ehr patch updates office hours ehrv1.1p7, tiuv1.0p1007, bhsv1.0p4, venv26p2: what’s new, what’s...

EHR Patch Updates Office Hours

EHRv1.1p7, TIUv1.0p1007, BHSv1.0p4, VENv26p2:

What’s new, What’s changed

IHS-Office of Information TechnologyEHR Program

Agenda• Introduction• Presenters

– Office Hour Presenters have different specialties within the EHR system who will be responding to your questions

• Questions/Answers– “Raise your hand” through the WebEx features provided– Please state your name/site– Please state your question clearly– Please keep background noise to a minimum to better hear the

questions/answers

• Patch 7 Resources– Patch 7 resources will be placed on FTP site (RPMS patch

folder) for your review after session– If you can not access the FTP site please e-mail

[email protected] for a copy

Office Hour Presenters• CDR Susan Pierce-Richards, ARNP, OIT EHR Project Lead• CDR Mary Ann Niesen, PharmD, OIT, ARRA Deployment Pharmacist• CDR James Gemelas, RPh, CAC, Chair IHS Pharmacy PSG (Warm

Springs)• Barbara Hess, ABD, OIT EHR Project analyst

What do I do if I haven’t installed EHR patch 6 yet?

• You have a lot of work to do!

• Need to engage IT and Pharmacy Ad Pac to prepare

• Go back and review the EHRv1.1p6 recorded web ex presentationsRecorded Web Ex trainings Posted here under Electronic Health Record

http://www.ihs.gov/RPMS/index.cfm?module=home&option=OITTrainingLinks

• Install EHRp6 prior to installing EHRp7

Topics

• TIUv1.0p1007

• BHSv1.0p4

• VENv26p2

• EHRv1.1p7– New Features/Modifications– Fixes– Known issues

TIUv1.0p1007

Installation

• Mega patch to provide infrastructure. Must install 2 small USR patches at the same time.

• Install with users OFF system

• There is some mapping of 1 document title and some labs so have that ready– This is configuration of a VA specific tool

TIUv1.0p1007

During install you’ll be prompted to select a document class, you can accept the defaults or change

Running Pre-Install Routine: EN^TIUWRII1

Select the DOCUMENT CLASS where the new title will be installed:

NURSING DOCUMENT CLASS DOCUMENT CLASS

TIUv1.0p1007

Enter your site's local lab name for CBC: CBC

1 CBC CBC/COMPLETE PROFILE (retired)

2 CBC HEMOGRAM

CHOOSE 1-2: 2 HEMOGRAM

Creation of TIU Object VA-WRIISC CBC successful...

During install you’ll be prompted for several lab names:

• CBC• Glucose• Hematocrit• Hemoglobin• Hepatitis C Antibody• Potassium• Sodium• Urinalysis

TIUv1.0p1007

New options and Menu

A new menu was created for the new VA options.

This new menu will be on the BTIU MENU2. It contains the new options

HIMS Special HIMS TIU Reports ... [BTIU SPECIAL REPORTS]

1 Missing Text Report [TIU MISSING TEXT NODE]

2 Missing Text Cleanup [TIU MISSING TEXT CLEAN]

3 Reassignment Document Report [TIU REASSIGNMENT REPORT]

BHSv1.0p4

New Health Summary Components ASTHMA CONTROL ASTHMA PLAN (Asthma Action Plan) ACTIVE WAIT LIST ENTRIES MEDICATION RECONCILIATION BRIEF DEM W/ADV DIRECTIVE IHS-IMAGING NUTRITIONAL RISK

SupplementsANTICOAGULATION THERAPYASTHMA PATIENT CARE

BHSv1.0p4

Updates/Fixes

Updates to sync with IHS Heath Summary changes

Changes being delivered in BJPCv2.0p5 (in beta) are scheduled for BHSv1.0p5

VENv26p2*** If you are currently using Well Child Module you MUST install this patch.

EHR now logically deletes measurements a user deletes or changes (stores as entered in error in the background) and the Well Child Growth Charts and Graphs will not display correctly until you install this patch ***

Install• VENv26p2 is a cumulative patch and installs the Well Child Module for

EHR• If you previously installed VENv26p1 and are using the Well Module for

EHR you only need to install KIDS.• If you have never installed the Well Child Module for EHR, then you install

VENv26p2 – both the KIDS and the set up file (.exe).

Fixes• Very small patch to correct 2 issues

– Filters out entered in error measurements on the Growth Chart and Graph– Stores patient education time as an integer correcting a problem with uploading

non integer data to the IHS Data Warehouse

EHRv1.1p7 New Features/Modifications

• Vital entry

• Medication reconciliation

• Lab POC parameter added

• New reminder dialog prompts

• Quick Notes

Vital entry

• “New date/time” button changeWhen you click New Date/Time you will see this dialog. It is defaulted to NOW, you may change to the Current Visit date and time by clicking the radio button. You may also change the date/time by using the calendar […] button

Vital entry – Historical Measurement entry

• Historical Measurements can now be entered through the Vital Entry component Historical entry is designed to capture measurements transcribed from

outside records, such as birth weight, cardiac ejection fraction from Echocardiogram report.

First click the Historical Visit radio button

============================== This is NOT late entry!

This creates a historical event!! ============================


• After clicking the Historical Visit button the Select Location for Historical Entry is presented


• After clicking OK on the Select location for Historical Visit dialog you are returned to the Select New Date/Time dialog.

• Enter the Date/Time of the historical measurement


• After clicking OK, the column with the Historical date/time is available for entry. Enter the historical measurement and click OK.

• This will store this

as a historical EVENT

type visit.

Medication ReconciliationOutside Medications

component now enhanced to assist with medication reconciliation.

If a patient cannot remember the med name, you can use the miscellaneous outside med (set up in P6 instructions) and enter as much or as little as the patient can give you)

Medication Reconciliation

Dosage, route and schedule are not required.


New fields for added info


New action – to alert user that more info is needed before med is reconciled.


New statuses

Lab POC parameterNew parameter added to control whether the

Ordering Provider is auto-populated or not based visit context provider.

BEHOLR SET DEFAULT PROVIDER ------ Setting BEHOLR SET DEFAULT PROVIDER for

Division: DEMO HOSPITAL ------Set default provider: ?? Parameter is used by the LAB POC component to

determine if the provider set in the visit context should be used as the ordering provider of the POC test.

Lab POC parameter---- Setting BEHOLR SET DEFAULT PROVIDER for System: DEMO-

HO.BEM.IHS.GOV ----

Set default provider: YES//

When this setting is used, the Ordering Provider defaults to the visit context provider or “doc in the box”

Lab POC parameter---- Setting BEHOLR SET DEFAULT PROVIDER for System: DEMO-

HO.BEM.IHS.GOV ----

Set default provider: NO//

When this setting is used, the Ordering Provider defaults blank and the user must select the appropriate provider

New reminder dialog prompts

• The following measurements may now be used to create reminder dialog prompts.

• Use only for resolution type “done at encounter.”

AG

ADM

AKBP

ASFD

AUDC

AUDT

BPF

CEF

CRFT

ED

FEF

FEFC

PF

PHQ2

PHQ9

TON

WC

Quick Notes• Provides shortcut for users from a button that

can be placed on the toolbar• Clicking quick note opens note and template (or

reminder dialog template) based on predefined settings– Can have several different quick notes that create the

same note title but each quick note launches different template or reminder dialog template

• Can also be configured to create a visit. This is appropriate for the following type visits:– Chart review– Telephone calls– Telephone triage– Non-ambulatory case management

Quick notes set upAssign CAC access to create/modify quick notes

CIAOQN QNOTES MODIFY - To assign access to the modify function.

Keep in mind that this allows the user to modify both personal and public quick notes.

• Consider restricting modify access to CAC and/or IT. • You will need to provide temporary modify access for users to set up their

personal quick notes. • Recommend CAC providing assistance with general users in setting up any

personal quick notes. • After the user has created their personal quick notes, the CAC can remove

access and the user can still use the quick notes.

CIAOQN PROMPT COSIGNER - used to prompt user for cosigner. This parameter controls whether or not a user will see the cosigner

dialog when TIU reports that a cosigner is required. If set to NO and the user has a default cosigner, the user will not see the dialog.

Quick notes – set upYou need to know the following (write it down)

1. What note titles you want a quick note to open2. What template you want to populate the quick note

(write down the template/reminder dialog template name – case sensitive)

3. Do you want this quick note to create a visit and if so what kind

• Would be mostly chart review or telephone but could be “on the fly” ambulatory visits for users who see drop in patients like PHN’s or DM educators.

4. Will this be public or personal• If personal, then the person who will use this needs temporary

access to create/modify to make this one

Quick notes – add to EHR GUI

• Super simple – add like any object. Best suited to toolbar so users can launch from anywhere in chart

Creating a quick note

Click the quick notes button

Then click Create


Name the quick note and

select Personal or Public


Type in the note title – it will search with part of the name


Now put in the template or reminder dialog name in.

BE SPECIFIC – it searches all templates. Remember the system sees each template “part” of dialogs as individual templates!

Creating a quick noteFor a note written by a

user during an ambulatory visit, you will have a visit created already and the user will be logged in. Selecting “Use Visit Dialog” and “Use current user for visit provider” will allow the user to quickly launch the note from within the visit.

Click SAVE

Creating a quick noteFor common on the fly type

documentation such as phone triage, you can force the creation of the visit when the note is launched.

Visit Category of TelephonicVisit Location of Phone-

RedlakeClicking User current user for

visit provider picks up the logged in user as provider, this would be most common

Set visit context – this is important because if you need to add any other visit data or orders the visit context will be set.

Using quick note

Click Quick Notes button

Then select the Quick Note and double click

Using quick notes

For this one, it creates a visit, starts a note and opens the template:

Editing quick notes

Launch quick notes and click on Quick Notes

Click Remove to delete

Click Rename to change name

Click Properties to bring up the

configuration dialog again

User launches from button that may be placed on toolbar

Quick Notes launches note AND

TIU template (creates text note)

OR

Reminder Dialog template (enters RPMS data and creates text note)

Can be configured to auto-populate clinic, hospital location and provider

Fixes• Clear now fully clears EHR screen• Outside meds are no longer duplicated on Cover Sheet• APSP 1009 fixed the problem with auto-finishing renewed meds• Inpatient panel now restored (was dropping off when patients were

discharged too early)• Copy to new order default to the pick up location in original order• Message field, if configured in the drug file, now appears on med order

dialog on new, change, renew, copy dialogs• Patient ed topics can now be stored more than once per visit.• The bug forcing the chart copy parameter to be set to prompt post patch 6

has been corrected • CPT modifiers are now returned when EDIT V CPT. This was only noted

on sites with CSV installed and has been corrected.• Edema (measurement) now allows entry of Zero• Entering DBP>SBP no longer allowed• Suicide reporting form updated to most recent Behavioral Health version

*** See patch notes for full list ***

Fixes – proper storage of provider narrative from Pharm Ed and

Reminder Dialogs• Provider Narrative text was storing as text

instead of a pointer to the Provider Narrative file in the V POV File. – This has been corrected– A post install utility will run to cleanup

incorrect values

Fixes - notifications• EHR Patch 6 changed the way notifications were

displayed. This was code from the VA software. • Only notifications for patients registered in the logged in

division appeared. • Display of notifications was restored to pre EHRp6

functionality– Although this was "working as designed" in EHRp6, with

feedback from the field the EHR team decided to restore the display so that all patients, even those patients not registered in the current logged in division, would be displayed for the user.

– Although a user may need to log into a different division to resolve the notification, the user will always be able to see all notifications intended for him or her.

Known issues/Planned enhancements

BEHOPTCX REQUIRES HRN parameter is only honored when selecting patient from the Patient context box (Patient Identification Header component).

ProblemUsers can enter the record from the Notifications tab if they receive a notification on that patient. Providers can process notification per usual; however, acting on information from the notification, the provider could inadvertently create a visit on a patient in a division in which the patient is not registered.

FixA future patch (EHRp9 or 10) will add a check of this parameter when entering a chart from notifications and honor that parameter.


Vital Entry Dialog New date/Time button now launches a dialog with 3 radio buttons: Current Visit, Historical Visit and Now. The default is NOW. This might not be the preferred default for all users.

Scheduled EnhancementEHR patch 9 (tentative) will deliver the ability to set the default as “Now” or “Visit Date/Time” as a parameter and will be available on the Vital Configuration menu in the RPMS EHR Configuration Master Menu.


Entering Historical Measurements through Reminder Dialogs is not available yet.

IssueNow that historical measurement documentation is available in the EHR Vital Entry, sites would like the same functionality in Reminder Dialogs. This has never been available and currently stores “now” if you try to set up a measurement dialog element using resolution type “done elsewhere.”

Scheduled EnhancementEHR p8 will deliver the ability to enter historical measurements through Reminder Dialogs.


Immunization component auto-population of CPT and ICD-9 codes Due to the frequency of updates/changes to codes included in immunization, CPT and ICD patches, the hard-coded auto-populating from the Immunizations component is extremely difficult to synchronize. Functionality exists that is more efficient.

Scheduled EnhancementEHR v1.1 Patch 9 will default package level setting of “Stop Immunizations from Adding CPT codes (CPT)” to YES. This will provide time for sites to select and implement a solution.

*** Sites need to decide how they are going to configure their system to assist users with coding of vaccines. Solutions include super bill associations, reminder dialogs or a combination of both. See patch notes for suggestions ***

Resourceslinks will be active AFTER patches released!

EHRv1.1p7 guideftp://ftp.ihs.gov/rpms/patches/ehr_0110.07o.pdfTIUv1.0p1007 notesftp://ftp.ihs.gov/rpms/patches/tiu_0100.1007nBHSv1.0p4 notes (Health Summary Components)ftp://ftp.ihs.gov/rpms/patches/bhs_0100.04nVENv26p2 notes (Well Child Module)ftp://ftp.ihs.gov/rpms/patches/ven_0260.02nftp://ftp.ihs.gov/rpms/patches/ven_0260.02o.pdfRecorded Web Ex trainings Posted here under

Electronic Health Recordhttp://www.ihs.gov/RPMS/index.cfm?

module=home&option=OITTrainingLinks

ehr patch updates office hours ehrv1.1p7, tiuv1.0p1007, bhsv1.0p4, venv26p2: what’s new, what’s...

Documents

ehrp7 slide

0p1007 new options

new menu

0p1007 bhsv1

whats new

new title

new va options

oit ehr project analyst