2014 workflows v51

2014 Workflows 2014

TABLE OF CONTENTS – NEW 2014 Workflows (EMR 9.8; CPS 12; MU 2014)

TABLE OF CONTENTS – NEW 2014 Workflows (EMR 9.8; CPS 12; MU 2014)..................................................................1General Setup/Workflow Changes.................................................................................................................................. 3Workflow 1A: Office Visit – Computerized Physician Order Entry (CPOE) – (Stage 1 Core Measure 1 (medications); Stage 2 Core Measure 1 (medications, labs, imaging)...................................................................................................5Workflow #2A: Office Visit – Using new FH/SH form for Family History- (Stage 2 Menu Measure 4)..............................7Workflow #3A: Office Visit –Risk Factors for Smoking Status/History (Stage 1 Core Measure 9; Stage 2 Core measure 5)................................................................................................................................................................................... 8Workflow #4A: Documenting TRANSFER IN (Stage 1 Core Measure 13; Stage 2 Core Measure 15)..............................9Workflow #4B: Office Visit – Reconciling Medications (and Problems and Allergies) (Stage 1 Menu Measure 7, Stage 2 Core Measure 14)......................................................................................................................................................... 10Workflow #5A: Office Visit – Producing a Clinic Visit Summary for the Patient (Stage 1 Core Measure 8, Stage 2 Core Measure 8,).................................................................................................................................................................. 12Workflow #5B: Office Visit – Documenting Transfer OUT & Producing a CCDA to send OUT (Stage 1 Menu Measure 7, Stage 2 Core Measure 15)........................................................................................................................................... 14Workflow #6A: Office Visit – Ordering and Giving Vaccinations (Stage 1 Menu Measure 8, Stage 2 Core Measure 16)..................................................................................................................................................................................... 16Workflow #6B: Office Visit – Ordering and giving medications in the office (Stage 1 Core Measure 1, Stage 2 Core Measure 1)................................................................................................................................................................... 18Workflow #7: Office Visit – Documenting a CARE PLAN...............................................................................................19Workflow #8: Office Visit – Using the INFO button (producing patient specific education material) (Stage 1 Menu Measure 5, Stage 2 Core Measure 13)......................................................................................................................... 20Workflow #9: Producing Patient Reminders (Stage 1 Menu Measure 4, Stage 2 Core Measure 11)............................21Workflow #10: Office Visit – Documenting Vital Signs (Stage 1 Core Measure 8, Stage 2 Core Measure 4)................22Workflow #11: Office Visit – Using Clinical Decision Support (Stage 1 Core Measure 10, Stage 2 Core Measure 6)....23

GE | @GE Healthcare 2014

2014 Workflows 2014

Workflow #12: Imaging Result in the EHR (Stage 2 Menu Measure 3)........................................................................24APPENDIX..................................................................................................................................................................... 259 Clinical Quality Measures (CQR Release 1 2014)......................................................................................................25Additional Clinical Quality Measures (CQR Release 2 )................................................................................................25Appendix #1 – Medication Administration form...........................................................................................................27Appendix #2 – Family History using FH-SH-CCC form..................................................................................................38Appendix #3 – Social History using the FH-SH-CCC form.............................................................................................41Appendix #4B – Reconciliation Form........................................................................................................................... 43Appendix 5A - CCDA Functionality & Workflows (Clinic Visit Summary).......................................................................45Appendix 5B - CCDA Functionality & Workflows (Produce a CCDA for a transition of care – out)................................48Appendix #6A – Immunization Form............................................................................................................................ 50Appendix #7 – Care Plan Form.................................................................................................................................... 64Appendix #8 – New User Fields................................................................................................................................... 68Appendix #9 – New Orders Setup................................................................................................................................ 69Appendix #10 – New Service Provider Fields...............................................................................................................70


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General Setup/Workflow Changes

The User Table has new fields for each EP as well as Credentialing for MAs) (see Appendix 8)1. EP (yes/no)2. Incentive Program3. Current Stage4. Reporting Year 5. Attested6. Licensed or Credentialed (what state and year)

Privilege/Security Changes1. ALERTS/FLAGS = Hide flags/alerts sent to other users2. CHART = Access Clinical Decision Support3. CHART = Export Summary Documents (Needed for CCDA)4. CHART = Export Unsigned Chart Data (Needed for CCDA)5. CLINICAL INQUIRIES/REPORTS = Export Patients6. CLINICAL INQUIRIES/REPORTS = Print Reminders for patients7. COMMON EVENT MODEL = Monitoring8. COMMON EVENT MODEL = Subscription Modification9. LINKLOGIC/10.REGISTRATION = Change Patient Specific Access Rights11.REGISTRATION = Modify First Visit Date12.SETUP = Change clinical report settings

The CCDA is used in several ways of MU2014 1. Core Measure 8 (CVS) – Stage 1 supply patients with summary w/i 3 days

a) For BOTH stage 1 & stage 2 (2014) you MUST NO LONGER USE THE HANDOUT PATIENT INSTRUCTIONS OR CLNICAL VISIT SUMMARY – the CCDA is used now for the CVS

2. The CCDA is what is used when receiving a clinical summary from another provider as well as generating a clinical summary when referring to a provider


2014 Workflows 2014

3. The CCDA is used to transfer clinical information about the patient to Clinical Quality Reporting (CQR) for clinical data about PQRI, Meaningful Use, etc.


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Workflow 1A: Office Visit – Computerized Physician Order Entry (CPOE) – (Stage 1 Core Measure 1 (medications); Stage 2 Core Measure 1 (medications, labs, imaging)

Key Considerations 2014 Rules now count medications given in the office as part of this measure of CPOE for medications. The

CCC-Basic (new) Medication Administration form now allows for documentation in such a way to count for this measure.

Changes to Medication Administration now constitute a CLINICAL LIST CHANGE in the application and therefore creates a clinical list lock when updated and not signed

Any NON-DRUG item that is categorized as so on the medication list is NOT counted in this measure New Data MEL Symbols have been added

Workflow StepsFront Desk

Clinical Staff

Provider

Task CPS Steps

X X Order Labs and Imaging through the Order Module

1. The authorizing provider must be an EP. The user entering the order must be licensed or certified to do so.

X Printing/Sending prescriptions 2. New category field in the New Medication screen must be set to Drug on the drop down list. EP must be in Authorized By field.

a. New prescribing method of Pending Approval added allows for EP to review and print/send prescription if entered by a non-EP

X X Document In-Office Medication Administrations

3. Open/Use the new Medication Administration form in an update. See Appendix #1


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Configuration Setup Orders at CATEGORY or CODE level as a Lab or Imaging Order (Appendix 9) Configure users in Setup/Administration to indicate which are Eligible Professionals, EP’s reporting stage and

year, and which users are Licensed or Credentialed Build and update Administered Medications custom lists in Settings/Administration module


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Workflow #2A: Office Visit – Using new FH/SH form for Family History- (Stage 2 Menu Measure 4)

Key Considerations The following must be done by the provider: The EP can participate in collecting, documenting, or viewing the

family history. The EP must sign the office visit note(s). For any returning patient after upgrade, previous family history will appear and be available, but new first degree

relative specific Family History will be required. Changes to Family History now constitute a CLINICAL LIST CHANGE in the application and therefore

creates a clinical list lock when updated and not signed


Clinical Staff

Provider

Task CPS Steps

X X Capturing first degree relative specific family history – (FH-SH-CCC Form)

1. FH-SH-CCC Form has been updated in this version. Form now requires capture of first degree relatives.

b. For details on using new FH-SH-CCC form refer to Appendix 2

X Make changes to patient completed forms – (PatientLink, Web Forms, etc.)

2. Any forms that the patient completes on their own (either paper or electronic) can be changed to reflect new opportunity for first degree relatives.

Configuration Update all forms that are given to patients for completing a family history. This includes paper forms and

electronic forms (i.e. PatientLink, Web Forms, etc.) Allow for additional time to capture first degree relative specific family history during appointments


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Use the FH-SH-CCC form to capture this – CCC 8.3.8 text files include SNOMED Codes for Family Practice specialty by default. If your practice uses any other specialty CCC content you must update the SNOMED codes for that specialty. Use this website for SNOMED codes: http://www.nlm.nih.gov/research/umls/Snomed/snomed_main.html


http://www.nlm.nih.gov/research/umls/Snomed/snomed_main.html

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Workflow #3A: Office Visit –Risk Factors for Smoking Status/History (Stage 1 Core Measure 9; Stage 2 Core measure 5)

Key Considerations The following must be done by the provider: The EP may participate in the collection, documentation, or review

of a patient’s Health Risk Factors (including smoking) The measure captures data for patients age 13 and up


Clinical Staff

Provider

Task CPS Steps

X X Documenting Patient’s Smoking Status

1. Values are available for documenting a patient’s smoking status on the FH-SH-CCC form. For details on using the updated form refer to Appendix 3

X Make changes to patient completed forms – (PatientLink, Web Forms, etc.)

2. Any forms that the patient completes on their own (either paper or electronic) should be changed to reflect new opportunity for smoking status options.

Configuration Update all forms that are given to patient’s for completing a smoking status/history


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Workflow #4A: Documenting TRANSFER IN (Stage 1 Core Measure 13; Stage 2 Core Measure 15)

Key Considerations The office visit documentation must be signed by EP Transfer IN means that a patient’s care has been transitioned into your practice from another setting, or referred

to your practice. See Workflow 4B for workflow instructions on reconciling patient information received from the referring provider See Appendix 4B for step-by-step instructions on reconciling patient information received from the referring

provider


Clinical Staff

Provider

Task CPS Steps

X X Identify a patient as being transferred IN to your practice (having been referred to your practice from outside of your organization)

1. When starting a NEW DOCUMENT a check box is available to denote that the patient is being TRANSFERRED IN for the purpose of this visit documentation.

X X 2. If not done so yet during the start of the encounter, when ENDING AN UPDATE a check box is available to denote that the patient is being TRANSFERRED IN for the purpose of this visit documentation.

Configuration Make sure all staff understand the definition of TRANSFER IN patient/visit


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Screen Shots of TOC Check Box

Workflow #4B: Office Visit – Reconciling Medications (and Problems and Allergies) (Stage 1 Menu Measure 7, Stage 2 Core Measure 14)Go back to Transfer In Workflow

Key Considerations The office visit documentation must be signed by EP If no CCDA documentation is received, then skip steps 1 and 2 of this workflow The reconciliation form is a WEB Based HTML form that cannot be edited at this time, nor is it required for use in

2014 MU measures. If used to reconcile medications the form will check the box MEDS REVIEW which is the data that qualifies for meeting this measure.

When using the Reconciliation form the button to MARK AS REVIEWED will remove the CCDA from being available for any other reconciliation (including if the current document is discarded without signature)


Clinical Staff

Provider

Task CPS Steps

X X Reconcile Medications, Problems and Allergies

1. Click the Reconciliation button from one of the following forms to launch the Reconciliation HTML form. HPI-CCC Problems-CCC CPOE A&P-CCC MU CORE Checklist

X X 2.See Appendix 4B for Instructions on completing the Reconciliation

X 3. On the MU CORE Checklist form check mark the Mark as Reviewed check box for Problems, Medications, and Allergies if not


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Front Desk

Clinical Staff

Provider

Task CPS Steps

done so already

Configuration Determine WHO will be the person to reconcile medications, problems and allergies Who will import CCDAs received by the practice If using custom forms, a button to launch the reconciliation form can be built by using the following function:

{SHOW_HTML_FORM("//localserver/EncounterForms/reconciliation/index.html","Reconciliation")}


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Workflow #5A: Office Visit – Producing a Clinic Visit Summary for the Patient (Stage 1 Core Measure 8, Stage 2 Core Measure 8,)Key Considerations The PATIENT INSTRUCTIONS HANDOUT can no longer be used in 2014 to count toward MU measure. Please

use the new Generate CVS button for the Clinical Visit Summary Stage 2 requirement changed to provide patient clinical visit summary with 1 business day. Stage 1 requirement

was to provide within 3 business days. A signed E&M service order must be entered for this patient to be counted for this measure


Clinical Staff

Provider

Task CPS Steps

X X Create Clinical Visit Summary 1. Click the Generate CVS button from the Patient Instructions-CCC form within an update

OR

Right click on a signed Office Visit document from the patient’s chart then click Create Clinical Visit Summary

X X Optional: Customize the Clinical Visit Summary prior to giving to patient

2. In the clinical Visit Summary screen click the Customize button and select which items to add or remove from the CVS. See Appendix 5A for complete steps.

X Determine how it will be given to the patient

3.Choose Print, Save To File, or Save to Chart and Close (to send via Secure Messaging at a later time)

X Document a declined CVS 4. If a Patient DECLINES a CVS then this should be indicated on the bottom of the MU


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Front Desk

Clinical Staff

Provider

Task CPS Steps

CORE Checklist form (and will only be used for THIS VISIT REPORTING).

Configuration Determine what if any customizations will be allowed to the CVS prior to producing for the patient How will patient electronic address be known / relevant to end user What (if any) external media will be allowed to save the file to and give to the patient Security Needed to Generate a CCDA for a chart/patient

o CHART = Export Summary Documentso CHART = Export Unsigned Chart Data

If using custom forms, and NOT using CCC you can add a button to generate the Clinical Visit Summary by using the following function: {MEL_GEN_CVS()}


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Workflow #5B: Office Visit – Documenting Transfer OUT & Producing a CCDA to send OUT (Stage 1 Menu Measure 7, Stage 2 Core Measure 15)

Key Considerations The referral is required to be AUTHORIZED BY the EP, and placed by the EP or licensed health care professional. Any Referral order (either by individual order code or by order category) can be designated as part of a

TRANSFER OUT event so that when that order is placed, the system will mark this event as a referral out (or TRANSFER OUT) for which a CCDA should be generated, no further action by the end user is required

See Appendix 5B for Step-by-Step instructions


Clinical Staff

Provider

Task CPS Steps

X Placing a Referral Order 1. “Authorized by” for the referral order is required to be the EP

2. REASON field entry is required when ordering a referral.

3.Sign Referrals/Orders/DocumentX Manage Referral and send

appropriate documentation to Service Provider / Generating a CCDA

4. The Referral Coordinator will manage the referral including generating the CCDA

a. Reason is now requiredb. From Orders tab of chart, change

order and fill in desired fieldsc. Click Save & Created. SAVE to CHART & CLOSE = may

send to provider through Secure Messaging

This will attach to the office visit as an Append


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Configuration Service Provider Setup – new field for secure electronic address (Appendix #10)

o When sending electronically (if using centricity clinical messenger – sure scripts – Kryptiq will provide the address in Service Provider (this process from Kryptiq)

Order Setup – Referral and Test orders can be managed in Administration/Settings to “Use as Transition of Care” on the category or individual order level

Security Needed to Generate a CCDA for a chart/patiento CHART = Export Summary Documentso CHART = Export Unsigned Chart Data

Anything looking at OBS terms, can be mapped to (custom/other) OBS terms


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Workflow #6A: Office Visit – Ordering and Giving Vaccinations (Stage 1 Menu Measure 8, Stage 2 Core Measure 16)

Key Considerations The document must be signed by the EP Immunizations are now considered a CLINICAL LIST and unsigned vaccines/immunizations entered on the form as

given/done will active the clinical list lock for that document until the document is signed (however, no evidence of this is seen in the View Clinical List Changes window)

See Appendix 6A for step by step instructions


Clinical Staff

Provider

Task CPS Steps

X Opt IN/OUT 1.Determine this patient’s participation in registry per practice and state regulations. Check registrationregistry tab to verify if correct

X Order immunizations to be given today

2.Using the new Immunization Management form double click on the blue circle next to the vaccine you wish to be given, and complete the required fields

X Communicate shots needed 3. The request for a shot can only be seen on the Immunization Management form itself

4.Communicate to staff regarding the need to give a shot

X Giving the shot 5.Document on the Immunization Management Form

X Give Patient a record 6. Print History View, Letter or Handout for patient if desired


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Configuration If using Qvera (QIE) for DPH immunization integration this new data model has to be used Complete Immunization setup in Administration Remove all old versions of the Immunization Management form from favorites and templates Create new Custom Lists for Immunization Management Form Edit Letters, Handouts, Reports, History Views to accommodate new Immunization table/model.

Remove the report in crwrpts folder (Immun.rpt) for the Immunization Management report (it will no longer be accurate)


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Workflow #6B: Office Visit – Ordering and giving medications in the office (Stage 1 Core Measure 1, Stage 2 Core Measure 1)

Key Considerations The following must be done by the provider: The note must be signed by the EP. This now counts towards the numerator and denominator for CPOE event(s).


Clinical Staff

Provider

Task CPS Steps

X Request a medication to be administered today

1. The Provider must request a medication be given to a patient using the Medication Administration form.

2.Utilizing the Medication Administration form appears to translate text into the narrative of the note indicating the medication to be given Appendix1

X Communicate Medication Event to staff

3.Route/Flag & communicate to staff the need for medication administration.

X Give/Administer medication 4. Using the Medication Administration form, document the medication given today

Configuration Create new Custom Lists for new form (Appendix #1)


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Workflow #7: Office Visit – Documenting a CARE PLAN

Key Considerations The documentation must be signed by the EP If a Care Plan is documented, it will be included in the CVS (CCDA) for the patient. However a Care Plan is not

required at this time to be documented per MU Guidelines. Although you can add and modify a care plan, there is not a way to delete a care plan at this time


Clinical Staff

Provider

Task CPS Steps

X Documenting a Care Plan in CPS

1. In an update, add the Care Plan Management form

X Document Plan per Problem/Diagnoses

2.See Appendix #7

X Assess Progress of Plan 3. You can review an existing care plans by going to the patient’s chartHistories section and selecting to view the Care Plan Hx View, or opening the Care Plan Management form while in an update.

Configuration Determine Document Template Setup, use of favorites, ADD FORM


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Workflow #8: Office Visit – Using the INFO button (producing patient specific education material) (Stage 1 Menu Measure 5, Stage 2 Core Measure 13)

Key Considerations Truven is the 3rd party vendor installed with CPS 12/EMR 9.8 (separate contract is required with Truven or other

3rd party vendor) The INFO BUTTON is located in the patient’s chart in the Problems, Medications, and Flowsheet screens. (It is

important to note that these buttons are not at this time available during an UPDATE window) In the flowsheet view, the Info Button will only work on an imported lab result The handout does NOT have to be printed by the EP, but an office visit signed by the EP is required in the chart

during the reporting period.


Clinical Staff

Provider

Task CPS Steps

x Look Up Relevant patient info 1.With the Problem or Medication or Flowsheet item (Lab Result) highlighted, click the INFO BUTTON

x Print Relevant patient info 2. Choose to print or otherwise share this info with patient

Configuration Decide if you will use the default vendor Truven, or if you want to utilize a different vendor Configure URL in Setup/Administration


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Workflow #9: Producing Patient Reminders (Stage 1 Menu Measure 4, Stage 2 Core Measure 11)

Key Considerations CPS12/EMR 9.8 cannot produce a list of patient due a vaccination or immunization Generating letters from the inquiry module occurs one at a time and cannot be stopped once started Measure is counted for patients with a Contact by: value of Letter


Clinical Staff

Provider

Task CPS Steps

X Run an Inquiry to find a list of the patients for whom a reminder is due

1.Use the Inquiry Module

X X Signing the letters generated and saved to a patient chart

2. These letters will go to a user desktop and must be individually signed, but the signer does not have to be the provider.

Configuration Letters to be used for this purpose should be placed in a folder with the word “Actionable” in its title Security Permission required for persons doing this action

o Clinical Inquiries/Reports>Print reminders for patients. This setting defaults ON after upgrade. Need to remove this permission from users or groups you do not wish to print reminders

New data symbol PATIENT.CONTACTBY can be added to letters, banners or other customizations


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Workflow #10: Office Visit – Documenting Vital Signs (Stage 1 Core Measure 8, Stage 2 Core Measure 4)

Key Considerations The encounter documentation must be signed by the EP The CCC-Basic Vital Signs form can be edited to include additional buttons for moving around the application and

performing certain tasks The Vital Signs-CCC form has reference available for high/low events such as BP/BMI info (MU Core item #6 )


Clinical Staff

Provider

Task CPS Steps

X Take a review vital signs for patients with an office visit

1. Using the Vital Signs-CCC form update height, weight, BP for all patients seen

2. BMI3. Growth Chart info

Configuration Update Vital Signs form with necessary links to other forms, and functionality, as needed. If not using the provided CCC form, change data fields in your custom form to only accept numeric values


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Workflow #11: Office Visit – Using Clinical Decision Support (Stage 1 Core Measure 10, Stage 2 Core Measure 6)

Key Considerations For Stage 1 only 1 CDS is required. For Stage 2 5 CDS’s are required. For both stages Drug/Drug and

Drug/Allergy interaction checking is an additional requirement. Recommended references to use:

Vital Signs Form – (reference for abnormal BP, temp, respirations, pulse included on form) CPOE form (CCC-Basic) – has the following CDS reference materials built in

Reference for Diabetes Patients (ACE/ARB & Contraindication. Aspirin therapy & Contraindication, Smoking Status, TEST/SERVICES DUE)

Preventive Health Care Screening PSA

The Drug/Drug Drug/Allergy interaction is separate from the 5 CDS interventions, but are a requirement of this measure


Clinical Staff

Provider

Task CPS Steps

X Determine the clinical decision support rules to be used by each EP for attestation.

1. No action needed. This is built into CPS/CEMR automatically

Configuration If not already there, create a new Security Group named “CDS Access” in Setup/Administration and assign

your selected users to this group


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Assign users you wish to see clinical decision support data to the “CDS Access” security group Assign security groups, or individual user as you wish to the permission of “Access Clinical Decision Support”

of the Chart Folder

Workflow #12: Imaging Result in the EHR (Stage 2 Menu Measure 3)

Key Considerations The EP must be the responsible provider for an Imaging Reports document type


Clinical Staff

Provider

Task CPS Steps

X An ImageLink Interface 1. EP receives an ImageLink Interface result in the EMR which links to an image view.

2. EP is responsible provider (and likely signer, but not required) of Document Type

X Scan/Import imaging report 3. Scanning Imaging Results – Results should have a document type OTHER THAN Imaging Report, since this would count against the EP

Configuration

Since the interpretation of this measure indicates that an Image is required to be linked to the document in the EMR, GE’s Best Practice solution to meet this measure is to have an ImageLink Interface with a vendor who sends both narrative result reports and a link to a stored image. An interface that links to a PACS system where images can then be viewed is ideal as well.

Other opportunities to meet this measure would be- If the patient presents with a CD of image files, then utilize one or more of those files to attach as an external

image through your document management (scanning/indexing) solution


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Starting with your reporting period, it is recommended to only use the document type of Imaging Report in the EMR for documents which meet the criteria above. Any other use of the document type Imaging Report may lead to inaccurate measure reporting. All other text-only imaging result reports should be brought into the application as a different document type (either when scanning/indexing, or through any integration currently enabled)

APPENDIX


CMS-22 Preventive Care and Screening: Screening for High Blood Pressure

CMS-65 Hypertension: Improvement in blood pressureCMS-69 Body Mass Index (BMI) Screening and Follow-Up

CMS-117 Childhood Immunization StatusCMS-122 Diabetes: Hemoglobin A1c Poor ControlCMS-123 Diabetes: Foot ExamCMS-124 Cervical Cancer ScreeningCMS-125 Breast Cancer ScreeningCMS-126 Use of Appropriate Medications for AsthmaCMS-127 Pneumonia Vaccination Status for Older AdultsCMS-130 Colorectal Cancer ScreeningCMS-131 Diabetes: Eye ExamCMS-134 Diabetes: Urine ScreeningCMS-138 Tobacco Use: Screening and Cessation

InterventionCMS-139 Falls: Screening for Falls RiskCMS-147 Influenza ImmunizationCMS-148 Hemoglobin A1c Test for Pediatric PatientsCMS-155 Weight Assessment and Counseling for Nutrition and Physical Activity for

Children and AdolescentsCMS-163 Diabetes: Low Density Lipoprotein (LDL) Management

and ControlCMS-165 Controlling High Blood PressureCMS-166 Use of Imaging Studies for Low Back Pain MeasureCMS-182 Ischemic Vascular Disease (IVD): Complete Lipid

Panel and LDL Control

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Appendix #1 – Medication Administration form

Click to go back to CPOE or Medication Administration workflow

Medication AdministrationThe Medication Administration form is intended to assist in the documentation of medications administered during a patient encounter. These can include injectable meds, oral meds, infusions, or any other kind medication. Medications captured through this form are stored discretely in the database and counted toward the Meaningful Use Stage 1 and Stage 2 CPOE measures.

Before You Begin:The Medication Administration form contains several dropdown lists that are edited using a new custom list editor. Practices must be sure to configure custom lists and the associated medications there first, before using the form. The CCC Basic package comes with a Text Component that can be used to pre-populate commonly administered medications into pre-built custom lists. This Text Component can also be configured with custom data. To load the content, open a chart update for any patient and insert the Text Component called “MedAdmin-DeliveryData”. Once loaded, discard the document. The form will now be loaded with any content configured within that Text Component.

Administered Medication Custom Lists

1 - Access the Administered Medication Custom List editor through Administration>Charts>Chart (CPS), or Go>Setup>Settings>Charts (EMR).

2 – Any number of custom lists names can be created or modified using the New, Change, Remove, or Copy buttons located at the top of the screen. Once selected, add medications to the selected list by clicking the “Add New Medication” button. Existing medications can be modified or removed by clicking the Change or Remove buttons next to the medications.


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3 – After clicking the Add New Medication button, search for and select the desired medication from the Medication Reference List. (This will be displayed as the “Reference Name”.) Once selected, the “Display Name” can be modified in the Edit Medication window and will be what the user sees in the form.

4 – The DDID and NDC numbers will display automatically if chosen form the Reference list. (Additional NDC numbers can be linked if desired.) The medication can be linked to an order by clicking the Change button to the right of the Order caption. The Medication Administration can be used to push an order to the Orders module if the Order is linked to the medication.


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5 –Once the Edit Order window opens, the user can attach an Order to the medication. (Note: The Order must first be built in the Centricity Orders module.) The Order Type, Order Category, Code, and Code Description are pulled from the Orders module using the Lookup buttons. Priority, Comment, Modifier, and Units are optional fields that can be used to provide further details.

6 – Once the Order is linked, the user can then move on to adding default options for Route, Site, Dose, and Units (units of measure for the Dose) using the associated Change buttons.


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7 – When finished, click OK. Continue to add additional medication to the custom list(s) as desired.


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Using the Medication Administration Form

The Medication Administration is designed to allow for multiple steps in the workflow of administering medications during a patient encounter. The form allows for a provider to request that a medication be administered (today or at a future date), and then allows for another clinician to then document the administration of the medication itself.

1 - The Administration Meds Summary allows the user to see a quick overview of any medications a provider has requested to be administered, the Start and Stop Dates, and the name of the provider who requested it. This information appears in top section of the form titled “Meds Due for Administration. The associated details are listed in the “Details For” section below.

2 – All administered medications must start with a request. To add or modify a request, the provider can click the “New” button, or the “Add/Update Request”.Add/Update Request Tab


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1 – Select a custom list to choose from. 2 – Select the medication from the custom list. 3 – An indication of a potential allergy or contraindication to the selected medication may be displayed.4 – A diagnosis can be selected to associate to the medication, either from the dropdown list which will display the patient’s current problem list, or by clicking the Problems button to access the Update Problems dialogue.5 – Select a “Requested By” provider or click the “Me” button to insert their own name.6 – Enter a Start Date7 – Enter a Stop Date. Using the buttons to the right will calculate a stop date based on the start date.8 – Enter any Instructions for the clinician who will administer the medication.9 – Enter any additional Comments.10 – Commit the RequestAdminister Medication Tab


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Once the request has been entered, the provider or another clinician can document the administration of the medication that was requested by going to the Administer Medication tab.

1 – Enter the user name of the person administering the medication, or click the “Me” button.2 – Enter a Route. This dropdown list is prepopulated based on the default values entered in the custom list enter for the specified medication.3 – Enter a Site. This dropdown list is prepopulated based on the default values entered in the custom list enter for the specified medication.4 – Enter a Manufacturer. This dropdown list is prepopulated based on the default values entered in the custom list enter for the specified medication.5 – Select a problem from the patient’s problem list. If entered when requested, this will already be populated.


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Clicking the “Manage Lots” button will open a separate window where multiple lot numbers can be stored. The lot numbers are set up by Manufacturer.

To set up Lot #s:1 – Choose a manufacturer from the dropdown list.2 – Enter the Lot# and associated Expiration Date. 3 – Click Add.Continue documenting administration:


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6 – Choose a lot number from the dropdown list of predefined values. Expiration date will default based on the value set up for the associated lot number.7 – Enter the amount given or choose from the dropdown list of predefined values. This dropdown list is prepopulated based on the default values entered in the custom list enter for the specified medication.8 – Choose the Unites for the Dose given. This dropdown list is prepopulated based on the default values entered in the custom list enter for the specified medication.9 – Enter a Start and Stop time for the beginning and end of the administration, or use the buttons to auto-fill the values.10 – Enter any Comments for the administration.11 – Check the box to have the form automatically enter orders for the medication.12 – Commit the Administration.


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1 – If the “Auto Generate Orders” checkbox had been checked when committing the medication, a new window will allow the user to select an order for the Medication Administration charge. (In addition to committing the order for the actual medication itself if set up that way.) Select the procedure from the dropdown list. (Note: the order category called “Medication Administration” must exist in the orders setup under Services.)2 – Enter a Comment3 – Enter the number of units to charge for.4 – Click Order5 –The user can Skip this step entirely if desired


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Example Text Translation: (modifiable within the “MedAdminTextTranslation” Text Component:


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Appendix #2 – Family History using FH-SH-CCC form

Click to go back to Family History workflow

1. Choose the Relationship for which the user would like to update Family History, and Refresh the page. (OR Indicate No Known Family History or No Known Relative)

2. Check the appropriate boxes to indicate family history (customizable through CCC Text File Editor)

3. Enter a Comment if desired. Then click Save. Note: Comments will apply to all checked items when saved. To enter a different comment per item, check the individual box and save one at a time.


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4. Repeat for additional relationships as needed.5. To modify or Remove a previously stored Family History item for an individual relationship, choose the

Relationship (if not already selected) and Refresh, as done in Step 1, then choose the Item to modify or remove:

6. To modify comments, make the changes in the Comment field, then click the Save Updates button. To remove an item, choose a removal reason then click the Remove button.

7. Saved Family History items will display in the Family Hx Summary area. To indicate that Family History has been reviewed during the visit, check the reviewed – no changes required box.

8. General Comments can be written to apply to the patient’s entire Family History, stored in the observation term “FAMILY HX”. Any prior family history data stored in this observation term will display here:


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Appendix #3 – Social History using the FH-SH-CCC form

Click to go back to Smoking Status workflow

1. Social History has been updated to include updated acceptable language for capturing smoking status. To capture Smoking Status, select from the radio button options. If “Current” is selected, choose a specific option from the additional drop-down list that appears:

2. If appropriate, indicate that the patient has been counseled to quit by marking the relevant checkbox. Once the appropriate options have been selected for smoking status, choose additional relevant social history from the list boxes (optional, and customizable with the CCC Text File Editor).


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3. Once all appropriate options have been selected, click the Insert Selected Values button. Social History information will appear in the edit field.

4. If Social History was completed prior to the visit and no changes are to be made, indicate by clicking the reviewed – no changes required checkbox. Changes can be made to smoking status by simply making the change and clicking the Insert Selected Values button again. Other changes would need to be cleared from the edit field first, and then re-inserted. Social History can be cleared completely by clicking the Clear All SH button.


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Appendix #4B – Reconciliation FormGo back to Transfer In Workflow or Reconcile Medications workflow

1. Select the document you wish to reconcile in the Documents to Reconcile field

2. The Forms defaults to the Problems tab so we will start with problems

3. On the problem list on the left side (Imported Problems), check mark the problems you wish to add to the patients chart then click Add To List

4. On the problem list on the right side (Active Patient Problem List), you can check mark problems in the patient chart to edit or remove if desired.


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5. Click on the Allergies tab to reconcile allergies and the Medications tab to reconcile medications using the same steps as above.

If a document has been imported and has NOT YET been used to reconcile clinical list information then that document will appear at the top of the screen as a choice for DOCUMENT TO RECONCILE.

There is a separate tab for managing PROBLEMS, ALLERGIES, and MEDICATIONSChoose from the left partition anything in the CCDA you wish to have brought over to the CPS Chart.Once completed with the exchange you can MARK AS REVIEWED

The mark as reviewed button IS NOT about reviewing the clinical list, but rather about reviewing the CCDA and once marked as reviewed this CANNOT be undone, and that CCDA will no longer be available for use in reconciliation. .


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Appendix 5A - CCDA Functionality & Workflows (Clinic Visit Summary)Go back to Clinical Visit Summary workflow

The Consolidated Clinical Document Architecture (or CCDA) document is a standard HTML document that contains a variety of information required for specific Meaningful Use workflows and EMR certification, generated for communicating clinical information to patients and providers. The following will outline the specific contents of the CCDA, and go through several of the workflows for generating and consuming CCDA documents in the CPS or C-EMR application to meet specific MU Phase 2 requirements.

CCDA OverviewThe CCDA document contains the following information as required by CMS:


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The CCDA document contains the information as it is structured in the chart at the time the CCDA was generated. Updating the chart will not update the information in any previously saved CCDA documents.

Required PermissionsIn order to generate the CCDA document, the user must have the following privileges:

Chart>Export Summary Documents Chart>Export Unsigned Chart Data

Workflows for Generating the CCDAClinical Visit Summary (MU Stage 2: CORE Measure 8)The Clinical Visit Summary is intended to be provided to patients at the conclusion of their visit, within 1 business day, for >50% of all office visits. It can be printed and handed to the patient or saved to a file and sent electronically. To generate the CCDA specifically for this requirement, the user must follow the steps outlined below. The patient also has the option to decline the Clinical Visit Summary. In this case, the chart should indicate this by populating the observation term “PTDECLINECVS”, in order to still be counted toward the measure. A checkbox is available at the bottom of the MU CORE Checklist form to accomplish this.

NOTE: For this workflow, in order to count the patient in the numerator of the measure, a signed Office Visit E&M code must have been entered through the Orders module.

1. Following the documentation of the encounter, while the update is still In Progress, generate the Clinical Visit Summary from within the update by using a button on a form component, utilizing a Quicktext, or by another means that utilizes the Data Symbol “MEL_GEN_CVS”.

OR

2. Once the document has been signed, generate the Clinical Visit Summary from the Chart ribbon:

For CPS: Choose More>Create Clinical Visit Summary


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For EMR: Choose Actions>Document>Create Clinical Visit Summary

OR

3 – Right-Click on the document and choose “Create Clinical Visit Summary”


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Appendix 5B - CCDA Functionality & Workflows (Produce a CCDA for a transition of care – out)Go back to Transfer Out workflow

Transition of Care Summary The Transition of Care Summary is intended to be provided to another of the patient’s providers when referred to them by the EP. This is to be done for >50% of transitions of care and referrals. This is to be specifically transmitted electronically (through a secure message) for 10% of transitions of care and referrals. To generate the CCDA for this requirement, the user must follow the steps outlined below.

1. If a Referral or Test and Procedure order is being generated, the provider has the option to select whether this order is to be used for a Transition of Care (or this can be defaulted)

2. The provider (or a delegate) can select the provider of service (Internal or External) where the patient is being referred.


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3. The order should be left on Admin Hold when signed.

4. From within the Change Order dialogue, a user can modify the referral information.5. The Transition of Care Summary is then created by clicking the Generate button.

6. Once generated, the TOC Summary can be printed, or saved to the chart and sent electronically


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Appendix #6A – Immunization FormGo back to Vaccine workflow

Immunization ManagementThe Immunization Management form is intended to assist in the documentation of immunizations administered during a patient encounter. Immunizations captured through this form are stored discretely in the database in a new Immunization table. It is important to note this new data structure, since all previous immunization form releases (including the “Immunization Management – CCC”, “Immunization Management – GE”, and others) stored immunization data into observation terms. Customers who have previously captured immunization data using observation terms will want to migrate their data to the new table using the Immunization Migration tool (released with CPS12/EMR9.8), before using this form.

Before You Begin:The Immunization Management form contains several dropdown lists that are edited using a new custom list editor. Practices must be sure to configure custom lists and the associated vaccines there first, before using the form.

Immunization Custom Lists1. Access the Immunization Custom List editor through Administration>Charts>Chart (CPS), or

Go>Setup>Settings>Charts (EMR).


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2. Any number of custom lists names can be created or modified using the New, Change, Remove, or Copy buttons located at the top of the screen. Once selected, add vaccine groups to the selected list by clicking the “Add New Vaccine Group” button. Existing Vaccine Groups can be modified or removed by clicking the Change or Remove buttons next to each listed.

3. After clicking the Add New Vaccine Group button, search for and select the desired vaccine group from the list provided. (Individual vaccine types will be added to each group in a later step)

4. Once the vaccine group has been chosen, individual vaccine types can be added to the group by clicking the Change button to the right of “Vaccine(s)”.

5. A separate window will open, allowing the user to select vaccine types by clicking “Add New Vaccine”.


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6. Once a vaccine type has been selected, the Edit Vaccine window will open, allowing the user to customize related information which appears in dropdown lists in the Immunization Management form. The Vaccine name, NDC#, DDID#, CVX code, and Manufacturer of the vaccine type chosen will display automatically.

7. The user can attach an Order to the vaccine. (Note: The Order must first be built in the Centricity Orders module.) The Order Type, Order Category, Code, and Code Description are pulled from the Orders module using the Lookup buttons. Priority, Comment, Modifier, and Units are optional fields that can be used to provide further details.


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8. Once the Order is linked, the user can then move on to adding default options for Route, Site, Dose, and Units (units of measure for the Dose) using the associated Change buttons.

9. Once finished with the individual vaccine type, click OK and continue to build additional vaccine types for the Vaccine Group as needed.


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10.Once finished adding vaccine types, click OK until returned to the Edit Vaccine Group window. The user can add a placeholder for every number of immunizations that can be given in the series by clicking the Change button to the right of Series. This is also where the schedule for the vaccine can be set up.

11.In the “Series List” window that opens, click Add New Series. Add the first number in the series for the vaccine group. (The should be a series number “1” at a minimum, for those vaccines that are either given only once or are given multiple times but not on a regular schedule. Example: Flu).


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12.Optional: Enter the Minimum Age in months for the series #.

13.Optional: Enter the Maximum Age in months for the series #.

14.Enter the Minimum Interval in days (the minimum time between when the last vaccine in the series was given and when this vaccine in the series should be given.)

15.Click OK. Continue for additional series numbers.

16.When returned to the Edit Vaccine Group window, complete the Vaccine Group information by entering the VIS Date for the vaccine group, and optionally any default Instructions.

17.Repeat the above steps for all other vaccine groups for the custom list selected.Immunization Administration Encounter Form Workflow


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The Immunization Management is designed to allow for multiple steps in the workflow of administering vaccinations during a patient encounter. The form allows for a provider to request that a medication be administered today, and then allows for another clinician to then document the administration of the vaccination itself.

Immunization Administration Overview

1. Custom list selector2. User can choose to view the immunization schedule in various views.3. Only Vaccine Groups that have been set up on the chosen custom list will display. Various indications of

historical immunizations for the patient will show in the corresponding rows.


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4. Example Icon – Indicates that the patient may be due for the immunization.5. If a vaccine is not due, this allows the user to document an immunization off schedule.6. Link to a Questionnaire page.7. Link to Icon Legend (describes the various icon meanings that appear on this form)8. Link to Preload page – allows quick entry of historical immunization data.9. Detailed History – Shows a detailed history of every immunization documented for the patient.10.Administered Today section – Shows immunization either requested or administered during today’s visit.11.Check this checkbox before documenting administration to have the form automatically enter the order for

the immunization.12.Check this checkbox to add an allergy to eggs to the patient’s problem list.


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Provider Workflow (Optional)

1. If the provider wishes to indicate that a vaccine should be given, he/she can do so by clicking one of the icons on the overview tab corresponding to the vaccine desired, which will bring up the Administration window.

2. Indicate the series # to be given (if not defaulted).3. Indicate the date to be administered.4. Click the Hold button.



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Clinician Workflow (Documenting the Immunization)

1. If the provider had requested that a vaccination be administered, an indication will display in the “Administered Today” section of the overview page. Double-Clicking on the “+” icon will take the user back to the Administration page to document the details of the immunization.

If the vaccine was administered:


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1. Choose Given (default)2. Choose VFC Eligibility (Optional)3. Choose Vaccine type administered (will default as indicated in custom list setup)4. Enter VIS Date (will default as indicated in custom list setup)5. Enter Manufacturer (will default as indicated in custom list setup)6. Enter Amount Given (will default as indicated in custom list setup)7. Enter Units (will default as indicated in custom list setup)8. Indicate who administered the vaccine, or click the “Me” button9. Enter Time of administration10.Enter Comments (Optional)

Use Manage Lots to set up lists of Lot numbers to choose from:

1. Choose a manufacturer from the dropdown list.2. Enter the Lot# and associated Expiration Date. 3. Click Add.

If the vaccine was NOT administered:


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1. Select Not Given2. Enter Reason

Once the form has been filled out:

1. Click Hold to save the data and come back to the form laterOR

2. Click Done to complete the documentation

To Note an Adverse Reaction

1. At the time of administration, or at a later time, an adverse reaction can be noted for a given vaccine. Click on the vaccine in the patient’s history to reopen the administration window. Then select Adverse Reaction. The Adverse Reaction window will open:


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2. Enter the Onset Date of the reaction3. Enter the Time of the reaction4. Enter the date the reaction stopped5. Enter a Reaction Description6. Enter the Criticality of the Reaction7. Indicate who noted the reaction8. Check the box to add an indicate of an allergy to the vaccine on the patient’s allergy list9. Click Save


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Icon Legend:


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Appendix #7 – Care Plan FormClick to go back to Care Plan workflow

Care Plan ManagementThe Care Plan Management form is intended to assist in the documentation of an individual patient’s care plan by entering problem-specific goals and/or targets. The Care Plan is a required component of the Clinical Visit Summary. While it is not required to document a Care Plan for a patient, it is required that if a plan of care has been established for a patient, that it appear on the Clinical Visit Summary required for Meaningful Use.

Before You Begin:The Care Plan Management form contains several dropdown lists that can be pre-loaded with default content, including problem-specific goals, targets, and instructions. To load the content, open a chart update for any patient and insert the Text Component called “Care Plan – Configuration Data”. Once loaded, discard the document. The form will now be loaded with any content configured within that Text Component.

Care Plan Management - Overview page:1. The View radio buttons allow the user to toggle between “Goals Met” (goals that have been marked as

complete with a Met Date), “Goals Not Met”, and “All” (a combination of both).

2. The Add button allows the user to add a new goal. The Update button allows the user to update an existing goal.


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3. – If adding a new goal, several fields are required. The first required field is “Set Date”, or the start date of the goal.

4. – The user should link the goal to an existing problem on the patient’s problem list by selecting it from the “Select Problem” dropdown.

5. – The goal can then be entered in either the “Select Goals” dropdown (displays a list of configurable goals), or via free-text in the “Enter Goals Here” edit field.

6. Optionally, the user can establish a target for the goal in the “Target” edit field.

7. Optionally, the user can enter instructions for the goal by selecting from the “Select Instructions” field (displays a list of configurable values), or via free-text in the “Enter Instructions Here” edit field.


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8. Clicking Save and Continue will allow the user to enter additional goals. Clicking Save and Close will return the user to the Care Plan overview page.

9. Once returned to the overview page, the user can continue to Add new goals, Update existing ones or exit the form by closing the window. Note: You can only update goals that have not been met.

10.To indicate that a goal has been met, enter a “Met Date” and check the “Met” checkbox.

11. Each time the Care Plan Management is used, current and past goals can be displayed and/or updated.


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Example Text Translation: (modifiable within the “Care Plan Text Translate” Text Component.

Adding or Changing Care Plan dropdown listsTo add or change a goal, target, or instruction for a given problem, the Text Component called “Care Plan – Configuration Data” must be modified and loaded. See CCC Basic Release Notes for instructions.


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Appendix #8 – New User FieldsGo back to General Setup

Each User setup (for EPs as well as non-EP Licensed/Certified Health Care professionals) will need to be completed – This information can be gathered early and put on the Master User Table/Spreadsheet used by the Organization


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Appendix #9 – New Orders Setup

Click to go back to Workflow 1A Configuration

Ideally at the CATEGORY LEVEL Orders can be classified as LABROATORY or IMAGING (which will assist with reporting CPOE orders)

Additionally, the Order Category can be used to default the status of being a TOC (Transition of Care) – most likely REFERRAL ORDERS.


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Make sure that Orders setup as Referrals in CPS (but are actually imaging tests) are appropriate tagged.

Appendix #10 – New Service Provider Fields

Go back to Transfer Out Configuration

There is a new field for Secure Electronic Address to associate with each service provider setup in the Service Provider Table. Please check with your GE EMR Consultant if this field requires manual set-up.

Secure Electronic Addresses are assigned when providers register with a Health Information Secure Portal (HISP).

If the provider to whom the patient is being sent is a member of a HISP, the electronic address will be available from the HISP directory.

For providers who are not members of a HISP, a direct address book will need to be created that contains the secure email addresses for those providers.


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2014 workflows v51

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