Topic

Level

Presenter(s):

Robert Murry MD, Alicia Carden, Steve Golato, Fabian Salgado,

Missy Starkey

NextGen Ambulatory and Clinical Content Release Preview

100

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development, release and timing of any features or functionality described for our products remains at our sole discretion. Future products developed beyond

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be placed on such statements that speak only as of the date hereof. Moreover, these forward-looking statements are subject to a number of risks and uncertainties, some of

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cause actual results to differ materially from those indicated by such forward-looking statements are: the volume and timing of systems sales and installations; the possibility

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Session Guidelines

• Silence all cell phones

• Questions will be addressed at the end of the presentation

• Refrain from personal discussion

Outline

• Introduction and Strategy Overview – Dr. Murry

• Review of KBM 8.3.10 – Missy Starkey

• Review of EHR 5.8 UD2 – Steve Golato

• Care Guidelines – Missy Starkey

• Review of KBM 8.3.11 – Alicia Carden

• Review of EHR 5.8 UD3 – Fabian Salgado/Steve Golato

Strategy Overview

NextGen Ambulatory Product Vision & Roadmap

Ambulatory roadmaps and R&D activities are driving towards these goals:

• Reduce physician clicks and increase their efficiency

• Improve quality of product

• Help clients transition to value-based care

Usability Strategy

• Transition to User-Centered Design• Iterative, frequent review and validation by clients

• Focus groups: PM (6 groups), EHR (2), KBM (8), Portal, Optik, etc. – 115 unique clients

• Beta partner & content validation partner programs

• Feedback on usability from VOC (Voice of Client) and beta partners

• Continue tactical specialty-based improvements• Begun in KBM 8.3.10, expanded in 8.3.11

• Primary Care, Women’s Health, Ophthalmology, Cardiology, Orthopedics, Dermatology, Behavioral Health

• Continue high-use area functionality improvements• Inbox, Communications, Care Guidelines, Ordering (My Plan), Closing Order Loop (PAQ),

Results/Signoff/Notification (PAQ), Chart Review (patient info bar, hover, pre-visit planning)

• Long term architecture improvements• Components causing sub-optimal usability, upgradeability, performance & scalability

KBM 8.3.10General release April 20, 2015

KBM 8.3.10

Over 390 clients live

• Initial response to degraded usability and quality in KBM “8-series”• Emphasis on better usability and workflow (w/o major redesign)

• Fixing important bugs, process changes from extensive Root Cause Analysis of defects

• It’s all about the way that clients & stakeholders were engaged• Clients told us what to fix first; iterative design, validated improvements

• “User-Centered Design” (MU-3)

• Much longer, improved beta testing• Client perception of usability and quality included in release criteria

• 10 beta clients, additional 18 “content validation partners”

• Click savers & physician efficiency:• Problem List editing from templates

• New Chronic Condition HPI template

• OB pregnancy history rewrite

• Etc

Primary Care / Core KBM – 8.3.10

1. SNOMED-CT® Problem List• Ability to edit Problem List without opening module

• On Home Page, Histories, Assessment & Chronic Conditions HPI templates

• Ability to modify the Problem description

• Ability to see (and change) the ICD code and description (also editable) associated with Problem

• Better display and editing of Problem Notes

2. Chronic Conditions HPI template• New, enhanced, single HPI template for charting on chronic conditions

• Better layout and tighter functionality

• Template is not a popup, so can open other sections of EHR while charting

3. Closing the orders loop• Remove restrictions on lab, diagnostic, referrals, and office services management popups when the

current user is not the user who authored the order

Editing SNOMED Problem List from Templates

Chronic Conditions HPI

Women’s Health Enhancements

1. Document Pregnancy Outcome & Pregnancy History

• Merge templates to roll to pregnancy grid seamlessly

• Pregnancy History grid should look the same regardless of

how you got there

• Create a document for Pregnancy Outcome

2. Post Partum Visit

• Address workflow and usability issues

• Create a document for Post Partum Visit

3. OB/GYN Details

• Make all details visible with a single click

• Display Pregnancy History grid

4. OB Flow Sheet Comments

• Create a single view for all comments in chronologic order

Redesigned Pregnancy Outcomes/History

Ophthalmology Enhancements

• Assessment and Plan Template• Redesigned, configured as a separate navigation tab to improve workflow

• Adding Clinical Problems, Diagnosis History, Favorites, Common Assessments, and Diagnosis Code lookup

(matches Core KBM)

• Provider OPH Template• Redesigning and streamlined template

• Fewer panels (combined Visual Acuity, Lensometry and Refractions)

• Added commonly needed fields to PE for test results entry and comparison to previous tests

• Eye Summary Template• Redesigned to include Gonio readings, Physical Exam Abnormals, and other fields for a more

comprehensive overview of the patient’s conditions

• Made all fields and grids read only

• Provider Start Template• Redesigned the order of individual sections to improve workflow and added more grids and fields

• The panel format removed from the template to minimize the need for scrolling

Ophthalmology Assessment and Plan

Eye Summary Template

Dermatology - Enhancements

• General

• Ability to show all charges for the encounter in the Derm

Procedure Grid on Finalize

• Ability to choose to submit specimen to pathology on

procedure and PE templates

• HPI templates

• Added the ability for the provider to verify pregnancy

status on any Derm HPI template.

• On Derm HPIs, allow longer comments and more free

texting

• PE

• Areas Examined on PE Pop-ups now appear in PE grid

• Add ability to search for diagnoses or use Common

Assessments on all PE templates

• Ability to choose to submit specimen to pathology

• Procedure templates

• Excision and Biopsy - Ability to free text into

location field

• Biopsy Procedure – Now will appear in

treatment summary grid

• Excision - Sterile technique is not added to

the document automatically

• Document Updates

• New Document: Consult Thank You/

Coordination of Care Thank You Letter

• Derm Master Document will show Rendering

Provider instead of the Provider from Top

Toolbar

• Physical Exam Areas Examined now

properly appears in the Physical Exam

Section

• Defect corrections

Derm Quick Exam – Diagnosis Search, Common

Assessment and Submit to Pathology

Derm – Referral Thank You

Orthopedics Enhancements

• Injection Procedure Template

• Complete rewrite

• Allow for multiple injections

• Improved Quick Saves

• Up to 5 medications per injection

• Orthopedic Physical Exam on Documents

• Easier to read columns instead of concatenated into a paragraph

• New practice setting controls new document format. Only affects the Orthopedics

specialty

New Joint Aspiration/ Injection Template

Orthopedic PE Grid View on the Document

Cardiology

• Coordination of Cardiac History with SNOMED® Problem Module • New ngkbm_config settings to copy Cardiac History to Problem Module across all

patients

• On Cardiac History template, new ability to “Move All” patient cardiac history items to the Problem Module

• Any new Cardiac Problems entered will be mapped to the Problem Module

• Physical Exam• Allow copy forward of any prior exam, can see provider who did exam

• Added Clear All button – easily clear and select new Quick Save

• SOAP template• Restore ability to use and manage user-defined diagnosis descriptions

Cardiac History – Move All Problems to the Problem List

Improved Generic Procedure Template

• Multiple indications

• Multiple CPT codes

5.8 UD2General release April 23, 2015

EHR 5.8 UD2

Over 429 clients live on UD2

• Focus on improving workflow in most commonly used areas of application• New workflow/inbox module

• Telephone Call / communication component (download from Knowledge Exchange)• Save clicks now, center of patient communication in the future

• Med Refill - Staff: 19 clicks vs 24 clicks on template – 20% reduction

Provider: 5 clicks vs 17 clicks – 70% reduction

• New Alerts Module• Configurable practice-level (e.g. Quality/ACO); patient-level alerts; combined with PM

• Better information summary and management (long term EHR clients)• Quick View / Summary View documents

• New encounter / category view filters

• Improved Template Load and Document Generation times

• NextGen Care (Patient Registry/Population Health)

New Workflow Module (Tasking)

Telephone Call Component

Alerts Module

Alerts Module

Encounter / Category View Filters

Quick View / Summary View

Patient DemographicsNew patient communication preferences define how patient prefers to be

contacted by the practice. Patient engagement using these methods can then be

automated using Population Health module.

Spec Not NeededSpec Not Needed

NGCare Phase 1 (UD2, released April 2015)

• Ability to create patient cohorts via EHR report writer (or SQL query)

• Options for cohort:

• Send Portal messages

• Create tasks with charts attached

• Create referrals or documents for chart

• See care gaps for each patient in Care Guidelines

• See Milliman risk stratification

• Ability to assign cohorts to user or group

• Track outreaches in log

• Export cohort to Excel

• Reads data in NextGen EHR/PM database

NextGen Care (Patient Registry)

Care Guidelines Standalone Release

Care Guidelines

• New front-end guideline management panel – actionable

• Easier setup and configuration, with built-in FAQ

• Top client-requested enhancements• Practices can have guidelines automatically be applied if patient meets age, gender,

and diagnosis criteria

• Changes to the guideline definition are automatically made for each patient when guidelines are refreshed

• Guidelines will “read” from the lab (orders) module

• Able to create individual, patient-level “tickler” items

Don’t need 8.3.11! Available as small, separate download

Currently in Beta

New Care Guidelines Paged View

Patient-specific items “on the fly”

New Care Guidelines Set-up Template

New Care Guidelines Set-up Template

KBM 8.3.11Spring 2016

KBM 8.3.11

User-Centered Design Approach

• Specialty & usability programs• Continue:

• Primary Care/Core

• Women’s Health

• Ophthalmology

• Cardiology

• Orthopedics

• Dermatology

• New: • Behavioral Health (DSM-5, etc.)

• GI & ASC

• Workflow improvements in CQMs & UDS reporting

• Incorporate Care Guidelines standalone release

8.3.11 – Pre-Visit Planning

Template for visit planners to anticipate tasks of visit and proactively gather necessary information to improve care team coordination and provider efficiency

• Filter data by provider, location, specialty, or visit type

• Identify gaps in care with new summaries

• Previous assessment/plans - openable

• Summary grid of documents and images – openable; can mark “favorites” for patient

• Portal messages for this patient

• All tasks for this patient

• Lab results

• Communicate with encounter provider via Work List

KBM 8.3.11 – Patient Visit Planning: Work List panel

Filter by days,

weeks or months

Free type

additional “other”

items

Items in the grid

concatenate in the

text box, and the

user can also use

My Phrases; free

type additional

information Print the Work List

Ability to send

Tasks

Access to new

Care Guidelines

template

Access to Care

Management

Plan/Intervention

template

System/Practice

template to

configure the items

in the “Other”

section.

KBM 8.3.11 – My Plan (order sets)

• Total redesign of the same order set concept

• Can use existing or new My Plan template; can convert existing order sets to new template

• Highlights• Unlimited number of orders of each type (labs, diagnostic tests, office services, instructions, referrals,

follow up, etc.)

• Extra data for each order (e.g. timeframe, laterality, comments) can be entered and saved in order set

• Can bypass Order Module Processing template if performing lab or diagnostic center is known

• Better control over multiple diagnosis groups and order sets for an assessment

• AOEs for lab tests entered as part of this workflow and controlled in File Maintenance

• Easy to create new or modify existing order sets

• Can edit or update orders in lower Order Management panel

KBM 8.3.11 – My Plan: Main Panel

KBM 8.3.11 – My Plan: AOE from File Maintenance

KBM 8.3.11 – My Plan: Order Management Panel

KBM 8.3.11 – Well Child

• New well child check SOAP template for that visit type

• Everything you need is on the template or 1 click away

• Based on AAP Bright Futures Content

• Some new panels, some familiar panels

KBM 8.3.11 – Primary Care: Well Child SOAP template

KBM 8.3.11 – Primary Care: Well Child Check

KBM 8.3.11 Specialty Programs

• Primary Care & Pediatrics (tentative)

• New SOAP template for Well Child Visits

• New Pre-Visit Planning template

• New My Plan (order sets) template **

• Configurable past medical, surgical and family histories

• Make the selection of visit “specialty” automatic based on rendering provider

• NGShare – ability to modify an existing referral

** = (configuration option for using old vs. new)

KBM 8.3.11 Specialty Programs

• Women’s Health (tentative)

• Gravidity and parity (G&P) auto-calculation

• “OBGYN synopsis” improvements

• New Abnormal Pap HPI template

• New Post Op template

• Post-Partum document/template improvements

• Ophthalmology (tentative)

• Updates to the Postoperative Exam - OPH template

• Updates to the Contact Lens Evaluation - OPH template

• Uniform display of procedures, diagnostic tests, and orders

• Interpretation forms for Topography Map

• Updates to Botox Injection template and billing like other ophthalmology procedures

KBM 8.3.11 Specialty Program

• Cardiology (tentative)

• Updated Pinnacle Registry

• Updates to procedure documentation templates to allow clients to meet IAC

certifications for Nuclear Medicine, Echocardiograms, and Vascular Testing

• Completion of the IHE IDCO profile to connect to top 4 device vendors

• Revised Procedure Summary Grid

• Orthopedics (tentative)

• Revised Fracture Casting and Strapping template

KBM 8.3.11 Specialty Programs

• Dermatology (tentative)• Enhancements to GET (graphical exam tool) in EHR

• Regionalize GET images to assign ICD codes based on findings and region

• Allow charting of multiple procedures in 1 line item

• Incorporate GET into Dermatology workflow• All findings documented in GET load to the grids on Full Skin Exam and

Biopsy/Destruction/Shave templates

• In HPI templates, replace Body Image graphic with appropriate GET regionalized image

• Add mapping of GET to Full Skin Exam template (“Quick Exam” Grid).

• Create Derm Quick Exam Defaults for the 30 most common dermatology findings

• Move panels (History Summary and Skin Cancer Log) off of the Histories grid onto Intake

• Revised Botox template to be image-based and used for all cosmetic injectables

• Dashboard automatically updates if the patient has a documented skin cancer in the Skin Cancer History Log

KBM 8.3.11 Specialty Programs

• Behavioral Health (tentative)

• Incorporate DSM-5 updates (from 8.3.10 HF3)

• Updates to BH master document

• Revised IAP Review template

• KBM Foundation / Core (tentative)

• Dynamic (configurable menu-driven) HPI enhancements

• Move “OK” / “Cancel” button to frame of long pop-up templates

• Updates to Electronic Signature on Finalize template for KBM documents

• Incorporate dental content into KBM

EHR 5.8 UD3Spring 2016

EHR UD3 - Major Themes of the Release

• Reduce physician clicks and increase their efficiency

• Usability and transition to User Centered Design

• Continue high-use area functionality improvements

• Improve quality of product

• Help clients transition to Value Based Care

EHR 5.8 UD3

• Closing the order loop in PAQ

• Send results to patient (even direct to portal), create tasks, sign off, etc.

• Create “rules” on the fly to reduce clicks next time

• “Complete” an open order (also when scanning in DM)

• Add patient to PM Recall Plan

• Inbox (workbench)

• Add number of items on each tab for Tasks, Portal, PAQ

• Can task DM images by category & HIE documents

• Patient Info Bar – more info on hover

• Lab results, vital signs, height, weight

• Re-categorize HIE documents in History sidebar

EHR 5.8 UD3

• Medication module enhancements: • Cancel Rx

• Custom eRx Denial Reasons

• Improved PRN & Reason For functionality

• Enhanced Interaction with Pharmacies Hidden in File Maintenance

• Orders module console: • Know when labs/radiology are “overdue”

• Required Fields Set up

• Confidential Lab Delegates

• Lab Results to Patient Portal

• Order Comments/Tracking

EHR 5.8 UD3

• Immunization module:

• Ability to require field(s) on administration screen, configurable vaccine names

• Bidirectional immunization registries

• NextGen Care (Patient Registry/Pop Health):

• Create cohorts on the fly or import from Excel

• Add a patient to a cohort while charting on them

• New options for cohorts

• Add Alerts

• Send patient education materials

• Ability to print care gaps (Care Guidelines)

• For single patient or all patients in cohort

• In patient log, can see what cohort created the outreach

Closing the Loop: Connecting Results with Orders

Closing the Loop: Adding to PM Recall

Result workflow: PAQ “Accept with Actions”

PAQ: Actions Pane

PAQ: Tasking Action

Task from PAQ: Open Task, Add Comments

Task from PAQ: Task Provider, Complete Task

Provider Signoff Details: View/Add from History Bar

PAQ Signoff Comments: View in Communication

Component

PAQ signoff comment: include in Custom Print

Patient Info Bar

Re-categorize History Item

Re-categorize certain items in Category View or from the Encounter View in the

History Tool Bar

Re-categorize History Item

New Security Group to allow re-categorization

Orders Management Console

• Ability to Open Patient Chart from directly in multi-patient view

Orders Management Console

• Ability to create filters based on Test Description

Orders Management Console

• Ability to filter past due / overdue orders

• Setup: Days to expect results in File Maintenance – Order Tests

Filter Overdue Orders

Required Field(s)

• Ability to set existing Orders Module fields as required when either placing or

completing an order

• Setup in Orders Module - Practice Preferences

Confidential Lab Delegates

• Feature to assign non-provider users as delegates to view lab results that

have been flagged as confidential

• Current functionality:

Logged in user is non-provider,

Results of test do not display

Logged in user is a provider,

Results display

Confidential Lab Delegates

• New functionality -- Setup:

Provider enables delegate users, who will now be able to view

confidential flagged test results

Lab Results to Patient Portal

• Ability to send Lab Results directly to the Portal from the Orders Module (and

through PAQ rules)

• Includes Document History showing comments sent with results and if patient opened

the result

Order Comments/Tracking

• Enhancements to current Sign-off Comments

• Better integration with the PAQ and Clinical Tasking

• Ability to add and view comments from multiple locations:

• Results tab in Orders Module

• Orders Summary

• Orders Management Console

• Within an Order

• My Phrases functionality

• Tasking ability

• Integration with Communication Component for document generation

Order Comments/Tracking

Order Comments/Tracking

• Includes display of comments from Order Management Action Log

Order Comments/Tracking

• Includes preference to turn on automatic comments from system actions

• Lab Result exported to Patient Portal

• Immunization sent to Registry

• Radiology Requisition Faxed to Facility

• Lab Requisition Sent electronically to Laboratory

Bidirectional Immunization Registry Support:

Reconcile incoming immunizations

Immunization Administration – Make Fields Required

• Ability to send a cancellation message on a prescription to the pharmacy

• Eliminates calls to the pharmacy

• Provides a method to mark prescriptions as “do not fill”

• Pharmacy responds with approval and number of dispensed fills

• Dependent on Provider and Pharmacy enrollment in this service level

Custom eRx Denial Reasons

• Ability to create practice customized reasons for why electronic refill requests are denied

• Master List in File Maintenance

• Support current Surescripts defined denial reasons

• Allows for adding of new custom denial reasons that will display in the EHR

Additional UD3 Features

• Improved PRN and Reason For functionality

• Moved under the SIG in the display

• Master List in File Maintenance to maintain Reason For options

• Incorporated into the SIG for consistency

• Enhanced interaction with Pharmacies Hidden in File Maintenance

• Upon Hiding a Pharmacy, user will be warned with number of patients associated with

that pharmacy

• Attempting to Send/eRx to a Hidden Pharmacy – user will be prompted and Alert

displays in the Send Dialog Window

Any Questions?

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