the most important information and sections. If there is no information for a section, that section is blank. Expanded view To view more detail about an area such as Problems, Medications, and so forth, tap anywhere in that section. To exit the expanded view and return to the basic view, tap on the section header. November 06, 2014 21

Chapter 3 Navigation Popover view To view even more details about a specific item in a section, tap that item in the expanded view. The application displays a popover with more information. To exit the popover, tap anywhere else. Patient header The application displays the Patient Header whenever a patient is in context. The Patient Header includes the following demographic information. > Patient picture > Patient name > Date of birth > Age > Sex > Primary insurance provider For further information about the patient, tap the patient's name or photo. 22 November 06, 2014

Patient header The application displays the Demographics popover, which includes information about the patient in context. > Patient name > Date of birth > Age > Sex > Patient ID > Marital status > Primary language > Primary insurance provider > Phone numbers including home, work, and cell > Address > Email > Primary provider November 06, 2014 23

Chapter 3 Navigation > Primary provider phone number If any information is not available, the section or label is not displayed. From the popover, tap in the patient's record. to use the ipad camera to take a photograph of the patient to store Add a patient portrait 1. With the Demographic popover displayed, tap the Photo icon ( ). The application displays the camera viewer. 2. With the patient in the view finder, tap the Photo icon to take the photo. 3. On the Move and Scale screen, use the guidelines to crop the photo to the square size, and then tap Use. 24 November 06, 2014

Add a chart photo to a patient's scanned documents list If the photo wasn't as you intended, tap Retake to take the photo again. Results of this task The patient is now identified with the photo. The photo appears next to the patient's name in the Patient Header and the Appointment List. Add a chart photo to a patient's scanned documents list Before you begin You must have a patient in context. This task has 5 steps. 1. On the Patient Review screen, scroll down to the Documents section. 2. Tap. The application displays the ipad camera screen. 3. Take the picture, and then tap Use. The application displays resulting image. 4. Annotate the image as needed. November 06, 2014 Allscripts Wand for TouchWorks EHR Version 2.2 User Guide 25

Chapter 3 Navigation > Tap to draw on the image with your finger or stylus on the surface of the ipad. > Tap to write on the image with the ipad keypad. The application inserts a text box on the image, and you must double-tap on it to move and add text. > Tap to erase the line you have drawn. 5. When you're done annotating the image, tap Done. Results of this task The application saves the annotated image in the Documents section on the Patient Review screen. Note: When you save the new photo to the Documents section, Allscripts Wand for TouchWorks EHR checks the My Documents filter option. This may result in a reduction in the number of documents displayed on the Patient Review screen. To display the documents again, clear My Documents. Create a task You can create a new task during any workflow in Allscripts Wand for TouchWorks EHR, not just when the Task screens are displayed. This task has 7 steps. 1. Tap the Task icon ( ). 2. Select the user who will receive the task. You can search for a user or group, or scroll through your favorites list of users. Favorites lists are configured in your base application. 3. If the task is not related to the patient in context, clear Patient Related. If a patient is in context, Patient Related is automatically selected. 4. Indicate the task's priority by selecting Routine (the default value) or Urgent. 5. Enter the subject of the message. 6. Enter the content of the message. 7. Tap Done. 26 November 06, 2014

Alerts and Review panels Alerts and Review panels When alerts and review items exist for the patient, the application displays the Review icon ( ) in the header. Tap the icon to display the Alerts and Review panels. Tap the Switch icon ( move between the two panels. Tap Close to close the panels. ) to Alerts panel November 06, 2014 27

Chapter 3 Navigation The Alerts Panel displays two sections: Meaningful Use alerts and Orders and Medications alerts. If there is no information in a section, that section is displayed blank. Within the Meaningful Use section, the application displays the Meaningful Alerts generated by the base application. The alerts are displayed in alphabetical order. Within the Orders and Medications section, the application displays incomplete items, followed by reminders, ordered chronologically by the associated date. This includes, as applicable by item type: > Order name > To be done date > Medication name > Renewal date 28 November 06, 2014

Alerts and Review panels Review panel The Review Panel displays the following read-only information about the patient. > Active problems > Current medications > Allergies November 06, 2014 29

Chapter 3 Navigation Search for a patient Most of your patient activities are driven by the Tasks List or the Appointments List. However, there might be occasions when you need to search for a patient that is not on one of these lists. Allscripts Wand for TouchWorks EHR enables you to search manually for a patient. 1. Tap the Patient Search icon ( ) in the upper right corner. 2. Enter the patient's name. You can type just the patient's first or last name. For example, if you type "Smith," the application returns patients who have either the first or last name of Smith. The application displays patients only in the organization associated with the site to which you are logged in. It does not display patients outside of the organization. The application displays patients that match the search criteria, including names, sex, phone number, and date of birth. 3. Tap the patient to load that patient into context and display Patient Review. Searching in the application When performing various workflows in the Allscripts Wand for TouchWorks EHR application, you will be required to search for items, such as medications, results, and so forth. When you perform a search, the application displays search results that start with your criteria first and then other results that contain the criteria. Up to 100 results are returned. If the desired item is not displayed, trying refining your criteria by entering a more general term. 30 November 06, 2014

Encounter linking Encounter linking Actions performed in the Allscripts Wand for TouchWorks EHR application are tied to a patient encounter. The application uses the following logic, in the following order, to match the action to an existing encounter or create a new encounter: > If the patient, provider, and appointment type match on the exact date, select that encounter > If the patient, provider, and appointment type match in the last two hours, select that encounter > If the patient, provider, and appointment type match in the last twenty-four hours, select that encounter > If the patient and appointment type match on the exact date, select that encounter > If the patient and appointment type match in the last two hours, select that encounter > If the patient and appointment type match in the last twenty-four hours, select that encounter > If the patient and provider match in the last two hours, select that encounter > If the patient has an existing encounter in the last two hours, select that encounter > If the patient has an existing encounter in the last twenty-four hours, select that encounter > If none of the previous conditions exist, create a new encounter. Help If at any point while using Allscripts Wand for TouchWorks EHR you need assistance, tap the Help icon ( ) in the upper right corner. The application displays an image of the Allscripts Wand for TouchWorks EHR application display that corresponds to the display you were on when you tapped the Help icon. The Help display is illustrated with lighted areas that you can tap. When you tap one of these areas, the application displays information on how to use that specific control. November 06, 2014 31

Chapter 3 Navigation To navigate to other Help displays, swipe to the left and right. To exit the Help, tap X. To determine the version number or view important notices, tap About on the last Help display. 32 November 06, 2014

Chapter 4 Working with Appointments Contents Appointments...33 View a patient appointment...33 Patient Review screen...34 Enable Chief Complaint...34 Vitals...35 Alerts and Reminders...42 Problems...44 History...49 Medications...54 Allergies...67 Immunizations...72 Results...75 Documents...76 Patient Timeline...84 Appointments When you are working from the Appointment List, you can display the selected patient's data in these formats: > Patient Review, from which you can review, add, and edit information in the basic, expanded, and popover views. > Patient Timeline, from which you can view trends and patterns in the patient's data over a specific timeframe. > Encounter, from which you can complete review of systems, physical exam, and assessment/plan, as well as order labs and medications for the encounter. View a patient appointment Select the provider and location to view current appointments. This task has 6 steps. November 06, 2014 33

Chapter 4 Working with Appointments 1. Tap Appointments. The Appointments popover is displayed with the current day's appointments scheduled for the logged in user at the selected location. 2. Tap Appointments to change the provider or tap the location name to change the location. 3. Tap the desired provider or location name. The Appointments popover is refreshed with appointments for the selected provider or location. 4. Tap the date to view appointments for alternate days. 5. (Optional) Tap the patient portrait photo to display demographic information, status, location, send the patient's chart, or print a Clinical Summary document. 6. Tap the patient's name to load the patient in context and display the Patient Review screen. Patient Review screen The Patient Review screen is comprised of the following sections: > Chief Complaint/HPI (configurable) > Vitals > Alerts and Reminders > Problems > History > Medications > Allergies > Immunizations > Results > Documents For more information on the controls in these sections, refer to those sections in this document. Enable Chief Complaint By default, the Chief Complaint section does not appear on the Patient Review screen. You must configure it to display. Allscripts Wand for TouchWorks EHR looks to the following preference in Allscripts TouchWorks EHR to determine whether to display the Chief Complaint section on the Patient Review screen. Wand Chief Complaint Enabled: When set to N, the application does not display the Chief Complaint section. N is the default value. When set to Y, Wand displays the Chief Complaint section on the Patient Review screen. The preference can be set at the enteprise level and overridden at the user level. 34 November 06, 2014

Vitals Note: Wand always displays the Chief Complaint section in the Encounter screen when a document has been created. Vitals Vitals section The patient's vitals are displayed on the Patient Review screen in a basic or expanded view. Also, in the expanded view, a popover view is available. Basic view Blank When no vitals readings have been entered for the patient for the current encounter, the application displays a blank (or empty) Vitals section. BP The application displays the most recent systolic and diastolic values for the current encounter. If there are multiples, they are in reverse chronological order. If the value falls outside of the normal reference range, the application displays the values in red text and includes the red triangle icon ( ). Reference ranges are defined in the Resultable Item dictionary and can vary by age and sex. Pulse The application displays the most recent pulse value for the current encounter. If there are multiples, they are in reverse chronological order. If the value falls outside of the normal reference range, the application displays the values in red text and includes the red triangle icon ( ). Reference ranges are defined in the Resultable Item dictionary and vary by age and sex. Resp The application displays the most recent respirations value for the current encounter. If there are multiples, they are in reverse chronological order. November 06, 2014 35

Chapter 4 Working with Appointments If the value falls outside of the normal reference range, the application displays the values in red text and includes the red triangle icon ( ). Reference ranges are defined in the Resultable Item Dictionary and vary by age and sex. O2 Sat The application displays the most recent oxygen saturation percentage for the current encounter. If there are multiples, they are in reverse chronological order. Temp The application displays the most recent temperature reading for the current encounter. The application displays F (for Fahrenheit) or C (for Centigrade), depending on the provider's preference in the base application. If there are multiples, they are in reverse chronological order. The preference is set in the HMP Vitals Unit. If the value falls outside of the normal reference range, the application displays the values in red text and includes the red triangle icon ( ). Wt A normal range is not set for temperatures. The application displays the most recent weight reading for the current encounter. The application displays the US (in pounds and ounces) or Metric measurement, depending on the provider's preference in the base application. If there are multiples, they are in reverse chronological order. Ht The preference is set in the HMP Vitals Unit. The application displays the most recent height reading for the current encounter. The application displays the unit of measure indicated by the provider in the base application. If there are multiples, they are in reverse chronological order. The preference is set in the HMP Vitals Unit. BMI The application calculates the patient's BMI based on the most recent readings for the current encounter. If there are multiples, they are in reverse chronological order. 36 November 06, 2014

Vitals Pain The application displays the most recent pain reading for the current encounter. If there are multiples, they are in reverse chronological order. LMP If the patient is female and greater than eight years old, the application displays the date of the patient's most recent menstrual period if it was recorded with the current encounter. Time The application displays the time at which the vital readings were recorded. If comments have been included in the base application, a gray dot is displayed to the left of the time. Tap the dot or time to view the comment. Other The application displays this button if there is additional vitals information in the base application for this patient. Tap Other to display a popover with the data. Time Performed is displayed for values from the current encounter. Date Performed is displayed for values from previous encounters. Expanded view When no vitals readings have been entered for the patient for the current encounter, the application displays a blank (or empty) Vitals section. Otherwise, the application displays all the vitals readings for the current encounter in reverse chronological order in black text. All previous vital readings are in gray text. If multiple values for the same vital are captured within the same minute, the last value is displayed. BP The application displays the most recent systolic and diastolic values for the current and past encounter. If there are multiples, they are in reverse chronological order. If the value falls outside of the normal reference range, the application displays the values in red text and includes the red triangle icon ( ). Reference ranges are defined in the Resultable Item Dictionary and can vary by age and sex. Pulse The application displays the most recent pulse value for the current and past encounter. If there are multiples, they are in reverse chronological order. November 06, 2014 37

Chapter 4 Working with Appointments If the value falls outside of the normal reference range, the application displays the values in red text and includes the red triangle icon ( ). Reference ranges are defined in the Resultable Item Dictionary and can vary by age and sex. Resp The application displays the most recent respirations value for the current and past encounter. If there are multiples, they are in reverse chronological order. If the value falls outside of the normal reference range, the application displays the values in red text and includes the red triangle icon ( ). Reference ranges are defined in the Resultable Item Dictionary and can vary by age and sex. O2 Sat The application displays the oxygen saturation percentages for the current and past encounter. If there are multiples, they are in reverse chronological order. Temp The application displays the most recent temperature reading for the current and past encounter. If there are multiples, they are in reverse chronological order. The application displays F (for Fahrenheit) or C (for Centigrade), depending on the provider's preference in the base application. The preference is set in the HMP Vitals Unit. If the value falls outside of the normal reference range, the application displays the values in red text and includes the red triangle icon ( ). Wt A normal range is not set for temperatures. The application displays the most recent weight reading for the current and past encounter. If there are multiples, they are in reverse chronological order. The application displays the US (in pounds and ounces) or Metric measurement, depending on the provider's preference in the base application. The preference is set in the HMP Vitals Unit. 38 November 06, 2014

Vitals Ht The application displays the most recent height reading for the current and past encounter. If there are multiples, they are in reverse chronological order. The application displays the unit of measure prefered by the provider in the base application. The preference is set in the HMP Vitals Unit. BMI The application calculates the patient's BMIs based on the readings for the current and past encounter. If there are multiples, they are in reverse chronological order. BMI is calculated using the last height and weight if both were not captured for the encounter. Pain The application displays the pain readings for the current and past encounter. If there are multiples, they are in reverse chronological order. LMP If the patient is female and greater than eight years old, the application displays the date of the patient's last menstrual period. Time The application displays the time at which the last vitals readings were recorded. If comments have been included in the base application, a gray dot is displayed to the left of the time. Tap the dot or time to view the comment. Date Performed The application displays the date performed for values from previous encounters. Other When additional readings have been recorded in the base EHR, an Other button is displayed. You can tap Other to review the information. Vitals popover When you tap a vitals item in the expanded view, the application displays a popover with read-only information. The information that displays depends on the vitals type (BP, Pulse, and so forth). November 06, 2014 39

Chapter 4 Working with Appointments The application displays the readings for the current encounter first with details. Next, the application displays the three previous readings of the same type. Multiples from a single date can be included. Add a vitals reading You can add a vitals reading from Patient Review. 1. On Patient Review, expand the Vitals section. 2. Tap the Add icon ( ). 3. The application displays the existing readings for the current encounter. Scroll through the list of entry values and add the readings available. Blood Pressure Pulse Respiration Enter a Systolic and Diastolic value by tapping the - and + buttons to manipulate the default values, or tap the default value and enter a number manually. You can also slide your finger along the slider. The default value is the previous reading's value. If there are no previous values, the value is blank. The valid range for systolic readings is 40 to 300. The valid range for diastolic readings is 20 to 200. Default values are defined in the caregiver options in the base EHR application. Enter a Rate value by tapping the - and + buttons to manipulate the default values, or tap the default value and enter a number manually. The default value is the previous reading's value. If there are no previous values, the value is blank. The valid range for readings is 0 to 200. Next, indicate the Pattern and Location. Tap the attribute, and then tap the modifier. Enter a Rate value by tapping the - and + buttons to manipulate the default values, or tap the default value and enter a number manually. You can also slide your finger along the slider. The default value is the previous reading's value. If there are no previous values, the value is blank. The valid range for readings is 0 to 150. Next, indicate the Pattern. Tap the attribute, and then tap the modifier. Default values are defined in the caregiver options in base EEHR application. 40 November 06, 2014

Vitals O2 Sat Temperature Weight Height Pain Enter a Level by tapping the - and + buttons to manipulate the default values, or tap the default value and enter a number manually. The default value is the previous reading's value. The valid range for readings is 0 to 100. Next, indicate the Source. Tap the attribute, and then tap the modifier. Enter a Temperature value by tapping the - and + buttons to manipulate the default values, or tap the default value and enter a number manually. You can also slide your finger along the slider. The default value is the previous reading's value. The valid range for readings is 10 to 120. Next, indicate the Method. Tap the attribute, and then tap the modifier. Enter a Weight value by tapping the - and + buttons to manipulate the default values, or tap the default value and enter a number manually. You can also slide your finger along the slider. The default value is the previous reading's value. If the provider's preference is to use US units of measure, the application displays Pounds and Ounces; otherwise, it displays Kilograms. The valid range for pounds is 0 to 999 and ounces is 0 to 15, allowing for one decimal point. The valid range for kilograms is 0 to 999. The preference is set in HMP Vitals Unit. You can tap a different unit of measure to change the default value. Enter a Height value by tapping the - and + buttons to manipulate the default values, or tap the default value and enter a number manually. You can also slide your finger along the slider. The default value is the previous reading's value. If the provider's preference is to use US units of measure, the application displays Feet and Inches; otherwise, it displays Centimeters. The valid range for feet is between 0 and 9. If feet have been entered, the valid range for inches is between 0 and 11. If no feet have been entered, the valid range for inches is between 0 and 100. If you have entered inches greater than 11, you cannot enter feet. If the metric system is used, the valid range for centimeters is 0 to 275. The preference is set in HMP Vitals Unit. You can tap a different unit of measure to change the default value. Enter a Pain value by tapping the - and + buttons to manipulate the default values, or tap the default value and enter a number manually. The default value is the previous reading's value. The valid range for readings is 0 to 10. November 06, 2014 41

Chapter 4 Working with Appointments Last Menstrual Period The application displays the last menstrual period for females greater than eight years of age. Enter a date using the date spinner control. The default value is the current date. Next, enter the Time Period if applicable. Values provided are Before, After, and Approximately. 4. Tap Done. Alerts and Reminders Alerts and reminders section Alerts and reminders about the patient are displayed on the Patient Review screen. A popover view is also available from the expanded view. Basic view The application displays a list of all alerts and reminders for the patient. Alerts and reminders are generated from the base application. Information in the Alerts and Reminders section is updated every 60 seconds. When an alert is resolved in the base application, the application removes the alert from the list. Alerts and reminders are generated for the following: > Text entered in the FYI screen in Allscripts TouchWorks EHR > Issues related to meaningful use legislation > Order reminders > Medication reminders > Incomplete orders > Incomplete administered medications or immunization orders > Appointments today and in the future Expanded view The application displays a list of all alerts and reminders for the patient. Alerts and reminders are generated from the base application. If no alerts exist within a section header, the application does not display the header. When an alert is resolved in the base application, the application removes the alert from the list. Alerts and reminders are grouped as follows in the expanded view: > Text entered in the FYI screen in Allscripts TouchWorks EHR. 42 November 06, 2014

Alerts and Reminders > Meaningful use. > Orders and Medications: includes the ordering or prescribing provider and the associated date, displayed chronologically by associated date. > Appointments - Today and Future: includes date and time, displayed with the soonest appointments at the top. You see the following read-only information in the expanded view: Meaningful Use The application displays the text of the meaningful use alert generated by the base application. Order and Medications For orders (including incomplete orders), the application displays basic view information, the ordering provider, and the alert status (such as overdue, near due, and so forth). For medications (including incomplete administered medications and immunization orders), the application displays basic view information, the renew label, prescribing physician, remaing number of refills or OTC, last refill label, and last refill date. Popover view The application displays a popover view when you tap on an alert or reminder in the expanded view. The popover view includes the following information for a medication: > Drug name > Dosage > SIG > Status > Prescribing provider > Method of delivery The popover view includes the following information for future orders: > The full text of the alert > Order > Ordered by > Start date > Frequency The popover view includes the following information for orders needing review: > The full text of the order > Status November 06, 2014 43

Chapter 4 Working with Appointments > Problem associated with the order > Date ordered > Ordered by > Date reported The popover view includes the following information for appointments: > Date and time > Provider for the apointment > Location of the appointment > Comments When you tap on a Meaningful Use alert, the application does not display a popover. Problems Problems section The patient's problems are displayed on the Patient Review screen in a basic or expanded view. A popover view is also available from the expanded view. Basic view The application displays a list of the patient's problems. The list order is: Unverified, Active, Active Historical, Resolved but included in Active, and Denied. Within each category, problems are displayed alphabetically. Blank When no problems have been entered for the patient, the application displays a blank (or empty) Problems section. Problem Name The application displays the problem name. If the problem is inactive, resolved, denied, or unverified, the application displays it with gray text. All unverified problems (active and PMH) appear on the Problems panel with Accept and Reject buttons (provided proper authorization). If an unverified item has been flagged as Active and Include in PMH, a user will see it as unverified on Past Medical History, but without actions. 44 November 06, 2014

Problems Date If the problem is active, the application displays the date that the problem was last assessed. If the problem is inactivated or resolved, the application displays the date that it was inactivated or resolved. If the problem is unverified, the application displays Unverified. Expanded view The application displays a list of the patient's problems. Promoted active problems are displayed first, followed by promoted inactive and resolved problems. Within each category, problems are sorted by significance, with major first. Past Medical History items display Resolved (in alphabetical order) and Denied (in alphabetical order). If there are no promoted active, promoted inactive, or promoted resolved problems to display, and there are Other Problem History problems, that panel is automatically displayed. Toggle view icons (, ) When tapped, the application displays the Other Problem History panel. Tap the Toggle View icon again to display the Problems section. If there are no other Problem History items, the icon is unavailable. Add icon ( ) When tapped, you can search for a new problem to add to the patient's record. Problem Name The application displays the problem name, the associated ICD-9 code (when available), and the number of times the problem has been assessed in parentheses. If the problem is inactive or resolved, the application displays it with gray text. If the problem contains comments, the application displays a gray circle icon next to the problem name. A gray circle is displayed to the left of the problem name if text is displayed for Today's Impression. Assessed If the problem is active, the application displays the date that it was last assessed. If the problem is inactivated or resolved, the application displays the date that it was inactivated or resolved. November 06, 2014 45

Chapter 4 Working with Appointments Name The application displays the name of the managing provider. Description The application displays the description text. If the full description cannot be displayed, ellipses are displayed. Onset The application displays the problem onset date, if entered. Denied Problems If you enter a problem with Denied status, this problem is displayed with the word Denied in front of the problem name, in gray text. If a denied problem is entered from the base system, it is displayed in both the Active and Past Medical History in both Allscripts TouchWorks EHR and Allscripts Wand for TouchWorks EHR. In Allscripts Wand for TouchWorks EHR, you can keep the problem from being displayed in the active list with the More icon. In this case, the problem is no longer displayed in the active list but still is displayed in the past medical history for both Allscripts TouchWorks EHR and Allscripts Wand for TouchWorks EHR. If a Denied problem is entered from Allscripts Wand for TouchWorks EHR, it is displayed only in the Past Medical History in Allscripts Wand. You can promote the problem, using the More icon, to see it in the active problem list. More icon ( ) Depending on the problem status, you can tap the More icon to perform the following actions. If a historical problem has been copied to the patient's active problem list, Edit is not available from the More control. 46 November 06, 2014

Problems Add a problem You can add a problem from Patient Review. This task has 9 steps. 1. On Patient Review, expand the Problems section. 2. Tap the Add icon ( ). 3. Scroll through the list of past and favorite problems, and tap the appropriate items, or search for a problem by typing the first few characters in the Search field. Allscripts Wand for TouchWorks EHR performs a starts with search when one to three characters are entered. An includes search is performed when four or more characters are entered. Tap a problem at any time it is displayed. If the problem is not displayed, tap the Search button to search the Master List using the ICD-9 filter. 4. Tap the problem. When you tap a problem, the application checks it and adds it to the accumulator at the top of the screen. If no allergy information has been added for the patient, the application displays a DUR alert. 5. To add or edit information about the problem, tap the problem in the accumulator. The application displays the Problem Details screen. 6. On Problem Details, tap relevant attributes of the complaint. Problem The application displays the problem and the associated ICD-9 term being added for the patient. If this is an edit, you can transition the problem. Using the Search field to the right of the problem, search for and select a new problem. The existing problem is moved to Transitioned From below. Note: Allscripts Wand for TouchWorks EHR does not display ICD-10 codes. Status Onset Date Resolution Date Change the problem's status. The default value is Active. The available values are defined in the Problem Status dictionary. Indicate the date on which the problem was first noticed, reported by the patient, or diagnosed by the provider. Indicate the date on which the problem was resolved. A resolved date can be set up to one year in the future. If the status is set to Resolved and a resolution date is not entered, the Resolution Date is selected. If the date is in the past or today, November 06, 2014 47

Chapter 4 Working with Appointments and the status is anything but resolved, the problem status is changed to resolved. If the status of a problem is changed from Resolved to Active, the Resolution Date is automatically removed. Clinical Progress Indicate the clinical progress of the problem. The default value is blank. The available entries are defined in the Clinical Progress dictionary. Classified As Severity Secondary To Description Managed By Transitioned From Include in Active Include in Past Medical History Annotations Annotations History Indicate the Problem Category. The default value is blank. Indicate the severity of the problem based on frequency. The default value is blank. Designate the problem as secondary to one of the patient's other existing active problems. Enter a free-text description of the problem. The default value is blank. Indicate the provider managing this problem for the patient. The default value is you, the current user. Select another provider from the popover, or search for another provider. This is read-only information. Indicates the problem and ICD9 code from which this was transitioned, as well as the date of transition, if applicable. When selected, the problem is displayed in the patient's list of active problems. The default value is clear. Available only if the problem is resolved or a Past Medical History item. When selected, the problem is displayed in the patient's Past Medical History. The default value is clear. Available only if the problem is active. Enter any additional information to be included with the problem. The default is blank. The application displays previous annotations in reverse chronological order. Applies to Allscripts TouchWorks EHR. 7. Tap Done. 8. Enter additional problems as needed. 48 November 06, 2014

History 9. Tap Close. Results of this task When you add the patient problem from Patient Review and create orders associated with the problem for an encounter, the application follows the preference PostToEncounter to determine if the problem appears as assessed. Verify an unverified problem You can verify an unverified problem for the selected patient from the Patient Review screen. When problems are added but not verified in Allscripts TouchWorks EHR, they are visible but marked as unverified in Allscripts Wand. For organizations using Allscripts TouchWorks EHR Version 11.4 or higher and thus using ICD10 problem codes, you cannot verify an ICD9 problem from Allscripts Wand for TouchWorks EHR. You must first transition the ICD9 problem to an ICD10 problem in Allscripts TouchWorks EHR. 1. With a patient selected on the Patient Review screen, scroll to the Problems section 2. Tap Problems to expand the section. 3. To verify the problem, tap the Accept icon ( ). The problem status changes to Verified. History History section You can review existing historical items and add new historical items for a patient from the Patient Review screen in a basic or expanded view. A popover view is also available from the expanded view. Basic view The application displays a list of the patient's historical items. Historical items are ordered by: 1. Surgical History 2. Social History 3. Family History November 06, 2014 49

Chapter 4 Working with Appointments The application does not delineate these categories in the basic view. The application displays unverified items at the top of each category, and displays the remaining items in alphabetical order. Expanded view The application displays a delineated list of the patient's historical items, including the name and (truncated if necessary) comments. Historical items are ordered alphabetically by: 1. Surgical History 2. Social History 3. Family History In the expanded view, headers only display for history items the patient has. The application displays unverified items at the top of each category, and displays the remaining items in alphabetical order. Add icon ( ) When tapped, search for a new historical item to add to the patient's record. Promoted indicator ( ) The application displays the blue promoted indicator when the history item is promoted. If the history item is both promoted and has comments, the comment indicator is displayed. Annotation indicator ( ) The application displays the gray annotation indicator icon when there are annotations entered in the base application for the historical item. Historical Item Name The application displays the historical item name and comments. Tap the item to display the popover to read the full text. More icon ( ) Depending on the item type and status, tap the More icon to perform the following actions: > Copy to Active List: Includes the item in the patient's active problem list. The application continues to display the item in the History section. > Suppress: Removes the item from the History section the next time the section is updated. > Exclude From Active List: Removes the item in the patient's active problem list. The application continues to display the item in the History section. 50 November 06, 2014

History > Resolve: Applies to Social History and Family History items only. Marks the item as resolved. > Edit: The application opens the History Details screen from which you can edit information about the item. History popover When you tap a history item in the expanded view, the application displays a popover with the following read-only information, if available: > Item type (Surgical History, Social History, and so forth) > Item name, followed by Promoted if promoted > Attributes > Date the item was recorded (or History marker) > Managing provider > Annotations > Category > Laterality > Severity > Secondary to > Procedure date (Surgical History) > Resolved date (Surgical History) > Procedure by (Surgical History) History Details screen You can enter details about a history item on the History Details screen. Cancel Tap Cancel to delete entries made on History Details and return to History Search. Item Name The application displays the history item name. Text Note icon ( ) Tap the Text Note icon to enter a free text note about the history item. When you are done entering the note, tap Done. This text is stored as a comment. November 06, 2014 51

Chapter 4 Working with Appointments Review icon ( ) Tap the Review icon to display a list of the patient's current problems, medications, and allergies. Tap the Switch icon ( ) to display a list of the patient's alerts, including orders and medications, reminders, and appointments. Item Attributes Tap an attribute for the item, and then tap characteristics of that attribute. For example, for a Family History item, tap Family Member, and then tap Father, Mother, and so forth. Done Tap Done to save entries made on History Details and return to History Search. Captured information (not labeled) The application displays any information about the history item in a preview pane. If no information has been captured, this area is blank. Add a history item You can add a history item from Patient Review. This task has 9 steps. 1. On Patient Review, expand the History section. 2. Tap the Add icon ( ). 3. Scroll through the list of favorite history items, and tap the appropriate items, or search for an item by typing the first few characters in the Search field, and then tap Search. You can also tap the Filter icon ( History. 4. Tap the desired history item. ) to limit the list to just an item type, such as Surgical 5. On History Details, tap relevent attributes of the item. For example, for a Family History item, tap Family Member, and then select the appropriate descriptor. You can select multiple family members. 6. Tap the Text Note icon ( to enter text for the item. 52 November 06, 2014

History You can add a comment of up to 500 characters. If you attempt to add more than 500 characters, the application displays a warning that the comment will be truncated. 7. Tap Done. 8. Enter additional history items as needed. 9. Tap Close. Work a history item You can change the status of history items from Patient Review. 1. On Patient Review, expand the History section. 2. Tap the history item. 3. Tap one of the following: Copy to Active List Suppress Exclude From Active List Resolve Edit Includes the item in the patient's active problem list. The application continues to display the item in the History section. Removes the item from the History section the next time the section is updated. Removes the item in the patient's active problem list. The application continues to display the item in the History section. Applies to Social History and Family History items only. Marks the item as resolved. Opens the History Details screen from which you can edit information about the item. You can only edit historical items from the History section of Patient Review. You cannot edit a history item that you've moved to the active problem list. November 06, 2014 53

Chapter 4 Working with Appointments Medications Medications section The patient's medications are displayed on the Patient Review screen in a basic or expanded view. A popover view is also available from the expanded view. Basic view The application displays a list of the patient's medications. The application displays unverified medications first in gray text, followed by active medications. Administered medications are displayed at the end of the list in reverse chronological order by due date. Medication The application displays the medication drug name. Doseage The application displays the dosage and SIG. Due Date For administered medications, the application displays the administration due date. Expanded view Header The application displays a shaded heading that includes "Medications," the date and time when the medications list was reconciled with the base application, and the name of the person who performed the reconciliation. Reconcile icon ( ) The application displays the active Reconciled icon when there are medications that require verification. Tap the Reconcile icon to reconcile the medication list and update the information in the section header. 54 November 06, 2014

Medications Toggle icons ( ) ( ) If the patient has past medications or past administered medications, tap the Toggle icons to move between the current information and the past information. Add Historical Medication icon ( ) Tap the Add Historical Medication icon to display Medication Search where you can search for a medication to record for the patient. This icon is used when a prescription should not be created. Add icon ( ) Tap the Add icon to display Medication Search, where you can search for a medication to add for the patient. This icon is used when a prescription should be created. Annotation indicator ( ) The application displays the gray annotation indicator icon when there are annotations entered in the base application for the medication. Unverified Medications The application displays unverified medications with following information: > Medication name > Prescribing provider > Dosage and SIG > Accept icon ( ): Tap to accept the medication, and then confirm the action. > Reject icon ( ): Tap to reject the medication, and then confirm the action. Active Medications The application displays active medications with following information: > Medication name > Dosage and SIG > Date last prescribed (pulled from Rx Date in Allscripts TouchWorks EHR) > Prescribing provider November 06, 2014 55

Chapter 4 Working with Appointments > Number of remaining refills or, if it is an over the counter drug, "OTC" > Date the script was last refilled > More icon ( ): Tap to complete or discontinue the medication. You can also tap Edit to edit medication details. > Quick Rx icon ( ): Tap to quickly renew the medication. A confirmation message is displayed. The Quick Rx icon is only available to users with a Provider profile. Note: > You cannot act on active medications that are in Needs Information status. > You cannot manually edit a medication's status in Allscripts Wand for TouchWorks EHR. Past Medications The application displays past medications with the following information: > Medication name > Dosage and SIG > End date if entered; otherwise, the inactivated/discontinued date > Prescribing provider > Medication status, either Discontinued or Completed > More icon ( ): Tap to complete or discontinue the medication. You can also tap Edit to edit medication details. > Quick Rx icon ( ): Tap to quickly renew the medication. A confirmation message is displayed. The Quick Rx icon is only available to users with a Provider profile. Administered Medications The application displays past administered medications for the last two years (based on the date completed) with the following information: > Medication name > Dosage and SIG > Number of times the medication was administered > Date the medication was discontinued or completed 56 November 06, 2014

Medications > Prescribing provider > Dose ordered and route > Date last administered Medications popover When you tap a medication in the expanded view, the application displays a popover with the following read-only information for active medications: > Drug name > Dosage > SIG > Status > Start date > Prescribing provider > Method of delivery > Pharmacy > Comments When you tap a medication in the expanded view, the application displays a popover with the following read-only information for past medications: > Past medication and number of times the medication has been previously prescribed > SIG > Status > Linked problems > Start date > Prescribing provider > Managing physician > Method of delivery > Pharmacy name, address, phone and fax number > Pharmacy instructions > Annotations, including the date and the name of the person who entered the annotation When you tap a medication in the expanded view, the application displays a popover with the following read-only information for administered medications: > Administered medication, dose form, and number of times the medication had been administered > Dosage ordered and route > Linked problems > Next administration date > Date last administered November 06, 2014 57

Chapter 4 Working with Appointments > First administered date > Ordered date > Ordering provider > Managing provider > Annotations, including the date and the name of the person who entered the annotation Medication Details screen You can enter details about a new or existing medication on the Medication Details screen. Review icon ( ) Tap the Review icon to review the patient's active problems, medications, and allergies. Formulary indicator The application displays a formulary icon indicates the degree of compliance. A green smile indicates that the medication is preferred by the PBM and a red frown indicates that it is not acceptable. Medication Name The application displays the medication name. If the medication is not accepted by the PBM, tap the medication name to perform a PAR Check to look for other medications preferred by the PBM. Suggested Dosage and SIG The application displays the currently selected dosage and SIG. DAW Select DAW (Dispense as Written) to indicate to the pharmacy that the prescription cannot be altered. DAW is not selected by default unless you are editing a previously prescribed medication for which DAW was selected. Days Indicate the number of days that you expect this fill of the medication to last for the patient. Tap - and + to decrease or increase the default value from Medications Search, or tap the number and enter a different value. 58 November 06, 2014

Medications Note: Allscripts Wand for TouchWorks EHR limits Schedule II medications to 90 days' supply; for Schedule III, IV, and V medications, the limit is 180 days' supply. Quantity Indicate the total number of items dispensed for each refill. Refills Indicate the number of refills you want to include in this prescription. Tap - and + to decrease or increase the default value from Medications Search, or tap the number and enter a different value. You can also use the slider bar. Package Size If the medication is not tablets, this field is displayed. The default value is based on the medication selected from Medication Details. Favorites, Instructions, Custom Tap a row and select Custom to edit or write a free-text SIG. The default values for the medication are copied from Medication Search. When you select a different frequency, the application updates the list of instructions with only the instructions for the selected frequency. Prescription Details Indicate the routing information for the prescription. Select one of the following: > Retail Pharmacy: Select the displayed Pharmacy to send the prescription electronically to the selected pharmacy when you tap Done. By default, the application displays the default retail pharmacy address associated with the patient. The retail pharmacy must have a fax number to be the default value. Tap Search to search for a different pharmacy based on the provider location. If a pharmacy does not have a fax number or a NABP/NCPDP number, it is not displayed in pharmacy search results. > Mail Order Pharmacy: Select Mail Order Pharmacy to submit the prescription to the mail order pharmacy when you tap Done. This option is unavailable if no mail order pharmacy is associated with the patient. The mail order pharmacy must have a fax number to be the default value. The application displays the name of the default mail order pharmacy on Medication Details. You cannot search for other mail order pharmacies. You cannot set Schedule 2 medications to mail order. > Print Rx: Select Print Rx to route the prescription to the device's default printer when you tap Done. You cannot select or change printers. November 06, 2014 59

Chapter 4 Working with Appointments > Sample Dispensed: Select Sample Dispensed to document that you provided the patient with a sample. You can enter the lot number for the sample or any other applicable information, as well as the expiration date. A month, day, and year are required. You can also select Print Patient Education to route patient education materials about the medication to the device's default printer. You cannot select or change printers. Note: You cannot use the fulfillment options Record or Call Rx from Allscripts Wand for TouchWorks EHR. To create a medication with one of those fulfillment options, perform the task in Allscripts TouchWorks EHR. Pharmacy Instructions If necessary, you can enter special instructions for the pharmacy in Pharmacy Instructions. There is a 210 character limit on this value. The application displays the number of characters remaining. Link To When you add a medication from Patient Review, the medication is not automatically linked to a problem. To link the new medication to a problem click the Add icon ( ). The application displays Problem Search where you can select from the patient's active problems or add a new problem for the patient. Up to five problems can be linked to a single medication. To delete a linked problem, swipe the problem. Delete is displayed. Whether the application requires a linked problem to save the new medication depends on the Prescribe Problem Linking Required preference in Allscripts TouchWorks EHR. If the value is Required to Save, a problem must be associated with a medication order before the script can be saved. If the value is Needs Info Reason, a problem is needed to complete the order, but is not required for the medication order to be saved. If the value is Not Required, a problem is not required for the medication order to be saved or completed. Ordered By Provider By default, the provider in the Allscripts TouchWorks EHR preference DefaultEnteringForProviderID is selected as the Ordered By Provider. Tap different provider. to select a Note: This behavior is different from the default setting in Allscripts TouchWorks EHR. Note: Any incomplete required fields are indicated with a blue halo. 60 November 06, 2014

Medications Additional information on how fields are made available The following table describes how preferences can influence the fields on Medication Details and Medication History when you are working with new or existing medications. Historical Medication Details screen You can enter details about a historical medication on the Historical Medication Details screen. Cancel Closes Historical Medication Details without saving information. Text Note icon ( ) Tap the Text Note icon to enter an annotation for the historical medication. Review icon ( ) Tap the Review icon to view alerts. Done Closes Historical Medication Details after the saving information you have entered. November 06, 2014 61

Chapter 4 Working with Appointments Formulary indicator The application displays a formulary icon that indicates the degree of compliance. A green smile indicates that the medication is preferred by the PBM and a red frown indicates that it is not acceptable. Medication Name The application displays the historical medication name. If the medication is not accepted by the PBM, tap the medication name to perform a PAR Check to look for other medications preferred by the PBM. SIG The application displays the currently selected dosage and SIG. Start Date Tap to enter the date on which the medication began. The application displays the spinner control from which you can select the month, day, and year. Dose Unknown Select Dose Unknown to indicate that the strength of the historical medication is unknown. When the historical medication is saved, the DDI that is stored in the base systems should be the DDI without the dose strength. Days Indicate the number of days that you expect this fill of the medication lasted for the patient. Tap - and + to decrease or increase the default value from Medications Search, or tap the number and enter a different value. Quantity Indicate the total number of items dispensed for each refill. Refills Indicate the number of refills that were included in the prescription. Tap - and + to decrease or increase the default value from Medications Search, or tap the number and enter a different value. You can also use the slider bar. 62 November 06, 2014

Medications Package Size If the medication is not tablets, this field is displayed. The default value is based on the medication selected from Medication Details. Favorites, Instructions, Custom Tap a row and select Custom to edit or write a free-text SIG. The default values for the medication are copied from Medication Search. When you select a different frequency, the application updates the list of instructions with only the instructions for the selected frequency. Print Patient Education Select Print Patient Education to route the patient education information about the historical medication to the default printer. You cannot change or edit the selected printer. Link To When you add a medication from Patient Review, the medication is not automatically linked to a problem. To link the historical medication to a problem click the Add icon ( ). The application displays Problem Search where you can select from the patient's active problems or add a new problem for the patient. Multiple problems can be linked to a single medication. To delete a linked problem, swipe the problem. Delete is displayed. On Completion Indicates the action that the application performs when the historical medication is saved. Select from No Action, Complete Therapy, Renew, or Evaluate. Responsible Provider Indicates the provider responsible for the historical medication. By default, the application displays the current user's name. This is referred to as Managed By in Allscripts TouchWorks EHR. Add a medication You can add a new medication for the patient from Patient Review. This task has 8 steps. November 06, 2014 63

Chapter 4 Working with Appointments 1. On Patient Review, expand the Medications section. 2. Tap the Add icon ( ). 3. Scroll through the list of past medications, and tap the appropriate items, or search for a medication by typing the first few characters in the Search field, and then tap Search. Allscripts Wand searches only on medication name, not on ingredients. Also, Allscripts Wand for TouchWorks EHR does not refer to the Allscripts TouchWorks EHR preference Prescribe Without Allergy status, and thus the applications may display the message Allergy status Unknown. 4. Tap the medication. 5. Complete the information on Medication Details. 6. Tap Done. 7. Enter additional medications as needed. 8. Tap Close. Renew a medication You can quickly renew an existing medication for the patient from Patient Review. Quick Rx is available when you are a provider with authority to prescribe the selected drug at the site on the current date. 1. On Patient Review, expand the Medications section. 2. Tap the Quick Rx icon ( ) next to the existing medication you want to renew. The Rx confirmation message is displayed. 3. Tap Yes. If the previously selected pharmacy no longer has a fax number, Medication Details is displayed. Select an appropriate pharmacy. Results of this task If you renewed the medication but you were not the original ordering provider, Quick Rx replaces the Ordered By provider with your name. Renew a medication with changes You can renew an existing medication while making changes for the patient from Patient Review. This task has 5 steps. 64 November 06, 2014

Medications 1. On Patient Review, expand the Medications section. 2. Tap the More icon ( ) next to the existing medication that you want to review. 3. Tap Rx with Changes. 4. On Medication Details, make any necessary changes to the script. If the previously selected pharmacy no longer has a fax number, select an appropriate pharmacy. 5. Tap Done. Edit a medication With the Edit function, you can access just a few fields associated with the medication: Sample Information, Print Patient Education, and Link Problem. This task has 5 steps. 1. On Patient Review, expand the Medications section. 2. Tap the More icon ( ) next to the existing medication that you want to review. 3. Tap Edit. 4. On Medication Details, make any necessary changes. 5. Tap Done. Add a historical medication You can record a historical medication that does not need a prescription issued for a patient from Patient Review. This task has 8 steps. 1. On Patient Review, expand the Medications section. 2. Tap the Add Historical icon ( ). 3. Scroll through the list of past medications, and tap the appropriate items, or search for a medication by typing the first few characters in the Search field, and then tap Search. Allscripts Wand for TouchWorks EHR searches only on medication name, not on ingredients. 4. Tap the medication. 5. Complete the information on Historical Medication Details. 6. Tap Done. November 06, 2014 65

Chapter 4 Working with Appointments 7. Enter additional medications as needed. 8. Tap Close. Search for a pharmacy You can search for a pharmacy from Medication Details. While adding or renewing medications from Medications Details, you can select the patient's default pharmacy (indicated first under Prescription Details) or you can tap Search to search for a different pharmacy. Note: Allscripts Wand for TouchWorks EHR must have access to google.com to perform a pharmacy search. 66 November 06, 2014

Allergies 1. On Medication Details, tap Search. The application displays Pharmacy Search with the map displaying the area based on the provider address. 2. In the Search field, enter the name of the desired pharmacy, such as CVS. The application displays pins on the map where the pharmacies that meet the search criteria are located. It also displays a list of the pharmacy names. Tap one of those names to display only that pharmacy on the map. 3. Tap on a pin to view the pharmacy popover. 4. If this is the correct pharmacy, tap Select. The application closes the popover and Pharmacy Search. It passes the selected pharmacy to the routing area and sets that pharmacy as the retail pharmacy for the medication. Work with a medication You can edit the status of a medication from Patient Review. 1. On Patient Review, expand the Medications section. 2. Tap the More icon ( ) next to the appropriate medication. 3. Tap Complete or Discontinue to change the medication status. 4. Tap OK. Allergies Allergies section Allergies are displayed on the Patient Review screen in a basic or expanded view. A popover view is also available from the expanded view. Basic view The following information is displayed in the basic view of allergies: November 06, 2014 67

Chapter 4 Working with Appointments Allergy Name The application displays the allergy name or, if no allergies are present in the patient's record, you might see a classification of No Known Allergies or No Known Drug Allergies. Allergies are displayed in alphabetical order by Medication with Allergies Major Significance, Non-Medication Allergies with Major Significance, Medication Allergies, and Non-Medication Allergies. If an allergy is classified as urgent in Allscripts TouchWorks EHR, it is displayed at the top of the allergy list in red text with a red triangle icon. If an allergy needs to be verified, it is also displayed at the top of the allergy list, immediately following urgent/major allergies. Urgency The application displays the urgency associated with the allergy. Urgency is specified in Allscripts TouchWorks EHR. An urgency is not specified when an allergy in entered using Allscripts Wand for TouchWorks EHR, and thus is blank. Alert icon The application displays a red triangle icon ( ) when an allergy is classified as urgent in Allscripts TouchWorks EHR. Expanded view The following information is displayed in the expanded view of allergies: Last Reconciled Date The application displays the date that the allergy was last reconciled. Reconciled By The application displays the name of the user who last reconciled the allergy. Reconcile icon The application displays the Reconcile icon ( ) when there are allergies that require verification. When you tap the Reconcile icon, the application updates the Last Reconciled Date and Reconciled By fields and displays a checked stamp ( ). 68 November 06, 2014

Allergies Add icon ( ) Tap the Add icon to display Allergy Search, where you can select allergies for inclusion in the patient record. Alert icon The application displays a red triangle icon ( ) when an allergy is classified as urgent in Allscripts TouchWorks EHR. The application displays a gray circle icon ( ) when an allergy is associated with annotations in Allscripts TouchWorks EHR. If an allergy is urgent and has annotations, the application displays only the gray circle icon, not the red triangle icon. Allergy Name The application displays the allergy name or, if no allergies are present in the patient's record, displays No Known Allergies or No Known Drug Allergies. Allergies are displayed in alphabetical order. If an allergy is classified as urgent in Allscripts TouchWorks EHR, then it is displayed at the top of the allergy list in red text with a red triangle icon ( ). If an allergy needs to be verified, it is also displayed at the to top of the allergy list, immediately following urgent or major allergies. Urgency Urgent is displayed if applicable based on the reactions chosen. Allergy Type The application indicates if the allergy type is a medication or non-medication. Reactions/Manifestations The application displays manifestations or reactions associated with the allergy. Manifestations appear in alphabetical order with urgent reactions first. Reaction Date The application displays the date associated with the allergy if it is available from the base application. November 06, 2014 69

Chapter 4 Working with Appointments More icon The application displays the More icon ( ). When you tap the More icon, you can edit or inactivate the selected allergy. If unverified allergies have been recorded for the patient in Allscripts TouchWorks EHR, the application displays the allergies in both the basic and expanded view. You can accept and reject these allergies from the Patient Review screen. Tap the Accept icon ( ) to accept the allergy (and then tap Yes to confirm the action), or tap the Reject icon ( ) to reject the allergy (and then tap Yes to confirm the action). Accepted allergies have Verified status, and remain in the Allergy list. Rejected allergies have Entered in Error status, and are removed from the Allergy list. The Allscripts TouchWorks EHR user preference Enable Allergy Verification must be set to N for a user to see these actions. Popover view If you tap on the allergy row, the application displays a detailed overlay that includes any of the following data that is known: > Allergy Name > Type > Reactions > Action taken > Reaction date > Annotation details Add an allergy You can add allergies to the patient's record from Patient Review. This task has 8 steps. 1. On Patient Review, expand the Allergies section. 2. Tap the Add icon ( ). 3. Scroll through the list of favorite allergies, and tap the appropriate items, or search for an allergy by typing the first few characters in the Search field, and then tap Search. 4. Select the allergy, or select No Known Allergies, No Known Drug Allergies (under Medications), No Known Environmental Allergies (under Non-Medications), or No Known Food Allergies (also under Non-Medications). If you have already selected an allergy, the No Known options are unavailable. 70 November 06, 2014

Allergies 5. Select the manifestations of the allergy. 6. If you need to add a free text annotation to the allergy, tap and type the text. This is stored as an allergy annotation in Allscripts TouchWorks EHR. If you edit this allergy later, the comment cannot be edited. 7. Tap Done. 8. Add additional allergies, or tap Close. The new allergy or allergies are added to the Allergies section on Patient Review. Edit an allergy You can edit a verified allergy from Patient Review. This task has 5 steps. 1. On Patient Review, expand the Allergies section. 2. Tap the More icon ( ), and then tap Edit. 3. On Allergy Details, select or clear manifestations. 4. If an annotation was entered for the allergy, you cannot edit that text. 5. Tap Done. Inactivate an allergy You can inactivate a verified allergy from Patient Review. 1. On Patient Review, expand the Allergies section. 2. Tap the More icon ( ), and then select Inactivate. 3. Tap OK. November 06, 2014 71

Chapter 4 Working with Appointments Immunizations Immunizations section You can review existing immunizations and add new historical immunizations for a patient from the Patient Review screen. Existing information is displayed in a basic or expanded view. A popover view is also available from the expanded view. Basic view The application displays a list of the patient's existing immunizations as recorded in the base application. Unverified immunizations are listed first in gray text. The remaining immunizations are ordered by administration date. Immunization name The application displays the immunization name. Series The application displays the series level of the last administered medication. Administration Date The application displays the last administered date. Expanded view The application displays a list of the patient's existing immunizations as recorded in the base application. Unverified immunizations are listed first in gray text. The remaining immunizations are ordered by administration date. Add icon ( ) Tap the Add icon to add a new historical immunization for the patient. The application displays Immunization Search, from which you can select the appropriate immunization, and then enter details on Immunization Details. Annotation indicator ( ) The application displays the gray annotation indicator icon when there are annotations entered in the base application for the immunization. 72 November 06, 2014

Immunizations Immunization Name The application displays the immunization name with the number of times the immunization was administered in gray text. Administration Date The application displays the last administered date. Accept icon ( ) If the immunization is unverified, tap the Accept icon to verify the immunization, and then tap OK to confirm the action. Note: If you encounter the message We are unable to accept this immunization at this time. Please log in to EEHR to accept this immunization, you must accept the immunization from Allscripts TouchWorks EHR to perform this action. The system must create a new immunization. Reject icon ( ) If the immunization is unverified, tap the Reject icon to reject the immunization, and then tap OK to confirm the action. Status The application displays the immunization status. These include Complete, Permanent Deferral, Temporary Deferral, Hold for Administration, and Hold for Documentation. Immunizations popover When you tap an immunization in the expanded view, the application displays a popover with the following read-only information: > Immunization name > Status > Last administered date and patient age at administration > Ordering provider > Annotations in reverse chronological order > Admin History: all administrations of this medication and patient age at administration in reverse chronological order November 06, 2014 73

Chapter 4 Working with Appointments Immunization Details screen You can enter details about a new or existing immunization on the Immunization Details screen. Cancel Tap Cancel to return to Immunization Search without saving entries made on Immunization Details. Review icon ( ) Tap the Review icon to display a list of the patient's current problems, medications, and allergies. Tap the Switch icon ( ) to display a list of the patient's alerts, including orders and medication, reminders, and appointments. Done Tap Done to save entries made on Immunization Details and return to Patient Review. Item The application displays the immunization name selected from Immunization Search. Historical Historical is selected by default and cannot be cleared. Use the date control to enter the approximate date when the immunization was administered. Comments Enter any comments about the historical immunization. Add a historical immunization You can add a historical immunization for a patient from Patient Review. This task has 8 steps. 1. On Patient Review, expand the Immunizations section. 74 November 06, 2014

Results 2. Tap the Add icon ( ). 3. Scroll through the list of immunizations, and tap the appropriate items, or search for an immunization by typing the first few characters in the Search field, and then tap Search. 4. Tap the immunization. 5. Complete the information on Immunization Details. 6. Tap Done. 7. Enter additional historical immunizations as needed. 8. Tap Close. Allscripts Wand for TouchWorks EHR does not perform DUR checking on historical immunizations. Results Viewing results Results for the patient in context are displayed on the Patient Review screen. This information is read-only. The results that are available meet the following criteria: > Order status is Complete, Administered, Auto Complete, or Resulted, but not Entered in Error or Rejected. By default, the results section is not expanded. You must tap the Results header to expand the section. The Results header is displayed, even when the patient in context has no results. Normal results are formatted in black text. Red text is used to indicate abnormal results. Results counter The Results header includes a counter that indicates the number of displayed results and the total number of results for the patient. When results are filtered, this counter is the visual indicator that all results are not displayed. The counter is formatted as x/y, where x is the number of results displayed, and y is the total number of results for the patient. Filtering results You can view all the results for the patient in context or just results for items you ordered. Tap All Results/My Results on the Results header to select the appropriate filter. The label on the Results header updates to reflect the selection. Additional results filters are available by tapping the search control on the Results header. These filters include: November 06, 2014 75

Chapter 4 Working with Appointments > From: Indicates the start date of the date range for which to display results. The date is calculated on the clinical date, meaning the date on which the test was performed or samples were collected. If there isn t a valid clinical date, then the date is calculated on the recorded date, meaning the date on which the result was last updated. A date value is required. > To: Indicates the end date of the date range for which to display results. A date value is required. > Type: Indicates the type of result. > Abnormal results only: When checked, indicates that normal results are filtered out of the results list. This is not the same as displaying all abnormal results; this displays only abnormal results in the specified date range. Note: Filters are applied immediately, not just when the pop-up is closed. As soon as you change a control on the Filter Results pop-up, the data in the Results section is updated. Likewise, the results count (for example, 10/20) is immediately updated. The Clear Filter button changes any applied filter settings on the pop-up back to the default settings. The Clear Filter button does not affect the All Results/My Results filter. Caution: When you filter results with the Filter Results pop-up, those filter settings are not indicated in the Results header in Patient Review, except in the results counter (x/y, where x is the number of results displayed, and y is the total number of results for the patient). For example, if you are reviewing only abnormal results, there is no visual indicator. Documents Documents section You can review clinical documents from the Patient Review screen. Basic view Note: CED Documents are excluded from the Document section. If it is necessary to review a CED, refer to the base EHR. Dictate icon ( ) Allows you to create a dictation file for the patient and encounter in context. 76 November 06, 2014

Documents Chart photo icon ( ) Allows you to create a chart photo using the ipad camera. Quick note icon ( ) Allows you to create a "quick note" document for the patient and encounter in context. The resulting document is not signed. My Documents The application displays thumbnail images of documents associated with the patient. If you are associated with any of the documents, My Documents is selected, and the documents that are displayed are limited to your most recent ten documents in reverse chronological order. If you are not associated with any of the documents, the most recent ten documents for this patient in reverse chronological order are presented. Blank If there are no documents for the patient, the Documents section is blank. Annotation indicator If the document has annotations associated with it, the application displays the gray circle annotation indicator. Date The application displays the date that the document was created. For example, encounter date for encounter notes, result date for results, and so forth. Name The application displays the name of the person who completed the service or medical procedure or the ordering physician. If the name exceeds the allowed space, the name is truncated and ellipsis ( ) are added after it if the name exceeds the allowed space. November 06, 2014 77

Chapter 4 Working with Appointments Title of document The application displays the title of the document. The title is truncated if the length exceeds the alloted space. If there is no title, the application displays the document type, as defined in the Document Type dictionary. Search To find documents related to key words or in a particular date range, tap the Search icon ( ). Document viewer The application displays the contents of a document in Document Viewer when you tap on the thumbnail on Patient Review. The Patient Banner remains visible. Within Document Viewer, use the pinch gesture to enlarge the contents to the appropriate size. Use the swipe gesture to move between pages within the document. Annotation indicator If the document has annotations associated with it, the application displays the grey circle annotation indicator. Tap the indicator to display the annotation in a popover. The popover displays all annotations for the document in reverse chronological order, including the date on which it was entered and the author. Note: Annotations are also displayed on the last page of the document. Document Identification The application displays the document indentifiers at the top of Document Viewer. This includes the date on which the document was created, the name of the person who completed the service or medical procedure or the ordering physician, and the title of the document (or document type if no title is available). Tap the document identification text to display the documents list popover. The popover displays all documents associated with the patient within the filtered view in reverse chronological order, including the following: > Date that the document was created > Name of the person who completed the service/medical procedure or, if not available the name of the document owner (that is, the person who ordered the procedure, lab, and so on) > Title of the document (or document type if no title is available) 78 November 06, 2014

Documents The green checkmark indicates the document that is currently in view. Tap another document to view it in Document Viewer. Left and right buttons ( and ) Tap the left and right buttons to move from document to document in the filter view. Move to the left to display the next more current document. Move to the right to display the next document in the past. Page scroller ( ) Tap the scroller to move from page to page within a single document. Move to the left to display preceding pages. Move to the right to display pages later in the document. Display a document To display a document, simply tap on it on Patient Review. This task has 6 steps. 1. On Patient Review, search for documents in the correct location in the Documents section. To search for documents in the My Documents directory on the device, select My Documents. When My Documents is not selected, the application displays documents from the base system. My Documents is a toggle to either include all documents or just the documents associated with the current patient. 2. Tap the Search icon ( ) to specify the text and the timeframe in which to search, and then tap Search. Key words are associated with a document, such as provider and type. To search for all patient messages, for example, type message. The application displays thumbnail images of the documents that meet your search criteria. For performance reasons, ten documents are displayed at a time. If more are available, the application displays the Load More button. 3. Tap a document thumbnail to display the document in full screen mode. 4. Pinch the document to increase and decrease the display size. 5. Use the controls at the bottom to move between documents. 6. Tap Done to return to Patient Review. November 06, 2014 79

Chapter 4 Working with Appointments Add a chart photo to a patient's scanned documents list Before you begin You must have a patient in context. This task has 5 steps. 1. On the Patient Review screen, scroll down to the Documents section. 2. Tap. The application displays the ipad camera screen. 3. Take the picture, and then tap Use. The application displays resulting image. 4. Annotate the image as needed. > Tap 80 to draw on the image with your finger or stylus on the surface of the ipad. November 06, 2014 Allscripts Wand for TouchWorks EHR Version 2.2 User Guide

Documents > Tap to write on the image with the ipad keypad. The application inserts a text box on the image, and you must double-tap on it to move and add text. > Tap to erase the line you have drawn. 5. When you're done annotating the image, tap Done. Results of this task The application saves the annotated image in the Documents section on the Patient Review screen. Note: When you save the new photo to the Documents section, Allscripts Wand for TouchWorks EHR checks the My Documents filter option. This may result in a reduction in the number of documents displayed on the Patient Review screen. To display the documents again, clear My Documents. Create dictation You can create a dictation file for a patient and encounter from the Patient Review screen. 1. On the Patient Review screen, scroll down to the Documents section and tap the Dictation icon ( ). 2. Select a dictation work type. Your default work type is configured in Allscripts TouchWorks EHR based on your user and site settings. If you have no default work type set in dictation preferences, the default work type is based on the sort order. 3. Record the selected dictation using the following controls: > Record ( ): Begin recording against the marker. This enables the duration and input level controls. > Pause ( ): Pause recording. Note: If you pause the recording, and then send it, the application automatically stops the recording prior to sending the dictation file. > Stop ( ): Stop recording. > Input level ( ): Indicates the strength of the input volume. November 06, 2014 81

Chapter 4 Working with Appointments > Delete ( ): Delete the recording (not the dictation marker). > Send ( ): Send the file to the appropriate web service for transcription. If you stop the recording and then begin recording again, Allscripts Wand for TouchWorks EHR combines the two recordings. It does not replace the first recording with the second. Also, the ipad device will not "timeout" (that is, dim and shutdown) while you are dictating. Results of this task The file is sent to the dictation service for transcription. It will return as a document associated with the encounter in context when it was recorded. Dictation files are always encrypted even as they are being recorded. They are never on the device in a non-encrypted format, and they are encrypted while in motion to the server as well. The maximum allowable size of the dictation file is 50 MB. Create quick note You can create a quick note for the patient and encounter in context from the Patient Review screen. Quick notes have a document type of Wand Quick Note. By default, the authorization level is set to 1, but your organization can change that to fit your workflows. This document type does not have a default mapping for Chart Viewer. 1. On the Patient Review screen, scroll down to the Documents section and tap the Quick Note icon ( ). The application displays the Add Quick Note screen. 82 November 06, 2014

Documents 2. Enter text in the document. You can do this using any of the following methods: > Type with the ipad keyboard > Dictate text with the recording controls 3. Tap Done to save the quick note. Results of this task The quick note is saved with a status of Unsigned. It can be edited and signed by selecting the document from document list on the Encounter screen or through Allscripts TouchWorks EHR. However, if you change the document's document type, you cannot change it back to the document type Wand Quick Note. November 06, 2014 83

Chapter 4 Working with Appointments Patient Timeline Patient timeline The Allscripts Wand for TouchWorks EHR patient timeline provides useful views of selected data sets to help you find patterns and relationships that contribute to diagnosis or treatment. You can view a snapshot of the patient's condition in time or to drill down for more detail. For a patient in context, the timeline displays: > Currently active problems with their ICD9 code (displayed along the top) > Current and past medications and their history > All data sets for vitals, labs, and test results, with the most current values prominently displayed in the panel on the right > Past medical events, including prescription orders, lab orders, encounters, and referrals > Reference ranges for vitals, labs, and tests, with out-of-range values visually distinguished To control the amount of time that data is displayed on the timeline, tap the values in the bottom right: > 3M: displays three months of data > 6M: displays six months of data > 1Y: displays one year of data > 2Y: displays two years of data The application displays two years of data by default. View a patient timeline Review the patient's timeline at a glance. Before you begin You must have a patient in context to view Patient Timeline. 1. Tap in the upper right corner or swipe to the left from Patient Review. Patient Timeline is displayed. 2. Tap or swipe to the right to return to Patient Review. 84 November 06, 2014

Patient Timeline Problems Timeline screen Patient Timeline displays the patient's active problem list. Basic view Deselect Problem icon (X) Clears the selection of problems within the patient timeline. When a problem is selected, the application displays a colored bar along the top. Tap the problem name to select it. Tap the problem again to clear the selection. Problem The application displays the patient's active problems in a horizontal display from left to right. Problems are indicated by name, ICD9 code, and last assessed date. You can tap a problem to select it. When a problem is selected, the application displays a colored bar along the top, and any data (such as medications) that are linked to that problem are called out with that same color along Patient Timeline. Tap again to clear the selection. Use the swipe left or right gesture on the problem list to scroll to problems that are not currently displayed. Medications Timeline section Patient Timeline displays the patient's active and past medications list. Basic view When you first open Patient Timeline, a list of the current and past medications for the patient in context are listed in the Medications section. The panel on the far right indicates the current state for all medications (name, dosage). Tapping the name of a medication within this panel disables it and moves it to the bottom of the medication list. The bar associated with the medication is still viewable. Tap the name again to enable and move back to its original position in the list. The bars next to the medication indicate the history for that medication. The medication bars can be viewed in two different states: collapsed and expanded. Collapsed is the default view. This November 06, 2014 85

Chapter 4 Working with Appointments view is a condensed version of the medication history. Any changes that occurred with the medication are displayed but might be truncated depending on how often the medication was changed. To access a more detailed view of the medications, tap in the medication header. In the expanded view, you can view the medication changes as stacked bars so that you can clearly see when a medication was started or stopped, a dose was changed, and so forth. In this view, each bar has its own popover to provide more detail about the medication at that point in time. Tap to return to the collapsed view. The Medication section is always visible and the medications, if there are any, are always displayed. You can tap the diagnosis at the top to display the medication prescribed for that diagnosis. The medications and diagnoses are displayed with a color-coded indication. Expanded view Horizontal bars When the Medications section is expanded on Patient Timeline, the application displays a horizontal bar for each active and past medication. If a dosage, dose form, or frequency changes, then the application indicates the change with a black line in the bar. Tap a horizontal bar to display the Medication popover. You can expand the Medications section by dragging up and down. You can drag anywhere on that bar to adjust the size of the Medications section. Medication summary The application displays a list of the patient's past and active medications on the right side of the Medications section on Patient Timeline. To move a medication from top to bottom or vice versa, tap the medication on the right. Popover view When you tap on a medication's horizontal bar, the application displays the popover for that medication. The popover includes the following read-only information: > Name > Dosage information > Prescribing physician 86 November 06, 2014

Patient Timeline > Last prescribed date Visualizations section Patient Timeline displays visualizations of the patient's BMI and weight, vitals, and results. Basic view When you first view Patient Timeline, the visualizations sections are visible, but no data is displayed. Tap a section header to view the data or double-tap the divider or slider bar to expand all the sections. Double-tap again to close all sections. Sparkline view Click the Sparkline icon ( ) to view the sparkline view of the data. Swipe left or right in each visualization section to scroll through time. The panel on the right shows the most recent value for each data item. Tap an item in this panel to disable the item and remove it from view (removes both the current value in the panel and related data points in the graph). Removed items line up along the top of the visualization section, below the header. To bring these values back into view, tap them to add them back to the section. November 06, 2014 87

Chapter 4 Working with Appointments The application displays a graphical visualization of the data. Certain conditions are indicated with colors and directions: > Blue circle: value is in safe range or value has no reference range. > Red triangle pointing up: value is higher than range. > Red triangle pointing down: value is lower than range. > Some results have text values. Tap a point to display a data popover. Annotated Sparkline view Click the Annotated Sparkline icon ( ) to view the annotated sparkline view of the data. The annotated sparkline contains the same sparkline visualization with numeric values called out. Table view Click the Table icon ( ) to view the table view of the data. The application displays the most recent values on the right. Tap a table label to collapse a row and remove it from the table. The removed data is displayed at the top of the visualization section. Tap the data item at the top of the section to add the item back to the table. Certain conditions are indicated with colors and directions: > Blue text: indicates a value in range 88 November 06, 2014

Patient Timeline > Red text: indicates a value out of range > Triangle pointing up: indicates value is higher than range > Triangle pointing down: indicates value is lower than range Value colors update to match the color of a selected problem if the data is linked to that problem. This is true for all views (sparkline, annotated sparkline, and table) Popover view When you tap a data point on one of the sparkline graphs, the application displays a data popover that includes the following read-only information: > Value and units > Relation to reference range > In Range in blue text or Out of Range in red text > Date Events section Patient Timeline displays medical event indicators. Timeline view When you open Patient Timeline, the application displays an icon for each medical event along the timeline. If multiple events occur on the same day, a number on the event icon indicates the number of events. Tap the icon to display all the individual events. Popover view November 06, 2014 89

Chapter 4 Working with Appointments When you tap on an event icon, the application displays a popover that contains any of the following read-only information that is available: > Encounter > Encounter date > Provider name > List of assessed problems for that encounter > Lab results > Date > Ordering provider name > Comments > Thumbnail of supporting documentation Tap anywhere in the popover to display the full text of the encounter. The full text of the encounter opens in Document Viewer. This is the same display that is accessible from the Documents section in Patient Review. 90 November 06, 2014

Chapter 5 Working with Encounters Contents Encounter-Related Workflows...91 Encounter-Related Documentation...134 Encounter-Related Charges...153 Encounter-Related Workflows Encounters Allscripts Wand for TouchWorks EHR allows you to manage a patient encounter from the ipad device. Once a patient is selected (either from the Appointment List or through a search), tap to display the Encounter screen. Note: You can also access the Encounter screen with the two-finger swipe gesture. From the Encounter screen, you can document the following areas of the encounter: > Chief Complaint > History of Present Illness > Medical History > Review of Systems > Vitals > Physical Exam > Procedures > Assessment and Plan > Comments Until you create a document for the encounter, only the Vitals and Assessment and Plan are available on the Encounter screen. November 06, 2014 91

Chapter 5 Working with Encounters Turn off encounter functionality You can turn off encounter-related functions in Allscripts Wand for TouchWorks EHR. The system administrator must set the following preference in Allscripts TouchWorks EHR, TWAdmin>Preferences: > Wand Encounter Enabled: Default is Y. When disabled, the Encounter button is not available in Wand, and you cannot swipe to access the Encounter screen. Administrators can set this preference at the enterprise level and then override it for individual users if necessary. Encounter screen You can create clinical documentation for a patient encounter from the Encounter screen. Controls on the Encounter screen before a document is selected 92 November 06, 2014

Encounter-Related Workflows When you first access the Encounter screen from the Patient Review screen, and a document has not yet been created or selected for the patient encounter, the application displays only the following controls. Documents When you tap Documents, the application displays: > Create New Document: Generates a new document for the selected encounter, including all sections > Previous documents for the selected encounter: Documents are identified by document type, provider, date, and status. If the document is not finalized, it is displayed in black text and can be selected; if the document is finalized, it is displayed in gray text and cannot be selected. November 06, 2014 93

Chapter 5 Working with Encounters Review and Alerts icon ( ) When you tap the Review and Alerts icon, the application displays the Review panel or the Alerts panel. You can move between the Review panel and the Alerts panel by tapping. Patient Review icon ( ) When you tap the Patient Review icon, the application displays the Patient Review screen. Vitals When you tap Vitals, the application displays the Vitals screen from which you can enter new vitals readings for the encounter. This information will appear in the Vitals section of the document. Assessment and Plan When you tap Assessment and Plan, the application displays the Problems Search screen. You can search for and select problems, and then manage them through protocols. This information will appear in the Assessment and Plan section of the document. If you have already entered a problem for the selected encounter, the application displays the Assessment and Plan screen from which you can manage existing problems or create additional problems. Charge When you tap Charge, the application displays the Charge screen. You can apply one visit charge to the encounter from a list of preconfigured charges. The charge is then saved as a draft. This button is available only when the applicable preferences are set. Controls on the Encounter screen when a document is selected 94 November 06, 2014

Encounter-Related Workflows After you have created or selected a document for the patient encounter, the application displays the previous controls as well as the following controls. Document header (not labeled) Indicates the document type, provider, date, and status of the selected document. You can tap the document header to select or create a different encounter. Chief Complaint When you tap Chief Complaint, the application displays the Document screen from which you can type or dictate the text for the Chief Complaint section of the selected document. November 06, 2014 95

Chapter 5 Working with Encounters History of Present Illness When you tap History of Present Illness, the application displays the Document screen from which you can type or dictate the text for the History of Present Illness section of the selected document. Medical History When you tap Medical History, the application displays the Cited List screen from which you can cite items to the encounter from the patient's medical history. This information will appear in the Medical History section of the document. Review of Systems When you tap Review of Systems, the application displays the Document screen from which you can type or dictate the text for the Review of Systems section of the selected document. Physical Exam When you tap Physical Exam, the application displays the Document screen from which you can type or dictate the text for the Physical Exam section of the selected document. Procedures When you tap Procedures, the application displays the Document screen from which you can type or dictate the text for the Procedures section of the selected document. Comments When you tap Comments, the application displays the Document screen from which you can type or dictate the text for the Comments section of the selected document. Document Type Indicates the selected document type. Document types are identified by the code defined in the Document Type dictionary in Allscripts TouchWorks EHR. You can select from document types that: > Do not utilize non electronic workflows (NONEW) > Have a manifestation of RTF > You have security rights to view > Are active 96 November 06, 2014

Encounter-Related Workflows The default document type is the document type from the most recently edited document that has the same owner, is RTF based, and the owner has access to. If one does not exist, then the default document type is the first document type the owner has access to (alphabetically). Otherwise, there is no default document type. Allscripts Wand for TouchWorks EHR verifies that both the user starting the document and the document owner have appropriate security codes for the available document types. Wand checks the users' default organization for these security codes. Note: Document types with Finalize on Save selected are not visible in Allscripts Wand for TouchWorks EHR. Preview When you tap Preview, the application displays the Note Preview screen from which you can review the generated document and, if appropriate, sign it. Charge When you tap Visit Charge, the application displays the Charge screen. You can apply one visit charge to the encounter from a list of preconfigured charges. The charge is then saved as a draft. This button is available only when the applicable preferences are set. Switch between encounters You can move between encounters for the selected patient. 1. From the Patient Review screen or the Encounter screen, tap the title bar. The list of open encounters for the patient is displayed, including the name of the provider, the appointment type, and the date and time of the encounter. The currently selected encounter is displayed with a green check. November 06, 2014 97

Chapter 5 Working with Encounters 2. Review the open encounters, and then tap the encounter to select it. A green check mark is displayed to the right of the encounter date and time. Note: You can tap Create New Encounter instead of selecting an open encounter for the patient. 3. Tap below the Encounters list to refresh the display with the selected encounter. If you have created a new encounter, there is no document in context, and thus only the Assessment and Plan and Vitals sections display on the Encounter screen. Information for the selected encounter is displayed in the appropriate sections (such as Assessment and Plan). 98 November 06, 2014

Encounter-Related Workflows Refreshing patient data While you are working in a patient's record in Allscripts Wand for TouchWorks EHR, changes may be taking place to that same patient's record in Allscripts TouchWorks EHR. For example, while you are documenting the patient encounter, another provider may be ordering an item for that patient. In that case, you may need to refresh patient data in Allscripts Wand for TouchWorks EHR. On the Encounter screen, pull down the table. Wand displays the message, "Refreshing Data." Wand updates encounter data, patient data, and information related to the Assessment and Plan document section. Text templates and diction markers are not refreshed. Note: This functionality is available on devices running ios 6.0 and later. Medical History The Medical History section of encounter documentation is populated by the information you enter on the Cited List screen. The application displays the Cited List screen when you tap Medical History on the Encounter screen. From the Cited List screen, you can select the following previously entered items for citation in the Medical History section of the document: > Problems > Past Medical History > History including Surgical History, Social History, Family History, Medications, and Immunizations Review medical history for an encounter Before you begin You must have an active patient in Allscripts Wand for TouchWorks EHR to view or select items on the Cited Lists screen during an encounter. 1. From the Encounter screen, tap Medical History. The application displays the Cited List screen with current encounter items indicated with. November 06, 2014 99

Chapter 5 Working with Encounters 2. Tap beside each item to include in the Medical History section of the document until is displayed beside the required items, or tap Include All. 3. Tap to review the patient's current problems, medications, allergies, and alerts on the Review and Alerts panels, and then tap anywhere on Cited Lists to close the panel. 4. After selecting the appropriate items to include in the Medical History section of the document for this encounter, tap Close to return to the Encounter screen. Cited List screen The Cited List screen allows you to cite items into the Medical History section of the document. Note: Allergies are automatically cited into the document. 100 November 06, 2014

Encounter-Related Workflows Problems Indicates the patient's active problems. Allscripts Wand for TouchWorks EHR displays the problem and ICD code (if available), the last date on which it was assessed, the managing provider, and the onset date (if available). You can check individual problems for citation into the Medical History section of the document, or you can check Include All to cite all problems into the document. Past Medical History Indicates the patient's past problems. The application displays the problem and ICD code (if available), the resolved date, the managing provider, and the onset date (if available). You can November 06, 2014 101

Chapter 5 Working with Encounters check individual problems for citation into the Medical History section of the document, or you can check Include All to cite all past problems into the document. Note: If a patient has a past medical history problem that has been marked for inclusion in the active problem list, you can cite the problem from either Problems or Past Medical History. Checking from either section marks the problem in both sections. History Indicates the patient's past social history, past surgical history, and past family history. The application displays the problem name and the last date on which it was assessed (if available). Unverified items are indicated in light gray text. You can check individual items for citation into the Medical History section of the document, or you can check Include All to cite all historical items into the document. Medications Indicates the patient's active medications and administered medications. The application displays the medication name, SIG, number of refills, prescribing provider, and the last date on which it was prescribed (if available). For administered medications, the application displays the medication name, requesting provider, and the date of the request. Unauthorized medications are indicated in light gray text. You can check individual medications for citation into the Medical History section of the document, or you can check Include All to cite all medications into the document. Past Medications Indicates the patient's past medications. The application displays the medication name, SIG, and number of refills (if available). Unauthorized medications are indicated in light gray text. You can check individual past medications for citation into the Medical History section of the document, or you can check Include All to cite all medications into the document. Immunizations Indicates the patient's immunizations. The application displays the immunization name, series, date, and status (if available). Unverified items are indicated in light gray text. You can check individual immunizations for citation into the Medical History section of the document, or you can check Include All to cite all immunizations into the document. Tip: When citing a large number of items from a section, it may be helpful to cite by exclusion. Check Include All in the header, and then clear only the items you don't want to cite into the document. 102 November 06, 2014

Encounter-Related Workflows Vitals In addition to entering vitals information from the Patient Review screen, you can now enter these readings in the context of an open encounter. The readings are then included in the resulting encounter-related documents. Enter vitals for an encounter Before you begin You must have an active encounter open in Allscripts Wand for TouchWorks EHR to enter vitals for a patient. 1. On the Encounter screen, tap Vitals. The application displays the Vitals screen. If a previous vitals reading was captured, it is displayed in gray text. All items out of normal range are displayed in red text. 2. Tap and enter all vitals with the appropriate options selected, such as Cuff Location. 3. Tap to review the patient's current problems, medications, allergies, and alerts on the Review and Alerts panels, and then tap anywhere on Vitals to close the panels. 4. After entering all relevant information for the patient's vitals, tap Done to return to the Encounter screen. Results of this task The captured vitals are displayed on the Encounter screen. Assessment and Plan Allscripts Wand for TouchWorks EHR uses the Assessment and Plan section of the encounter to facilitate ordering items and prescribing medications linked to a selected problem. Note: In Allscripts TouchWorks EHR, these activities are normally managed from the Add Clinical Item screens. When you tap Assessment and Plan on the Encounter screen, the application allows you to search for and select the problem (or problems). Once the problem is selected, you can order medications, orderable items, referrals, instruction orders, immunizations, supplies, and administered medications from the Assessment and Plan screens. November 06, 2014 103

Chapter 5 Working with Encounters Create an assessment and plan You can build the Assessment and Plan section for a document by adding medication, orders, referrals, instructions, immunizations, supplies, and administered medications. Before you begin You must be assigned the CanOrder security code in Allscripts TouchWorks EHR in order to access the Assessment and Plan screens in Allscripts Wand for TouchWorks EHR. This task has 11 steps. 1. With the patient selected, access the Encounter screen. The application displays the Encounter screen. Note: You can begin documenting the Assessment and Plan section without creating a document. 2. Tap Assessment and Plan. 3. (Optional) If you have already entered a problem for the encounter, the application displays the Assessment and Plan screen. Otherwise, you must search for and select a problem for the patient. When you have selected the problem(s) for the patient, tap Close. When searching for a problem, the application displays the patient's active problems, followed by your favorites. Use the search control to search all problems. When you add the patient problem from Assessment and Plan and create orders associated with the problem, the problem always appears as assessed. The application displays the Assessment and Plan screen. 4. Tap + next to the problem to which you want to link orderable items. 5. (Optional) You can order items using Quick Sets (defined in Allscripts TouchWorks EHR). Check the Quick Set option. Allscripts Wand for TouchWorks EHR learns the items you order for each problem and adds them to the Quick Set for future use. As your Quick Set for a specific problem grows, you may want to use the Quick Set "by exclusion," meaning you check Quick Set, and then clear individual items you don't need for the patient. The application displays items within the Quick Set by their display name in the Orderable Item dictionary in Allscripts TouchWorks EHR. When you check Quick Set, Allscripts Wand for TouchWorks EHR automatically checks all the orders for the selected protocol and adds them to the accumulator section. For medication orders, the appropriate DUR and Medication Details screens display for each individual medication listed on the protocol. You can cancel each medication from the DUR and Medication Details screens, and the application clears the checkmark and removes it from the accumulator section. 104 November 06, 2014

Encounter-Related Workflows Note: The Quick Set protocol should be a well-structured list of orders specific to the treatment of the problem and not a comprehensive list of all potential treatments applicable to the problem that you can pick from. An ideally structured protocol allows you to reasonably select all the orders simultaneously because together they comprise a correct treatment plan for the problem. 6. (Optional) You can also order items using your favorites list or Quick List items. On the Assessment and Plan screen, tap 1 of [x] next to Quick Sets, and then select Quick List Favorites. Select individual items. As you select items, the application adds them to the accumulator at the top of the screen. 7. You can also tap + next to the item type (Medications, Orders, and so forth), to search for and select an item. You cannot create a free text reminder from Allscripts TouchWorks EHR. 8. Once the items appear in the accumulator section either on the applicable search screen or on the Assessment and Plan screen, tap on the item to complete details. If there are required values on the applicable details screen, the application displays the information icon ( ). Until these values are completed, the Done button is not enabled. 9. When there is no longer any information required on any of the details screens and you have entered what you intend to, tap Done on the Problem screen. The application displays the Assessment and Plan screen with the items under the problem. Caution: If you add an order or immunization more than once (for separate problems), the application does not display a duplicate warning. This is different from Allscripts TouchWorks EHR functionality. 10. (Optional) You can add additional problems and related orderable items. 11. Tap Done to complete the Assessment and Plan section of the document for the encounter. The application displays the Encounter screen. The problems (with ICD code if available) display, along with items you linked to the problems. What to do next If you selected a problem, and then deselected it, the action results in an assess, followed by an unassess action. To mark a problem as entered in error, you must manually select the problem and then change Status to Entered in Error on the Problem Details screen. November 06, 2014 105

Chapter 5 Working with Encounters Related Screens Assessment and Plan screen Review and Alerts icon ( ) When you tap the Review and Alerts icon, the application displays the Review panel or the Alerts panel. You can move between the Review panel and the Alerts panel by tapping. Done When you tap Done, the application saves the problems and orderable items to the Assessment and Plan document section and displays the Encounter screen. Problems As problems and orderable items are added to the Assessment and Plan document section, the Problems table grows. The table displays problems selected for the encounter, and orderable items are listed under the problem to which they are linked. You can add new problems by tapping + next to Problems. The application displays the Problems Search screen. Existing problems for the encounter are displayed in the accumulator section at the top. You can select from the patient's active problem list or your favorites list. You can also search for a problem. When all problems are selected, tap Close. 106 November 06, 2014

Encounter-Related Workflows Note: If you have already added a problem for the selected encounter in Allscripts TouchWorks EHR, then that problem displays in Allscripts Wand for TouchWorks EHR. However, be certain that you have selected the same encounter. The application will not display the problem on the Assessment and Plan screen if it was added for a different encounter. You can add additional linked orderable items to a specific problem by tapping + next to that problem. The application displays existing protocols for the selected problem. Selected items are displayed in the accumulator section at the top. You can select orderable items by: > Check Quick Set to add all orderable items for the Quick Set to the accumulator. > Tap 1 of [x] next to Quick Set and the tap Quicklist Favorites to select individual items from your Quick List or favorites list. > Check individual orderable items. > Tap + next to an orderable item type (medications, orders, referrals, instructions, immunizations, supplies, and administered medications) to display the problem based order screen from which you can search for and select an orderable item. Note: Items are organized in the accumulator section in the order they are selected. The newest item is at the top of the list. Order Details screen November 06, 2014 107

Chapter 5 Working with Encounters Item Indicates the name of the orderable item. This information is read-only. The name is configured in the Display Name in the Orderable Item dictionary in Allscripts TouchWorks EHR. Link To Indicates the active problem to which the order is linked. The problems for the current encounter are displayed. You can link an order to up to five active problems. 108 November 06, 2014

Encounter-Related Workflows Order Details To Be Performed Indicates the location where the order will be performed. The list contains locations configured in the Requested Performing Location dictionary in Allscripts TouchWorks EHR. These entries can be configured at the organization and enterprise level. Entries are based on provider, patient insurance, and site, and can be configured through SSMT. For more information on Requested Performing Locations, see documentation related to SSMT, as well as the Allscripts TouchWorks EHR Application Design and Behavior Reference (ADBR). Communicated By Indicates the method used to communicate the order to the location. The list contains methods configured in the Communication Method dictionary in Allscripts TouchWorks EHR. The default value is the communication method designated for the Requested Performing Location assigned to the orderable item, which displays when the assigned RPL is selected in To Be Performed. This default is set through the Communication Method in the Orderable Item dictionary, Order Defaults Requested Perf Location content category of SSMT. Caution: If you set Communicated By to Print Requisition and automatic printing defaults have not been configured for the selected site, the order will not print. Status Indicates the order status. The default value is Active, but the application evaluates the data entered for the order to determine the status of the order when it is saved. For example, if an order requires authorization when it is saved to the patient s record, then the status changes from Active to Unauthorized. The available statuses include: > Active: The order is current and active. Typically, the status remains Active if all required information is entered when it is saved. If there is an absolute contraindication question in the Clinical Questions section, the status cannot be Active unless the answer to the question is set to No. > Complete: The order is finished and considered as past order in the patient s record. > Temporary Deferral: The order is deferred for a period of time from the recommended period for when the order is to occur, but the order is still expected to be done when the period for deferment expires. For example, the patient is planning an invasive procedure at the time of the order and the provider defers the order until that procedure has been performed. If there is an absolute contraindication for a non-medication order (Laboratory, Imaging order, or other diagnostics testing) as determined by one or more of the Clinical Questions items, November 06, 2014 109

Chapter 5 Working with Encounters clinical users must select either Temporary Deferral or Permanent Deferral to document why the order was not placed or cancel the order. You must enter a time frame for the deferral. Indicate a number and a unit of measurement (Days, Weeks, Months, or Years). > Permanent Deferral : The order is permanently deferred from the recommended period for when the order is to occur and is never expected to be done. For example, the patient refuses to have the order performed due to personal beliefs. If there is an absolute contraindication for a non-medication order (Laboratory, Imaging order, or other diagnostics testing) as determined by one or more of the Clinical Questions items, clinical users must select either Temporary Deferral or Permanent Deferral to document why the order was not placed or cancel out of the order. Note: You can manually change the status for procedure orders, referrals, immunizations, and medication administrations. You cannot manually change the status for medications, supplies, or instructions. Reason Indicates the reason for the change in order status. The available reasons are based on Status. Reasons are configured in the Order Status Reason dictionary in Allscripts TouchWorks EHR. To Be Done Indicates the date by which the order must be completed. You can enter the date using one of the following methods: > Select a specific date and urgency indicator (ASAP, Pre-Op, Routine, Stat, or Today). > Enter a free text date or time. > Configure a recurring order. You can enter a number and measurement (Days, Weeks, Months, or Years), and then indicate a specific starting date and the number of times the order should be performed. Note: When configuring a schedule for an order, Allscripts Wand for TouchWorks EHR ends the order after 99 occurrences or after five years in the future. You cannot start an order in the past. Medical Necessity Checking Medical necessity checking is used if there is a financial authorization requirement from the patient s primary insurance, typically Medicare, which determines if the order meets the requirements of medical necessity. 110 November 06, 2014

Encounter-Related Workflows Clinical Details If additional modifiers or clinical questions have been configured for the orderable item in the Orderable Item dictionary in Allscripts TouchWorks EHR, you may need to enter additional clinical details about the patient and order. Some questions are conditional (meaning that depending on your response, Wand may or may not ask additional questions). For information on how clinical questions are configured, refer to the Allscripts TouchWorks EHR Application Design and Behavior Resource (ADBR). Caution: If you respond Yes to a contraindication question, you will not be able to save the order. When you tap Done, Allscripts Wand for TouchWorks EHR displays a message indicating that the order could not be saved due to the response. If questions are configured for the following: > 'Missing answer results in ''On Hold'' status' > 'Missing answer results in ''Needs Info'' status' Wand displays an asterisk (*) in the question prompt. A response is not required. Note: Modifier information is entered in the Clinical Questions section. If a modifier has been configured for the order in the Orderable Item dictionary, the application displays the information icon ( ) even if a default value has been configured. Additional Details Comments to Performing Location Indicates additional information to be included with the order and provided for the performing location/facility. Ordered By Indicates the provider ordering the item. Managed By Indicates the provider responsible for managing the patient s care. For example, if you are in a group practice and attending the care of another physician s patient in that physician s absence, then you would want to select the patient s physician for Managed By. You are only temporarily providing medical care for the patient until their physician returns. The order will be routed based on this value. November 06, 2014 111

Chapter 5 Working with Encounters Supervised By Indicates the provider who is supervising the provider who ordered the item. If the Supervised By provider is not the same as the Ordered By provider, then the order is saved in Unauthorized status, and an Authorize Order task is sent to the Supervised By provider. That task must be completed in Allscripts TouchWorks EHR. Other Annotations New Annotations Allows you to enter a new annotation for the order. Annotation History Indicates annotations saved previously for the order. Administered Medication screen 112 November 06, 2014

Encounter-Related Workflows Item Indicates the name of the administered medication. This information is read-only. Link To Indicates the active problem to which the administered medication is linked. The problems for the current encounter are displayed. You can link an administered medication to up to five active problems. November 06, 2014 113

Chapter 5 Working with Encounters Order Details Favorites, Instructions, Custom Tap a row and select Custom to edit or write a free-text SIG. The default values for the medication are copied from the Medication Search. When you select a different frequency, the application updates the list of instructions with only the instructions for the selected frequency. Status Indicates the medication administration status. The default value is Active, but the application evaluates the data entered for the medication administration to determine the status of the item when it is saved. For example, if a medication administration requires authorization when it is saved to the patient s record, then the status changes from Active to Unauthorized. The available statuses include: > Active: The medication administration is current and active. Typically, the status remains Active if all required information is entered when it is saved. If there is an absolute contraindication question in the Clinical Questions section, the status cannot be Active unless the answer to the question is set to No. > Complete: The medication administration is finished and considered as past order in the patient s record. > Temporary Deferral: The medication administration is deferred for a period of time from the recommended period for when the order is to occur, but the order is still expected to be done when the period for deferment expires. You must enter a time frame for the deferral. Indicate a number and a unit of measurement (Days, Weeks, Months, or Years). > Permanent Deferral : The medication administration is permanently deferred from the recommended period for when the order is to occur and is never expected to be done. Note: You can manually change the status for procedure orders, referrals, immunizations, and medication administrations. You cannot manually change the status for medications, supplies, or instructions. Reason Indicates the reason for the change in status. The available reasons are based on Status. Reasons are configured in the Order Status Reason dictionary in Allscripts TouchWorks EHR. 114 November 06, 2014

Encounter-Related Workflows To Be Done Indicates the date by which the medication administration must be completed. You can enter the date using one of the following methods: > Select a specific date and urgency indicator (ASAP, Pre-Op, Routine, Stat, or Today). > Enter a free text date or time. > Configure a recurring medication administration. You can enter a number and measurement (Days, Weeks, Months, or Years), and then indicate a specific starting date and the number of times the order should be performed. Additional Details Comments to Performing Location Indicates additional information to be included with the administered medication and provided for the performing location/facility. Ordered By Indicates the provider ordering the administered medication. Managed By Indicates the provider responsible for managing the patient s care. For example, if you are in a group practice and attending the care of another physician s patient in that physician s absence, then you would want to select the patient s physician for Managed By. You are only temporarily providing medical care for the patient until their physician returns. The order will be routed based on this value. Supervised By Indicates the provider who is supervising the provider who ordered the item. If the Supervised By provider is not the same as the Ordered By provider, then the order is saved in Unauthorized status, and an Authorize Order task is sent to the Supervised By provider. That task must be completed in Allscripts TouchWorks EHR. Other Annotations New Annotations Allows you to enter a new annotation for the administered medication. November 06, 2014 115

Chapter 5 Working with Encounters Annotation History Indicates annotations saved previously for the administered medication. Supplies Order screen 116 November 06, 2014

Encounter-Related Workflows Item Indicates the name of the orderable item. This information is read-only. The name is configured in the display name in the Orderable Item dictionary in Allscripts TouchWorks EHR. Link To Indicates the active problem to which the order is linked. The problems for the current encounter are displayed. You can link an order to up to five active problems. Order Details Location Indicates the location where the ordered item is to be dispensed to the patient. The default is blank, and you can select only one option for the location. Enabled for new orders, but is disabled for orders that have been saved and committed except for orders in Needs Info and Unauthorized status. Instructions For Use Indicates free text additional instructions for using the orderable item. Quantity Indicates the number of item to be delivered to the patient. DAW When checked, indicates there can be no substitutions for the orderable item and it must be dispensed as written. When clear, another equivalent item may be substituted for the selected item, if appropriate. Communicated By Indicates the method used to communicate the order to the location. The list contains methods configured in the Communication Method dictionary in Allscripts TouchWorks EHR. The default value is the communication method designated for the Requested Performing Location assigned to the orderable item, which displays when the assigned RPL is selected in To Be Performed. This default is set through the Communication Method in the Orderable Item dictionary, Order Defaults Requested Perf Location content category of SSMT. November 06, 2014 117

Chapter 5 Working with Encounters Caution: If you set Communicated By to Print Requisition and automatic printing defaults have not been configured for the selected site, the order will not print. Additional Details Comments to Performing Location Indicates additional information to be included with the order and provided for the performing location/facility. Ordered By Indicates the provider ordering the item. Managed By Indicates the provider responsible for managing the patient s care. For example, if you are in a group practice and attending the care of another physician s patient in that physician s absence, then you would want to select the patient s physician for Managed By. You are only temporarily providing medical care for the patient until their physician returns. The order will be routed based on this value. Supervised By Indicates the provider who is supervising the provider who ordered the item. If the Supervised By provider is not the same as the Ordered By provider, then the order is saved in Unauthorized status, and an Authorize Order task is sent to the Supervised By provider. That task must be completed in Allscripts TouchWorks EHR. Other Annotations New Annotations Allows you to enter a new annotation for the order. Annotation History Indicates annotations saved previously for the order. Instruction Order screen 118 November 06, 2014

Encounter-Related Workflows Item Indicates the name of the orderable item. This information is read-only. The name is configured in Display Name in the Orderable Item dictionary in Allscripts TouchWorks EHR. Link To Indicates the active problem to which the order is linked. The problems for the current encounter are displayed. You can link an order to up to five active problems. November 06, 2014 119

Chapter 5 Working with Encounters Order Details Text (not labeled) Indicates the text of the instructions, as configured in the Orderable Item dictionary in Allscripts TouchWorks EHR. This is read-only information. Communicated By Indicates the method used to communicate the order to the location. The list contains methods configured in the Communication Method dictionary in Allscripts TouchWorks EHR. The default value is the communication method designated for the Requested Performing Location assigned to the orderable item, which displays when the assigned RPL is selected in To Be Performed. This default is set through the Communication Method in the Orderable Item dictionary, Order Defaults Requested Perf Location content category of SSMT. Show on Orders List When checked, indicates that the instructions order will appear on the patient s list of orders. When clear, the instructions order does not appear in the patient s list of orders. The default value is configured in the Orderable Item dictionary in Allscripts TouchWorks EHR. Additional Details Ordered By Indicates the provider ordering the item. Managed By Indicates the provider responsible for managing the patient s care. For example, if you are in a group practice and attending the care of another physician s patient in that physician s absence, then you would want to select the patient s physician for Managed By. You are only temporarily providing medical care for the patient until their physician returns. The order will be routed based on this value. Supervised By Indicates the provider who is supervising the provider who ordered the item. If the Supervised By provider is not the same as the Ordered By provider, then the order is saved in Unauthorized status, and an Authorize Order task is sent to the Supervised By provider. That task must be completed in Allscripts TouchWorks EHR. 120 November 06, 2014

Encounter-Related Workflows Instructions Displays the patient instructions to communicate to the patient about certain conditions, behaviors, and practices specific to the orderable item. Immunization screen Item Indicates the name of the immunization. This information is read-only. November 06, 2014 121

Chapter 5 Working with Encounters Link To Indicates the active problem to which the immunization is linked. The problems for the current encounter are displayed. You can link an immunization to up to five active problems. Note: Allscripts Wand does not display expiration date or lot number on this screen because the immunization administration is not documented in an Allscripts Wand for TouchWorks EHR workflow. Administration of the immunization is documented in Allscripts TouchWorks EHR. Order Details Favorites, Instructions, Custom Tap a row and select Custom to edit or write a free-text SIG. The default values for the medication are copied from the Medication Search screen. When you select a different frequency, the application updates the list of instructions with only the instructions for the selected frequency. Status Indicates the immunization status. The default value is Active, but the application evaluates the data entered for the order to determine the status of the immunization when it is saved. For example, if an immunization requires authorization when it is saved to the patient s record, then the status changes from Active to Unauthorized. The available statuses include: > Active: The immunization is current and active. Typically, the status remains Active if all required information is entered when it is saved. If there is an absolute contraindication question in the Clinical Questions section, the status cannot be Active unless the answer to the question is set to No. > Complete: The immunization is finished and considered as past order in the patient s record. > Temporary Deferral: The immunization is deferred for a period of time from the recommended period for when the order is to occur, but the order is still expected to be done when the period for deferment expires. For example, the patient is planning an invasive procedure at the time of the order and the provider defers the order until that procedure has been performed. If there is an absolute contraindication for a non-medication order (Laboratory, Imaging order, or other diagnostics testing) as determined by one or more of the Clinical Questions items, clinical users must select either Temporary Deferral or Permanent Deferral to document why the order was not placed or cancel the order. You must enter a time frame for the deferral. Indicate a number and a unit of measurement (Days, Weeks, Months, or Years). 122 November 06, 2014

Encounter-Related Workflows > Permanent Deferral : The order is permanently deferred from the recommended period for when the order is to occur and is never expected to be done. For example, the patient refuses to have the order performed due to personal beliefs. If there is an absolute contraindication for a non-medication order (Laboratory, Imaging order, or other diagnostics testing) as determined by one or more of the Clinical Questions items, clinical users must select either Temporary Deferral or Permanent Deferral to document why the order was not placed or cancel out of the order. Note: You can manually change the status for procedure orders, referrals, immunizations, and medication administrations. You cannot manually change the status for medications, supplies, or instructions. Reason Indicates the reason for the change in immunization status. The available reasons are based on Status. Reasons are configured in the Order Status Reason dictionary in Allscripts TouchWorks EHR. To Be Done Indicates the date by which the immunization must be completed. You can enter the date using one of the following methods: > Select a specific date and urgency indicator (ASAP, Pre-Op, Routine, Stat, or Today). > Enter a free text date or time. > Configure a recurring order. You can enter a number and measurement (Days, Weeks, Months, or Years), and then indicate a specific starting date and the number of times the order should be performed. Additional Details Comments to Performing Location Indicates additional information to be included with the order and provided for the performing location/facility. Ordered By Indicates the provider ordering the item. November 06, 2014 123

Chapter 5 Working with Encounters Managed By Indicates the provider responsible for managing the patient s care. For example, if you are in a group practice and attending the care of another physician s patient in that physician s absence, then you would want to select the patient s physician for Managed By. You are only temporarily providing medical care for the patient until their physician returns. The order will be routed based on this value. Supervised By Indicates the provider who is supervising the provider who ordered the item. If the Supervised By provider is not the same as the Ordered By provider, then the order is saved in Unauthorized status, and an Authorize Order task is sent to the Supervised By provider. That task must be completed in Allscripts TouchWorks EHR. Other Annotations New Annotations Allows you to enter a new annotation for the immunization. Annotation History Indicates annotations saved previously for the immunization. Follow Up Referral screen 124 November 06, 2014

Encounter-Related Workflows Note: You cannot create a free text reminder from Allscripts Wand for TouchWorks EHR. Item Indicates the name of the follow-up or referral item. This information is read-only. Link To Indicates the active problem to which the follow-up or referral item is linked. The problems for the current encounter are displayed. You can link a referral item to up to five active problems. November 06, 2014 125

Chapter 5 Working with Encounters Order Details Note: For more information on how to configure referrals for internal and external organizations, see the Allscripts TouchWorks EHR Application Design and Behavior Resource (ADBR). Internal When selected, you can select a provider from within the Allscripts TouchWorks EHR system. External When selected, you can select a provider from an external system (outside Allscripts TouchWorks EHR). Practice or Vendor Indicates the name of the organization or enterprise to which the followup or referral is to be placed. Location Indicates the actual physical location where the followup or referral is to occur. Provider Indicates the provider who is to perform the followup or referral. Order Status Indicates the followup or referral status. The default value is Active, but the application evaluates the data entered for the followup or referral to determine the status of the followup or referral when it is saved. For example, if a followup or referral requires authorization when it is saved to the patient s record, then the status changes from Active to Unauthorized. The available statuses include: > Active: The order is current and active. Typically, the status remains Active if all required information is entered when it is saved. If there is an absolute contraindication question in the Clinical Questions section, the status cannot be Active unless the answer to the question is set to No. > Complete: The order is finished and considered as past order in the patient s record. > Temporary Deferral: The order is deferred for a period of time from the recommended period for when the order is to occur, but the order is still expected to be done when the period for deferment expires. For example, the patient is planning an invasive procedure at the time 126 November 06, 2014

Encounter-Related Workflows of the order and the provider defers the order until that procedure has been performed. If there is an absolute contraindication for a non-medication order (Laboratory, Imaging order, or other diagnostics testing) as determined by one or more of the Clinical Questions items, clinical users must select either Temporary Deferral or Permanent Deferral to document why the order was not placed or cancel the order. You must enter a time frame for the deferral. Indicate a number and a unit of measurement (Days, Weeks, Months, or Years). > Permanent Deferral : The order is permanently deferred from the recommended period for when the order is to occur and is never expected to be done. For example, the patient refuses to have the order performed due to personal beliefs. If there is an absolute contraindication for a non-medication order (Laboratory, Imaging order, or other diagnostics testing) as determined by one or more of the Clinical Questions items, clinical users must select either Temporary Deferral or Permanent Deferral to document why the order was not placed or cancel out of the order. Note: You can manually change the status for procedure orders, referrals, immunizations, and medication administrations. You cannot manually change the status for medications, supplies, or instructions. Reason Indicates the reason for the referral. The available reasons are based on Status. Reasons are configured in the Order Status Reason dictionary in Allscripts TouchWorks EHR. To Be Done Indicates the date by which the followup or referral must be completed. You can enter the date using one of the following methods: > Select a specific date and urgency indicator (ASAP, Pre-Op, Routine, Stat, or Today). > Enter a free text date or time. > Configure a recurring order. You can enter a number and measurement (Days, Weeks, Months, or Years), and then indicate a specific starting date and the number of times the order should be performed. Type Indicates the type of referral or follow-up. These types are configured in the Referral Type dictionary in Allscripts TouchWorks EHR. November 06, 2014 127

Chapter 5 Working with Encounters Communicated By Indicates the method used to communicate the order to the location. The list contains methods configured in the Communication Method dictionary in Allscripts TouchWorks EHR. The default value is the communication method designated for the Requested Performing Location assigned to the orderable item, which displays when the assigned RPL is selected in To Be Performed. This default is set through the Communication Method in the Orderable Item dictionary, Order Defaults Requested Perf Location content category of SSMT. Caution: If you set Communicated By to Print Requisition and automatic printing defaults have not been configured for the selected site, the order will not print. Additional Details Comments to Performing Location Indicates additional information to be included with the follow up or referral and provided for the performing location/facility. Ordered By Indicates the provider ordering the follow up or referral. Managed By Indicates the provider responsible for managing the patient s care. For example, if you are in a group practice and attending the care of another physician s patient in that physician s absence, then you would want to select the patient s physician for Managed By. You are only temporarily providing medical care for the patient until their physician returns. The follow up or referral will be routed based on this value. Supervised By Indicates the provider who is supervising the provider who ordered the item. If the Supervised By provider is not the same as the Ordered By provider, then the order is saved in Unauthorized status, and an Authorize Order task is sent to the Supervised By provider. That task must be completed in Allscripts TouchWorks EHR. Other Annotations New Annotations Allows you to enter a new annotation for the follow up or referral. 128 November 06, 2014

Encounter-Related Workflows Annotation History Indicates annotations saved previously for the follow up or referral. Problem Details screen November 06, 2014 129

Chapter 5 Working with Encounters Problem Indicates the problem and the associated ICD-9 term added for the patient. If this is an edit, you can transition the problem. Tap Search, and then search for and select a new problem. The existing problem is moved to Transitioned From. Note: Allscripts Wand for TouchWorks EHR does not display ICD-10 codes. Details Status Indicates the problem status. The default value is Active. Other statuses are configured in the Problem Status dictionary in Allscripts TouchWorks EHR. Onset Date Indicates the date on which the problem was first noticed, reported by the patient, or diagnosed by the provider. Resolution Date Indicates the date on which the problem was resolved. A resolved date can be configured for one year in the future. If the status is set to Resolved and a resolution date is not entered, Resolution Date is selected. If the date is in the past or today, and the status is anything but Resolved, the problem status is changed to Resolved. If the status of a problem is changed from Resolved to Active, Resolution Date is automatically removed. Clinical Progress Indicates the clinical progress of the problem. The default value is blank. The available entries are configured in the Clinical Progress dictionary in Allscripts TouchWorks EHR. Classified As Indicates the problem category. The default value is blank. Severity Indicates the severity of the problem based on frequency. The default value is blank. 130 November 06, 2014

Encounter-Related Workflows Secondary To Indicates the problem is secondary to one of the patient's other existing active problems. Description Allows you to enter a free-text description of the problem. The default value is blank. Managed By Indicates the provider managing this problem for the patient. The default value is you, the current user. Select another provider from the popover, or search for another provider. Transitioned From This is read-only information. Indicates the problem and ICD9 code from which this was transitioned, as well as the date of transition, if applicable. Include in Active When selected, the problem is displayed in the patient's list of active problems. The default value is clear. Available only when the problem is resolved or a Past Medical History item. Include in Past Medical History When selected, the problem is displayed in the patient's Past Medical History. The default value is clear. Available only when the problem is active. Annotations New Annotations Allows you to enter a new annotation for the problem. Annotation History Indicates annotations saved previously for the problem. Drug Utilization Review Drug Utilization Review (DUR) is enabled in Allscripts Wand for TouchWorks EHR. When a user orders items, adds allergies, prescribes medications, or performs other clinical activities through November 06, 2014 131

Chapter 5 Working with Encounters Wand, the application performs DUR checking and displays relevant warnings and information in line with functionality available through Allscripts TouchWorks EHR. All configuration related to DUR checking is performed within Allscripts TouchWorks EHR. For more information, see the Application Design and Behavior Resource. Allscripts Wand for TouchWorks EHR assumes that the organization has the default settings for DUR checking; the application does not look at the preferences configured in TWAdmin>Org Setup>Enterprise>DUR. The text of the alerts displayed in Allscripts Wand for TouchWorks EHR and the data and conditions triggering those alerts are developed and delivered by Medi-Span. DUR alert types Drug-Drug A Drug-Drug DUR alert occurs when the application detects a potential reaction occurring between different selected medications, such as a medication being ordered and a current medication already prescribed for the patient. Allscripts Wand for TouchWorks EHR does not perform DUR checking on historical immunizations. PAR (Prior Adverse Reaction) A PAR DUR alert occurs when the application detects a reported allergic or adverse reaction for the patient that is caused by a specific medication or medication allergy with the specific medication, similar types of medications, typical reaction, and symptoms. PAR alerts are only performed against medication allergies. The application always generates a DUR alert when the user prescribes any medication for a patient with no allergy information. Allscripts Wand for TouchWorks EHR does not use the Allscripts TouchWorks EHR preference PrescribingWithoutAllergyStatus to engage or suppress this functionality. These warnings are displayed as messages, not DUR alerts, in Allscripts TouchWorks EHR. Drug-Health State A Drug-Health State alert (or disease alert) occurs when the application detects problems that have ICD-9 or ICD-10 diagnosis codes associated with them that may interfere with the selected medication. Drug-Food A Drug-Food alert occurs when the application detects the patient should avoid consuming certain foods while also taking the prescribed medication or therapeutic equivalent, because it could adversely interfere with the medication therapy. 132 November 06, 2014

Encounter-Related Workflows Drug-Alcohol A Drug-Alcohol alert occurs when the application detects the patient should avoid consuming alcohol while also taking the prescribed medication or therapeutic equivalent, because it could adversely interfere with the medication therapy. Duplicate Therapy A Duplicate Therapy alert occurs when the application detects that the medication being ordered is the same or therapeutic equivalent to a medication that is currently in the patient s medical record. Dosage A Dosage alert occurs when the application detects that the dosage for the medication being ordered may not be appropriate or available for the patient. The application always generates No dose range available alerts when conditions are appropriate. Allscripts Wand for TouchWorks EHR does not use the Allscripts TouchWorks EHR preference DisplayDoseRangeMissing to limit these types of alerts. Pregnancy A Pregnancy alert (an absolute contraindication) occurs when the application detects that the medication being ordered is not appropriate for a pregnant patient. DUR Alerts screen When the application detects a condition that triggers a DUR alert, the application displays the DUR Alerts screen. This screen allows you to: > Select a reason to override the alert, and then continue with the action Note: The override reason you select applies to all the alerts displayed on the DUR Alerts screen. You cannot select different reasons for individual alerts. This is different from Allscripts TouchWorks EHR functionality. > Read additional information and guidance about each individual alert > Cancel without taking any action and return to the previous screen Cancel Cancels the action, and displays the previous search or details screen. Review icon ( ) Displays the patient s Alerts and Review panels. November 06, 2014 133

Chapter 5 Working with Encounters Done Records the value entered in Override Reason, and continues the action. Override Reason Indicates the reason why the user is acknowledging the alert and continuing the action. This value is referred to as Reason for Continuing in Allscripts TouchWorks EHR. These values are configured in the Ignore Reasons dictionary in TWAdmin>Dictionaries. DUR Alerts Indicates the alert(s) generated by the medication or item and a summary of the interaction. Tap on the alert to display the full text of the alert. This content is provided by Medi-Span. Encounter-Related Documentation Documents Allscripts Wand for TouchWorks EHR allows you to create, edit, and sign/finalize unstructured documents from the ipad device. Note: This documentation is referred to as "unstructured documents" in Allscripts TouchWorks EHR. Allscripts Wand for TouchWorks EHR does not allow you to create or edit structured notes. For more information, see the section below. A document is comprised of a combination of some or all of the following sections: > Chief Complaint > History of Present Illness > Medical History: includes problems, medications, and allergies Note: By default, all patient allergies are cited into documents. > Review of Systems > Vitals > Physical Exam > Procedures > Assessment and Plan 134 November 06, 2014

Encounter-Related Documentation > Comments Note: By default, all Assessment and Plan information for the current encounter is included in the document. The application does not automatically create a document for each encounter. You can enter information for the Vitals and Assessment and Plan sections without creating a document. However, to create unstructured documentation for the remaining sections, you must create a document from the Encounter screen. Compatibility with Allscripts TouchWorks EHR Allscripts Wand for TouchWorks EHR can create visit documentation. The documentation created has the ability to cite the discrete data previously entered into the chart, such as the patient s allergies, medications, and problem lists. In addition the assessed problems and the orders for those placed in the application are included in the visit documentation. The user can utilize M*Modal, text templates, and keyboard entry to enter the Chief Complaint, Physical Exam, and Review of Systems. The visit documentation created in Wand is visible in the desktop version of Allscripts TouchWorks EHR as soon as the document is created. In the desktop, this document appears as an unstructured document. It can be edited and finalized in the desktop or on the ipad. However, once it is edited in the desktop, there are changes in how it can be edited on the ipad. For organizations who use v10 note, the application enables you to dictate against dictation markers created in those notes on the desktop. Allscripts Wand for TouchWorks EHR does not allow you to edit these v10 notes. In order to create visit documentation, you must use the Wand Encounter screen, which generates a unstructured document in Allscripts TouchWorks EHR. Turn off Document functionality You can turn off document-related functions in Allscripts Wand for TouchWorks EHR. The system administrator must set the following preference in Allscripts TouchWorks EHR, TWAdmin>Preferences: > Wand Document Enabled: Default is Y. When enabled, the Documents button is enabled on the Encounter screen. Otherwise, you can only view documents through the Patient Review screen, and creating documents is not available in Wand. Administrators can set this preference at the enterprise level and then override it for individual users. Note: Setting Wand Document Enabled to N does not prevent users from signing documents. It only prevents new document creation. Document workflows with Allscripts TouchWorks EHR If a document is edited in Allscripts Wand for TouchWorks EHR, you cannot edit the document in Allscripts Wand for TouchWorks EHR. You can, however, view the document in Wand. November 06, 2014 135

Chapter 5 Working with Encounters Documents that are created in the application can be viewed and edited in Allscripts TouchWorks EHR. Carefully consider how this potentially affects your organizational workflows. For example, if a nurse normally creates the document, and then the provider completes it, both the nurse and the provider should be working in Allscripts Wand for TouchWorks EHR. Select or create a document With an encounter selected, you can select an existing document for the encounter or create a new document. When you first access the Encounter screen, the application displays only the document sections for Vitals and Assessment and Plan. This indicates that no document has been created for the encounter. Note: Allscripts Wand for TouchWorks EHR does not create the document until you tap Create New Document. It does not create documents automatically. 1. On the Encounter screen, tap Documents. If other RTF documents exist for the encounter, the application displays them in the list, including Version 10 documents that include dictation markers. Otherwise, the only option available is Create New Document. Other documents that have been finalized are displayed in gray text and cannot be selected. You can view all documents for the patient (finalized and non RTF types, including those dictated in the Text Input Utility) from Patient Review. Status in Allscripts TouchWorks EHR Unsigned (created) Signed (signed but not finalized) Unsigned (was signed but then edited) Signed (signed after an edit) Final-Signature (signed with make final checked) Amended, Unsigned (was final, but then was amended) Amended, Signed (was amended, unsigned) Amended, Final Wand action Available Available Available Available Not available Not available Not available Not available 2. To load an existing document, tap that document. Otherwise, tap Create New Document. 136 November 06, 2014

Encounter-Related Documentation If you select a document that is currently open in Allscripts TouchWorks EHR, the application displays a warning and does not open the document. Results of this task With a document in context, the document sections Medical History, Chief Complaint, History of Present Illness, Review of Systems, Physical Exam, Procedures, and Comments are visible. While you don't need to add content for each section, they are all available for selection from the Encounter screen. Allscripts Wand for TouchWorks EHR determines the document owner to be: > The encounter owner > If no encounter owner exists (for example, an audit document), then the user who created the document This accommodates organizational workflows where nurses begin documents for providers. Note: In the event that you create a document for a patient, and (after the document is created in Allscripts Wand for TouchWorks EHR) the associated document type is changed to not support an electronic workflow, you can still complete and sign the document in the application. However, you will not be able to create future documents with that document type. Select a document type You can select the document type associated with the document in context. Before you begin Document types are defined and configured in the Document Type dictionary in Allscripts TouchWorks EHR. Allscripts Wand for TouchWorks EHR displays document types that: > Do not utilize non electronic workflows (NONEW) > Have a manifestation of RTF > You have security rights to view > Are active The default document type is the document type from the most recently edited document that has the same owner, is RTF based, and the owner has access to. If one does not exist, then the default document type is the first document type the owner has access to (alphabetically). Otherwise, there is no default document type. Allscripts Wand for TouchWorks EHR verifies that both the user starting the document and the document owner have appropriate security codes for the available document types. Wand checks the users' default organization for these security codes. November 06, 2014 137

Chapter 5 Working with Encounters Note: Document types with Finalize on Save selected are not visible in the application. 1. On the Encounter screen, tap Document Type. The application displays the code used to describe the document type in Allscripts TouchWorks EHR. 2. Select the appropriate document type. Results of this task To view changes resulting from the different document type, preview the document. Edit a document section You can edit individual document sections from the Encounter screen. Before you begin You have created a document for the encounter. Note: This topic applies to Chief Complaint, History of Present Illness, Review of Systems, Physical Exam, Procedures, and Comments document sections. 1. On the Encounter screen, tap the appropriate document section header. If you tap Medical History, the application displays the Cited List screen. If you tap Vitals, the application displays the Vitals screen. If you tap Assessment and Plan, the application displays the Assessment and Plan screen. See the related tasks. Otherwise, the application displays the Document screen. 2. Enter text in the document. You can do this using any of the following methods: > Type with the ipad keyboard > Dictate text with the recording controls > Tap to use a text template 3. Tap to format the text in the document section. 4. When you have completed the document section, tap Done. Results of this task The application closes the Document screen and displays the Encounter screen. The section under the document section header expands to display the text you have added. 138 November 06, 2014

Encounter-Related Documentation Note: Allscripts Wand for TouchWorks EHR does not use the Apple spell checker. Preview and sign a document You can preview and sign the completed document from the Note Preview screen. Before you begin You have created a document for the encounter and completed the content in the individual document sections. This task has 7 steps. 1. On the Encounter screen with the document in context, tap Preview. The application displays the Note Preview screen. 2. (Optional) Check Hide empty sections to remove document sections for which there is no content. 3. After you have reviewed the document and are ready to sign it, tap Sign. The application displays the Signature screen. 4. Enter your Password. Allscripts Wand for TouchWorks EHR uses the Allscripts TouchWorks EHR preference OrderAuthenticationTimeout to determine if a password is required when signing a document. If the preference is set to 0 or blank, a password is not required. Otherwise, you must enter a password. 5. Select the appropriate Signature Type. 6. (Optional) Check Make Final to finalize the document 7. Tap Done. Results of this task After you sign a document, the application does the following: > Adds your name and the date and time to the Signature section of the document. The application displays credentials, but will not display occupation information. The application does not use the Note Default Signature Display preference in Allscripts TouchWorks EHR. > Saves the document. > Changes the status of the document from Unsigned to Signed or Final if you have sufficient signing authority. If the document has been edited in Allscripts TouchWorks EHR while it was displayed on the Note Preview screen, you cannot sign the document. However, items that you have ordered throughout document creation (for example, from the Assessment and Plan) are saved. Note: Allscripts Wand for TouchWorks EHR does not support a co-signature workflow. November 06, 2014 139

Chapter 5 Working with Encounters Text templates When you tap on the Document screen, the application displays a list of available text templates for inclusion into the document section. When you select the text template, the application displays the contents of the template using the conventions described below. After you have selected and/or entered the appropriate text, tap Done to insert the text template into the document section. Section Mappings When you tap the text template icon, the list of available text templates includes templates that are: > Configured for structured notes, and > "Mapped" to the document section in which you are working The following table describes the sections as they are configured in Allscripts TouchWorks EHR and how they are mapped to sections in Allscripts Wand for TouchWorks EHR: EEHR Assessment Chief Complaint Health Management History of Present Illness Immunizations Personal History Physical Exam Plan Previous Therapy Previous Tests Reason for Visit Review of Systems Subjective Test Conclusions Tests Wand Comments Chief Complaint Comments History of Present Illness Comments History of Present Illness Physical Exam Comments History of Present Illness History of Present Illness Chief Complaint Review of Systems History of Present Illness Comments Procedures 140 November 06, 2014

Encounter-Related Documentation EEHR Therapeutic History Therapy Wand History of Present Illness History of Present Illness Completing text templates When you are presented with a text template complete, you may notice some or all of the following display conventions: > Ungrouped items: When there is no boundary around the items, you can select as many or few of these items as appropriate. > Exclusive group of items: When there is a dark boundary around the items, you can select only one of these items. > Required group of items: When there is a blue boundary around the items, you must select an item before you can tap Done. Required groups can be exclusive or non exclusive. > Required group of items: When there is a blue boundary around the items, you must select an item before you can tap Done. Required groups can be exclusive or non exclusive. > Optional entries: When the area is shaded in dark gray, you can include or exclude all text (including labels) from the resulting document. To exclude the contents, tap +; to include the contents, tap -. November 06, 2014 141

Chapter 5 Working with Encounters > Yes/No entries: To respond Yes to a Yes or No question, tap the checkmark; it turns green. To respond No, tap X; it turns red. > Free text entries: When you tap on a free text entry, the application displays the ipad keyboard. If a numeric entry is expected, the numeric keyboard displays; if an alphabetic entry is expected, the alphabetic keyboard displays. Mark All Yes/No When there are Yes/No controls on the selected text template, Wand displays Mark all Yes/No with the following additional controls: > : Selects the Yes (checkmark) value for each option that has been configured for Yes/No values in the text template. Yes/No values have no correlation to Positive and Negative values. When selected, this icon turns green. > : Selects the No (x) value for each option that has been configured for Yes/No values in the text template. When selected, this icon turns red. > Clear: Clears all selected Yes and No values in the text template. > Apply to optional groups: Applies the Yes or No value to optional groups in the template. Optional groups include groups that only appear in a text template when a dependent value is selected. Check All Left When there are Yes/No controls on the selected text template, Wand displays Check All Left with the following additional controls: 142 November 06, 2014

Encounter-Related Documentation > : Selects the value that is left (or first) in each group. When selected, this icon turns green. When configuring text templates, it is important for system administrators to consider this option and put default values in the leftmost (or first) area of the group. > Apply to optional groups: Selects the value that is left (or first) in optional groups as well as regular groups. Copy forward When you tap on the Document screen, the application displays a list of both documents from which you can copy forward text and text templates. When you "copy forward" text into a document, the application copies text from a selected existing document's section to another document's corresponding section. For example, you can copy the Review of Systems section from a past document to the Review of Systems section in the document in context, and then edit the previous text to accommodate the current encounter instead of starting the section's content from scratch. This can significantly reduce the amount of time it takes to create clinical documentation. Note: Allscripts Wand for TouchWorks EHR limits the sections from which you can copy forward text to only those documents for which you are the owner. You cannot copy forward other provider's text. Documents from which you can copy forward text include the prefix Copy. When you select an existing document, the application inserts the text at the location where the cursor is placed. The newly added text is highlighted. You can then edit and format the text from the Document screen as you would any other text. Work with dictation markers Allscripts Wand for TouchWorks EHR allows you to dictate against dictation markers. You must create a V10 note in Allscripts TouchWorks EHR, insert the dictation markers, and save the note prior to opening it in the application. Wand records dictations using the same quality settings for your user name in Allscripts TouchWorks EHR. These values are configured in TWUser Admin>User Admin>Provider Details II. If default dictation format quality settings have not been configured for the user, Allscripts Wand for TouchWorks EHR uses the lowest fidelity in order to keep file sizes small. Caution: If you are working over cellular communications instead of Wi-Fi, it will take longer to transmit dictation files. November 06, 2014 143

Chapter 5 Working with Encounters Your default work type is configured in Allscripts TouchWorks EHR based on your user and site settings. If you have no default work type set in dictation preferences, the default work type is based on the sort order. This task has 6 steps. 1. With a patient selected, access the Encounter screen. 2. Tap Documents. The application displays a list of documents for the current encounter. Documents containing dictation markers are indicated with the Dictation icon ( ). 3. Tap a document with a dictation marker. 144 November 06, 2014

Encounter-Related Documentation The application displays the Document screen. Existing dictation markers are indicated with blue hyperlinks; after a dictation has been sent, the link is no longer active. 4. Tap a dictation marker. The application displays the dictation controls that allow you to manage recording. 5. Record the selected dictation using the following controls: > Record ( ): Begin recording against the marker. This enables the duration and input level controls. > Pause ( ): Pause recording. Note: If you pause the recording, and then send it, Wand automatically stops the recording prior to sending the dictation file. > Stop ( ): Stop recording. > Input level ( ): Indicates the strength of the input volume. > Delete ( ): Delete the recording (not the dictation marker). > Send ( ): Send the file to the appropriate web service for transcription. When you tap the Send icon, the application disables the HTML link for the dictation marker. If you stop the recording and then begin recording again, Allscripts Wand for TouchWorks EHR combines the two recordings. It does not replace the first recording with the second. Also, the ipad device will not "timeout" (that is, dim and shutdown) while you are dictating. 6. After you send the dictation file, you can tap a different dictation marker in the document in context or tap Done to exit the Document screen and display the Encounter screen. Dictation files are always encrypted even as they are being recorded. They are never on the device in a non-encrypted format, and they are encrypted while in motion to the server as well. The maximum allowable size of the dictation file is 50 MB. November 06, 2014 145

Chapter 5 Working with Encounters Related Screens Document screen You can type or dictate the Chief Complaint, History of Present Illness, Review of Systems, Physical Exam, Procedures, and Comments sections of the document from the Document screen. Cancel When you tap Cancel, the application displays the Encounter screen. It does not save any text that was entered on the Document screen. Header (not labeled) Indicates the section of document you are entering text for or dictating (Chief Complaint, History of Present Illness, Review of Systems, Physical Exam, Procedures, or Comments). Text template icon ( ) When you tap the text template icon, the application displays a list of text templates that you can insert in the document section. Note: The text templates that are available from this list are determined by your specialty, secondary specialty, and favorites in Allscripts TouchWorks EHR. Allscripts Wand for TouchWorks EHR displays the template name, followed by the note section and specialty. If specialty is not available, the app displays the group name. Text templates are used to expedite entry of clinical documentation into the patient record. They allow the user to insert text blocks into the document. Once selected, the user can enter additional personalized text to complete the documentation. Text templates are configured in Allscripts TouchWorks EHR. The list includes text templates that: > Have TW Module set to Note (structured) > Are mapped to Allscripts Wand for TouchWorks EHR through SSMT When you select a template, the application inserts the text into the document at the point where your cursor was placed. You can then edit the contents of the text. Note: You can enter multiple text templates in one document section. 146 November 06, 2014

Encounter-Related Documentation In addition to text templates, this icon is also used to copy forward text. Entries in the list with the prefix Copy indicate previous document sections of the same type that you can copy into the document. For example, you can copy the Review of Systems section from a past document to the Review of Systems section in the document in context, and then edit the previous text to accommodate the current encounter instead of starting the section's content from scratch. You can only copy forward section text from documents for which you are the owner. Format text icon ( ) When you tap the format text icon, the application displays the Text Style screen. This enables you to manipulate the selected text's attributes, including color, presentation (bold, italic, underline), size, font, and orientation. Done When you tap Done, the application saves the text entered on the Document screen for the selected document section, and displays the Encounter screen. Recording Level Indicates the input sound level from the microphone. Record/Stop When you tap Record, the application begins recording through the ipad device's microphone. When you tap Stop, the recording stops, and the application renders the text on the Document screen. If your ipad is configured to use Fluency Direct by M*Modal, then the M*Modal icon ( ) is displayed with Record/Stop. Text Style screen You can format individual text elements in a document using the Text Style popover. This applies to the following document sections: Chief Complaint, History of Present Illness, Review of Systems, Physical Exam, Procedures, and Comments. Note: The application uses default text attributes for the ipad device. If you format text in fonts that are not supported by Allscripts Wand for TouchWorks EHR, the EHR substitutes an appropriate font. November 06, 2014 147

Chapter 5 Working with Encounters The application displays the Text Style screen when you tap on the Document screen. The formatting changes apply to the text selected on the Document screen. Text color Allows you to select a different color for the selected text. Allows you to format the selected text with bold text, italicized text, and/or underlined text. 148 November 06, 2014

Encounter-Related Documentation Allows you to incrementally increase or decrease the font size or set it to a specific font size. Font Allows you to select a specific font by name. Allows you to justify the text on the left, center, or right. You can also fully justify the text (meaning that all rows are the same length). Note Preview screen You can preview the document content output from the Note Preview screen. November 06, 2014 149

Chapter 5 Working with Encounters Cancel When you tap Cancel, the application closes the Note Preview screen and displays the Encounter screen. Sign When you tap Sign, the application closes the Note Preview screen and displays the Signature screen from which you can finalize the current document content and apply visit charges to the encounter. 150 November 06, 2014

Encounter-Related Documentation Document content (not labeled) Indicates the current document content. This information is read-only. To edit document content, you must do it from the Encounter and Document screens. Hide empty sections When checked, the application hides document sections for which there is no content. When clear, the application displays the section titles for document sections without content. Signature screen You can sign and finalize a document from the Signature screen. You can also apply visit charges to the associated encounter. Cancel When you click Cancel, the application closes the Signature screen and displays the Preview screen without having signed or finalized the document. Review and Alerts icon ( ) When you tap the Review and Alerts icon, the application displays the Review panel or the Alerts panel. You can move between the Review panel and the Alerts panel by tapping. Done When you tap Done, the application: > Adds the user name and the date and time to the Signature section of the document > Saves the document > Changes the status of the document from Unsigned to Signed or Final if the user has sufficient signing authority. Users cannot sign documents as other users. This is why the current user s user name is automatically entered, and it cannot be modified. Multiple users can sign the same document, and if appropriate, the same user can sign the same document multiple times. This is important in cases where documents are routed to other providers to view. Signing the document, and therefore leaving a signature line with a date and time stamp at the bottom of the document, is a good way to record having reviewed a document. November 06, 2014 151

Chapter 5 Working with Encounters User Name Indicates the current user's user name. Password Enter your password. This is the same password you use to log into both Allscripts Wand for TouchWorks EHR and Allscripts TouchWorks EHR. Show Password When checked, the application displays the text as you type it in Password. Signature Type Indicates your signature type for the document. The following signature types are available for selection: > Acknowledgment > Administrative > Author > Co-author > Co-participant > Review > Transcription/Recorder > Validation Note: Allscripts Wand for TouchWorks EHR does not use the Allscripts TouchWorks EHR preference Default Signature Display to load a default Signature Type. Make Final When checked, the application will finalize the document when you tap Done. Your default value is specified in the Note Default Make Final preference in Allscripts TouchWorks EHR. Make Final is disabled if you do not have a high enough Finalization Level for the Document Type or the document is already in a Final state. Authority level for finalization for the document type is defined in the Document Type dictionary in Allscripts TouchWorks EHR. A user s Finalization Authority is specified in TWUser Admin in Allscripts TouchWorks EHR. 152 November 06, 2014

Encounter-Related Charges Print Clinical Summary icon ( The application generates the Clinical Summary document and prints it based on the document type, site, and provider settings. This process follows automatic printing settings configured in Allscripts TouchWorks EHR. The Clinical Summary document includes patient demographic information, reason for visit, treatment plan, vitals, current medications list, current health issues (problems), allergies, and results, as well as contact information for the provider. Note: When the patient's Clinical Summary Communication Method is set to Declined, this icon is disabled. Encounter-Related Charges Introduction to charging in Wand Allscripts Wand for TouchWorks EHR enables you to generate charges while documenting a patient's encounter. Charges generated in Allscripts Wand for TouchWorks EHR are inserted in the patient encounter (referred to as saved as draft ), but not submitted for billing. The remaining steps in a client s charge workflows must be performed in Allscripts TouchWorks EHR. Note: Because charges are saved as draft and not submitted from Wand, certain business rules associated with Allscripts TouchWorks EHR (such as the number of encounters/day/patient a provider can bill for) are not validated on the ipad device. Configuring Wand for charging To enable charge functionality in Allscripts Wand for TouchWorks EHR, all the following must be true: > The following preference in Allscripts TouchWorks EHR TWAdmin>Preferences must be configured: Wand Charge Enabled: Default value is N. When enabled, the Charge button is visible on the Encounter screen. Otherwise no charge functionality is available in Wand. Administrators can set this preference at the enterprise level and then override it for individual users. > Allscripts TouchWorks EHR must be configured for charge-related functionality. November 06, 2014 153

Chapter 5 Working with Encounters > The user must be configured as a billing provider in Allscripts TouchWorks EHR. Users are configured as billing providers through TWUser Admin in Allscripts TouchWorks EHR. For a user to be considered a billing provider, the Billing Provider option must be selected under Provider Detail I on the User Admin page. By default, users are not billing providers. > The user must be working on an encounter type that is configured as billable in Allscripts TouchWorks EHR. Encounter types are configured in the Encounter Type dictionary in Allscripts TouchWorks EHR. For an entry to be considered billable, the Can submit charges for the encounter type option must be selected under Detail I on the Dictionaries page. By default, encounter types are not billable. Generating charges This task has 12 steps. 1. From the Patient Review screen, two-finger swipe to display the Encounter screen. Allscripts Wand for TouchWorks EHR displays only the Vitals and Assessment and Plan document sections, indicating that a document has not been generated. You can tap Documents> Create New Document to generate a document for the encounter in context. However, you can generate charges without necessarily creating a document for the encounter. 2. Enter Vitals findings and Assessment and Plan information as appropriate. 3. Tap Charge. Allscripts Wand for TouchWorks EHR displays the Charges screen. Existing visit or procedure charges for the encounter display in the accumulator (aka shopping cart ) at the top of the screen. They are also checked in the lists below. 4. Tap the appropriate charges. > Visit Charge Favorites: Includes your (user level) favorite visit charges. Visit charge favorites can also be added or removed in Allscripts TouchWorks EHR using the Physician Admin Tool (PAT) through Phys Admin>By Category>Favorites>Visit Charge Favorites. > Procedure Charge Favorites: Includes your (user level) favorite procedure charges. Procedure charge favorites can also be added or removed in Allscripts TouchWorks EHR using the Physician Admin Tool (PAT) through Phys Admin>By Category>Favorites>Procedure Charge Favorites. > Search: Allows you to search the master list of both visit and procedure charges. Visit and procedure charges are configured in Allscripts TouchWorks EHR in the Charge Code dictionary. Enter the search term, and then tap Search. Allscripts Wand for TouchWorks EHR displays search results in the following order: (1) results from your favorites list that meet the search criteria, (2) visit charge results, and (3) procedure charge results. 5. Tap the appropriate charges. 154 November 06, 2014

Encounter-Related Charges Selected charges are checked and accumulate at the top of the screen with any preexisting charges for the encounter. 6. Tap the charge in the accumulator at the top of the screen to apply modifiers. Allscripts Wand for TouchWorks EHR displays the Modifiers screen. This screen includes modifiers in the accumulator applied to the selected charge previously or in the current workflow. 7. Select modifiers: > From the list of available modifiers. This list includes all modifiers for the charge groups assigned to the user, or > Search the list of all modifiers. Allscripts TouchWorks EHR prevents the user from applying more than five modifiers. When you select a modifier, it is checked in the list of modifiers and added to the accumulator at the top of the screen. 8. Tap Done. Modifiers applied from the Modifier screen appear next to the applicable charge code in parentheses (). 9. Enter additional charges and modifiers as appropriate. 10. Tap Next. Wand displays a grid indicating the problems assessed and the charges generated during the encounter. The checkmarks indicate the charges linked to individual problems. In Allscripts TouchWorks EHR, on the Personalize Charge screen in Auto Link of Dx(s) to Charges, you can determine whether all diagnoses automatically link to all procedure charges, only the primary diagnosis automatically links to all procedure charges, or no diagnoses automatically link when charges are added to the procedure charge codes summary. Wand utilizes this same setting to determine the default linking behavior. You can change this linking on the fly from the grid. 11. (Optional) The number of units associated with each charge defaults to one (1). To edit the number of units, tap (1) next to the charge, and then edit the number with the keyboard or spinner. To clear the Units control, tap anywhere on the screen. 12. Tap Done. Results of this task The charges are saved. If there are issues saving the charges to the Allscripts TouchWorks EHR database, Allscripts Wand for TouchWorks EHR displays the applicable error message. November 06, 2014 155

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Chapter 6 Working with Tasks Contents Task Details screen...157 Task types and icons...160 Task actions...161 Approve or deny a task...163 Reassign a task...164 Task Details screen The Task Details section displays information about the task and related details. When you select a task from the task list, the application displays the Task Details section, where you can research and work the task. If you receive a task for a patient that is registered in an organization to which you do not have access, the application will not display clinical information about the patient. It will, however, display information about the task. November 06, 2014 157

Chapter 6 Working with Tasks Task Details The application displays information about the task in the Task Details section. This information includes task type, who sent the task, the date it was sent, a subject (if entered), and a task message (if entered). You can scroll up and down if necessary, and you can tap to expand the section. You can drag the slider bar up or down to customize the view of the Task Details section and related details. Double-tap or tap does not expand or collapse either section in tasking. Related Details The application displays any patient information that is relevant to the selected task. The information that is displayed depends on the task type. 158 November 06, 2014

Task Details screen > Rx type tasks display medications and allergies. This includes tasks of type Refill, Rx Refill, Refill Request, erefill, erefill Request, Dispense Sample, Med Renewal Date, Med Renewal Request, Rx Info-Problem, Rx Renew Request, Rx Xmit Fail and erefill unmatched. > Note type tasks and Referral type tasks display all patient-related details except chief complaint, alerts, and documents. Note type tasks include Chart Review, Chart Message, Co-Sign Note, Cosign Note, Co-Sign Review, Finish Note, Sign Note, Note Signed but not Final, and Co-Sign Request. > Transcription type tasks display problems. Transcription type tasks include Transcription, Scanned Document, Document Review, and Internal Transcription. > Result type tasks and authorization type tasks display problems and medications. Result type tasks include Procedure Result, Procedure Result Review, Lab Result Review, Verify Patient Results, and Results Review. Authorization type tasks include Order Authorization, Lab, Order Notification, Perform Order, and Authorize Order. > Message type tasks display problems. Message type tasks include Action Item, erx Error, Cancel Response, PHI Request, PHI Request Submit, Patient Message, Mail Message, Call Back, Overdue Reminders, Schedule Appointment, Schedule Results Follow-up, and erx Message. > All other task types display all patient-related details except documents. Information in the Related Details section is displayed in a basic view by default. Tap the header to expand the different data types (problems, allergies, and so forth), and then tap an individual item to display a detailed popover. Reassign Tap Reassign to display Reassign Task, where you can assign the task to a different user in your base application. Save to Chart Tap Save to Chart to include this task information in the patient's chart record and close the task. Approve Tap Approve to approve the task action. You must confirm the action. Deny Tap Deny to deny the task action. You must confirm the action. November 06, 2014 159

Chapter 6 Working with Tasks Delete Tap Delete to delete the task and remove it from your list entirely. Close Tap Close to close the task that is currently in view. Task types and icons The application displays the following icons for these task types. These icons are displayed in the Task List next to the task they are associated with. > Authorize Order > Call back > Co-Sign Note > Dispense Sample > Finish Note > Med Renewal Date > Med Renewal Request > Note Signed but not final > Order Notification > Overdue Reminders > Perform Order > Rx Info-Problem 160 November 06, 2014

Task actions > Rx Renew Request > Rx Xmit Fall > Schedule Appointment > Schedule Results F/Up > Sign Letter > Sign Note (applies to Version 10.x notes only) > Verify Patient Results > All other known task types > Custom Task types Task actions Base System Task Type Icon Icon graphic Action buttons TouchWorks EHR Authorize order Order authorization reassign TouchWorks EHR Call back Message complete, reassign Call in failed rx Generic reassign TouchWorks EHR Co-sign note Note view note, sign, reassign TouchWorks EHR Dispense sample Refill request reassign November 06, 2014 161

Chapter 6 Working with Tasks Base System Task Type Icon Icon graphic Action buttons TouchWorks EHR Finish note Note reassign Follow up complete, reassign Med admin Generic reassign TouchWorks EHR Med renewal due (this is an automatic task based on renewal due date) Refill request reassign TouchWorks EHR Med renewal request (as a result of a patient phone call) Refill request reassign Miscellaneous Generic complete, reassign TouchWorks EHR Note signed but not final Note reassign TouchWorks EHR Order notification Order authorization reassign TouchWorks EHR Overdue reminders Message reassign TouchWorks EHR Perform order Order authorization reassign TouchWorks EHR Rx info problem Refill request reassign TouchWorks EHR Rx renew request Refill request approve, deny, reassign 162 November 06, 2014

Approve or deny a task Base System Task Type Icon Icon graphic Action buttons Rx renew request (controlled med) Refill request deny, reassign TouchWorks EHR Rx xmit fail Refill request reassign TouchWorks EHR Scan note Note view task, reassign (cannot sign or verify) TouchWorks EHR Schedule appointment Message reassign TouchWorks EHR Schedule results follow up Message reassign TouchWorks EHR Sign note (applies to Version 10.x notes only) Note view note, sign, reassign TouchWorks EHR Verify patient results Procedure results verify, verify and schedule patient TouchWorks EHR All other known task types Generic TouchWorks EHR Custom task types Generic Approve or deny a task 1. Navigate to the task list. 2. Tap the appropriate task. November 06, 2014 163

Chapter 6 Working with Tasks The application displays Task Details, where you can review information about the task and related details. 3. After reviewing pertinent information, tap Accept or Deny as appropriate. 4. Confirm the action. The application removes the task from the tasks list. Reassign a task 1. Navigate to the task list. 2. Tap the appropriate task. The application displays Task Details, where you can review information about the task and related details. 3. After reviewing pertinent information, tap Reassign. The application displays Reassign Task. 4. Search for the appropriate user of your base application to reassign the task. You can enter a person's name in the Search field or select a user from your favorites list. Favorites lists are configured in the base application. The application removes the task from the tasks list. 164 November 06, 2014

Index Index A actions tasks 161 Administered Medication screen 112 alert types DUR 132 alerts meaningful use 27 orders and medications 27 alerts and reminders 42 Alerts panel 27 allergies 67 add 70 edit 71 inactivate 71 no known 70 App Store 9 10 appointments display 33 view 33 approve tasks 163 assessment and plan 103 create 104 Assessment and Plan screen 106 B basic view 21 C camera 24 25, 80 charges configuring 153 generating 153 154 chart photo 25, 80 chief complaint 34 Cited List screen 100 Medical History section 99 configuration 9 copy forward 143 D Default Signature Display preference 151 DefaultEnteringForProviderID preference 58 deny tasks 163 November 06, 2014 165

Index dictation create 81 dictation markers 143 dictation related preferences 143 display progressive information 21 DisplayDoseRangeMissing preference 132 Document screen 146 document section mappings 140 document types 137 documents 76, 134 compatibility with Allscripts TouchWorks EHR 134 copy forward 143 create 136 display 79 edit 138 preview 139 select 136 sign 139 turn off functionality 134 drug utilization review 131, 133 alert types 132 DUR 131, 133 DUR (continued) alert types 132 DUR Alerts screen 133 DUR preferences 131 E edit medication 65 Enable Allergy Verification preference 67 encounter linking 31 Encounter screen 91 92 encounters 91 92 switch between 97 turning off functionality 91 events 89 expanded view 21 F favorites lists 26 Follow Up Referral screen 124 G gesture two-finger swipe 91 H help 31 166 November 06, 2014

Index Historical Medication Details screen 61 historical medications add 65 history 49, 51 add 52 work items 53 History Details screen 51 HMP Vitals Unit preference 35 I Immunization Details screen 74 Immunization screen 121 immunizations 72, 74 add historical 74 inactivity 12 installation 9 Instruction Order screen 118 ipad settings 9 L login 12 Login screen 10 M mapping document sections 140 meaningful use alerts 27 medical history 99 review 99 Medication Details screen 58 medications 54, 58 add 63 add historical 65 edit 65 edit status 67 historical 61 Patient Timeline screen 85 renew 64 renew with changes 64 My Documents 79 N note quick 82 Note Default Make Final preference 151 Note Default Signature Display preference 139 Note Preview screen 149 O online help 31 November 06, 2014 167

Index Order Details screen 107 OrderAuthenticationTimeout preference 139 P password 10 patient search 30 patient data refresh 99 Patient Header 22 patient portrait 33 Patient Review screen 34 Alerts and Reminders section 42 Allergies secton 67 Documents section 76 History section 49 Immunizations section 72 Medications section 54 Problems section 44 Vitals section 35 Patient Timeline 84 view 84 Patient Timeline screen 85 Events section 89 Patient Timeline screen (continued) Medications section 85 Visualizations section 87 pharmacy search> 66 photo 24 chart 25, 80 popover view 21 portait patient 24 preference Default Signature Display 151 DefaultEnteringForProviderID 58 dictation related 143 DisplayDoseRangeMissing 132 DUR 131 Enable Allergy Verification 67 HMP Vitals Unit 35 Note Default Make Final 151 Note Default Signature Display 139 OrderAuthenticationTimeout 139 Prescribe Problem Linking Required 58 Prescribe Without Allergy Status 63 PrescribingWithoutAllergyStatus 132 168 November 06, 2014

Index preference (continued) Wand Chief Complaint Enabled 34 Wand Document Enabled 134 Wand Encounter Enabled 91 Prescribe Problem Linking Required preference 58 Prescribe Without Allergy Status preference 63 PrescribingWithoutAllergyStatus preference 132 Problem Details screen 129 problems 44 add 47 verify 49 progressive information display 21 Q quick note create 82 Quick Rx 64 R reassign tasks 164 recording against dictation markers 143 reference ranges 35 refresh patient data 99 reminders and alerts 42 renewal medication 64 renewal (continued) medication with changes 64 results filtering 75 viewing 75 Review panel 27 S search for a patient 30 pharmacy 66 results 30 settings ipad 9 sign documents 139 Signature screen 151 Supplies Order screen 116 T task creating 26 Task Details screen 157 tasks 26, 157 actions 161 approve 163 deny 163 icons 160 November 06, 2014 169

Index tasks (continued) reassign 164 types 160 text incomplete 140 optional 140 Text Style screen 147 text templates 140 thumbnails documents 79 timeline patient 84 timeout 12 two-finger swipe 91 U unstructured documents 134 update 10 username 10 V view basic 21 expanded 21 popover 21 visualizations 87 vitals 35, 103 add a reading 40 enter for an encounter 103 W Wand Chief Complaint Enabled preference 34 Wand Document Enabled preference 134 Wand Encounter Enabled preference 91 170 November 06, 2014