CHESI EHR NextGen MU Go-Live

Pediatrics

Table of Contents
Table of Contents ........................................................................................................................................2 NextGen Basic Navigation ...........................................................................................................................4 Setting Preferences ...................................................................................................................................12 Telephone Template .................................................................................................................................14 Generating a Telephone Message or Documenting Patient calls .....................................................14 Medication Management Template .................................................................................................16 Medical Question Template..............................................................................................................17 Tasking Module (Responding to a Template tasked to you) ....................................................................18 Task List .............................................................................................................................................18 Accepting or Reassigning a Task .......................................................................................................19 Using the Medication Module and E-prescribingAccessing the Medication Module...................24

Medication Action/Prescription Toolbar ................................................................................................26 Medication Details ...................................................................................................................................27 Additional Medication View Details ........................................................................................................27 Medication Searches ................................................................................................................................28 Searching for a Medication without the Formulary Browser .................................................................29 Other Prescription Options ......................................................................................................................32 Printing/ E-scribing Prescriptions ............................................................................................................33 Controlled Substances......................................................................................................................33 Non-Controlled Substances .............................................................................................................33 Renewing Medications.............................................................................................................................35 Proper eRx flow using Formularies ..........................................................................................................36 Option #1: (recommended) Batch Eligibility ...........................................................................37 Option #2: (recommended) Check Eligibility .............................................................................37 Option #3 (recommended) Eligibility Checks When Creating a New Encounter in the EMR (chart abstraction, telephone calls) .................................................................................38 Setting Preferences to see Formulary Browser for Providers (Optional) ..............................................40 Accessing the Formulary Browser (if the preferences are set)...............................................................41 Searching for a Medication ...................................................................................................................41 Patient Eligibility Status........................................................................................................................42 Medication Status.............................................................................................................................43 Formulary Notes ...................................................................................................................................43 Prescribing a Medication .....................................................................................................................44

Non-Formulary Search .........................................................................................................................45 Using Mail Order Pharmacies ..................................................................................................................46 Using the Visit Templates and Clinic Workflow .....................................................................47

Peds MA/Nurse Workflow ........................................................................................................................48 Intake PEDS Template ..........................................................................................................................49 Reason for Visit HPI Detail ................................................................................................................50 Entering Vitals ......................................................................................................................................51 Medication Reconciliation ...............................................................................................................52 Reviewing Allergies ..............................................................................................................................52 Standing Orders....................................................................................................................................58 Entering Histories on the History Tab..................................................................................................58 Interim History .................................................................................................................................59 Medical and Surgical History ...........................................................................................................60 Family History ...................................................................................................................................61 Social History ....................................................................................................................................62 Peds Provider Workflow ..........................................................................................................................68 Summary tab ........................................................................................................................................69 Histories tab .........................................................................................................................................75 SOAP Tab ..............................................................................................................................................77 Finalize OV tab......................................................................................................................................84 Meeting Meaningful Use in Next Gen ......................................................................................................85 Vaccine Documentation........................................................................................................................85 Vital Signs ..............................................................................................................................................87 All Orders Placed in the EHR .................................................................................................................88 Plan recorded in the EHR ......................................................................................................................88 Asthma ..................................................................................................................................................88 Tobacco Usage ......................................................................................................................................90 Patient Education..................................................................................................................................92

NextGen Basic Navigation

From the Desktop, select the NextGen icon From the Application Launcher select EHR.

Enter your username and password.

NextGen consists of 5 main sections. Title Bar: Displays Patient Name, Date of Birth, etc. Menu Bar: Displays links to various functions. Several important items are found in the menu bar that will be discussed later. Tool Bar: Contains many shortcuts to basic navigation in the EMR application. Content Screen: Displays selected templates, modules, and documents. History Tool Bar: Displays Basic Chart contents. Content Screen History Tool Bar

Title Bar

Menu Bar

Tool Bar

Tool Bar

Closes information in the content screen These icons access other user applications within NextGen Also known as the Workflow module, displays provider schedules and users tasks Opens the patient History Tool Bar to display chart information

Patient look up Default Provider and Location Save, Clear and Delete information in the content screen Soft Log out. Allows you to exit EMR without losing your place in the documentation process. You will see the initial log in screen once you log back into the system, the patient information will still be open on the screen.

Navigating a Patient Chart Select the History icon from the NextGen tool bar (this allows you to search and display the History Tool Bar

The Patient Look up dialog box will be displayed. Type the appropriate patient information in the designated fields then click Find. NOTE: Medical Record Number, Date of Birth or Social Security are the
safest search criteria.

Double click the name for the patients chart you wish to open.

Patient History Tool Bar Once the patients chart has been opened, review the History Toolbar on the right side of the screen.

History Tool Bar Tabs: Patient Encounters: displays encounter dates and all associated templates, images, and documents. Patient Demographics: displays patient specific templates. Categories: displays patient information by client-defined category Patient Demographics

Patient Encounters

Categories

New Button- Creates a new encounter. Usually non-clinical services (telephone calls, faxes, voice messages). Lock Button- Places all information in encounter in a Read Only status. Search Button- Opens a pop-up window that allows the user to filter displayed patient encounter based on provider, location, specialty, and/or diagnosis. Users can also filter based on a date range.

Encounters are like containers for patient information. Everything that is documented in the patient chart must have an encounter. The Encounter Display window contains the encounter date and all associated templates, documents, images, and modules. Encounters lock after a certain time period that is defined by the client. These encounters can only be unlocked by users with the appropriate security level.

Encounter Date

Templates, Documents and Modules

Locked Encounter

Tic Tac Toe Menu The Tic Tac Toe menu consists of 9 icons which open various Modules within Next Gen. There are only 3 modules that we will be using during phase 1: Templates, Allergies and the Medications.

Templates Allergies

Medications

Templates: Templates are forms that ease the process of collecting patient data that displays in the chart. The box below will be displayed when you click the Templates icon. You will then select a template to use depending on what you are attempting to document.

Allergies: When you click on the Allergy module the following window will be displayed. You can review, add, delete and resolve allergies from this module. More detailed information will be provided in the allergy module

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Medication: After clicking on the Medication Module icon the following window will be displayed. You can add, prescribe and refill medications from this module. See the Medication Manual for detailed instructions on how to use this module.

To close Medication Module once you have completed your documentation, click the Close icon on your NextGen Tool Bar. A message may display asking if you want to save your changes. Click Yes to save your changes. Once you are finished with the patient chart the only way to completely close ALL patient records is to click File then Close Patient Note: Patient name in the Title Bar

Now all Patient records are closed because there is not a patient name displayed in the Title Bar.

ALL patient records are closed

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Setting Preferences
Each user will need to set their preferences within the EHR system. In the toolbar, go to ToolsPreferences.

Go to the Templates tab of the preference box.

The arrows in the middle will move items from side to side. If you select the double arrows it shifts all items to the other side, this option is not recommended.

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Locate the desired templates in the left hand box and select the single arrow pointing to the right hand box. Change the Template Type to Demographics and locate the PHI_Log and the Patient templates and utilize single arrow to right to move to preferred template box. You may select additional templates at a later time.

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Telephone Template
Generating a Telephone Message or Documenting Patient calls
1. Verify no patient record is open in NextGen No patient info displayed

2. Search for your patient using the History Icon

3. Search for the desired patient using any of the following criteria. NOTE: Social Security and Date of Birth are the safest search criteria to use.

4. Create a New Encounter for todays phone message

NOTE: An encounter is created for each telephone call received with the exception of: Return calls in regards to a previously created encounter/phone template from the same calendar day. New issues on the same day are new encounters. 5. Make sure your new Encounter is highlighted and click the Template button to access a new, blank Telephone Template. Always use the Telephone Call template.

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1- Verify the new encounter is selected

3- Highlight the Telephone Call Template

4- Click OK

2- Click the Templates Icon

6. Choose the type of Communication by clicking on one of the links below:

7. Each link will launch a pop-up that is specific for the type of communication selected. The most frequently utilized are the Medication Management and the Medical Question Templates.

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Medication Management Template

Choose or verify patient pharmacy

Indicate Contact Type

Document spoke with info and Urgency

Checkboxes to indicate actions taken on selected medication.

Select medication from list of active meds or type in the name of med requested

Click Send and Close to task refill request and close the template medication.

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Medical Question Template

Indicate Contact Type

Document spoke with info and Urgency Checkboxes to indicate actions to be taken by the MA Document patient question/concern and detailed comments Click Send and Close to task refill request and close the template medication.

8. When the Template is displayed fill in the appropriate information. Example: Patient Complaint and Details then click Send and Close to forward the task to the appropriate resource. 9. Select the individual or group to task and move them into the Task Recipients list by clicking either Add Users or Add Group(s) and click OK.

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Tasking Module (Responding to a Template tasked to you)

Start by opening your Work Flow/Inbox to view your tasks.

Task List The Task List allows you an easy way to: Keep track of all tasks to be completed for the day Accept incoming tasks assigned to you Reassign tasks assigned to you and accepted by you

The Task List Displays tasks: Created by you sent to someone else: Created and sent to yourself:

Sent to you created by someone else:

Sent to you and accepted:

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To ADD or REMOVE Completed Tasks, Deleted Tasks or Tasks sent to Someone Else click the
Task Menu and click the items you want to appear in your inbox. You can return to the task menu and click the item again to remove it from your inbox.

Accepting or Reassigning a Task To Accept or Reassign a Task Assigned to you: Select the required task Double-click to prompt the Task Details dialog Click the Accept or Reassign button

NEVER select DECLINE

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If Reassigning the Task Select the user or group to reassign the task to

4. To view the Communication Template associated with the accepted task, right click on the message line in the inbox and select Open Patients Template

This will take you directly to the Communication Template attached to the task and open the relevant Patients chart-To see the patients history information you may need to click the History button

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5. The selected communication then displays. Example: Medical Question

6. When the Template is displayed, fill in the information required to respond to the message.

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7. If you need to task the template again for completion or follow up, click the Send and Close Teply and Close or the Save and Close button and select the appropriate resource. The process is the same as previously documented.

8. If you are the last person to touch the task (no other follow up is required by any other user) Select the Complete radio button and click Save and Close 9. Open the History toolbar and select the Telephone Template then 10. Click the Preview Document button on the lower left side of the template to generate the documentation.

11. Click file Close Patient to close the active patient and return to the primary EMR desktop or to your inbox.

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12. Return to Your Inbox

13. Mark the Task associated with the Template Complete to remove it from your Workflow by checking the box next to the clipboard icon.

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Using the Medication Module and E-prescribing

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Accessing the Medication Module

Medication Module can be accessed in EMR by either clicking on the Medications button on the bottom right corner in the tic-tac-toe

or by selecting a medication entry from the Encounter History window.

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Medication Action/Prescription Toolbar

Users will perform specific actions regarding patient medications such as renew, inactivate or interaction checks from the medication action toolbar. It also provides users the ability to prescribe new medication and launch the medication search window. By selecting the arrow located to the left of the medication action icons you will see a drop down list of related actions displayed.

The table below lists the functions available in the Medication Action/Prescription toolbar: Function Prescribe New Description Print The ability to prescribe new medication Launches the medication search window The ability to add historical medications (prescribed elsewhere)

The ability to print multiple medications using either the control key or the shift key The ability to Erx (if enrolled in Surescripts) The ability to print Rx The ability to Erx (if enrolled in Surescripts) The ability to edit Rx The ability to renew Rx Mark Ineffective to alert doctor if medication is prescribed again Stop requires stop date to stop prescription

Erx Renew

Stop

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Education

Opens medication monograph window. Provides information about the selected medication. This information can be printed Opens the dosing range window. Provides the minimum and maximum dosage for the selected medication based on patient criteria. Provides the ability to delete a medication. The following criteria must be established: User must have permission to delete The patient encounter must not be locked

Dose range

Delete

Medication Details
Users can view details of the current medication viewed by performing one of the following actions: Highlight medication in Current Medication View window to view Details of currently selected Medication

Highlight medication you want to and the detail will display in Prescribe Medication window below.

Additional Medication View Details

The medication module allows users to view additional medication details. The Full History, Dispense History, as well as the DUR History are available as additional view options in the medication view window.

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Full History View

The full history medication view provides a comprehensive view of a selected medication. It gives users the ability to see all rows of medication history if needed. Stopped medication will appear in full history view as inactive. Users can view medication full history by right clicking the selected medication in the medication history window and selecting full history.

Dispense History View

The Medications Dispense History View provides a comprehensive view of all information related to dispensing the selected medication.

Medication History View

The Medications DUR history view provides a comprehensive view of all available medication interaction information. This information includes a display of acknowledgement reasons.

Medication Searches
A medication search is done by performing the following steps: Logon to NextGen EMR Select a desired patient Open the history tool bar Select the medications module The medication module displays Click either the medication search icon or the prescribe new button

Or click the prescribe new button

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Searching for a Medication without the Formulary Browser

The medication module provides several options for prescribing medications including: Provider-Defined Favorites Lists Traditional Search Search by Class Prescription Renewal

Non-Formulary Patients: (once the alert has been cleared by clicking OK)
Users can search using the following options: o Keying the medication directly into the medications field o Class- this specifies a medication class to search in, for example, antibiotics, beta blockers or anticoagulants o Filter- this specifies a medication type. The types available are: Brand Generic

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Or Select the desired medication from the list of all medications or the FAVORITES TAB(s)

Double click the desired medication The desired medication appears in the lower portion of the med module window Click Select or double click desired medication Fill in pertinent information (Quantity, Refills, Stop Date, etc.) and click Accept

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Formulary Patients:
Select the Use Formulary option in the upper right corner of the Search window. The search is dynamic, begin to type the name of the drug and select it. The formulary detail will appear:

Once the medication is selected off the formulary list it will drop into the grid for completion.

**Prescribing from this point is same for FORMULARY and NON-FORMULARY patients:
Double click the desired medication from the grid The desired medication appears in the lower portion of the med module window Fill in pertinent info (Quantity, Refills, Stop Date, etc.) and click Accept

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Other Prescription Options

Users can modify other prescription options by selecting the appropriate checkbox in the prescriptions window. Refer to the list below for option descriptions.

Dispense as written The medication should be filled as prescribed Brand Name Prescribed Elsewhere Identifies where the medication was prescribed if not at the practice PRN- Take as needed. A Reason field is provided with pick list Additional Prescription Detail- This link displays a window (seen below) that allows the user to print prescriptions in Spanish, mark the medication as a sample, limit renewals, and/or record Prior Authorization information.

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Printing/ E-scribing Prescriptions

Once a prescription has been added, saved, and shows as Active in the Medication window it can be printed to security paper or e-scribed and sent electronically directly to the pharmacy (if the pharmacy participates in Surescripts)

Controlled Substances
Users must print controlled substances on paper rather than sending electronically. To print a prescription, click on the Print button on the medication toolbar and be sure that the proper printer has been selected. NOTE: If a medication printer has not been installed at your location, enter the medication in the Med Module, as it is the medication record, but use existing prescription pads

When printing medications, the user has the ability to print only the selected medication or all medications that have been prescribed during that encounter.

Non-Controlled Substances
Providers must be enrolled with Surescripts prior to E-scribing. See your NextGen Administrator if you are unsure of whether you have been properly enrolled.

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Prescriptions other than controlled substances should be sent electronically. If the selected medication is a controlled substance, the Erx button will be disabled.

Highlight the medication to be E-scribed and click the Erx button. The user will be prompted with the Send Electronic Prescription window.

If the pharmacy is blank, or the default pharmacy is not correct, click the ellipses button to search for the correct pharmacy. Only those pharmacies that have been enrolled to accept Surescripts will be listed. Click the send button to submit the prescription electronically.

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Renewing Medications
Highlight the medication to be renewed and click the Renew button.

Renewals may be limited if the medication is inactive, number of renewals were limited; the original medication was prescribed elsewhere, etc.

Note: The medication renewed is changed to Inactive with a stop date of the current day and a new medication entry is added as Active with a current start date.

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Medications must be renewed into a current encounter. If one does not exist it will ask if the user wants to create one.

Acknowledge any alerts before proceeding. EACH ONE must be highlighted and acknowledged.

Proper eRx flow using Formularies

Eligibility request to SureScripts/RXHub View plan formulary information Send retail or mail order eRX Receive retail refills (optional)

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Eligibility Checks
Eligibility for each patient is checked only once in a 24 hour period. Therefore, if a batch eligibility check is run in the morning for all of the patients with appointment and the medication module is opened a little later, it will automatically check to see when the last eligibility check was performed. Only if it has been greater than 24 hours since the last eligibility check will it send the request for eligibility to the RxHub.

Eligibility Checks via the Workflow Appointment List

Eligibility checks performed through the Workflow window are considered to be "On Demand." You can either check eligibility for all patients (batch) or individual patients.

Option #1: (recommended) Batch Eligibility

This method checks the eligibility for all patients that have appointments. Eligibility checks performed through the workflow window are considered to be "On Demand." Nextgen recommends running this check 1-2 times per day max. This can affect performance. To use this method, open the Inbox, click the Appointment Batch Eligibility. button and select

Option #2: (recommended) Check Eligibility

This method checks the eligibility of a specific patient that has an appointment and can be used for add-ons. To use this method, right-click a patient in the Appointment List and select Check Eligibility.

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Option #3 (recommended) Eligibility Checks When Creating a New Encounter in the EMR (chart abstraction, telephone calls)
This method of eligibility performs a check automatically when you create a new Encounter for a patient in the EMR. This method checks the eligibility of that patient only

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What happens if eligibility check is not completed?

Providers can see the status of the eligibility check in the upper-right corner of the medication module

If eligibility has not been checked the Provider will receive the following message when attempting to dispense medications.

Select Yes to run the eligibility check

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Setting Preferences to see Formulary Browser for Providers (Optional)

The Formulary tab of the NextGen EMR Preferences allows you to change preferences for the InfoScan Formulary Browser. (Tools- Preferences- Formularies)

Check the following in the screenshot

Each Provider must set these preferences if they want to use the Formulary search by default. Access the formulary browser from the default browser by selecting Use Formulary.

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Accessing the Formulary Browser (if the preferences are set)

To access the Formulary Browser: 1 Select an Encounter and then click the Medications Module Toolbar. The Medications window displays. 2 Click the New to open the Formulary Browser. icon on the History

You can now search and prescribe medications using the formulary browser

Searching for a Medication

To search for a Medication with the Formulary Browser: 1 2 3 Access the Formulary Browser. Verify that the Use Formulary check box is selected and that MEDCO HEALTH SOLUTIONS appears as the Formulary Provider. Enter the name of the medication and click Search. If you are unsure of the spelling, you can enter a partial name, as well as use a percent sign (%) as a wildcard. The Formulary Browser displays the results of the search.

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If you entered the full medication name, available dosages and forms, medication status, and any formulary notes (if available) display. If you entered a partial name or used a wildcard, expand the medication folder to view the specifics.

Patient Eligibility Status

When you search for a medication using the RxHub Formulary Browser, the patient eligibility status appears below the Formulary provider drop-down list. The status window indicates one of the following: The patient is eligible

The patient is not eligible

No eligibility status is available

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Medication Status
Each Formulary assigns a specific status to each medication. The InfoScan Formulary Browser displays the pertinent status for each of the available medications. The following is the list of definitions used in Formularies: Status
Preferred Approved Prior Authorization Non Formulary Not Reimbursed

Definition
This drug is favorable over all other drugs in the same therapeutic category. This drug is authorized for reimbursement for the pertinent payer. Reimbursement will be allowed only when the claim has been submitted to the payer by a physician for review prior to the issuance of a prescription. Specified by the payer as not on the Formulary or on the Formulary at a higher co-pay level. This may or may not be reimbursable. The payer does not pay for this drug. The patient will be required to pay for the medication if she or she chooses to do so.

Formulary Notes
Any information specific to the Payer that you should be aware of in order to properly write or fill a prescription according to that plans policies is included in Formulary Notes. Notes are categorized as Restriction or Advisory. Restriction Notes are important messages from the Payer that restrict the use of a drug. Advisory Notes are informational messages. Notes are attached on a drug-by-drug basis. Any given drug can have numerous notes attached to it. If available, you can view Formulary Notes by right-clicking the Note icon.

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Prescribing a Medication
To prescribe a Medication using the Formulary Browser: 1 2 Open the Formulary Browser. Search for the medication to prescribe.

Double-click the desired medication, dosage and form. If enabled, the system performs a Drug Interaction check, in which case, a warning dialog displays when an interaction with another prescribed drug or known allergy occurs The medication now appears in a list of the patient's prescribe medications.

Complete the prescription by entering Stop Date, Quantity, etc.

Non-Formulary Search
If needed, you can search for a medication using the generic search engine without disabling the Formulary Browser. To perform a Generic Search: 1 2 Open the Formulary Browser. Clear the Use Formulary box. The Formulary Browser expands and displays additional search options.

3 4

Type in the medication name, select any additional options and click Search. The Formulary Browser displays the results of your search.

Double-click on the desired medication to prescribe it.

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Using Mail Order Pharmacies

The following Mail Order Pharmacies participate in RxHub (this list is subject to change) o Caremark Mail Service Pharmacy o ESI Mail Order Pharmacy o Medco Mail Order o Prime Mail o Wellpoint NextRX Mail Pharmacy o Prescription Solutions Mail Order To successfully send a Mail Order prescription, the following must take place o Provider MUST be enrolled in RxHub o Patient MUST be Mail Order eligible o Medication MUST be selected from the formulary browser Once all conditions are met during the PHARMACY search there will be a box MAIL ORDER PHARMACIES ONLY to check during search. (It will appear just under phone/fax in the pharmacy search window)

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Using the Visit Templates and Clinic Workflow

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Peds MA/Nurse Workflow

When EHR launches the first screen that will appear is Workflow. You will see all appointments and tasks in this window. From the appointments window select the patient that you are going to room. The Status should display as Checked In. Right click on patients name and select Go to Patients Chart.

You are now in the patients chart. You will need to STOP and do a 4 point check. Do you have the correct patient, location, provider and date? 1 . 2 . 3 . 4 .

When you have verified these 4 points you will select the Templates icon. From the Preferred list you will select IntakeOV and select OK.

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Intake PEDS Template

Input type of patient (New or Established). The system should default to Established if the patient has previous encounters. Select the Template Set by clicking in the blank field. From the list select Family Practice. Select the Visit Type. Office Visit = Sick, Preventative = Physical, Annual, Well Visit. Select the Reason for visit or chief complaint from the list that appears when clicking in the blank field. If Preventative visit select physical exam or well visit. If there is a blank space you can enter free text. A Well Child Visit will automatically populate Well Visit as the Reason for Visit. Select the HPI Detail button to enter information on the chief complaint.

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Reason for Visit HPI Detail

Each reason for visit is linked to an HPI template. There are 3 kinds of templates we will focus on problem specific, Quick Visits and Generic. If you free type a Reason for Visit it will always pull up the Generic HPI. Nurses and MAs are required to get the basic information located in the top half of the template.

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Entering Vitals
Select the Add button

Enter the vitals that you currently collect in the pop up template that appears. You may use the large key pad to the left or your keyboard to enter the values. You can also tab through the fields. This will automatically calculate the patients BMI. When you are finished select Save and Close.

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Reviewing Medications
You will review the patients medications the same way you currently do by interviewing them. On the Intake template either indicate No medications by checking the box or selecting the Reconcile button if they have current meds. Make sure to ask them if they are taking any Over the Counter meds and if not, check the No OTC box, and if so add to the Med Module.

Medication Reconciliation
Select the verify mode checkbox. Single click on each medication listed under Medication Module as you ask them about that medicine. The medication will drop to the Medication Reconcile box at the bottom of the template. Enter ONLY if the patient needs a refill or is not compliant as ordered. After each medicine is entered select Save. When you have completed all select Save & Close. Required for MU measure - You must BOTH check the box Completed for Transition of Care on the Medication Reconcile template AND enter a listed Interim History to complete this measure.

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Reviewing Allergies
You will review the patients allergies as you do currently. You will document on the Intake template by selecting No know allergies, Reviewed, no change or Allergies added today if there was new information added.

Begin by double clicking in the Allergies grid Click on the magnifying glass

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Type 3 characters to begin:

Search

Results

Double click on the allergy to select:

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User can enter a Severity, Reaction, and Allergy Comments if appropriate. Click the Add button to complete the process:

Add additional allergies as warranted, by clicking

again:

Peds Review of Systems

Well Visits require that you gather Age-Specific Interval/Social History and completed a Developmental History. Access the templates by clicking on the links.

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Age-specific Interval/Social History

Fill out only the information that your practice currently gathers via the patient history forms and be sure to select a radio button under Last detailed doc date. This information will carry forward to the corresponding fields on the History Tab

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Developmental History
Enter the data in the appropriate section by clicking on the Detals link. Add information Developmental Screenings the MCHAT and PSC are embedded in NextGen. Any other screenings, such as Ages and Stagers can be entered by clicking Add New

And selecting or entering the name of the screeing tool and any other pertinent data.

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Standing Orders
To result standing orders (urine dipstick, glucose fingerstick, pregnancy test) you will select the Office Diagnostics link at the bottom of the template.

Select the test from the list with a single click. The information appears below the list. Select the Detail button and complete the pop up template. Select OK. Select Place Order and then Close. The provider will now see these results prior to going into the Exam room.

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Entering Histories on the History Tab

Select the Histories tab across the top.

Interim History
Required for MU measure. When adding Interim History, you must check the box Completed for Transition of Care on the Medication Reconcile template. Begin with Interim History any hospital stay, urgent care, outpatient surgery or ER visit since the patients last encounter. Select Interim History

Complete the pop up template that appears. Only input the pertinent information (type, problem, date, hospital) if the patient knows and will disclose. When complete select Save and Close. If there is more than one incident to document select Clear for Add before entering the next.

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Medical and Surgical History

Select the Update button

Select the past medical history from the group of checkboxes at the top of the template and the surgical history from the middle. If you cannot find your disease or procedure use the Additional History section at the bottom of the template to search for the item. If there is more than one to document in the Additional History section select Save & Add New, if not, select Save & Close.

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Family History
Select the Update button

Choose the family member that you wish to document. You only need to indicate Yes for a disease if that family member has it. If you know age of onset or death you can complete that. If the disease was a cause of death you check the box under #3. If you are documenting more than one family member select Save and the screen clears for the next set of information. When complete select Save & Close.

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Social History
**Tobacco Usage must be captured for Meaningful Use** Select Tobacco Usage and complete the pop up template. Complete Alcohol Use, Marital Status and exercise type and frequency.

Complete tobacco use for anything other than cigarettes and smoking status for cigarette smoking status. It may be never for both, but complete both! Select Add and Save & Close.

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Check Out Tab - Discharging the patient

When the provider is finished with their portion of the visit you will see the status change in the inbox to ready for checkout OR be told by the provider. Right click on the patient as you did at the beginning of the visit and select Go to Patients chart or double click to open.

Select the Intake PEDS template from the History window.

Select the Checkout tab

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All orders, medications, referrals, patient education and follow ups will appear in the grids on this template.

Labs, Referrals and Diagnostics will be printed. Select the line in the grid and select the Requisition button.

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Injections
The Office Services grid will contain injections that need to be administered. You are going to document that the shots are given here. The provider will order them and task them to you.

For all orders that ARE NOT immunizations you will select the item in the grid and double click. You are going to select the Performed checkbox and input the information. When it is a lab like a Urine dip, you will need to select When complete select Save and Close.

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Immunizations
When you see any order in the list that is an immunization you will need to go to the Immunizations link on the left hand navigation. Scroll down the template to the grid titled Immunizations and Titers Ordered at This Encounter. Double click on the immunization that you are going to document.

Complete the Site and click in the Lot Number field. A list containing the Lot Number, Manufacturer and Brand Name will pop up. Choose the appropriate vaccine given..

Select the Immunization given check box and then select Save and Close.

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Navigate back to the Check Out using the history window.

Patient Plan
Required for MU measure. The Patient Plan will be printed and given to the patient at each visit. Select the Patient Plan button and the document that is generated should be printed and given to the patient. The check boxes at the bottom of the Check Out template should be used to document what was given or refused by the patient. If any of the items listed were given or ordered for the patient select Yes.

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Peds Provider Workflow

From the Workflow Module, double click on the patient to be roomed (Status should be waiting for provider if they have checked in at the front desk. Immediately conduct a Four Point Check: Patient, Location, Provider, and Encounter Date.

Click on the Templates icon on the Tic Tac Toe grid.

Select the *Summary template and click OK.

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Summary tab
The Summary tab is a place to overview Chronic problems, orders, vital signs, medications, allergies, and previous assessments. Use the Order View to flip to the various sections in the chart.

The Order view can be filtered by the selections below. This will display all previous orders that have been input during the patients previous visits.

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Chronic problems can be updated and addressed by selecting the Add Problems button.

The medications and allergies can be reviewed on this tab.

The patients medications can be verified by selecting the Reconcile button.

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Medication Reconciliation The medications will have dropped to the Medication Reconcile box at the bottom of the template. You can verify the compliance if the MA or Nurse has entered it.

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Reviewing Allergies You will review the patients allergies that have been input by the nurse. You will document on the template by selecting No known allergies, Reviewed, no change or Allergies added today if there was new information added.

Begin by double clicking in the Allergies grid Click on button:

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Type 3 characters to begin:

Search

Results

Double click on the allergy to select:

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User can enter a Severity, Reaction, and Allergy Comments if appropriate. Click the Add button to complete the process:

Add additional allergies as warranted, by clicking

again:

The Assessments/Office Visits grid will display according to the radio button selected. It will give you the assessments (diagnosis) or visit types for past encounters.

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Histories tab
When you are finished with the Summary tab and ready to review/update the patients histories you can move to the Histories tab.

Medical/Surgical/Interim History This grid is where interim histories (such as ER visits) are documented. It contains all past medical conditions and past surgeries. Nursing inputs this information. You must select either Reviewed, no changes, Reviewed, updated, No relevant medical/surgical history, or History unobtainable.

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Family History This grid is where the health of immediate family is documented. Nursing inputs this information. You must select Reviewed, no changes, Reviewed, updated, No relevant medical/surgical history, or History unobtainable.

Social History The patients tobacco, alcohol and exercise information appear on the main template. More extensive social history can be reviewed by selecting Update. You must select Reviewed, no changes, Reviewed, updated, No relevant medical/surgical history, or History unobtainable.

Smoking Cessation Click on the Tobacco Cessation button to open the Tobacco Cessation template and fill in applicable fields. Then click the Save button and the Close button to return to the OV Template.

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SOAP Tab
When you have reviewed the Summary and Histories tabs, you are ready to begin the patients visit on the SOAP tab HPI Read the HPI Detail and enter any additional information on paper

Enter the remainder of your HPI, ROS, Physical Exam and any Procedures on paper for later scanning Assigning diagnosis Click inside the first blank Assessment field.

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Add to todays assessments utilizing the patients Diagnosis History, Chronic Problems, and My Listfields. Provider can also click Add Common Assessment to choose from a pop up template filled with specialty specific diagnosis codes. To search all diagnosis codes, click the first blank assessment field. Click Save & Close.

Click on the My Plan/Orders button

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The tabs along the top of the template give the provider options for constructing a plan for the patient. The My Plan template allows the provider to customize diagnostics, labs, procedures, and instructions based on assessment. These order sets are provider specific and once saved can beused for any patient with the same diagnosis. You must enter Instructions and Follow-Up Visit in order for it to appear on the Patient Plan. The Plan Details tab allows the provider to free text on each assessment. The Common Phrases and My Phrases features are available on this template.

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The next three tabs are where you will place orders. You may or may not order all three for any given patient. Each tab has a Save & Close button in the lower right corner. When you have ordered all that you need to, click on Save & Close to return to the SOAP Template. Each of these tabs allows you to select the appropriate time frame for you order. It defaults to today, so if you want to place future orders, you will need to adjust the time frame section. The Labs tab allows the provider to order send out labs. Click on the appropriate diagnosis, click desired labs, and click Place Order.

Lab subtemplates will also have a Place Order button, but do not drop to the Order grid until the Place Order button on the main Lab Master template has been pushed.

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Diagnostics tab is functionally similar to Labs. Click on the appropriate assessment, choose the diagnostic study with any other necessary info (side, site, modality), and click Place Order.

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Referrals tab is used to create specialist, DME, and therapist referrals. Choose a radio button in the To section for the appropriate referral you want to make. Choose the appropriate diagnosis. Fill in applicable treatment and clinical information. You must fill in the To, Diagnosis and Services Requested section in order to process. Click Place Order.

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The Office Procedures tab is used to order in office DME, Injections (not immunizations), Spirometry, etc. Click the appropriate assessment, choose the procedure with pertinent info (Dose, Strength), and click Place Order. You can also document if you personally performed the service as well by checking the box in the lower left corner of the template as well as indicate that it is a future order

Once you return to the SOAP page, click the Meds button to add or adjust medications in the Medication Module and use the Well Visit link (which will only appear if a well child age was chosen on the Intake PEDS tab.) to enter Anticipatory Guidance. You may add additional Plan Comments as necessary. These comments will appear in the Patient Plan.

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Do not enter data in the Office Services or Immunizations sections only use the Anticipatory Guidance sections and check the box if you gave handouts.

Click on the Patient Plan button to generate a document for the patient that includes todays assessment(s)/plan, medications, and orders. Click on Chart Note to generate the final document for the encounter. Click Next to take you to the Finalize Template to submit your visit for review if you are a supervised provider.

Finalize OV tab
If you require sign off, you will go to the Finalize OV tab and in the Provider Sign Off section in the lower left of the template and check the box for Physician Sign Off Request. Supervising providers will also have to come to this page to use the Supervising Physician Sign Off section once they receive the task that it is ready.

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Meeting Meaningful Use in Next Gen

Several key indicators of care are directly obtained from the Next Gen EHR program. The 8.0 KBM offers "Meaningful Use" reporting of elements. This tool has been developed to assist end users with documentation in Next Gen.

Vaccine Documentation
All vaccines need to be recorded in the Immunization template within Next Gen. Vaccines administered by CHESI may be pulled for reporting by searching for the CPT code associated with the vaccine administered. Any vaccine not administered by CHESI, should be entered in the "Previous Immunization" template with the appropriate sequence number if it is known.

Adult Immunization Template

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Pediatric Immunization Template

Previous Immunization Template

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Vital Signs
All vital signs should be recorded within the "Vital Signs" template within EHR for patients over the age of 2.

BMI- A height and weight need to be recorded in the same unit of measure for a BMI to calculate. There is an ability to select "carried forward" for a height recording from a previous visit. This template contains a link to the BMI Plan template for any abnormal findings.

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All Orders Placed in the EHR

All Orders for a patient visit must be placed in the EHR this includes outside labs, referrals & diagnostics.

Plan recorded in the EHR

Plan must be recorded in the EHR to generate on the Patient Plan. Plan must be printed and given to patient before they leave the clinic. Plan can be generated at the bottom of the Check Out tab or SOAP note.

Asthma
Audits are based upon patients with the diagnosis of asthma in the assessment template and a status of persistent who have been prescribed an inhaled corticosteroid in the Medication Module. The administration of an annual influenza vaccine is also reviewed. The influenza vaccine would follow the same guideline for vaccine documentation listed earlier in this document.

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The status must be indicated on the Asthma Flowsheet, accessed off the Chronic Conditions HPI Template by clicking on Flowsheet, selecting Asthma and choosing Update.

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The Pediatric Asthma Flowsheet is used to track patient progress

Tobacco Usage
The 8.0 KBM contains a specific area for documentation of tobacco status. This may accessed by selecting the "Tobacco Use" link in multiple templates which takes you to the Tobacco Use template. The Tobacco Use section, along with Smoker Status on the Tobacco Use template will need to be completed at the top of the grid and the Add button selected to meet requirements.

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History Tab Link

Tobacco Cessation Template Link

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Screening Summary Link- This is found on the Intake and Summary tabs.

Patient Education
The system records orders that are under "EDU" or "INSTRUCT" as meeting this requirement. The "My Plan" has an area to place instructions. Anything in this area of the template that is marked for a patient with a check mark and the order is placed would qualify.

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Counseling documentation for tobacco cessation or using the BMI plan link from the Vital Sign template would also qualify for measure.

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The Pediatric WCC anticipatory guidance template records sections as patient education and would also meet this requirement.

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The Screening Summary template also contains a link to the "Counseling/Educational Details" template.

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