GE Healthcare Centricity Physician Office EMR 2005 Functionality Training Manual

1. GE Healthcare Centricity Physician Office EMR 2005 Functionality Training Manual That’s Powerful Medicine

2. Table of Contents • Chapter 1: Getting Started with Centricity Physician Office EMR • Chapter 2: Working with Flags • Chapter 3: Creating Quick Text • Chapter 4: Use of Phone Notes • Chapter 5: Rx Refills • Chapter 6: Protocols, Letters, Handouts, Graphs • Chapter 7:Clinical Lists Updates • Chapter 8: Desktop and Document Maintenance • Chapter 9: Charting a Visit • Chapter 10: File Attachments • Chapter 11: Orders Module • Chapter 12: Save and Restore

3. Chapter 1:Getting Started with Centricity Physician Office EMR Learning Objectives: Log On & Off Orientation to EMR features Orientation to the Desktop features Orientation to the Chart features Online Help

4. Login Screen

5. Desktop Orientation Menu Buttons Title Bar Action Buttons Note: Desktop is Depressed Exit Button Allows the user to logout Tabs to manage information

6. Menu Bar-Go Button

7. Preferences allow you to customize your desktop views of a variety of documents. The above example is of the appointment screen view.

8. Menu Bar-Actions Button

9. Menu Bar-Options Button

10. Desktop: Out of Office Assistant Options- Out of office assistant You can set up an Out of Office assistant that alerts senders of flags or documents that the recipient is out of the office.

11. Desktop: Summary Tab Flags & Flag Action buttons Documents & Document Action buttons Appointments and Action Buttons • The Summary tab of the desktop allows a user a snap-shot view of appointments, flags, and documents. • Appointments are seen on the left side of the screen. (this information crosses over via interface from IDX) • Flags are displayed in the upper-right corner and documents in the lower-right corner.

12. Desktop Icons

13. Desktop: Flags Tab Flags are “electronic post-it notes” that are sent to one or more users. You can even send flags to yourself and post-date them for future reminders. Flags can be attached to a recipient's desktop, patient chart, registration, and appointments. The Flags tab of the desktop is the best place to review and manage flags. From the flags tab, you can hover on a selected field to expand the text within that field for previewing a flag. Flags in bold are unread flags. Flags in italics are saved flags that have not been completed & sent to a recipient. Documents and Flags are displayed by the priority given by the sender. Red exclamation (!) is for urgent priority---shown at the top Yellow exclamation (!) is for important priority----displayed after urgent flags and documents No marking is for normal priority---displayed last DO NOT PUT CONFIDENTIAL INFORMATION IN FLAGS!!!!!

14. Desktop: Documents Tab Information from the highlighted document above Document management for reviewing and signing is best accomplished using the documents tab on your desktop. Once the document is signed, the document will no longer appear on the desktop. The “View Documents to” allows the user to change providers and view documents on another provider’s desktop (with proper privileges). The drop-down allows the user to view users in their current location of care. The binoculars allows you to select from outside your location of care. The folder structure in the upper left-hand side can be organized by the user to sort documents on their desktop by document type in the order desired. The “All” folder displays all document types on the desktop. The number in parenthesis ( ) beside the “All” documents folder shows the user how many documents are on the desktop. The subfolders sort the documents based on type. When you click on one particular folder, only those documents are displayed. Documents with the pencil icon mean the document is unsigned. Comments are “throw away” information, they do not become a part of the permanent medical record.

15. Patient’s Chart-Searching • There are 4 ways to do a chart look up: • CTRL + F button • Actions-Find Patient • Go – Chart – Summary • Chart Button • Patients can be searched for by name, Date of Birth, SSN, Patient ID, etc. • Please use first 3 letters of last name, first 3 letters of first name as in IDX search.

16. Chart: Summary Patient banner: Blue = Active patient chart (will have DOB) Red = Inactive or deceased patient (deceased will have DOB and DOD) View Only with tabs Summary-overview of all areas of chart Problems-list of patient diagnosis or surgery Medications-list of medications that the patient is on Alerts-allergies/directives Flowsheet-vital signs/lab values/immunizations (These are called OBS TERMS) Orders-services requested Documents-patient phone notes/rx refills/visit notes/consents ***BUTTONS DO, TABS VIEW ***Update, Phone Notes, Refill buttons float

17. Chart: Problems The problems tab of the patient’s chart allows the user to view active and inactive problems (ICD-9 diagnosis codes) for the patient. This information is read-only; thus we cannot add a problem to the patient’s chart through this tab. The “Active Only” radio button allows the user to toggle on only the current problems whereas the “All” radio button allows the user to view all problems ever associated to the patient. Resolved problems will appear highlighted in gray. Highlighted problem- information regarding the problem displays on the grid and assessment's) that are associated with the problem display at bottom. “View problem details” button displays the same details above, only in a separate window. Double click on the problem to view document's) associated with that problem.

18. Chart: Meds The medications tab of the patient’s chart allows the user to view active and inactive medications for the patient. This information is read-only; thus we cannot add a medication to the patient’s chart through this tab. The “Active Only” radio button allows the user to toggle on only the current medications whereas the “All” radio button allows the user to view all medications ever associated to the patient. Historical meds will appear highlighted in gray. Highlighted medication - information regarding the medication displays on the right side. Instruction and Refill information appears on the lower right side. Double click on the medication to view document's) associated with that medication. ***BMN =Brand Medically Necessary Updates are done quarterly on drug list….there is a mechanism that allows addition of study drugs/new meds.

19. Chart: Alerts The alerts tab of the patient’s chart allows the user to view active and inactive allergies and directives for the patient. This information is read-only; thus we cannot add either of these to the patient’s chart through this tab. The “Active Only” radio buttons allow the user to toggle on only the current allergies and directives whereas the “All” radio button allows the user to view all alerts ever associated to the patient. Historical alerts will appear highlighted in gray. Highlighted alerts- information regarding the alert displays on the right side. Double click on the alert to view document's) associated with that alert. Three types of allergy alerts are available and can be classified as critical or non-critical reactions. Drugs Foods Environmental Variety of Advanced Directives are available

20. These are the symbols that you will see associated with allergies.

21. Chart: Flowsheet Values Observation Terms Flowsheet contains discrete clinical data elements that originate from several possible areas: Interfaces (i.e. lab interface) Chart updates containing form components that are programmed to record to specific observation terms (obs terms). Manual updates to the flowsheet during a clinical list change. The observation terms are the labels going vertically down the page. The observation values lie within the grid and correspond to: an observation term, and the date the value was observed Blue valueshave beenimported via an interface and black values were manually entered. When highlighting a value in the flowsheet, the details regarding that value display below. When you double click on a value, it takes you to the chart documentation in which the value is associated. Various icons (tags) are displayed next to the values. Observation terms that come with the system are updated every couple of months. Date resolution can be toggled from days, months, years, minutes, and you can also look at last observation. The observation term name column can be resized to accommodate the long label names. ***15,000 observation terms are available ***flowsheets are very customizable to each patient or clinic practice

22. These are the Icons found on the flowsheet along with definitions. When working in EMR use the HELP button to find this information.

23. Chart: Orders ***ORDERS = CPT CODES Order Types: Services = visit types, billing information Tests = labs, radiology Referrals = referral to specialist, require authorization or insurance approval Order Statuses: Admin Hold, In Process, Complete, Canceled Highlighted Orders will display detail information in the lower half of the window. Double click on the order to view document's) associated with that order. ***Orders Module will not be implemented with initial go-live

24. Chart: Documents • Documents tab contains all documents for the patient, unsigned or signed. • To view information in the Documents tab in a variety of ways, you can: • Sort the columns by clicking on the column header. • On the left hand side, you can filter to look at certain documents • <ALL> click on + sign---The documents tab shows every available type of document • Other system setups allow you to have folders with different document types. Users can create their own views from the “Organize” button. • You can open up more than one document at a time and resize the windows with the full document viewer. • Group by date: Several documents for the same date are all grouped together; click the full document viewer and get a composite view for that date with page breaks.

25. Appointments VIEW ONLY!!!!! Appointments can be viewed via a daily, split or weekly view ALL APPOINTMENTS MUST BE SCHEDULED IN IDX, info then flows from IDX via an interface to EMR SCHEDULES ARE TO BE PRINTED FROM IDX PATIENTS ARE ALWAYS ARRIVED/CANCELLED/NO SHOWED IN IDX, an indicator is then populated on the EMR schedule Cancelled appt = box with an X Arrived = black dot by pt name System automatically defaults to current date. Use up/down arrows to scroll to different date, use ellipsis to change month Provider appointment screen can be changed via select view button

26. Patient Registration • VIEW ONLY!!!!! • Only 4 items may be changed in EMR are: (with privileges) • Marking the chart sensitive • Adding/Changing a registration note • Taking a patient photograph • Adding a pharmacy • There are 3 levels of access for sensitive charts: • No Access-cannot view the chart and a pop-up will display • Access on Demand-sensitive chart message will appear stating a log is being made on all charts • View Sensitive charts (all access)-no prompt at all

27. Flags: Action Buttons-New Select Flag Recipient Message to Recipient See next slide

28. To Create a New Flag: 1) Select the New Button from the Action Button toolbar (The New Flag Window appears) 2) To Section-- Select the drop-down box to see users within your location of care OR click the binoculars button to see all users in the system. Highlight the user's) who are to receive the flag. ***HINT: To remove a user from the recipient list: Highlight the user, then click the red “X” icon. 3) Properties Section: a) Priority---Mark the flag as normal, important, or urgent. b) Due Date---Defaults with today’s date, however flags can be post-dated. c) Attach to---Flags can be attached in 4 places: Recipient’s Desktop, Patient’s Chart, Patient’s Registration, and Appointments. ** Flags attached properly allow the user to view the pt’s chart/registration /appointment with fewer steps d) Subject: It is also recommended to include a subject for the flag. 5) Messages Section: Type the message. ***remember that this content can be converted to a document in the pt chart 6) Clicking the send button will now send the flag to the recipients. 7) The save button will allow your flag to remain on your desktop to finish & send later and will display in italics.

29. Flags: Action Buttons-View Allows to view flags due anytime It is important where the flag is attached because when attached properly, it will automatically allow the recipient to view the chart, registration, or appointment. Use “Recipient’s Desktop” for generic flags - for example, meetings & reminders. ****TIP: If your flag references a patient, open the patient’s chart, registration, or appointment, prior to starting the flag, otherwise you must select the patient by clicking on the … button.

30. F1: Online Help Help can accessed by right clicking or clicking on the Help Buttons NOTE: Use of help is not privilege driven because it is a Windows function, not CPO EMR. **Help is content specific: Help in desktop accesses desktop related information Help in chart accesses chart related information

31. Chapter 2:Working with Flags Learning Objectives: Identify potential use of flags Forward, reply to and convert flags Use the organize flags feature Identify 4 places to attach flags

32. Desktop: Flags Tab Flags are “electronic post-it notes” that are sent to one or more users. You can even send flags to yourself and post-date them for future reminders. Flags can be attached to a recipient's desktop, patient chart, registration, and appointments. The Flags tab of the desktop is the best place to review and manage flags. From the flags tab, you can hover on a selected field to expand the text within that field for previewing a flag. Flags in bold are unread flags. Flags in italics are saved flags that have not been completed & sent to a recipient.

33. Flags: View, Open, Reply, Forward, Remove View another user’s flags Highlighting a flag will allow the user to open the highlighted flag, reply to the sender, forward to a new recipent, or remove the highlighted flag Displays details --including time sent and where this flag is attached for flag highlighted above Complete message for flag highlighted above

34. Flags: Convert Feature Converting a Flag Flags can be converted to Documents within the patient’s chart. There are 4 Document types that can be converted into documents: Phone Note, Rx Refill, External Correspondence or Internal Other.

35. The Organize button will allow users to arrange flag views. It will also allow the user to bring up deleted flags

36. Flags may be organized according to: • Who they are from • Who they are to • Date that a flag is due • Content of summary line • Content of message

37. Chapter 3: Creating Quick Text Learning Objectives: Distinguish the global list from the personal list Create quick text using data symbols Create quick text using text only Identify areas where quick text can and cannot be used

38. Quick Text Next Slide

39. Quick text is a shortcut tool that lets you insert common phrases, form components, text components, and data symbols into a chart note just by typing a few characters. For example, when you type “.wnl” during a chart update, the EMR application inserts the phrase within normal limits and when you type “.med” the patient’s current list of medications is inserted. Similarly, you can insert a form component by typing the quick text “.fc”. Quick text can be global (shared by all users) or user specific (personal). Users at a clinic can share a common core of quick text and, also, can define their own personal list of quick text shortcuts. If the same quick text abbreviation is used on both the personal list and the global list, the quick text on the personal list will override the global list. Quick text can be accessed via the Options menu>Quick Text. The Define Quick Text box displays, which will allow the user to set up a personal quick text. ***Only designated staff with privileges can set up global use quick text. Instructions for building Personal Quick text Quick text can be built from your desktop or while working in a patients chart Select Options Select Quick Text Choose Personal Use Type in QT abbreviation preceded by . (ex: .wnl) Tab to with section; type in definition (ex: within normal limits) Click Add

40. NextSlide

41. The Quick Text help lists information about a particular symbol and how it can be manipulated. It gives examples of what kind of data can be pulled into text using that particular symbol. QUICK TEXT TIPS AND EXAMPLES: Quick text abbreviations are case-sensitive. Build both upper and lower case if you are not consistent in upper/lower case letter use. Quick text may be added will in a patient chart and then used immediately. Review the list of Global Quick Text available so as not to reinvent the wheel. Quick text may be used in the following areas: Within a comment section of an encounter form (CCC) Phone note Flags Instructions on Rx refill Example: .wnl = withxEin normal limits .sign = users signature date and time .lp = After the patient was adequately sedated, prepped and draped in sterile manner, Lumbar Puncture was performed. Opening pressure was noted and approximately 6ml of cerebrospinal fluid removed and sent to lab. Patient tolerated procedure well, vital signs remained stable. Patient to recovery area via carrier with RN. *****Quick Text is not required, but in highly recommended.

42. Chapter 4:Use of Phone Notes Learning Objectives: Creating Phone Notes Routing Phone Notes Signing Phone Notes

43. Creating Phone Notes From the patient’s chart, you can create a Phone Note. This automatically launches an update. Creating a phone note: Open patient’s chart Click the Phone Note Button

44. This is the phone note you will see in the Live EMR application. The first tab allows for multiple types of calls in or out of the clinic.

45. A chart update with the standard phone note form will open up Fill in data (i.e., caller, responsible provider, etc.) as necessary per phone call. The person who receives the call (or generates the call) will start the note, document appropriate information, then close and route to appropriate staff member.

46. The recipient may then use either tab of the phone note to document actions. If the first tab is used recipient must remember to .sign their contribution to the note. If second tab is used then just click on the teal colored Follow up by button to sign, date and time the entry. The phone note is then closed and update ended. If user is allowed by privileges to sign the note they may do so, or route to Physician for signature.

47. Routing Phone Notes Click End Update, New Button. Select recipient where you see To box. Click OK, check sign clinical list changes, then Hold Document

48. Chapter 5: Rx Refills Learning Objectives: Creating Rx Refills Routing Rx Refills Signing Rx Refills Faxing/Printing Prescriptions

49. Rx Refill Next Slide

50. From the patient’s chart, you can create a Rx Refill this will automatically launch an update. • Creating a document for a prescription refill: • Open patient’s chart • Click the Rx Refill button • A chart update with the Rx Refill form will open up • Fill in data (i.e., refill info, pharmacy, authorization, etc.) as necessary per refill • Click the Sign Rx button (if authorized to create an Rx Refill), or click Close button (if another staff member will be ending the update and signing the Rx Refill) • NOTE: If you have already refilled the medication within the same update, the text on the Refill form will appear in blue.