PatientKeeper Version 8 Overview of Changes Feb 12, 2014

Agenda Topic Details Overview Supported Applications and Platforms Physician Portal Browsers Portal Updates Native Mobile Devices Apple and Android Light Browser System Administration Institution Department User Bulk User Edit System Management Options and Backend Updates Manual Registration

Overview- Supported Applications and Platforms Mobile Clinical Results Browser (on Android™ and Apple®, for Patient List v1 users only) Mobile Clinical Results Native (on Android™ and Apple®) Physician Portal (desktop clinical results) The following PatientKeeper application is not supported in the current release: Mobile Clinical Results Browser (on Android™ and Apple®, for Patient List v2 users)

Physician Portal

Portal – Browsers Supported Browsers for Release 8: Microsoft Internet Explorer® versions 7 and 8 - secondary support Microsoft Internet Explorer® version 9 and version 10 Google Chrome™ Apple Safari® (excluding Admin Tools) Please refer to the PatientKeeper Technical Brief on PatientKeeper Supported Browsers for more information. Other Browsers: Internet Explorer version 11 is not supported for use with the PatientKeeper application at this time. If used with PK you will receive a message stating that the browser version isn’t supported. Firefox – Use at your own risk

What kinds of changes were made with the Portal Facelift? The Portal user interface was updated to make it easier to use. The online help and sign out icons were added at the top right. The online help documents were updated and are now automatically modified for the user’s display based on whether PatientList 1 or 2 is in use. New PDFs for the portal and mobile devices are available via online help when the PDF icon is selected for downloading. The tabs for navigation were streamlined. Provider Directory is now a tab rather than link (where configured).

Physician Portal - Patient Search and Patient Details The Admit From and Admit To dates were added to the search criteria options. Patient Details The HIPAA privacy address is now displayed under the patient’s regular mailing address if available from Meditech. When configured at HCA’s request, the insurance information from the most recent visit can be displayed on the Patient Detail screen.

Physician Portal – Patient List Updates – Version 1 The Manage, Sort, and Print options are now located under the Actions drop- down. The expand and collapse icon was updated for hiding the patient list. User declared relationships with a patient are now auto assigned for any visit with the same account number.

Physician Portal – Patient List Updates - Continued The patient length of stay(LOS) calculation and field labels have been changed to be consistent wherever displayed. If the patient length of stay is less than one day, only the hours will be displayed with rounding to one digit. Previously a 1 would be displayed if the patient visit was less than 24 hours. Please see other documentation for information on Patient List 2 updates

Home Meds The new Home Meds Module was added to PK. This module displays information from RxM for Meditech Magic environments.

Messaging (Where configured) Send Message About This Patient was placed under Actions menus. Send Message was placed under the Inbox tab, which now shows a number of new messages. A new Delete All option was added for removing all messages at one time.

Flowsheets for Labs, Medications, and Vitals Using the multi‐graphing tool, you can select clinical data (Lab Results, Medications, and Vitals) to display in a table (as shown below), and to create a basic flowsheet. You can save your settings as a snapshot for reuse with other patient data. See the section on “Multi‐Graphing Clinical Data” in the Physician Portal User’s Guide for more information. To create a Flowsheet using Snapshots: Select a patient and the desired timeframe from the either the Meds, Vitals, or Labs Summary screen. Click the Graph icon on the upper right corner of the summary screen: Click Clear if previous data was displayed. Click on labs, meds, or vitals to graph or display in a table (multiples can be selected of each) and name the Snapshot. Save the snapshot. Make this the default if desired. Use the Manage Snapshots link to delete,sort, or rename snapshots.

Flowsheets for Labs, Medications, and Vitals

Clinical Results Updates (Several Modules) When a filter is applied, we now list XX of NN in the header where the number of items appears. This change was made to allow us to know that we are only seeing a portion of the total data. This update was made in: Clinical Notes Medications Lab Results Order Status Test Results

Clinical Notes The time the note was entered was added to the summary screen., and the column header label was changed from Date to Date/Time. You can now select more than one filter when limiting the display of the Clinical Notes.

Clinical Notes (Cont) The footer description of signed clinical notes now uses the text “Electronically Signed by” instead of “Signed By.” Printed Clinical Notes The word Draft has been added to the footer. Previously a large watermark with the word “Draft “ was printed across the entire report page. Printed Notes now contain additional information such as the patient name, age, gender, DOB and MRN. Previously only the date of printing and the signing information was included

Clinical Notes (Cont) Full support has been added for displaying standard images from Meditech PDOC reports. These documents are available as PDFs within PatientKeeper

Medications The MAR status is now displayed on the Medications orders List screen to eliminate the need of viewing each medication to see its MAR information. The bolding/unbolding feature for viewed and unviewed Medications has been removed.

Lab Results Lab Component names display in their abbreviated or mnemonic form instead of their full description in the Expanded Panels view for better view ability and clarity. Components are now sorted by Category in the Component Table view. The category name will display as a header row and the associated components will be grouped in panels that are listed in alphabetical order.

Lab Results Printed Lab Reports The Lab Component graph now uses the most recent normalcy range in its display. The lab result comment text has been expanded on the pop-up that is displayed when you hover over an asterisk indicating a comment on the lab result. Lab graphs will no longer be displayed for results that have non numeric values. Printed Lab Reports The printout for the lab results has been changed from HTML to PDF output. The colorized highlighting for Abnormal and Critical values has been removed. Addition lab comments have been added to the report. The footer of the report has changed to display “Any laboratory data incorporated into this document may not be complete as this is not the official patient record. The original full report is available in Meditech”

Test Results Micro blood culture test result comments are now included in the test results. Printed Test Results have been updated to include the Date/Time and Status on the header of each Test Result page. Pathology Reports: Pathology reports have been improved to more closely resemble Meditech PCI reports. We now have the ability to pull all data from the Pathology questionnaires, include full descriptions of diagnoses instead of codes that reference these diagnoses.

Other Clinical Updates Allergies - The bolding/un-bolding feature for view and unviewed allergies has been removed since allergies are viewed through the overview screen rather than being viewed individually. Vitals – When configured on a system, we have the ability to display subsets of Vitals by using a Snapshot.

Provider Directory (Where configured) The following fields were added to the Provider Details section of the Provider Directory tab: Prefix Suffix Physician group name Campus credentialed Physician group number Primary specialty Note The Provider Directory module is now a tab rather than a link.

What are the known Portal issues in this release? Test Results - Using a single character as a search results in an error message display. Workaround: Use a minimum of two characters in the Search field. Allergies – Text does not wrap to new lines as it had with the previous release. Order Status – Active Only filter does not work Inbox - After searching for a message, selecting any message from the results always displays the first message.

Native Mobile Devices

Handheld Native – Upgrade Paths Apple All users will be required to upgrade their Apple devices. This will require the removal of the old application and the installation of the new application. Android Upgrades can be taken without application re-installation

Handheld Native – (Apple) iOS Re-installation To delete the current version, press and hold the PK icon until the screen shakes. A black “X” appears at the top right of any application that may be deleted. Click the X on the PatientKeeper icon. When prompted to do so delete the existing PK module by clicking Delete. The main screen will be displayed with the wavy icons and the delete option. Press the menu button on the phone to regain normal operation. Open the App store and do a search for PK80479R

Handheld Native – iOS Re-installation The App store will find the new application. Click on the Free button. Click on the install button. The application will download. After the PK app has downloaded it will be on your device. Click on the PK icon to launch and then enter the host name (the system URL).

Handheld Native – iOS Re-installation Click the username prompt. *Note that the device will connect to the server to confirm the connection with a check next to the host name. Enter your username and password and click the Go button. The device will provision and perform a sync. Once this has been completed the patient list will be displayed.

Handheld Native – Android App Upgrade After the system upgrade open the PK app and login.  After the app initiates a sync, the user will be prompted that there is a software upgrade available. Press the OK button. The user will be prompted about replacing the application.  Press the OK button. The user will be prompted if they want to install the App.  Press the Install button. The installation process then occurs. Once complete, the device will note that the application has been installed.  You can click on Done or Open.  Press the Open button. The App will now perform a sync to get the updated user and patient information. Once the sync is complete, the user will need to log into the application.  Enter in Username and Password and press the Login button.

Handheld Native – Supported Devices Please see the PatientKeeper Certified Devices technical brief for details. iPod touch – Only iOS 5.0 and greater are supported with this PK version. iPhone 3G devices are no longer supported

Handheld Native – Login/Provision and Icons There is a new login and provision process to simplify the end user experience: -Upon PK installation the new Login screen is presented, which contains the Host field in addition to the Username and Password fields. -After entering the Host, Username and Password and the device is provisioned, the Patient List screen is immediately displayed. Apple device icons for the bottom button bar have been updated. The buttons work the same only the icon designs have changed

Handheld Native - Portal Broadcast Messages The Portal Broadcast Message feature has been expanded. Android and Apple users will now be able to receive general announcement messages from the system administrators. When activated on the system, messages can be sent two ways: 1) By Push Notification – This process, when activated on the Android or Apple device, displays a message to the user much like an SMS text message, even when the user is not logged on to the PK application. The push notification will only notify the user that there is a message in PK for viewing. 2) At the time of logon to the PK application or when a sync is processed when the user logs on.

Messaging Updates with Push Notifications (where configured) Inbox Messaging Updates (Note: This is not in use on most HCA systems) If Push Notifications is set to Yes for the system, and the mobile device is also configured with this setting, messages from one PK user to another are pushed immediately to the handheld devices: If the handheld user is logged on to PK, a notice is immediately received indicating that a message was received in the Inbox. The user is prompted to open the Inbox, and if they open it the latest Inbox message is shown. If the handheld user is not logged on to PK, they receive a push notification indicating that they have a message. When the notification is tapped, the PK app is launched. After logging into PK the Inbox is opened and the latest Inbox message is shown.

Handheld Native – Mobile Help Android and Apple devices now have the new Mobile Help System for PK. This is similar to the functionality found on the portal

Handheld Native – Mobile Help (cont) To close the Mobile Help application:

Handheld Native – Patient Search and Details Patient Search - Apple/Android: -The Advanced Search process was updated to have improved performance. -The search criteria was updated to use the PK Visit Type instead of the ADT Visit Type. -When searching by name, the only patients displayed are those that have active visits (when Add/Edit Visit is Disabled). This change was made to remove names that did not have active visits for selection. -Apple: The type of Patient Search (Last Name vs Advanced) last used is now sticky. Patient Details: The Patient Details screen Length of Stay calculation has been modified to match the Visit Details screen.

Handheld Native – Other Updates On Android and Apple, fields have been relabeled across screens for Account Number/Financial Number/Visit Number to be consistent The HIPAA privacy address is now displayed under the patient’s regular mailing address if available. Filters are now sticky in all clinical modules if enabled for the system . Note – Assumed San Antonio only at this time (portal) Negative numbers are now graphed on Apple devices for Labs and Vitals.

Handheld Native – Other Updates Medications – On Apple devices, when viewing the Details screen for a medication, the MAR tab now includes the MAR status or a status of Given or Not Given. When the status is Not Given, the Date/Time will be displayed in strikethrough text.

Handheld Native – Performing a Refresh – Apple Devices Since all devices are configured to sync automatically on a regular schedule, the patient information on your device is usually up to date. However, if you think some new information might have come in recently for a particular patient, and you do not want to wait for the next Automatic Sync to see it, you can do a quick Refresh to retrieve it. A Refresh retrieves the most recent information for the currently selected patient, in the current module. To perform a Refresh, - Go to the Summary screen for one of these modules: Allergies, Clinical Notes, I/Os, Lab Results, Medications, Order Status, Test Results, or Vital Signs. - Touch the screen anywhere below the heading area, drag down, and release. The latest information for this patient in this module is quickly retrieved and displayed.

Handheld Native – Performing a Refresh – Apple (cont)

Handheld Native – Lab Results – Apple and Android Lab Results – The Panel Table View has been added. This view displays a history of all instances in the selected lab panel. The default view for labs is the Panel Details View. To switch to the Panel Table View, select Menu > Panel Table View. This view remains the default until you choose something else.

Handheld Native – Lab Results – Apple Only Sorting - Lab Results can now be sorted by date/time or by panel name by tapping on either the Date/Time or the Lab Panel heading (A to Z). Tap the column heading a second time and the sort order reverses. Lab Results Summary – Search by Term - Providers can now filter the Summary list by searching for any term or phrase. Expose the Search field by touching the screen anywhere below the heading. Drag down until the Search field is show and then release. Enter any phrase in the Search field and then select the Search key on the virtual keyboard. The virtual keyboard will then be hidden and only the panels that match your search criteria will be shown. (next slide for example)

Handheld Native – Lab Results – Apple Only To Search by term, such as WBC (see below). To clear the search term, tap on X on the right side of the field.

Handheld Native – Options Filter Criteria - Android and Apple users have the ability to combine filter criteria in clinical modules. For example a user could create a personal filter called “Progress & DC Summary”, which combines standard filters (system wide) such as Progress Notes or Discharge Summary. This feature is available in Allergies, Clinical Notes, Lab Results, Medications, Order Status and Test Results. Please see MCR User Guide for additional information

Clinical Notes – PDF Documents On Apple devices, PDF documents can be viewed in Clinical Notes if they are also available in the Portal. An example document of this type is the Meditech PDOC reports that contains fishbones, tables, and pictures. PDF documents are not available for viewing on: - Android devices - Light browser handhelds - From the Apple based PK Live View function

Test Results - Mobile Imaging for Apple iPad Devices (where configured) Note: As of 2/14/14 This is not yet an option at HCA. A new optional Mobile imaging feature enables iPad users to view images for test results such as EKGs, echocardiograms or radiologic tests when the imaging system integration is deployed with an HTML 5 connection. When this is implemented, the Test Results Summary screen displays a cloud icon for a report that has an associated image. The associated display may contain one or more images or videos. Various controls were added to the bottom of the screen to allow the user to view the image data by zooming, pausing, or moving to the next image, etc.

Test Results - Mobile Imaging for Apple iPad Devices (cont)

What are the known Handheld Native issues in this release? Broadcast Messages - When HTML commands are used in a Broadcast Message, they are displayed as text. Work around – Do no use formatting commands such as bolding, color changes, etc. This will be fixed in a future release. Allergy Summary – The severity column is not displayed. Workaround – View this information in the Allergy details. Test Results - On iOS, the source column header shows blank and causes misalignment and truncation. Inbox - After searching for a message in the Inbox, selecting any message from the results always displays the first message. Lab Results – Chem 7 diagrams with unmapped values have display alignment issues.

Mobile Browsers

Mobile Browser Updates Patient Details Contact Info labeling was added for Home Address, Alternate Address (if any) and Home Phone.

Known Issues On Android Devices The I/Os Module Cannot scroll right and left after the user taps in the value area and then drags right/left after the first time it is used. ***Workaround – Tap and drag using the heading area. Users can scroll until columns are hidden after tapping the hours shift header area and then dragging left Test Results Module– The user can scroll a fixed font report until it is hidden when viewing the detail screen (if the user taps on the screen and drags to the left)

System Administration

Administration – Institution Institution Reports Added the ability to export all usage reports. Includes: Unique Active Users, Session logs, Error Reports Session Report – Added the user’s first and last name to the report. System Settings - Added ability to export and import system settings. This enables administrators to perform direct comparisons between systems. Usage Report Added links to audit report directly from the Usage Report

Administration – Institution (cont.) Usage Reports - When login activity involves emulation of one user by another the Usage Report identifies the user doing the emulation under the login name of the emulated user System Reports Screen Modifications -Sync and Error links replaced with MobileWeb Sessions Link. -Obsolete references for Handheld have been removed.

Administration – Institution - Site Administration Patient List1/Patient List 2 - Major changes were made to the system to offer a new version of Patient List processing. This setting controls the version(s) of the Patient List that are available. Please see the PatientList 2 training materials for additional information and setup requirements

Administration – Institution - Site Administration (cont) Web Default Options – New Results/Patient Summary Defaults can now be set for all new users of the system. Without the use of this setting all users are required to make these selections when they begin as new portal users. The Filters Sticky by Modules (yes/no) setting was added. This determines if changes made to date range filters are propagated to all modules or whether settings remain ‘local’ to each module. This will be set to No for most HCA systems.

Administration – Institution - Site Administration (cont) Temporarily Disable System Access – Administrators can now disable access to the entire system to prevent users from accessing the system during maintenance window periods, such as upgrades or validation testing. When this preference is set to Yes, users (except those who have been exempted via the Bypass List for Entire System) are prevented from logging in. They receive an error message stating “Access to the system is temporarily disabled. Please try again later. Contact your administrator for more details.”

Administration – Institution – Edit Settings: Device (1) The following three new fields sere added

Administration – Institution – Edit Settings: Device (2) Show Web Views -This option allows Apple users to see current information between syncs when requested by the handheld user for specific clinical information for the last 7 days or specified time period. This is typically used for acquiring addition history on the HH. Enable Push Notifications – (for Apple and Android) - A push notification is a notice that is “pushed” or sent immediately to the HH. This is a new feature in release 8. This setting determines whether HH Native users are notified when: 1. They have a new Broadcast Message (from the portal Admin) 2. For Inbox Messages (from one PK user to another). A) If logged on to PK, a notice is displayed immediately and the user is prompted to open the Inbox. OR B) When not logged on they receive a notification that they have a new message. When the notice is tapped, PK is launched and the Inbox is opened to the latest Inbox message. Enter the text for Push Notifications This field is used to compose text that will be displayed for the handheld users.

Administration – Institution – Patient List Patient Header for HH – This new setting was added to allow for the selection of patient identifiers to display in the banner area at the top of the handheld screens for the Handheld Native devices (iOS only).

Administration - Department Administrators now have the ability to search by Departments by using part or all of a department name. Support was added for re-activating a department that was de- activated in error.

Administration – User Tab

Administration – User – System Defaults Administrators can now configure handheld modules to activate by default during creation of new users. From Admin>User> Default User> Edit Settings: Device: Assign Modules link

Administration – User – Create User From Provider During the creation of a new user account we now have the option to Clone Preferences from another user Note: This copy operation is restricted to user preferences that are configured on the primary Preferences screen. Preferences that are on subordinate update screens are not included.

Administration – User - Edit Settings: General Copy Preferences to Another User was added. This setting is used to replace the selected user’s configuration preferences with another user’s preferences. This launches another window to search and select the desired user. Note: These updates only change the settings on the Edit : Preferences function. Reset Preferences – Replace settings for this user with the setups of another.

Administration – User - Edit Settings: General (2) The emulate function was added to the General settings screen. The domain name was added (used for multi-domain LDAP systems only). Level 0 and Level 1 Administrators are now given the authority to create wallet entries for users needing access to one or more systems.

Administration – User - Edit Settings: General (3) The date and time that users were created is now included among the general settings, as well as the name of the user responsible for creating the selected user.

Administration – User - Edit Settings: Device Administrators can now obtain the creation date and time for when a user account was added from the user’s Device screen: Admin>User>Edit Settings (Device)

Administration – User - Edit Settings: Provider Info The provider groups associated with a user account now displays along with the other provider data.

Administration – User - Other Updates Edit Settings - User Permission Updates - Level 1 administrators can now configure which other level 1 users can emulate other users. This update is made from the Can Emulate User field for the desired user accounts. User Delete The deletion warning message was updated. The default setting to delete the related provider records during a user delete was unchecked. A processing indicator after deleting a user was added to show the system is being updated.

Administration – Tracking and Reporting Devices Sessions Tab: An new category for Status was added to device reporting data for sessions that remain in progress. Previously these were considered successful and were reported under “Successful Sessions”.

Administration – Bulk User Edit New Preferences were added. Items of interest for HCA include the following:  General – Domain Name ( for LDAP/Active Directory Domain) This is useful for Divisions that have multi-domain security configured. Device Preferences: Enable Sync Exclusion Period, Only Sync when Application is in Foreground, Sync Exclusion Period Start, Sync Exclusion Period End, Sync Interval User Permissions: Admin Emergency Access, Can Emulate User, Clinical Emergency Access, Medical Records User, Restricted Local User, Submission Record Management, Tracking/Reporting View Access Level 1 - Can Import Provider Directory, Can Use Bulk User Edit Level 2 - Can Add Users to Assigned Departments Patient List Preferences – All User-level Patient list Manipulation, Can Access Patient Summary on the Web.

Administration – Bulk User Edit (cont 2) The Bulk User Edit Function was redesigned and a number of new features were added.

Administration – Bulk User Edit (cont 3) For the Preference Settings we can expand or contract the sections of updates by using the Expand All or Contract All buttons. We now have the ability to search for fields for modification. Once in the contracted view we can expand only a specific section by using the expand arrows. The “Show Finding Only” highlights the selected item in green.

Administration – Bulk User Edit (cont 4) -The ability to search by user Roles was added -Several of the preference names have been modified to be consistent with their associated user settings. -Obsolete options were removed -A partial or complete listing of users can now be exported from the Bulk User Edit. -Support was added for uploading a spreadsheet of users that will be changed by the Bulk User Edit. Typically this would be a file that originated from the previously exported file of users from the Bulk User Edit. -The hover over feature was changed to a new icon that is used to launch the display of additional information. -Reset Preferences to Another User was added.

Administration – System Management The links to the System Management functions have been sorted by function name

Administration – System Management – Audit Report -For Clinical Note activity, the type, date, and note author were added. -Patient assignment and re-assignment tracking was added. -The report now has more user navigation activity in the Description column and might include the following “Web – “ activities: Admin, AllergyList, ClinicalNotesList, HomeMediationList, LabItemList, MedicationList, OrderList, TestResultsList. -Messaging activity between users has been added as “Web-Sent Message). The information icon displays the details of the message.

Administration – System Management ADT Visit Maintenance – The PK Visit Type field is now displayed on the overview screen. Self Assign Report -Manually added patients for PatientList2 (PL2) users will display on the report with a Self Assign Reason entry that lists the PL2 patient list name where the user was added rather than the Self Assign relationship displayed in PL1. -The User Name column was added, and the report can be sorted by User Name. -The ability to search by user Facility was added.

Administration – System Management – Date Range Filters The Date Range Filters update function was added to -Define the desired display options available for the system. -Define the default selection when users first navigate to the Patient Data ---Display Area. -Sort filters

Administration – System Management Provider Maintenance A provider export option was added Provider Group Maintenance The provider group name can be updated from the user interface Reference Lists Added the ability to denote Lab Normalcy Status by facility XML Customizations: The user level can now be used to determine where to apply customizations (new Apply to user Level field)

Provider Directory Provider Directory – NPI field can be used as an alternative to the UPIN field. -The category name is no longer displayed next to the category data on the web and the handheld browser. -You can now change the column header names though an XML customization. -Selected users can now edit data in the Provider Directory. Updates are allowed via this setting: Admin>User>Edit Settings – User Permissions from the CanEdit Provider Info in Provider Directory field.

Provider Directory To update a Provider entry: Search for a provider and then select the related provider for viewing in the Provider Directory. From there the Edit Provider button will be displayed if the user has the related permissions. Notes: 1. No additions can be made from the edit function. 2. All edits will be replaced when a new Provider Directory Upload is executed.

Administration – New Options and Backend Updates Patient Search - We now have the option of making fields required for executing a Patient Search by using an XML customization (when configured). Printing Options - Some reports have been updated to allow printing of Facility/Division icons. Meditech Bridge – The timeframe for pulling data for scheduled visits has been extended to include scheduled visit data from the past. Previously patient data was only pulled a maximum of three days from the past. Purge - The option to purge clinical information has been added to the system. This backend process is being tested by HCA Corporate. Heights and weights are now configurable as pounds/ounces, pounds, or kilograms and height as either feet/inches, inches, meters or centimeters. For systems that previously had combined weight readings (such as lb/oz), new combined weights will begin to store separately from the old combined readings after the upgrade. h

Administration – New Options and Backend Updates CAP Lab Report Printout Options – The image, title, label for user name of the person printing the report, label for print date/time, and subtitle above the report headings can be updated via DXML customization. Header Bar - An XML customization is now available that will display the patient location and other information such as account number and date of birth on the header of the Patient Data Display pane. iOS Version Tracking - On Apple devices, the iOS version data is now updated each time that Apple users sync. Previously this information was only sent to the server when devices were provisioned. The Bulk Upload process (see PK for details since this is not a web supported function ) has been updated to allow the associated Domain for environments that have multiple domains.

Manual Registration A warning displays if a patient is being created with an existing MRN. Additional registration fields may now be added via an XML customization. Added the ability to change the existing Visit type from the Edit Visit option. The MRN automatically populates to the function when registering a patient that was not found by searching with last, and first name and MRN using the Patient Search.