3NOT......Teach you how to codeHow to get a 9921x with every encounterDecide what AHLTA really stands forReveal the new EHR solutionProvide System Admin training
4DisclaimerPatient names shown in the slides are certified as fictional, are created only for training, and without intended correlation to real people.
5Optimal Settings Computer AHLTA At least 2 GB RAM (4G recommended) Virtual Memory at least 1.5x total RAM(Windows 7: Control Panel>System>Advanced system settings>Advanced>Performance>Advanced>Virtual Memory)Display color resolution set to 16 bit (CITRIX: 16 bit color setting)AHLTARelease Version SP1C (pending release)MEDCIN Knowledgebase Version: 4th QTR 2012 R1 (14 NOV 12)(AHLTA>Help>About)Encounter Summary Properties(Turn off Auto-print unless clinic policy)(Set “Auto-save S/O every” to “0” Min)Health History Tab; Do Not Retrieve Vital Signs (see screenshots)
6Optimal Settings (Health History) Access Health History from Folders ListSelect Options to open Health HistoryConfiguration window
7Optimal Settings (Health History) Select Vital Signs Review from drop down menuUncheck “Do Not Retrieve”
8AHLTA CustomizationsWith opened encounter, click Options to reveal Encounter Summary Properties and customize your AHLTA Settings.
9Suggested AHLTA Customizations Signature Block (job title, Co-Signer)Minimize AutoCite preferencesConvert (+) ROS to HPI if using a Medcin TemplateE&M Calculator Defaults (check with your coder Re: Service and Exam Type settings)Sensitive Default (Mental Health Providers)Include ICD9/CPT/HCPCS codes in encounter noteDon’t default TSWF or Usability AIM FormsDon’t use Merge Dx Prompt/Prompt with Default Template
10AHLTA Customizations: Setting Order of Columns Drag and drop Column headings to configure the order of columns in Appointments and Telephone Consults ModulesClick on Column headings to re-order lists based on that column data
11AHLTA Customizations: Appointments Module From the Appointments Module, click on Options to customize Appointment Module settings.
12AHLTA Customizations: Telephone Consults Module From the Telephone Consult Module, click on Options to configure Telephone Consult Module Settings
13TemplatesThe best time saverDefault template (except TSWF, Usability AIM)TSWFUsability AIM FormGeneric example
15Template Management Purge unnecessary Templates From Template Management:Select ‘Default Encounter Template to set a Default EncounterRight click to remove the template from your favorites
16Template Management Make the most of improved Template Management: Use Edit to modify existing templatesAdd Order setsUse “Add To Default Template” to modify your default template while documenting an encounter.
17Templates: Approved templates Borrow don’t build templates. Look for “approved” templates in the Enterprise Folders based on specialty.
18The Tri Service Workflow (TSWF) The TSWFThe Tri Service Workflow (TSWF)Workflow concept built around a core AIM formTeam documentation effort“Live” DocumentTakes advantage of effective AHLTA features, overcomes AHLTA challenges to create:“One form fits all” conceptManageable Problem List, Medication List, Family HistoryReadable notesAHLTA down-time solutionCPG complianceCoding guidelines
20Usability AIM FormAlternative to the TSWF“One form fits all” conceptPresents data in easy to select formatIncludes care guidelinesDoes not include team documentation conceptNot Tri-Service approved contentNo longer updated
22Usability AIM FormUsability AIM Form: Presents data in easy to select formats
23Usability AIM FormIt even includes care guidelines
24Generic TemplateGeneric template example. Based on Medcin terms. Advantages vs Disadvantages.Some users are more familiar and comfortable with using Medcin based templates. Consider creating or finding a generic template that serves as a basic and default template used in all or almost all of your encounters. This example was created and used by a Family Practice doctor who based the template terms on his most common clinic diagnoses.Some Advantages of using this type of template:Familiarization (user knows the content of the template and when/if to bring in additional terms)Standardized process to bring in additional terms (Browse From Here, Find Term, Dx Prompt or change templates)Facilitates team documentation (staff members load this template during patient check-in and contribute to the same note)Some Disadvantages:Medcin terms (less readable note, less logical search for terms)Doesn’t fit all circumstancesTendency to get too big
25Team DocumentationProcedures, lists, med recon, questionnaires, etcUse a common templateMake sure you take over note correctlySupport staff can document all but the HPI
26Take Over the NoteTo assume ownership of the support staff encounter note, click the ‘Edit This Note…’ button.“Add Additional S/O Note…..” creates a duplicate note under the support staff note.
27Take Over the NoteThe Provider can edit the support staff’s note accordingly.
28Take Over the NoteThe Provider has taken ownership of the note and the note output is not duplicated.The support staff’s documentation goes to the “Change History” portion of the note (next screen shot)
29Take Over the NoteStaff portion of the note goes to “CHANGE HISTORY” in small font for audit purposes but is also retained within the provider’s documentation.Support staff and providers should work off the same template when possible and practical so the provider can see during documentation what has already been documented by the corpsman.Remember: Refresh, Edit, No, Yes
31Check-Out From the Appointments Module, select Check Out. Note: The Patient’s appointment status must be ‘InProgress,’ ‘Completed,’ or ‘Updated’ for the Check Out icon to activate.
32Check-OutUse Check Out to configure a Check Out Date and Time and select the type of handout to print for the patient. Use Print Preview to view form(s) prior to printing.
33Check-Out : Update Check-out Data From the Tools Menu, select Update Check-out Data to configure the Print Orders (Instructions) template.
34Favorites ListsUse List Management to populate Favorites Lists for Diagnosis and Procedures. Suggest populating your templates with common procedures and your Favorites with uncommon or hard to find procedures.
35Copy ForwardTo use the Copy Forward function, open a current encounter.
36Copy ForwardGo to Previous Encounters, open the desired encounter and click Copy Forward.(The S/O, A/P Diagnoses, Procedures, and Orders will be available for selection.)36
37Copy Forward You are returned to the current encounter. Click the S/O or A/P button.
38Copy ForwardPositive and normal findings in the Medcin tree in the left pane copied from the previous encounter display in yellow.Findings copied from the previous encounter do not populate the current encounter note until you select them.
39Copy ForwardThe A/P information associated with the previous encounter will display on the appropriate tabs. (i.e. Diagnosis)
40Copy ForwardThe A/P orders associated with the previous encounter will display in the order set tab.
41Dx PromptThis is the Dx Prompt tool that can help with finding appropriate Hx and PE terms to include in the encounter note. Creates a template “on the fly.”
42Dx PromptDx Prompt will present added terms consistent with the Search or listed selection diagnosis. You can return to your template by using the template drop down menu. Click on the List Size to expand the terms up to List Size 3. Suggest not selecting the Merge DxPrompt option.
43Spell CheckerBuilt into AHLTA SP1 (in case you didn’t notice)Can create some conflicts if using As U TypeMacros capability
44Creating MacrosWith an opened encounter, right click inside a text box (S/O or A/P)Select “Autocorrect Options”
45Creating Macros3. Make sure “Replace text as you type” is selected from AutoCorrect Options
46Creating Macros4. Type in the name of your macro in the “Replace:” boxType in the macro phrase in the “With:” boxClick on “Replace” to store your macro phrase in the Dictionary
47Creating MacrosType in the title of your macro from an AHLTA Text box, hit space bar to reveal your phrase. Click “OK” to add to your encounter note.
48Voice DictationThis is the logo for Dragon Naturally Speaking48
49Time Saving Strategies Minimize size of Template FavoritesComplete A/P firstStandardize processes and trainingBe prepared for catastrophesAvoid temptations to postpone documentationDon’t let providers do all the documentation
50BHIE Share BHIE Share DoD FHIE/BHIE Framework VA BHIE CHCS CPRS or VistAWebSHARE GUIBHIE ViewerBHIE-TBHIE-EssentrisBHIE-AHLTABHIEFHIE/BHIEFramework/DoD MPIMasterPatientIndexVistACHCSCDREssentrisTMDS
51BHIE Share: Web Link Access Essentris Web LinksAHLTA Links FolderTHIS !NOT THIS!
52BHIE ShareType in your CHCS Credentials to LogonSelect the Site Link that corresponds to your MTF and save to your Internet Favorites
53BHIE-Share vs BHIE-AHLTA More robust dataFaster retrievalLocal and remote data retrievalUser Preferences
54BHIE Share: Patient Summary The Patient Summary Page loads when a patient is selectedView details of results by selecting hyperlinksPage may be configured to user preferencesPatient Data Categories: Select Documentation to retrieve Essentris notes
55BHIE Share: Remote Data The Patient Summary Page loads when a patient is selectedRemote data auto loads by Health Data category if availableDate range defaults and display may be set in preferences, dates may be changed on the Summary Page
56BHIE Share: Essentris Notes Sample Essentris Note:Available in Documentation Patient Health Data categoryView by clicking hyperlink in Documentation box of Patient Summary PageRequires Essentris configuration (LOINC code) to be viewable in BHIE-Share
57Virtual Lifetime Electronic Record (VLER) Health Enterprise
58VLER: Virtual Lifetime Electronic Record VLER Health Enterprise External Health Data Sharing provides the ability to:Find and retrieve healthcare information within and between health information exchanges and other organizations.Deliver a summarized patient record to support patient care and the patient’s health.Support consumer preferences regarding the exchange of personal information, including the ability to choose not to participate in External Health Data Sharing.Match patients to their data without a national patient identifier.Exchange information securely.
62ReferencesAll reference materials will be loaded on the DHIMS Knowledge Sharing Site (KSS). For more information, please visit:https://www.ehrknowex.com/welcomeFollow onscreen instructions to create an accountRequest to join desired content groupsType in desired topic in Search window (do not hit Enter)Select from created drop-down listDownload and/or review desired content
63SURVEYSURVEYPlease fill out a brief survey regarding this presentation. The survey provides the DHIMS Training Team with input to assist in creation and delivery of better quality training presentations.Date:Session:Training Team: GarrisonTrainer: