1. AHLTA Documentation Tips and Efficiencies

2. AGENDA
Optimal Settings
Templates
Team Documentation
AHLTA tools
Time saving strategies
Cross Product/Cross Environment Access

3. NOT......
Teach you how to code
How to get a 9921x with every encounter
Decide what AHLTA really stands for
Reveal the new EHR solution
Provide System Admin training

4. Disclaimer
Patient names shown in the slides are certified as fictional, are created only for training, and without intended correlation to real people.

5. Optimal 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)
AHLTA
Release 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)

6. Optimal Settings (Health History)
Access Health History from Folders List
Select Options to open Health History
Configuration window

7. Optimal Settings (Health History)
Select Vital Signs Review from drop down menu
Uncheck “Do Not Retrieve”

8. AHLTA Customizations
With opened encounter, click Options to reveal Encounter Summary Properties and customize your AHLTA Settings.

9. Suggested AHLTA Customizations
Signature Block (job title, Co-Signer)
Minimize AutoCite preferences
Convert (+) ROS to HPI if using a Medcin Template
E&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 note
Don’t default TSWF or Usability AIM Forms
Don’t use Merge Dx Prompt/Prompt with Default Template

10. AHLTA Customizations: Setting Order of Columns
Drag and drop Column headings to configure the order of columns in Appointments and Telephone Consults Modules
Click on Column headings to re-order lists based on that column data

11. AHLTA Customizations: Appointments Module
From the Appointments Module, click on Options to customize Appointment Module settings.

12. AHLTA Customizations: Telephone Consults Module
From the Telephone Consult Module, click on Options to configure Telephone Consult Module Settings

13. Templates
The best time saver
Default template (except TSWF, Usability AIM)
TSWF
Usability AIM Form
Generic example

14. Templates: Advantages
Most efficient documentation process
Minimizes duplicative efforts
Standardizes documentation process
Configure readable notes
Familiarity facilitates efficiency
Promotes patient safety
Improved coding compliance

15. Template Management Purge unnecessary Templates
From Template Management:
Select ‘Default Encounter Template to set a Default Encounter
Right click to remove the template from your favorites

16. Template Management Make the most of improved Template Management:
Use Edit to modify existing templates
Add Order sets
Use “Add To Default Template” to modify your default template while documenting an encounter.

17. Templates: Approved templates
Borrow don’t build templates. Look for “approved” templates in the Enterprise Folders based on specialty.

18. The Tri Service Workflow (TSWF)
The TSWF
The Tri Service Workflow (TSWF)
Workflow concept built around a core AIM form
Team documentation effort
“Live” Document
Takes advantage of effective AHLTA features, overcomes AHLTA challenges to create:
“One form fits all” concept
Manageable Problem List, Medication List, Family History
Readable notes
AHLTA down-time solution
CPG compliance
Coding guidelines

19. AHLTA Tri-Service Workflow
Tri-Service AIM Form
Provider takes over note
Provider reviews tech input 19 19

20. Usability AIM Form
Alternative to the TSWF
“One form fits all” concept
Presents data in easy to select format
Includes care guidelines
Does not include team documentation concept
Not Tri-Service approved content
No longer updated

21. Usability AIM Form
Usability AIM form: “One template fits all”
Do not Default.

22. Usability AIM Form
Usability AIM Form: Presents data in easy to select formats

23. Usability AIM Form
It even includes care guidelines

24. Generic Template
Generic 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 circumstances
Tendency to get too big

25. Team Documentation
Procedures, lists, med recon, questionnaires, etc
Use a common template
Make sure you take over note correctly
Support staff can document all but the HPI

26. Take Over the Note
To 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.

27. Take Over the Note
The Provider can edit the support staff’s note accordingly.

28. Take Over the Note
The 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)

29. Take Over the Note
Staff 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

30. AHLTA Tools
Check-out
Favorites List
Copy forward
Dx prompt
Spell Checker Macros
Voice dictation

31. Check-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.

32. Check-Out
Use 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.

33. Check-Out : Update Check-out Data
From the Tools Menu, select Update Check-out Data to configure the Print Orders (Instructions) template.

34. Favorites Lists
Use 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.

35. Copy Forward
To use the Copy Forward function, open a current encounter.

36. Copy Forward
Go 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

37. Copy Forward You are returned to the current encounter.
Click the S/O or A/P button.

38. Copy Forward
Positive 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.

39. Copy Forward
The A/P information associated with the previous encounter will display on the appropriate tabs. (i.e. Diagnosis)

40. Copy Forward
The A/P orders associated with the previous encounter will display in the order set tab.

41. Dx Prompt
This 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.”

42. Dx Prompt
Dx 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.

43. Spell Checker
Built into AHLTA SP1 (in case you didn’t notice)
Can create some conflicts if using As U Type
Macros capability

44. Creating Macros
With an opened encounter, right click inside a text box (S/O or A/P)
Select “Autocorrect Options”

45. Creating Macros
3. Make sure “Replace text as you type” is selected from AutoCorrect Options

46. Creating Macros
4. Type in the name of your macro in the “Replace:” box
Type in the macro phrase in the “With:” box
Click on “Replace” to store your macro phrase in the Dictionary

47. Creating Macros
Type 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.

48. Voice Dictation
This is the logo for Dragon Naturally Speaking 48

49. Time Saving Strategies
Minimize size of Template Favorites
Complete A/P first
Standardize processes and training
Be prepared for catastrophes
Avoid temptations to postpone documentation
Don’t let providers do all the documentation

50. BHIE Share BHIE Share DoD FHIE/BHIE Framework VA BHIE CHCS CPRS or
VistAWeb
SHARE GUI
BHIE Viewer
BHIE-T
BHIE-Essentris
BHIE-AHLTA
BHIE
FHIE/BHIE
Framework/
DoD MPI
Master
Patient
Index
VistA
CHCS
CDR
Essentris
TMDS

51. BHIE Share: Web Link Access
Essentris Web Links
AHLTA Links Folder
THIS !
NOT THIS!

52. BHIE Share
Type in your CHCS Credentials to Logon
Select the Site Link that corresponds to your MTF and save to your Internet Favorites

53. BHIE-Share vs BHIE-AHLTA
More robust data
Faster retrieval
Local and remote data retrieval
User Preferences

54. BHIE Share: Patient Summary
The Patient Summary Page loads when a patient is selected
View details of results by selecting hyperlinks
Page may be configured to user preferences
Patient Data Categories: Select Documentation to retrieve Essentris notes

55. BHIE Share: Remote Data
The Patient Summary Page loads when a patient is selected
Remote data auto loads by Health Data category if available
Date range defaults and display may be set in preferences, dates may be changed on the Summary Page

56. BHIE Share: Essentris Notes
Sample Essentris Note:
Available in Documentation Patient Health Data category
View by clicking hyperlink in Documentation box of Patient Summary Page
Requires Essentris configuration (LOINC code) to be viewable in BHIE-Share

57. Virtual Lifetime Electronic Record (VLER) Health Enterprise

58. VLER: 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.

59. External Health Data Viewer: Patient Summaries

60. VLER: Patient Summary Document
Patient Summary Data Categories
Patient Demographics
Allergies
Medications
Problems
Diagnostic and Lab results
Next-of-kin/Emergency Contacts
Vital Signs
Immunizations
Procedures/Surgeries
Appointments/Admissions
Insurance Provider/Payer

61. VLER: Patient Summary Document

62. References
All reference materials will be loaded on the DHIMS Knowledge Sharing Site (KSS). For more information, please visit:
Follow onscreen instructions to create an account
Request to join desired content groups
Type in desired topic in Search window (do not hit Enter)
Select from created drop-down list
Download and/or review desired content

63. SURVEY
SURVEY
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64. QUESTIONS?