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Using Common EHR Functionality in eClinicalWorks to Help Improve Population Health

• This document summarizes common functionality in Electronic Health Record (EHR) software and the corresponding nomenclature used by eClinicalWorks to describe a particular function.

• The functionality described in this document may help health care systems and health care providers improve clinical quality and population health through more consistent patient identification, communication, and adherence to clinical pathways.

Please note:

• This document has not been reviewed or endorsed by eClinicalWorks. The user is solely responsible for implementation, testing, and monitoring to ensure proper orientation in the EHR system. Merck does not take responsibility to revise this high-level summary if the software changes.

• The high-level summary document is for eClinicalWorks. The functionality described in this summary may not apply to all available versions of eClinicalWorks and capabilities may vary based on each individual EHR system.

• While EHRs may assist providers in identifying appropriate patients for vaccination, the decision regarding whom to vaccinate should ultimately be decided by a provider in consultation with a patient, after a review of the patient’s records to determine eligibility.

Objective Functionality

Identifying gaps in care, assess patient adherence, and practice performance

Registry ReportsRegistry Summary ReportsDashboards (Overviews)

Expanding communications with patients via the patient portal, email, or hard copy

MessengerAppointment Reminders (Patient Recall)Visit Summary

Enhancing point-of-care interactions Immunization ScheduleClinical AlertsOrder SetsDocumentation Templates

1

2

3

Imm / T. Inj Encounters Structured Data Structured Reports Referrals Reports Allergies

Demographics Vitals Labs / DI / Proc. ICD CPT Rx Chief Complaints Medical History

Results Date Range to

CPT Codes Sel90715

Save Queries Run Subset Run NewRun Subset (NOT)

Imm / T. Inj Encounters Structured Data Structured Reports Referrals Reports Allergies

Demographics Vitals Labs / DI / Proc. ICD CPT Rx Chief Complaints Medical History

Results Date Range to

ICD Codes SelE08

Save Queries Run Subset Run NewRun Subset (NOT)

Search TypeSearch in AssessmentsSearch in Problem List

Select Assessments

Switch To Classic Search IMO Selected Assessments

—No Suggestions—

Smart Search

Did you mean?

Problem List

Previous Assessment

Real Time

Mail Merge

Chart Data

Open Clear Add Edit Delete

Diabetes

ICD Diagnosis SNOMED

Go

Code Diagnosis SNOMED

E08.0 Diabetes mellitus due toE08.1 Diabetes mellitus due toE08.2 Diabetes mellitus due toE08.3 Diabetes mellitus due toE08.4 Diabetes mellitus due toE08.5 Diabetes mellitus due toE08.6 Diabetes mellitus due toE08.7 Diabetes mellitus due toE08.8 Diabetes mellitus due toE08.9 Diabetes mellitus due to

E08.0 Diabetes mellitus due to underlying

OK Cancel

<

<<

>><<

Save Registry Report

CancelOK

X

NameOverdue Influenza

Due and Overdue for Influenza …

NamePatients with diabetes with Influenza CPT code

Flowsheet to use

CDSS Enabled

ExampleHOME ENHANCEEXPAND> IDENTIFY

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OBJECTIVE 1:

Identifying gaps in care, assess patient adherence, and practice performanceFunctionality: Registry Reports

Registry Reports can be run based on many criteria, including demographics, lab results, diagnosis, procedures, prescriptions, immunizations and vital signs.

To create Patient Lists:

1. Select Registry Reports from the left navigation.

2. Select appropriate criteria from each tab.

Example: List of patients with diabetes past due for a flu vaccination

1. From Registry Reports, select the Diagnosis tab. Select an appropriate diagnosis. Select Run New. Utilize ranges of ICD-10 codes (e.g. E08-E13)

rather than adding each code individually.

2. Select the CPT tab, and enter an appropriate CPT code. Select Run Subset (NOT). Run Subset or Run Subset (NOT) should

be selected with each criteria.

• Save Queries as Registry Report to repeat them consistently with fewer steps.

• Check CDSS Enabled to enable reminders for patients meeting query criteria.

• Use the reports as part of a defined workflow for measurable improvement.

2

CPT=Current Procedural Terminology. Copyright © 2016. American Medical Association. All Rights Reserved. CPT is a registered trademark of American Medical Association.

ICD-10=International Statistical Classification of Diseases and Related Health Problems Copyright © 2016 American Medical Association. All Rights Reserved. ICD-10 is a registered trademark of American Medical Association.

Client (Facility)

*use control key to select more than one option

Patients seeing PCP at selected Client(s) /Site(s)Patients seeing Any Provider at Selected Client/Site(s)Patients Referred to a Provider with in the Selected Client/Site (s)

Registry Enabled PatientsAll PatientsOnly Active PatientsPatients continuously enrolled for the selected date rangePatients visiting PCP for the selected date range

*Site (Facilities)

*Insurer:

Provider:

NP/PA:

Patients With:

Age Group:

Date Range:

Report Name:

From

Start Date End Date… …

To

--Select NP/PA--

--select Age Group--

Registry Summary Report

Report Type: PDF Report

Generate Report

All Documents

All Insurances

Reporting Home Page

Female

REGISTRY SUMMARY REPORT

DEMOGRAPHICS TEST INFO

Gender

Age

Influenza147 50.3%

Male145 49.7%

<=140 0%

15-40

41-64

>=65

26 8.9%

160 54.8%

106 36.3%

Patients Immunized75 25.7%

% to goal Overall

% to goal Female

% to goal Male

75 57.3%

32 42.7%

32 42.7%

Tdap

Patients Immunized75 25.7%

% to goal Overall

% to goal Female

% to goal Male

75 42.7%

43 57.3%

8 10.6%


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OBJECTIVE 1:

Identifying gaps in care, assess patient adherence, and practice performanceFunctionality: Registry Summary Reports

To create Registry Summary Reports:

1. Select Immunizations from the Reports menu.

2. Select the appropriate criteria, such as Patient Age.

3. Click Run.

• Reports must be preconfigured. • Run the report at standard intervals to view most current performance

levels.• Use the reports as patient lists if action is needed to close gaps in care.• Use the report to review CDSS rules to identify opportunities for rules to

close gaps.

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Details Patient Age Status Last Visit Next VisitD001003223 70 At Target 3/6/2015 6/5/2015

D000371258 69 At Target 8/4/2014 None

D000047569 65 Not at Target 11/16/2014 None

D000205315 77 Not at Target 12/29/2014 None

D000172095 65 Not at Target 3/26/2015 9/23/2015

D000146094 69 At Target 3/10/2015 9/8/2015

Primary Care Overview

PREV Influenza Vaccination

Show All

Select Measure

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

4035.00

Patient List

Scorecard Care Opportunities Today’s Patients All Patients Measure Specs

Patient: Status Reference Date

HTN

HTN: Aspirin Use 3/25/2014

HTN: LDL Screening 3/5/2015

HTN: LDL Control (<100) 3/5/2015

HTN: BP Control (<140/90) N/A

PREV

PREV: Influenza Immunization 3/25/2014

PREV: Screening for Future Fall Risk 5/10/2014

PREV: Depression Screening 3/26/2014

PREV: Tobacco Assessment 3/27/2014

Data As Of:

4/14/2015

Status

At TargetNot at Target

Provider

(All) 17 values

Next Appointment Status

Insurance

Type to search in list

(All) 196 values

Type to search in list

Age1130

Gender

FEMALEMALEOTHER

Reset Filters

NotesThis list only shows patients who are currently attributed to you.To see all patients, go to the All Patients tab.


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OBJECTIVE 1:

Identifying gaps in care, assess patient adherence, and practice performanceFunctionality: Dashboards (Overviews)

To monitor progress for reducing gaps in care:

1. Select My Dashboard (also called Overviews in eClinicalWorks).

2. Select the Care Opportunities tab.

3. Select appropriate Measure.

4. Select parameters, such as: Provider, Payer, Age, Gender and At/Not at Target.

5. A list of patients meeting the selected criteria and statistics regarding the population will be displayed for review.

• Periodic review of the Dashboard enables health care providers to evaluate and improve CDSS reminders and ensure that Quality Improvement (QI) initiatives are effective.

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All Campaigns 38 Campaigns What’s New

Search Campaign by Name or Type Filter by Status Draft Actived Inactive Unused Select Category

+

Custom CampaignUNUSED

POLICY STATUS

0 0 0Drafts

Effortlessly send pertinent notifications to a customizedlist of patients.

Active Inactive

View Details & Activate

Custom Campaign

+

Influenza

57158 Patients

Reach out to patients who haven’t been seen in the pastyear and get them to schedule and appointment

Potential ReachAs of May 07, 2016


Preventive Program Administrative

UNUSED

+

Lab Reminder

57 Patients

Track high Priority (Stat) labs for which patients was sent,but results have not been received. Determine whether

pat

Potential ReachAs of May 07, 2016


Program Administrative Clinical

UNUSED

Select CategoryAll CampaignsDisease ManagementWellnessAdministrativeClinicalPreventiveImmunizationsCustom Campaign

Overview Details Message Example

Influenza Vaccination Reminder

Delivery:Deliverable as electronic message via portal app. or as voice or text message.Trigger:Patients who are over the age of 65 and have not received their Influenza Vaccination.Controls:Facility, provider (Rendering Provider/Primary Care Giver), enterprise.Frequency: quarterly, biannually, annually.

Category: Preventive, AdministrativeSetup Instructions Subscribe

ExampleHOME ENHANCE> EXPANDIDENTIFY

OBJECTIVE 2:

Expanding communications with patients using patient portal, email, or hard copyFunctionality: Messenger

To send campaign-focused communications to patients:

1. Select Messenger from Admin toolbar.

2. From the dropdown, select the appropriate campaign.

3. Select the appropriate type of communication: reminders, letters, or eMessages.

4. Review Delivery, Trigger, and Controls.

5. Review Program Details.

6. Select Publish.

5

Patient Recall

Run Letter

Patient Hub New Appointment Copy Flowsheet Release Lock Send eMesage Enrollment RequExclude from Search

Clear Search Analyze Data< Prev Next >

ALL Facilities / All Patients

LookUp

Protocol Provider/Facility Filter

Date (s)Report List

TestPatient

Consolidated View

DOB Sex Age Home Phone Last Done Due Date Last Visit Next

W

Influenza /1947 F 69Y No Record Now 03/17/2016 03/20/2016/1932 F 83Y No Record Now 04/23/2015

/1938 F 77Y No Record Now 11/12/2015

/1946 F 69Y No Record Now

Influenza

Influenza

Influenza

Letter 1-100

04/13/2016 Due By

of 890 records…

…Influenza

Appointment Date Patient Protocol All Labs/DI/Imm Alerts DX RX

Patients Over 65 No Encounter


OBJECTIVE 2:

Expanding communications with patients using patient portal, email, or hard copyFunctionality: Appointment Reminders (Patient Recall)

To send Pre-Visit Reminders (Patient Recalls) for scheduled appointments:

1. Navigate to Recalls.

2. Select Immunization Protocol.

3. From the dropdown Report List, select a specific saved query which meets the criteria desired.

4. Click Lookup.

5. Patients meeting the criteria display.

6. Select the appropriate type of communication: reminders, letters, or eMessages.

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Not - •Unknown • D • N • NMedical • a • wAllegri • a • w

(1 day Three tim

1 once dailyon as directed 2as directed 2

Progress Notes Scribe Orders

Appointment Facility:

Subjective:

Print Fax Lock Details SRecord

PrintPrint OptionsPrint PreviewPrint RxPrint OrderPrint LabsPrint Diagnostic ImagingPrint ProceduresPrint Visit SummaryPrint Rx, Orders and Visit Summary

Consult NotesAll Categories

Save options as my defaultShow associated assessments

Print Options

Print Preview Decline Cancel

Publish to Portal

MedicationsTestsReferralsNext Appointment DetailsHealth RecommendationsDiagnosisImmunizationsPreventive MedicineProblem ListAllergiesChief ComplaintsVitalsCare PlanProceduresCare Team Members


OBJECTIVE 2:

Expanding communications with patients using patient portal, email, or hard copyFunctionality: Visit Summary

To generate the Visit Summary:

1. Ensure Immunizations are populated as structured data in Preventive Medicine.

2. Navigate to the Progress Note in the Patient Chart.

3. From the Print menu, select Print Visit Summary.

4. From the Print Options, make sure that Next Appointment Details, Immunizations and Preventive Medicine are checked.

5. To give a copy to the patient during the visit, select Print, or

6. Select Publish to Portal.

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Immunization/Therapeutic Injections

Quick Order

Hx Imm Schedule

X

Imm. SeriesTdap3 Shots

01/27/20142M 9D

Tdap

03/20/20144M 2D

Tdap

06/11/20146M 23D

Tdap

Influenza3 Shots

01/27/20142M 9DInfluenza



Vaccine X3 Shots

01/27/20142M 9D

Vaccine X

03/20/20144M 2D

Vaccine X

06/11/20146M 23DVaccine X

Vaccine Y2 Shots

01/27/20142M 9D

Vaccine Y

03/20/20144M 2D

Vaccine Y

Add

Dose 1 Dose 2 Dose 3 Dose 4

Add

Imm Forecast:

Forecast

All

Complete

Complete

11/18/204Due Now

11/18/204Future Recom…

Treatment Billing

Immunization/T. Injections

Immunizations Add Delete Print Print Form

Therapeutic Injections Add Delete

X

Name

Influenza Vaccine Preservat…

Tdap (age 7 >)

0.5mL 10/25/2011 LD UH438AA

C3927BARD10/25/20110.5mL

S Dose Date Given By Location Lot Number

Hx IMM Schedule Flu Schedule

+

10

NameS Dose Date Given By Location Lot Number+

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Lab: CELIAC DISEASE COMPREHENSIVE PANEL Lab: COMPREHENSIVE METABOLIC PANEL W/O ALT (Ordered for 06/26/2015Others Referral To: Arthur Smith Neurology Reason: eval

Quick SearchProgress Notes Scribe Orders

Procedures:Immunizations:Therapeutic Injections:Diagnostic Imaging:

SF CP

ExampleHOME > ENHANCEEXPANDIDENTIFY

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OBJECTIVE 3:

Enhancing point-of-care interactionsFunctionality: Immunization Schedule

To access the Immunization Schedule:

1. Navigate to the Patient Chart (called Patient Hub in eClinicalWorks)

2. From the top menu, select Imm/T.Inj

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• The Immunization Schedule can also be accessed from within the Progress Note by clicking on the Immunization link, if included in the template.

• Immunization Schedules can be set up to identify items that are due or past due. Immunization forecasts are recommendations provided by ICE Web Service.

• Not all CDC-recommended vaccines are included by ICE, but they can be added manually.

Save Registry Report

CancelOK

X

NameOverdue Influenza

Due and Overdue for Influenza Vaccine …

NamePatients age =/> 62 with no Influenza vaccine in past 365 days

Flowsheet to use

CDSS Enabled

Name

Description

Web Ref.

Order Set

AgeLower Limit

Influenza Recommendation

Influenza Recommendation

62 year(s)

AgeUpper Limit 200 year(s)

Frequency

Gender

Once

Male

yearly

Sel

…

BothFemale

Immunization Alerts

Addl Entities …

CancelOK

DeleteAddProvider List

Provider Name

ExamplePatients who meet the criteria on the report will have a Registry Alert displayed.

—

— CDSS Alerts

Registry Alerts

Needs Annual Flu Immunization

Update registry alerts

There are no over due alerts today for this patient.

?

Overview History CDSS Alerts

X

HOME > ENHANCEEXPANDIDENTIFY

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OBJECTIVE 3:

Enhancing point-of-care interactionsFunctionality: Clinical Alerts

To create a Registry Alert to notify the health care provider (HCP) of due or past due vaccines:

1. From the Registry, create an immunization query.

2. Click Save Queries.

3. In the Save Registry Report dialog box, name the report. Enter the report criteria or flowsheet entry, if desired.

4. Check the CDSS Enabled option.

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• Each time the CDSS- Enabled registry report is run, Alerts are updated for patients listed in the registry.

• When CDSS Alerts are used with the Immunization Schedule, they can prompt HCPs of vaccination(s) which are due or past due.

• Registry Reports can also be used to create customized Alerts.

ORDER SET: MEASURE:

Name Strength Take Freq Duration Refills Route Formulation Dispense

New

Browse

Copy Update Delete

Rx

All Age

Unknown

Immunizations

QUICK ORDER SET: NO

DIAGNOSES (TRIGGER):

DIAGNOSES (LINKED):

AGE: (TRIGGER):

GENDER (TRIGGER):

Show AllShow Favorite Lab Companies Only

Aspirin E 81MG 1 tablet Once a day 30 day(s) OrallyMega Multivitamin for men

Tablet Delayed Release 30as directed

Display Labs/DI based on PRACTICE ADMINISTRATOR

Labs BrowseDescription Lab Company Delete

Diagnostic Imaging Browse

Browse

Description DI Company Delete

Name Dose Delete Name DeleteSmart Forms

Add Follow-Up

Browse

ReferralsAppointments

Add

Add

Patient EducationPhysician Education

Add Save Add Save

Add SaveAdd Save

PDF

WEB REFERENCE

PDF

WEB REFERENCE

CBC W/ DIFFERENTIAL (CBC) -85025

COMPREHENSIVE METABOLIC (GCP0 -80053

CT CARDIAC CALCIUM SCORING ONLY (75571)RAD CHES 2 VIEWS AP (PA) & LAT (71020)

Procedures Browse

ELECTROCARDIOGRAM REPORT (93010) - DONE IN CLINIC

Tdap (age 7 >) 0.5 mL

COLONOSCOPY, DIAGNOSTIC, FLEXIBLE (45378)

Description Delete

FM/Well Male


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OBJECTIVE 3:

Enhancing point-of-care interactionsFunctionality: Order Sets

To create or update an Order Set in eClinicalWorks:

1. From the EMR menu, select Order Set Administration.

2. When the Order Set window displays, select New to create, or select an existing Order Set from the dropdown list.

3. In each appropriate section, click Add to include options such as next in series, patient education, and Web references. Age triggers may be appropriate.

4. Click Save to complete each section.

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• Order Sets can include orders for vaccines, follow-up appointments, and patient education.

• Use the Message field to display comments or information to the health care provider during use of the Order Set.

• Use the yellow Star icon to mark this order set as a Favorite.

Add As Favorite Merge Template Close

< Prev Next >

Pr Template Access New Patient Initial Visit Public Existing Patient New Visit Existing Patient Followup Visit Immunization Visit Lab Check Sick Visit Well Visit Earache Sinusitis Sore Throat

Copy And Merge Templates

Patient Encounter Date

Find

Facility

All

Relation

Contains

Template For

Choose Template

Generic

Patient Specific

Category

Sel

Go

All Options

CCHPICurrent MedicationMedical HistoryAllergiesSurgical HistoryHospitalizationFamily HistorySocial HistoryROSVitalsExaminationPhysical ExamAssessmentTherapeuticTherapy AssessmentTreatmentProceduresImmunizationsXRayLabs


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OBJECTIVE 3:

Enhancing point-of-care interactionsFunctionality: Documentation Templates

To add a Template to a progress note:

1. From within the Progress Note, select Template from menu at the bottom of the progress note window.

2. When the Copy And Merge Template window displays, select Generic to see all templates.

3. In the Find text box, enter a description or key word for template.

4. Select Contains and click GO to display a list of available templates.

5. Select the appropriate template from the list and click Merge Template.

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• To preview the template before merging to the progress note, click on the icon to the left of the template name in the list.

• Consider checking Immunizations as part of the template in the Options list.

Template Categories Configure My Favorites Add as Favorite

New Update Delete

View Close

< Prev Next >

Name AccessNew Patient Initial Visit PublicExisting Patient New VisitExisting Patient Followup VisitImmunization VisitLab CheckSick VisitWell VisitEaracheSinusitis

Template List

Templates

Facility

Category

All

All


OBJECTIVE 3:

Enhancing point-of-care interactionsFunctionality: Documentation Templates

To update Template to include Immunizations:

1. From the File menu, select Templates.

2. In the Templates text box, type the name of the template to edit.

3. Click View to display the template within a progress note.

4. Make changes, such as adding the Immunizations section. Changes are automatically saved as they are made.

5. To finish editing the template, navigate away from the test patient.

Copyright © 2016 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc. All rights reserved. VACC-1182285-0000 09/1612