1. Quick Orders Carla Guzic, PharmD Hastings Indian Medical Center Tahlequah, OK

2. Quick Orders Why? –Standardization –Provider ease of use when ordering –Pharmacy staff satisfaction –Accuracy –Data requirement Days supply, chronic vs. prn, etc

9. Naming Conventions ORZGeneric and nursing text quick orders LRZLaboratory quick orders RAZRadiology quick orders PSOZOutpatient medication quick orders PSJZInpatient medication quick orders PSJIZIV quick orders FHZDiet quick orders GRMCZConsult quick orders PSOZMPharmacy Order Menus

10. Naming Conventions Order sets –ORZSET To be used when mixing data elements –LRZSET (Lab) –RAZSET (Radiology)

11. Naming Conventions Order menus –PSOZM Antibiotics/Antivirals –PSOZM Behavioral Health Meds –PSOZM Diabetes –PSOZM Quick Orders (A-B) –PSOZM Quick Orders (T-Z)

12. Outpatient Medication Quick Order

14. ALWAYS YES Dose and Route: Setup by Pharmacy in the PDM

16. Special Med Quick Orders Clinic medications –Pick up: Clinic –Status: DONE –Not dispensed by pharmacy Outside Medications (ORX) Never Auto-accept Quick Order Medications

18. Quick Orders-Inpatient Medications

19. Unique to inpatient

20. Quick Orders-IV Meds

23. Order Menu Setup Actions –Add (enter row and column) –Remove –Edit –Toggle Display (what provider sees vs. actual order) –Assign to User –Order Dialogs (can create quick orders) –Select New Menu

25. Creating an Order Menu Standard naming convention (i.e PSOZM) Built on the RPMS side Viewed on the EHR side

27. Order Sets For meds commonly used together –Albuterol and normal saline nebulized –H.pylori treatment –Multivitamins and iron Labs –Cardiac enzymes (CPK and Troponin) –Lipid Panel Can combine elements –Lab with Radiology

34. Quick Order Wizard Can create quick orders Cannot add to Order Menu

35. MAKING TEMPLATES Carla Guzic, PharmD Hastings Indian Medical Center Tahlequah, OK

37. EHR Templates Create New Templates: for users with access to personal templates Shared Templates: for Clinical Coordinators Edit Template Fields: for users setup in the TIU FIELD EDITOR CLASS

38. Template Editor Personal Shared New

39. Create a New Template Type The Boilerplate

40. Objects vs.Template Fields Template Boilerplate Panel: –Data Objects are surrounded by straight brackets such as |ALLERGIES| Must be made locally Brings information into template –Template fields are surrounded by curly brackets Such as {FLD:WWH INR RESULTS} Prompts author to input information into template

42. Some advice….. Apply: Changes will not be saved when leaving the Template Editor dialog if this button is not used Modify/Build Templates in your Personal Templates Limit access to who can modify Shared Templates and/or Template Fields

44. Tools Menu: Edit Template Fields –Edit Existing Template Fields –Use with CAUTION!! Many fields are used in various different templates IMPORT/EXPORT Templates –Sites can send/receive templates to other sites –Data objects are local –Template fields can be shared –To IMPORT a template a file should be loaded on the computer and then placed into the Template Editor

45. Template Fields Old Fields Create New

46. Template Fields EHR installation includes many template fields Also, made locally, PLUS Imported into template editor whenever any new templates are imported (national and/or other local facilities) Don’t modify template fields, unless certain that they are specific to only one template

47. Template Fields Types of Fields

48. Creating a Template Field Click on the New Button Enter a Unique Template Field Name (can be up to 60 characters long) Select the desired Template Field Type

49. Creating a Template Field (continued) The right side of the template field editor will change depending on which template field type is specified.

50. Template Fields Edit Box: used for short responses Combo Box: drop-down list of choices Button: contains a label that changes when you click it Check Boxes: can fill with a check mark, may have >1 choice Radio Button: call fill with a mark, but only allows one choice Date: Contains the month and year; enter the year first followed by the month. Number: contains a numeric value Hyperlink: sends user to an on-line location Word Processing: used for long responses Text: Used for instruction; data isn’t stored in the progress note. Users cannot edit this field

51. Edit Box Fields Field length: size of the edit box in the template (up to 70 characters) Text length: how much text can be typed into the field (up to 240 characters) Default Text: what always pops up for the author

62. Date Field

63. Number Fields

65. Word Processing Field

66. Hyperlink

67. Text Field Text fields provide a mechanism for embedding predefined (non-editable) text into the dialog Predefined Text is entered in the Items property of the field

68. Common Field Properties Most template fields share several of the following common properties: –Inactive –Required –Indent Field –Indent Text –Notes

69. Required Field REQUIRED

70. Finishing Formatting Options

71. Template IMPORT/EXPORT Utility Allows templates to be shared from facility to facility Location of action: under TOOLS menu in the Template Editor

72. Template Import/Export (Continued) Users can EXPORT their templates into documents (with.txml extension) that can be sent to other systems/sites/users via e-mail Local patient data objects cannot be exported with this template import/export function However, template fields will be added when importing a template Can also import the basics of a word document (not fancy formatting, etc)

73. Data Objects Display established data already in EHR Only programmers may create/copy objects Every patch brings in more data objects Objects can be created for any data that exists in RPMS –Single answer (i.e. patient sex) –Group of answers (i.e. active medications)

86. Using Dialogs

88. Template Making “Words of Advice” EHR is a documentation tool Templates should……… –Be customized to the user –Provide appropriate documentation Medical/legal necessities Billing/coding requirements Communicate necessary details to other providers

89. Template Making “Words of Advice” Minimize: –Clicks/keystrokes for the provider –Duplication of documentation Maximize: –Standardization of templates with respects to mandatory information (i.e. similar layout) –Flexibility –Capture of needed data (i.e. data objects) –Customizability

90. Template Making “Words of Advice” Match Templates to the Workflow –Nursing/Triage –Providers Collecting data –Physical Exam/Review of Systems Recording data Assessments Plans –Pharmacy Staff DUE parameters, lab monitoring requirements, allergy assessments, etc.

91. Template Making “Words of Advice” Provider skill level –Poor keyboarding/computer skills –Excellent keyboarding/computer skills –Using the mouse vs. using the keyboard –Voice recognition Style of Templates –A lot of free text vs. minimal free text with template driven responses Use objects to pull in information!

92. New Terminology POE: Provider Order Entry CAC: Clinical Applications Coordinator GUI: Graphical User Interface (the EHR side) OE/RR: Order Entry/Results Reporting VueCentric: Proprietary name of the GUI that permits data exchange with RPMS PIMS: Patient Information Management System (scheduling software for RPMS/EHR compatibility)

93. New Terminology TIU: Text Integration Utilities. Required on the RPMS side to provide notes in the EHR Vista: Veterans Health Information System & Technology Architecture. (equivalent to our RPMS) CPRS: Computerized Patient Record System (VA’s equivalent to our EHR)

94. Provider Training Handout given –Step 1: Select Patient –Step 2: Select Visit –Step 3: Enter New Medication Order –Complex Orders –Renew Medication Orders –Dealing with Hold Orders –Changing Medication Orders –Discontinuing Medication Orders

95. Provider Training Quick Orders –Update as necessary Templates –Make the templates specific for their specialties Discuss CII Orders (Paper Only)

96. Additional Information: WebEX Training Center: https://ihs- training.webex.com/https://ihs- training.webex.com/ Click on “Recorded Sessions” under the “Attend a Session” menu on the left:

97. Other Resources List-serv: www.ihs.gov/CIO/EHR/index.cfm?module=listserv www.ihs.gov/CIO/EHR/index.cfm?module=listserv General Information: http://www.ihs.gov/CIO/EHR/index.cfm http://www.ihs.gov/CIO/EHR/index.cfm –EHR Clinical Overview –EHR Technical Overview –EHR National TIU Templates Also can be from local resources –EHR Presentations