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Session 1 Training Agenda

Session 1 (4 hours)

System overview/Intro to EHR

EHR Overview Logging In Layout Terms Preferences Settings Workflow Module (Inbox) Basic Tasking Patient Lookup 5 Point Check Telephone Call Preferred Pharmacy Exiting/Logout of NextGen Scenarios Support

ELECTRONIC HEALTH RECORD TRAINING

SESSION 1

Intro to EHR and System Overview

NextGen Training

Created: February 1, 2011 NextGen Training-Session 1 Page 1

EHR Overview:

When initially logged in to NextGen EHR, you will notice a center desktop area with various buttons and menus. After initiating access to a patient chart you will notice that patient specific information will appear and that there are a lot of features in the layout of the system. You will need to become familiar with all of the areas to enter information that you are accustomed to documenting right now in a paper chart. Much of this familiarity will come with hands on practice in the EHR while you are mentally walking through the processes that you are already accomplishing with every patient encounter. We will do our best to provide you with enough information in this workflow based training to support you when you go live, but keep in mind that there are more advanced features, tips and tricks that we will be introduced along the way in our newsletters as well. As with many software applications, there are typically several ways to accomplish the same process and that is true with NextGen EHR. In most cases, we will be showing you only one way, but be open to other workflows as you grow more familiar.

Logging In:

Solo, a single sign on application, is used to initiate individual usage of NextGen EHR via a launching application called Citrix. Once logged into Solo, you will be prompted to Log on to NextGen EHR with your Practice/Enterprise (Utah), personal User Name and Password.

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Layout:

In the image below, review the elements of the overall layout within NextGen EHR. These items will be available to you during your workflows most of the time, with the exception of the History Toolbar (#6) which can be toggled on and off with the History button, and the Left Navigation Pane (#5) which is minimized to the left in most windows.

1. Title Bar – first bar on the screen; Gray in color and includes patient information, encounter and template name

2. Menu Bar – similar to Microsoft menus; offers, printing, fax status, preferences, password management, addendum,

custom encounters and help

3. Top Toolbar – series of common buttons such as Save, drop down menus for Location and Provider, Patient Lookup,

and a History Toolbar toggle button. The remaining buttons on this Toolbar are called Modules (see #8).

4. Status Bar – on the far right end the bar shows your practice (Utah) and the user name used to log in for this session

5. Left Navigation Pane - this pane includes an active text list of templates that are commonly used for encounters

6. History Toolbar – the tabbed medical record pane (Encounters, Demographics, Scanned Images) that, when used for

Encounters (first tab), chronologically lists all billable and non-billable encounters and their contents

7. Encounter – a dated interaction with a patient, listed chronologically in the History Toolbar, used for documentation

8. Modules – topic specific patient summary and/or system library (i.e.: Workflow, ICS, Templates, Medications,

Allergies, Images, Diagnoses, Procedures and Documents)

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Terms:

In addition to the EHR layout elements, you will also learn these documentation tools and features within the EHR that may be new to you. Understanding these terms will promote communication with support and peers during your EHR learning and usage.

1. Template – a data collection tool, capable of sharing information with other templates, is capable of generating an

organized legal document *Note: A template cannot be printed or faxed.

2. Drop Down Menu - similar to a pick list, drop down menus are recognized by a downward pointing arrow; they

include a list of relevant items to choose from

3. Required Fields - red text indicates fields that require attention or required data entry before proceeding

4. Radio Button - a round, selection button that is used when only one choice is appropriate (i.e.: new/established)

5. Pick List – a list of items to select from to populate a field; often there is a blank choice which will allow free text

6. Check Box - square selection indicator; unlike the radio button, multiple check boxes may be selected

7. Active Text - dark blue text, similar to a web link in that it navigates to another template or opens a pop up

8. Text Field - any blank field that accepts information from a pick list or free text

9. Tabs – a view selector located at the top of a template, window or pane offering related views

10. Button - action-driven icons of varying size and shape used throughout the EMR application

11. Data Grid - table used to display information that has been entered and saved

12. Document – similar to documentation found in a paper medical record, the EMR is able to compile data entered within

the templates and organizes it to a format, much like a word document, which can be printed and faxed

13. (not shown) Pop Up Template - sub-template that displays for the purpose of gathering additional details, typically

related to its source template

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Preferences:

In many cases, your preferences will be set up for you in a way that offers the best settings for your workflow(s), but it is also beneficial to be oriented to these items so that you can change them when necessary. From the Menu Bar, click Tools, Preferences and set the tabs as described below:

General: Display KBM Help; Initial Module: Workflow

Main Toolbar: Encounter Display: Include Provider and Location; Filter Billable Encounters

Medical Records: Select Provider and Location; check Default to Last Selected

Templates: Prefer Chart Abstraction IASIS, Documents and Letters, Intake OV, Provider Test Action and Telephone Call

Medications: Search: All, click Show Brand for Generic, DUR: Level 2 or lower on all tabs

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Settings:

In addition to the Preferences mentioned, the following list of settings is also recommended.

Workflow Module Viewing: Remove bottom email Inbox window by right clicking window bar, then configuration, click side by side layout

Appointment View: Do not show cancelled appointments; Add one minute refresh

Task View: Uncheck: Completed, Deleted, Tasks assigned to someone else

Task Recipient Favorites: Click New Task, Click Assign To, Locate your staff groups, Right click, Click Add Favorites, Repeat for each Task group

Scan viewing: Open any image in ICS, Right click, and Fit image width to screen

Last Audit column: Med Module, Right Click, Custom, Last Audit, Move Up (to top)

Medication Favorites*: Med Module, Prescribe new, Right click second tab, rename using an abbreviation to conserve space (i.e.: ABX, PAIN, CV, EENT, ENDO, SPLMTS), drag most commonly prescribed meds to appropriate opened tab, edit sig, qty etc as needed. MA can edit this based on Provider in Top Toolbar.

*Providers and nursing staff only; Discussed again in Session 3

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Workflow Module (Inbox):

The Workflow module (also known as Inbox) is initiated by clicking the Inbox button on the Top Toolbar. This module includes the McKesson patient schedule information on the left, and a Task inbox on the right. The schedule includes appointment time, room, patient name/subject, reason for visit and appointment status for any provider you choose to view from the Provider selection button at the top of the schedule. When the front desk staff has checked the patient in within the McKesson application, the status in this schedule automatically changes from “Booked” to “Kept” and a billable encounter (folder) is created in the History Toolbar within the patient’s chart. Double clicking any appointment in this schedule will open that patient’s chart. A new encounter should never be created for a patient appointment or the interface to McKesson for billing and tracking will not work properly.

The Task inbox is an area where tasks are collected until the receiving user can complete them. Tasks can be sent to either individual users or groups of users and can be initiated at the Task Inbox or anywhere a “to do” or “send task” button is found. To navigate to a patient’s chart from any accepted task, simply click the “Go To Chart” button found on the lower right of this window.

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Basic Tasking:

Whenever a Task is initiated, the sender will need to fill in the small New Task pop up that appears. Fill out as much pertinent information as possible: Priority, Due Date, Subject, Comments, Individual or Group Assignee and Attachment as needed.

Once the Assignee has received the task, he or she will be able to review the task details and decide to Accept, Decline or Reassign the task; act on the request; concluding by clicking the “Completed” checkbox when appropriate. The task will then disappear from the inbox, refreshing within 1 minute.

Tasks can be Modified and moved to appear as a follow up item in a Task tab when built within the window.

Note: If the task is assigned to a group, once the task is accepted by one person, it will no longer appear on the task list of the other members of that group.

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Patient Lookup:

Many times a patient communication is initiated outside of a scheduled office visit. It is necessary to document each of these communications within the electronic chart just as you would within a paper chart. The following is a basic Non-Visit workflow:

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To navigate to a patients chart in this scenario, we do so by clicking the Patient Lookup button found on the Top Toolbar. It is important to enter specific information to achieve a successful search. Once you have located the correct patient, double click their name to enter their chart.

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5 Point Check:

The 5 Point Check is an accuracy protocol in place to help you to avoid errors associated with documenting information in the incorrect patient chart or encounter. This brief step will greatly reduce the risk of these documentation errors when performed prior to all EHR workflows. The 5 Point Check is to be completed every time a patient is accessed in the EHR.

1. Correct Patient Name in Title Bar

2. Correct Patient Date of Birth in Title Bar

3. Correct Location in Top Tool Bar

4. Correct Provider Name in Top Tool Bar

5. Correct Encounter highlighted in History Tool Bar

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Telephone Call:

Now that you have entered the patient’s chart and have completed a 5 point check, click the “New” button in the History Toolbar to create a new (non-billable) encounter, then the Templates button, selecting Telephone Call to initiate the template used to document the communication with that patient. Remember that communication with a patient is not limited to a telephone call. This template can also be used for occasions when a patient has come to the office to pick up prescriptions, samples, DME or discuss a concern.

Begin by clicking the appropriate topic of the communication in the section labeled “Communication” then Task the template to the appropriate staff member. Once you have filled in the sub-template the active text, seen here, will change color and the summary of your communication will appear in the data grid. To conclude your workflow, click Preview Document to generate the Telephone document.

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Preferred Pharmacy:

If we had to over-generalize the function of Healthcare across our modern culture, we might say that Providers are primarily prescribers of medication. While that is really just a piece of what a Provider does, we must admit that is a large part of the work that is done.

There is a very large number of pharmacy communications occurring each day in a medical practice and one way to improve the flow of this essential piece is to identify the patient’s preferred pharmacy. Thus, entering that information into the EHR at the beginning of office visits and telephone calls is an essential step in efficiency. This entry can be made later in the workflow for nursing staff but it is also available within the Telephone Template and the Demographics Template as well. While true demographic changes should only be made within the McKesson system, enter at least one preferred pharmacy for the patient whenever possible.

Click the Demographics Tab within the History Toolbar, and then click Patient Demographics. The Preferred Pharmacy fields are found on the right side of the template.

Exiting/Logging Out:

At the conclusion of your workflow(s), it is important to close the patient’s record from the File Menu (File > Close Patient) to avoid beginning your next workflow within your previous patient chart. Likewise, it is necessary to follow the policies of IASIS and your practice when locking your workstation when taking a break away from your workstation. When concluding your use of NextGen for the day secure your workstation by closing with Solo.

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Scenarios:

Perform a Patient Look Up for the following patients:

Test, T

Smith, A

Smart, John

Send the following Tasks to another person in this class from the Task inbox:

Test, T had a Chest X-Ray and I have scanned it for your review.

Smith, A called to say that she will be 10 minutes late for her appointment.

Smart, John was seen today and would like a copy of his chart note.

Perform 5 Point check, Document, Task and generate a note from the Telephone Call template:

Test (choose any) called requesting an Rx refill sent to Walgreens on Antelope

Smith (choose any) has a rash after exposure to chemical in garage

Smart (choose any) had MRI of brain 10 days ago at Davis, requests results

Support:

Each practice within the IASIS Enterprise has designated at least one Super User, (in addition to the office manager) who has the aptitude and ability to support your practice. There is also a designated provider who acts as the Clinic Champion. They are your first line of support after your Go-Live support period has ended, please reach out to them first if you encounter issues with the EHR. Beyond these support roles, your helpdesk is available to address any concerns that arise. For best results, when opening a help ticket, it is important to make every effort to identify the template experiencing the issue (if applicable) and to capture a screenshot of the issue or error message that you are experiencing.

Screenshot capture can be accomplished by simply pressing the Function Key (Fn) on the bottom row of your keyboard and the Print Screen (Prnt Scrn) key on the top row of your keyboard, then pasting the image to a word document (right click, then select paste). This document should be saved and then attached to your helpdesk ticket to Support.

Standard Keyboard (models may vary in appearance) Laptop Keyboard

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Created: February 1, 2011 NextGen Training-Session 1

TRAINING EVALUATION

COURSE TITLE: NEXTGEN EHR Session 1 DATE: _________________________

NAME AND TITLE: ________________________________ SITE EMPLOYED: __________________________

INSTRUCTIONS: Participant evaluation of each educational offering is the most effective way for us to determine whether or not your learning needs were met, and to identify if any changes are necessary. Please indicate the number that most closely corresponds to your feeling about each statement and answer the questions at the bottom.

General course Evaluation

1

Strongly

Agree

2

Agree

3

Disagree

4

Strongly

Disagree

5

NA

My overall impression of the class was excellent

The course presentation was what I expected from the Course Title

The course objectives were met

The content was appropriate to the length of the class

The environment was conducive to learning

The packet material was well written and useful

The teaching strategy (lecture, discussion, etc.) facilitated learning content.

The presentation was appropriate for my learning needs.

The audio visual aids were helpful.

The instructor was knowledgeable.

ADDITIONAL COMMENTS:

What did you like most about the course? What suggestions would you make to improve the course?

What other courses would you like to see offered in the future?

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