Presented By: HCN Clinical Operations

1. Achieving meaningful use Intergy v9 Presented By: HCN Clinical Operations

2. The goal The goal of this presentation is to demonstrate how to correctly document within Intergy EHR v9 to: • Improve Patient Care • Standardize documentations for easier/faster review of patient’s chart • Achieving Meaningful Use requirements

3. Table of contents

5. Registration Check List for Front Desk Staff Contacts Patient Internet Access Preferred Communication Method Imaging Results Patient Information Sex DOB (Date of Birth) Race Ethnicity Language (Preferred) eMail

6. Patient information Race/Ethnicity are separate fields and each must be completed

7. contacts Once your organization has set up the Patient Portal, the ‘Preferred Comm. Method’ field will allow for documentation. This field defaults to ‘Paper’ and must be manually changed to ‘Secure Message.’

8. Imaging Results A standardized folder labeled ‘Routine Health Maintenance’ has been created for your organization to capture and report on the following images: • Colonoscopy • Mammogram • Ophthalmology/Optometry • Podiatry Report • Sigmoidoscopy

9. Patient visit Clinical Support Staff Check List Summary Page Problems Allergies Medications List Encounter Note Vital Signs Smoking Status Family History (First Degree) Patient-Specific Education Lab Results Immunization(s)

10. Problems, Allergies, and Medications List • Maintaining a Patient’s chart up-to-date includes documenting: • No Known Allergies • No Active Problems • No Active Medications • Reported Medications You can also mark the medication list ‘Reconciled’ in this window

11. Vital Signs • Blood Pressure is to be taken for patients 3 and older • Height and Weight should be documented for all ages • Height and Weight must be documented within the same encounter to obtain and calculate the BMI • CMS is looking for growth charts of patients 0-20 years

12. For audit purposes of patients 0-20 years, you can graph the vital signs within the ‘Vitals’ tab in the patient’s chart. You only need to check the Blood Pressure, Height, Weight, and Body Mass Index before selecting ‘Graph’ on the top right corner of the screen

13. Smoking status and family history

14. Smoking status New Patient Established Patient

15. Family History – Established Patient

16. Family History – New Patient • Marking any ONE finding under the Mother, Father, Sister, or Brother columns will count your patient compliant for Meaningful Use. • OR – • Select ANY diagnosis and change or add any of the following ‘Prefix’ to mark your patient compliant: • Maternal history of • Paternal history of • Sororal history of • Fraternal history of • Daughter’s history of • Son’s history of

17. Patient-Specific Education You can now ‘right click’ on either a diagnosis, a medication, a lab results’ component and generate patient-specific education referencing the item you have selected. Selecting this functionality defaults to the National Institutes of Health’s (NIH) Medline Plus website.

18. Patient-Specific Education Documentation in the patient’s encounter note which states that patient education was provided is still required.

19. Lab Results If you are setup with a lab interface and you receive more than 40% of lab results that your providers have ordered using the CPOE, your lab results are Automatically updating the patient’s record and satisfying this measures. For those that Do Not have a lab interface set up in your organization or do not receive more than 40% of lab results automatically to your EHR, manual lab entry will be required. The following slide provides you with step-by-step instructions followed by screen shots of these steps.

20. Manual Lab Result Entry Step-by-step Instructions From the Top left corner, click on Intergy EHR> Tools> Lab Information (this opens the Lab Information screen within Intergy) Select from list of options on the right side> Result Entry and then below that, select> New Select the patient and the ‘New Lab Results’ window opens The minimum fields requiring data are: Lab; Ordered By; Ordered; Received by Lab; Reported by Lab. Once these fields have been completed, select Test The final window opens at which point at minimum you will complete: Test Code; Flag (abnormal, normal, high, low, etc.); Result Value (if a numeric value is applicable); Reported (date you are entering the lab); and Stat (final report, preliminary report, etc.) Upon completed the necessary fields, select ‘Add’ on the top right corner. You will then proceed to repeat step 5 above for all the lab results you need to enter for said patient. After entering the last lab for this patient and ‘Adding’ it to the patient’s record, select ‘Finish’

21. Manual Lab Result Entry Step-by-step Instructions Step 1 Step 2 Step 3

22. Screen 4 • Lab: Select the Manual lab created by your Organization • Ordered By: Select the provider that will be tasked the lab result for review • Ordered, Received by Lab, and Reported by Lab: Dates on the lab Report containing results

23. Screen 5

24. Immunizations: Record history • To Record History of a Vaccine: • Click Record Hist. • Click the Imm. Date radio button in Entry Mode • Select the date the Immunization was received • Stamp the Dose field of each immunization that was received on this date

25. Immunizations: Record other To Record History of Immune or Contraindicated: Click Record Hist. Click the Other radio button in Entry Mode Select the Immune or Contraindicated Stamp the Dose field of the associated immunization Although you can mark Prev. Hist and Refused, note that the patient’s record will not be marked compliant as this is not an exclusion for the measure. Flu vaccines CAN be marked refused for Meaningful Use credit.

26. Patient visit Check List for Providers Problem List Medication Reconciliation CPOE (Computerized Provider Order Entry) 60% Medications 30% Labs 30% Radiology Electronic Prescriptions Patient-Specific Education (Refer back to Slide 17) Electronic Note signed

27. Problem list Maintaining an up-to-date problem list remains one of the most important aspects of a functional EHR. It is tied to almost all aspects of the patient’s chart as well as many reports. You can now copy an assessment directly from the encounter note into the Problem list! Simply right click on the diagnosis and choose ‘Copy to Problem’

28. Medication reconciliation NEW! Once you have reviewed the patient’s medication list, simply click on ‘Mark as Reconciled’ TIP! Any action (renewing, prescribing, adding reported meds) will automatically ‘Mark as Reconciled’

29. CPOE: prescriptions Summary Page Meds Tab Orders/Charges

30. CPOE: lab orders Orders/Charges Labs Tab Summary Page

31. CPOE: Radiology orders Orders/Charges Summary Page Orders Tab

32. E-Prescribing Remember the key is to select via: Electronic Transmission

33. Electronic note signed Sign And Seal your Note Sign And Seal your Note

34. Post visit • Generate Exchange Document • Clinical Summary • Referral Summary • Provide the Patient with PIN Letter

35. Clinical Summaries A summary of the patient’s visit must be provider to the patient within one (1) business day. In order to generate a complete clinical summary, the following must be available/updated during the patient visit: • List of diagnostic tests pending • Clinical instructions • Future appointments • Referrals to other providers • Future appointments • Referrals to other providers • Future schedule tests • Demographic information (sex, race, ethnicity, date of birth, preferred language) • Smoking status • Care plan field(s), including goals and instructions • Recommended patient decision aids • Patient Name • Provider’s name and office contact information • Date and location of the visit • Reason for the office visit • Current problem list • Current medication list • Procedures performed during the visit • Immunizations or medications administered during the visit • Vital signs taken during the visit (or other recent vital signs) • Laboratory test results Any information previously entered in the patient’s chart that is discussed in the current visit, must be cited into the note to appear in the clinical summary (e.g., Lab results received or entered on a previous date reviewed with the patient during this encounter.

36. Generate and print Clinical Summary Provider’s best practice Once the patient encounter note is completed, click ‘Sign’ Verify ‘Exchange Document’ is checked and ‘Print Clinical Summary’ is selected from the drop down option Click ‘Sign’ Select the printer and print

37. Generate and Send Clinical Summary Provider’s best practice • Once the patient encounter note is completed, and you are ready to generate and send the visit summary via the patient portal, click ‘Sign’ • Verify ‘Exchange Document’ is checked and ‘Open Generate Dialog’ is selected from the drop down option • Select the following: • To: Patient • What: Clinical Summary • Include: De-Select any data that may be harmful for the patient • Click ‘Send’

38. Generate and print Clinical Summary Clinical support staff’s best practice Once an encounter note has been created, the ‘Print Summary’ option will appear on the top right corner in the patient’s summary page. When the provider has completed the necessary information and you are ready to generate the summary: Click ‘Print Summary’ Select the printer and ‘Print’

39. Generate and send Clinical Summary Clinical support staff’s best practice Once an encounter note has been created, the ‘Print Summary’ option will appear on the top right corner in the patient’s summary page. When the provider has completed the necessary information and you are ready to generate and ‘send’ the visit summary via the patient portal: Click ‘More’ The ‘Generate Exchange Document’ window will open at which point you may make any edits required. When ready to generate the summary, click ‘Send’

40. Generate Patient PIN Letter • Within Intergy, under Menu: • Open Communications and select ‘Letters and Labels’ • Click ‘Patient Portal Letter’ • Search for the patient • Select ‘Run’ and print the letter Within Intergy, under Patient Information: Choose ‘Reports’ from the Menu screen Select ‘Letters/Labels’ Click ‘Patient Portal Letter’ Select ‘Run’ and print the letter

41. Achieving Meaningful Use Open forum

42. The Clinical Operations team and I Thank you for attending our presentation