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EHR Patch Updates Office Hours
EHRv1.1p9
What’s new, What’s changed
IHS-Office of Information TechnologyEHR Program
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Office Hour Presenters• CDR Susan Pierce-Richards, ARNP, OIT EHR Project Lead• CDR Mary Ann Niesen, PharmD, OIT, ARRA Deployment
Pharmacist• Barbara Hess, DHA, OIT EHR Project analyst
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Agenda• Introduction• Presenters
– Office Hour Presenters have different specialties within the EHR system who will be responding to your questions
• Questions/Answers– Please do not put your phone “On Hold” during the
conference call– “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 9 Resources
– Patch 9 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
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FIXES
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FixesComponent Issue
Allergy/ADR -Properly filters out “Other Reaction” for both reactant and sign/symptom
CCD viewer -No longer hangings on VPN session-PDF generation with IE9 fixed-No longer allows query if no patient selected-Print/Save button disabled until processing complete
Chart Review -Adding problem from Visit Diagnosis or Historical Diagnosis now stores Reviewed and Updated
CSV -ICD9 look up now returns long narrative text
Immunizations
-No longer populate CPT codes-Education now stores properly when “Patient/Family Counselled by provider” checked.
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FixesComponent Issue
Notifications -Flagged OI Expiring notifications work properly now-Now honors BEHOPTCX REQUIRES HRN parameter and if set will not allow user to process a notification for patient not registered in logged in division.
Order Checks
-Height and Weight limits now honored for CT and MRI order checks
Outside Med Details
-Documented by now displays logged in user rather than visit context provider
Quick Order -Now honors default Clinical Indication set in Quick Order
Patient Education
-Text now properly wraps when viewing standards
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FixesComponent Issue
Reminder dialogs
-Measurements “done elsewhere” now store the correct date/time
Reminder dialogs
-No longer creates second Primary Provider when processing reminder dialogs on inpatients
Reports -Requestor no longer displays on Outside Medication entries in the Order Summary Reports
Suicide Form -Updated to current Behavioral Health GUI
Visit Context -Now excludes ancillary inpatients when selecting visit
Windows 7 -Superbill and Patient Education check box behavior resolved
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NEW FEATURES/CHANGES
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New FeaturesFunctionality Features
Med Order Dialog Clinical Indication PromptMed Order Field RestrictionsPharmacy type settings
InternalInternal/ExternalExternal
Controlled substance prescribing parameters
Pre-placed for future useCII prescribingExamples
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New FeaturesFunctionality Features
Printing prescriptions and medication orders
Queue PrintRx Print Format (template) editorRx Printer Configuration
RPMS parametersRx Printer Preferences editor
Configuration Summary
All sitesInternal set upInternal/external set upExternal set up
Screen shots Med Order ExamplesPharmacy Search ExamplesPrinting examples
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MED ORDER DIALOG
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Clinical Indication promptICD9 coded clinical indication now required for
medication orders*** The changes for Med Orders were done to comply with eRx
requirements ***
• You must select an indication for each med order• New med order will display a blank clinical indication
– Not pre-populated with the last entered – This is a change, please alert your providers
• Offers Problems, POV’s after filtering out un-coded diagnoses, “Other”
– “Other” search returns only coded entries for selection
• Renew, Copy and Change pre-populates with clinical indication of the original order*** Tip ***Encourage maintenance of clean problem listsEncourage selection of POV prior to ordering medications
Once a clinical indication is chosen, the indication “follows” the medication order through its lifecycle (refill, renew, change, copy)
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Clinical Indication prompt
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Med order field restrictions• Character limit is 140 characters for
transmitted prescriptions• Character limit for comments is 210
characters for transmitted prescriptions
*** Tip ***Recommend setting APSP AUTO RX ADD PRV COMMENT to No at the system level
Add “Comments” to the bottom of Prescription template to communicate comments to outside pharmacist
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Setting Pharmacy type
The APSP AUTO RX parameter sets the type of pharmacy you have.
You will be required to set this for electronic prescribing.
*** Tip ***The APSP AUTO RX setting and associated parameters are designed for use in advance of electronic prescribing and provide enhanced Med Order dialog and Prescription/CII order printing capability.
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Benefits of setting APSP AUTO RX
1. Enhanced Med Order dialog with pick up locations presented to prescriber based on facility type and other configurable settings.
2. Can enable “Internal/External” and “External” without using ePrescribing
– Meds for outside fill are auto-finished and queued for printing– Can help sort out workflow issues prior to eRx
3. Enhanced printing– CII order for signature, CII prescriptions, Non CII prescriptions and
receipts for electronically transmitted prescriptions “queued”– Configurable default settings for formats and printers.– Click sends all jobs to appropriate printers.
*** Tip ***There is now a “P” (for print) for pick up location in Quick Orders
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Pharmacy Type Settings
APSP AUTO RX Setting
Internal Patients only fill Rx written by in house providers at in-house pharmacy1.In house options for Clinic, Mail, Window retained2.CII order for signature queued to print
Internal/External
Patients fill Rx written by in-house providers at in-house and outside pharmacies
1. In house options for Clinic, Mail, Window retained- CII order for signature queued to print
2. Prior to Surescripts® set up/deployment enables the “Outside Pharmacy – Print” functionality
- Auto-finishes meds upon signature and queues prescription for printing3. After Surescripts® set up/deployment enables the “Outside Pharmacy – eRx
functionality - Auto-finished meds upon signature, transmits and queues receipt for printing
External No in-house pharmacy1. All med orders auto-finish upon signature2. Prior to Surescripts® set up/deployment enables the “Outside Pharmacy – Print”
functionality - Auto-finishes meds upon signature and queues prescription for printing
3. After Surescripts® set up/deployment enables the “Outside Pharmacy – eRx functionality
- Auto-finished meds upon signature, transmits and queues receipt for printing
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Pick up locationsMed order dialog has 5 pick up locations exposed to the user depending on APSP AUTO RX
parameter settingsPick up location APSP AUTO RX SPI* Status on signature
Clinic InternalInternal/ExternalExternal
N/A PendingPendingActive
MailWindow
InternalInternal/External
N/A PendingPending
Outside Pharmacy – eRx **Requires Surescripts® implementation and population of SPI
Internal/ExternalExternal
YesYes
ActiveActive
Outside Pharmacy – Print Internal/ExternalExternal
N/AN/A
ActiveActive
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Setting Pharmacy Type
APSP AUTO RX - set at division or system
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CII-V electronic prescribing parameters
APSP AUTO RX ERX OF CII• Pre-placed for eventual allowance of electronic
transmission• Defaulted to “null” which disallows transmission• Not editable at this time
APSP AUTO RX SCHEDULE RESTRICT• Pre-placed for eventual allowance of electronic
transmission• Defaulted to schedules 2,3,4 & 5 to disallow
transmission• Not editable at this time
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Med Order Dialog examples:Pick up locations
Internal – Legend and Controlled drugs
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Pick up locationsInternal/External – non CII, provider has SPI
Internal/External – CII orNon CII and provider has no SPI
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Pick up locationsExternal – non CII, provider has SPI
External – CII and/or provider has no SPI
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CII prescribingAPSP AUTO RX CII
PRESCRIBING You may now restrict CII
ordering at the following levels ***– User– Class– Division– System
*** Tip ***When set the “CII ordering disabled” dialog pops up when a user selects a CII drug from the Medication Order dialog
*** This works for meds ordered via Medication Order (ie. “other meds”) and not quick order menus. EHRp10 will add this functionality
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PRINTING FUNCTIONALITY
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Printing functionality• “Smart logic” is used to determine which order
requires a print job and if so which type based on– Status (Active or Pending)– Pick up location – Type of drug (Controlled or not)
• “Queues” the print jobs for printing• Formats may be defaulted to specific templates• Formats may be defaulted to specific printers
at the User, Location, Division and System level
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Queue PrintFacility type
Pick up location Status after signing
CII?
Print format Icon
Internal
ClinicMailWindow
ClinicWindow
PendingPendingPending
PendingPending
NoNoNo
YesYes
N/AN/AN/A
CII Order for SigCII Order for Sig
External
Clinic
Outside Pharmacy – eRx
Outside Pharmacy - Print
Active
Active
Active
NoYes
No
NoYes
N/APrescription (CII)
Receipt (Non CII)
Prescription (Non CII)Prescription (CII)
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Queue PrintFacility type
Pick up location Status after signing
CII?
Print format Icon
Internal/ External
ClinicMailWindow
PendingPendingPending
NoNoNo
N/AN/AN/A
ClinicWindow
PendingPending
YesYes
CII Order for SigCII Order for Sig
Outside Pharmacy – eRx
Outside Pharmacy - Print
Active
Active
No
NoYes
Receipt (Non CII)
Prescription (Non CII)Prescription (CII)
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Queue Print
After signing, the meds that have print jobs are highlighted and the Queue Print button is active
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Queue Print
Click the Queue Print button and the print jobs are displayed, associated with pre-defined templates for each format and default printer (user may change)
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Reprinting
If you need to print a prescription due to failed transmission, re-print due to printer failure, or destruction of prescription you may do so. You may only print the day the prescription was finished and must put in a reason. Reasons for re-printing are logged.
• Highlight med you wish to reprint• Click PRINT button• Select Prescription (New Format) • Click “Print”• Select reason• Enter comment (optional)• Select printer (or accept default)• Click “OK””
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Order Detail
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Rx Print Format (Template) editor
Set up:1. Design mode> Desktop Properties> Custom Menus2. Add Menu item “Rx Template Editor”3. Add the following in Action (lightening bolt)
$(BEHRXGENERATORSERVICE.RXGENERATOR.edittemplates)
4. Click Apply and Ok5. Make sure you have BEH Rx Generator Service
checked under “required services”6. Only place on EHR GUI templates of those who are
responsible for editing Prescription formats (ie. CAC, pharmacy Ad Pac)
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Rx Print Format (Template) Editor
Design Mode Rx Template Editor
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Rx Print Format (Template) Editor
• Template type (format)– Prescription (Non-CII)– Prescription (CII)– Order for signature (CII)– Order for signature (Non-CII)– Receipt (Non-CII)– Receipt (CII)
• Template– Default template for each
template type delivered with EHRp9
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Rx Print Format (Template) Editor
Importing template:The files are .ptxml
files1.Save the files to a
local drive2.Open Rx template
editor3.Select template type4.Click Import5.Change the name if
desired, click OK
5. Click “active on”6. Select Yesterday
at 6:00 am, then OK
7. Now you may edit the template
8. Click OK to store
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Rx Print Format (Template) Editor
• Active on – set activation date (usually Yesterday at 6:00am)
• Preview – Display preview of current template
• Import – import template• Export – export template• Add Free Text – you may add as
many as you like. May include header info for format, alternate signature lines, etc.
• Mark Inactive – inactivates template so users cannot select
*** Tip ***To Copy a template - export, save and import:- Change to a local name on imports. - Set “active on” to Yesterday at 6:00 am.- Make changes then click OK
Highly recommend using the copy process and creating local templates rather than editing nationally delivered default templates ***
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Rx Print Format (Template) Editor
• Change font • Set fields for
inclusion, change print labels, and set columns in the Fields section
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Rx Printer Configuration
In RPMS set the BEHORX PRINT FORMATS parameter• Associates the Format
type with the Format (Template)
• May set at User, Class, Location, Division and System level
• Most commonly will be set at System or Division level
Select Format Type: ?? Instance values are (Commonly set
format types) : PC:RX CII PN:RX NON-CII OC:ORDER CII ON:ORDER NON-CII RC:RECEIPT CII RN:RECEIPT NON-CII LC:LABEL CII LN:LABEL NON-CII
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Rx Printer Configuration
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Rx Printer Configuration
Populate the BEHORX PRINT FORMAT TYPE
This associates the Format type: Order for signature (CII)
Prescription (CII)
Prescription (Non-CII)
Receipt (Non-CII) with a default printer. – Set at User, Location, Division or System level– In RPMS or in EHR Printer Preferences tool
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Rx Printer Preferences Editor
Set up:1. Design mode> Desktop Properties> Custom Menus2. Add Menu item “Rx Printer Config”3. Add the following in Action (lightening bolt)
$(BEHRXGENERATORSERVICE.RXGENERATOR.EditPrinterPreferences)
4. Click Apply and Ok5. Make sure you have BEH Rx Generator Service
checked under “required services”6. Users will only be able to set their own defaults7. Assign the BEHORX PRINT key for CAC/IT staff who
will set Location, Division, System settings
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Rx Printer Preferences Editor
Design Mode Printer Preferences
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Rx Printer Preferences Editor
Use dropdown to select level, template type, printer settings.
Click APPY to store the parameter.
To remove a parameter level, bring up the level and click REMOVE
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Rx Printer Preferences Editor
RPMS display parameterBEHORX PRINT FORMAT TYPE
RPMS enter/edit parameterBEHORX PRINT FORMAT TYPE
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CONFIGURATION SUMMARY
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Configuration steps – All Sites
*** This is in addition to pharmacy package optimization for eRx and Surescripts® credentialing/set up/deployment ***
Parameter Setting
APSP AUTO RX Appropriate facility type
APSP AUTO RX ERX OF CII Verify is set to Null at System Level
APSP AUTO RX ADD PRV COMMENTS
Set to NO at the System Level (recommended)
*** Tip ***DO NOT TOUCH ANY OF THE OTHER APSP AUTO RX PARAMETERS. The majority of these are for use in eRx configuration for Surescripts®. This is a separate set up and deployment!
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Configuration steps – All Sites
*** This is in addition to pharmacy package optimization for eRx and Surescripts® credentialing/set up/deployment ***
- Review Formats (Templates) for Prescriptions, CII order for sigs and Receipts using the Prescription Print service Template Editor tool and copy/edit accordingly
- Set BEHORX PRINT FORMATS parameter to set default format (template) for print Format types
- Determine printers for system, division and/or locations and set using Prescription Print Service Printer Preferences tool or the BEHORX PRINT FORMAT TYPE parameter.*** Tip ***
This is a business process review. Review current processes and optimize with new features.
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Internal Set UpAPSP AUTO RX
Internal Internal pharmacy only. Able to print “Order for Signature (CII)” using Queue Print button
BEHORX PRINT key
Assign to CAC, Site Manager
Allows GUI configuration of Rx printing
BEHORX PRINT FORMATS
Set default Template forOrder for Signature (CII)
BEHORX PRINT FORMAT TYPE
Set default Printer for Order for Signature (CII)
Depends on workflow
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Internal/External Set UpAPSP AUTO RX
Internal /External Internal pharmacy that also sends prescriptions out.Auto finishes on signature med orders with “Outside Pharmacy Print” pick up location.Enables printing of “Order for Signature (CII)”
BEHORX PRINT key
Assign to CAC, Site Manager
Allows GUI configuration of Rx printing
BEHORX PRINT FORMATS
Set default Template for: Order for Signature (CII)Prescription (CII)Prescription (Non CII)
BEHORX PRINT FORMAT TYPE
Set default Printer for the Order for Signature (CII)Prescription (CII)Prescription (Non CII)
Depends on workflow
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External Set UpAPSP AUTO RX
External External pharmacy – sends prescriptions out. Auto finishes on signature med orders with “Outside Pharmacy Print” pick up location.
BEHORX PRINT key
Assign to CAC, Site Manager
Allows GUI configuration of Rx printing
BEHORX PRINT FORMATS
Set default Template for: Prescription (CII)Prescription (Non CII)
BEHORX PRINT FORMAT TYPE
Set default Printer for thePrescription (CII)Prescription (Non CII)
Depends on workflow
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SCREEN SHOTS
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Med order examples
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Med order examples
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Med order examples
• Click on Outside Pharmacy – eRx
• Click on search button to locate pharmacy
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Pharmacy search
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Pharmacy search
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Pharmacy Search
Highlight chosen pharmacy and click OK
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Printing
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Printing
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Resourceslinks will be active AFTER patches released!
EHRv1.1p9 guideftp://ftp.ihs.gov/rpms/patches/ehr_0110.09o.pdf