Allscripts Certified Workflows

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Allscripts Certified Workflow 2010

Allscripts Certified Workflow 2010

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  • 1. Allscripts Enterprise EHR Certified Workflows v. 11.1.xCopyright ©2009 Allscripts-Misys www.allscripts.com
  • 2. Copyright © 2009 Allscripts-Misys Healthcare Solutions, Inc.This document is the confidential property of Allscripts-Misys Healthcare Solutions, Inc. It is furnished under anagreement with Allscripts-Misys Healthcare Solutions, Inc. and may only be used in accordance with the termsof that agreement. The use of this document is restricted to customers of Allscripts-Misys Healthcare Solutions,Inc. and their employees. The user of this document agrees to protect the Allscripts-Misys HealthcareSolutions, Inc. proprietary rights as expressed herein. The user further agrees not to permit access to thisdocument by any person for any purpose other than as an aid in the use of the associated system. In no casewill this document be examined for the purpose of copying any portion of the system described herein or todesign another system to accomplish similar results. This document or portions of it may not be copied withoutwritten permission from Allscripts-Misys Healthcare Solutions, Inc. The information in this document is subjectto change without notice.The names and associated patient data used in this documentation are fictional and do not represent any realperson living or otherwise. Any similarities to actual people are coincidental.CPT copyright 2008 American Medical Association. All rights reserved.Fee schedules, relative value units, conversion factors and/or related components are not assigned by theAMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectlypractice medicine or dispense medical services. The AMA assumes no liability for data contained or notcontained herein.CPT is a registered trademark of the American Medical Association.International Statistical Classification of Diseases and Related Health Problems (ICD) is copyright 2009 WorldHealth Organization (WHO).Microsoft® Excel and Microsoft® Word are either registered trademarks or trademarks of Microsoft Corporationin the United States and/or other countries.11/18/2009 2 Allscripts Enterprise EHR Certified Workflows
  • 3. 11/18/2009 3 Allscripts Enterprise EHR Certified Workflows
  • 4. Table of ContentsCertified Workflows Overview ............................................................................................................. 8(A) Appointment Scheduling................................................................................................................ 9(B) Appointment Preparation............................................................................................................. 11(C) Appointment Check-In................................................................................................................. 13(D) Patient Visit Overview ................................................................................................................. 15(E) Intake Introduction ....................................................................................................................... 18(E1) Intake Process – Basic .............................................................................................................. 20(E2) Intake Process – Detailed.......................................................................................................... 24(E3) Intake Process – With Order ..................................................................................................... 29(F) Retrieve Introduction.................................................................................................................... 34 Adult Patient View – Clinical Desktop View:.............................................................................. 35 Pediatric Patient View – Clinical Desktop View:........................................................................ 36 Pediatric Patient View: .............................................................................................................. 37(F1) Chart Review – Basic ................................................................................................................ 38(F2) Chart Review – Detailed ............................................................................................................ 41(G) Document Introduction ................................................................................................................ 44 Utilizing Structured Notes – General Note Concepts ................................................................ 45 Patient Education Materials – Print Actions .............................................................................. 47(G1) Note: Acute Visit ....................................................................................................................... 52(G2) Note: New or Chronic Visit ........................................................................................................ 57(G3) Note: Procedure Visit ................................................................................................................ 62(G4) Note: Health Maintenance......................................................................................................... 66(G5) Note: Results Review................................................................................................................ 70(G6) Dictation .................................................................................................................................... 73(G7) Admin Forms............................................................................................................................. 76(H) Order and Plan Introduction ........................................................................................................ 78(H1) Ad Hoc Prescription................................................................................................................... 80(H2) Meds Management.................................................................................................................... 86(H3) Med Administration.................................................................................................................... 90(H4) Immunizations ........................................................................................................................... 94(H5) Future Orders ............................................................................................................................ 97(H6) Ad Hoc Diagnostic Orders....................................................................................................... 101(H7) Follow-up or Referral Orders................................................................................................... 105(H8) Instructions/Supplies Orders ................................................................................................... 108(H9) Order Reminders..................................................................................................................... 111(H10) QuickSets.............................................................................................................................. 114(H11) CareGuides ........................................................................................................................... 117(J) Finalize and Charge Introduction ............................................................................................... 120(J1) Basic Ambulatory Charges....................................................................................................... 12211/18/2009 4 Allscripts Enterprise EHR Certified Workflows
  • 5. (J2) Charging from Note.................................................................................................................. 127(J3) Charging for Orders ................................................................................................................. 130(J4) Charging for Administrations.................................................................................................... 133(J5) Review Encounter Charges ..................................................................................................... 135(K) Follow-Up and Checkout Introduction ....................................................................................... 138(K1) Scheduling Order Appointments.............................................................................................. 139(K2) Referral Appointments............................................................................................................. 142(L) Renewal Management Introduction ........................................................................................... 146(L1) Prescription Renewals ............................................................................................................. 148(L2) Surescripts Renewals .............................................................................................................. 156(M) Document Management Introduction ........................................................................................ 159(M1) Inbound Transcription ............................................................................................................. 161(M2) Transcription with Dual Signature ........................................................................................... 165(M3) Document Reconciliation ........................................................................................................ 169(N) Transcribe Introduction.............................................................................................................. 172(N1) Transcribe Basics.................................................................................................................... 173(P) Scanning Introduction................................................................................................................ 177 Active Chart Scanning Strategies ........................................................................................... 178 Scanning Correspondence Approach ..................................................................................... 179 Lessons Learned Statements from Allscripts Clients .............................................................. 179(P1) Scanning Active Charts ........................................................................................................... 181 Certified Workflow Tips ........................................................................................................... 184(P2) Scanning Correspondence ...................................................................................................... 186(Q) Miscellaneous Introduction........................................................................................................ 190(Q1) Call Processing ....................................................................................................................... 192(Q2) Tracking Overdue Orders........................................................................................................ 197(Q3) Financial Authorization............................................................................................................ 200(R) Results Introduction................................................................................................................... 204(R1) Entry of Paper Results ............................................................................................................ 206(R2) In-House Testing ..................................................................................................................... 210(R3) Results Verification.................................................................................................................. 213(R4) Results Referral ...................................................................................................................... 222(R5) Results Communication .......................................................................................................... 225(S) Inpatient Introduction ................................................................................................................. 230(S1) Inpatient Charges .................................................................................................................... 23211/18/2009 5 Allscripts Enterprise EHR Certified Workflows
  • 6. Certified WorkflowsThis Certified Workflows guide contains all of the Certified Workflows for Allscripts Enterprise EHRVersion 11.1. Each of these workflows is discussed in detail in the following sections.The following are overview road maps of the Patient Visit Workflows, Non-Patient Visit Workflows,and the Inpatient Visit Workflows. Figure 1 Patient Visit Workflows Road Map11/18/2009 6 Allscripts Enterprise EHR Certified Workflows
  • 7. Figure 2 Non-Patient Visit Workflows Road Map Figure 3 Inpatient Visit Workflows Road Map11/18/2009 7 Allscripts Enterprise EHR Certified Workflows
  • 8. Certified Workflows OverviewThe Certified Workflows consist of the following items: ▪ High-level Road Maps = 3 ▪ Overview Workflow = 1 ▪ Introductions = 13 ▪ Workflows = 50The Overview Workflow (Patient Visit – D) is a high-level overview of the entire patient visit and isdesigned to provide the “big” picture of the overall steps involved in the process. It provides a break-out of each “work lane” (also referred to as a “swim lane”) to assist in breaking out the work intomore easily understood sections (workflows). The Overview Workflow (D) can be used to achieve an“end-to-end” understanding, but the details behind each step are contained in the subsequent 50workflows.The 13 Workflow Introductions (E, F, G, H, and so on) include a summary of the particular “worklane,” a VISIO diagram, and information concerning the terminology or concepts being utilized. TheWorkflow Introductions contains a series of questions/decisions and acts as a guideline for whichspecific workflow path to follow.Each Workflow section of this document (E1, E2, and so on) contains the detail steps to completethe workflow. Each workflow has a VISIO diagram with the corresponding summary and detailedsteps. The user role is defined for each process step. Each workflow has been validated by Allscriptsemployees and clinical consultants.These Certified Workflows and the “Pre-Configuration” go “hand-in-hand.” Pre-configuration isconfiguring the software in such a manner so that you can log into the Allscripts Enterprise EHRsoftware and perform any of the 50 Certified Workflows without being stopped because, for example,you have not yet built the correct enterprise task views, Worklist views, or set the systempreferences and so on. The Pre-configuration “Gold” database contains all of these items alreadyconfigured to enable the Certified Workflows. One of the primary purposes of the Pre-Configurationis to support the Certified Workflows.11/18/2009 8 Allscripts Enterprise EHR Certified Workflows
  • 9. (A) Appointment SchedulingThe first step of a patient visit is the scheduling of the appointment. The purpose of the followingAppointment Scheduling workflow is to achieve a basic understanding of the data flow at the time offirst contact with the patient and the impact to Allscripts Enterprise EHR. Figure 4 (A) Appointment Scheduling (3) (1) (2) Staff creates New A Patient requests Is appointment for Yes Patient in practice appointment a new patient? management system (PMS) (4) Staff schedules (5) appointment in PMS Patient demographic B No & populates & scheduling info Comments with sent to TouchWorks reason for visitTo schedule a patient appointment, do the following:1) The start of a patient visit begins with the patient requesting an appointment from your front desk, scheduling line, or another role in your organization that handles patient appointments.2) Is the appointment for a new patient? The amount and type of information you need to obtain from the patient depends on whether the individual is an established patient or a new patient.3) If the patient is a new patient, then you typically collect a certain set of basic demographic information from the patient and enter it into the Practice Management System (PMS). If a “mini registration (reg)” is done at this time and a temporary medical record number is utilized, verify this number will be handled correctly in your registration/scheduling interface.4) If the patient is an established patient, or once the demographic information is collected for a new patient, you then schedule the appointment in the Practice Management System and add comments regarding the reason for the visit.11/18/2009 9 Allscripts Enterprise EHR Certified Workflows
  • 10. 5) The registration and scheduling information is then sent via an interface to Allscripts Enterprise EHR. This enables all Allscripts Enterprise EHR users to monitor their schedules directly from Allscripts Enterprise EHR without having to switch to the Practice Management System. It is important to understand what patient demographic data interfaces with Allscripts Enterprise EHR from the Practice Management System.6) Once the patient appointment is scheduled, the next step within the patient visit is appointment preparation. Proceed to workflow (B) Appointment Preparation for the Certified Workflow steps.11/18/2009 10 Allscripts Enterprise EHR Certified Workflows
  • 11. (B) Appointment PreparationAfter scheduling the appointment, the second step to prepare for the patient visit is typically thepreparation of the paper chart. Your organization’s use of the Allscripts Enterprise EHR Scanmodule for scanning paper charts into the electronic health record will impact this workflow step.Your organization will go through two phases for this process. The first phase is the transition ofhaving paper charts and scanning in active (historical) chart information. The second phase occurswhen all paper charts have been scanned and you no longer have to consider them in yourworkflow.Your organization can select from among several strategies to complete the scanning of active(historical) paper charts. Please refer to the (P) Scanning Introduction chapter for additionaldetails. Figure 5 (B) Appointment Preparation A (2) (1) Medical B Is appointment for Yes Records new patient? prepares new patient packet P1 (4) (3) Medical Records Existing patient No Yes scans patient have a paper information prior to chart? visit No C11/18/2009 11 Allscripts Enterprise EHR Certified Workflows
  • 12. To prepare for a patient appointment, do the following:1) The first step of the appointment preparation process is to determine if the appointment is for a new or an established patient. If the patient is new and your organization is scanning, no paper chart will currently exist and typically one will not be created.2) If the appointment is for a new patient, a patient packet is usually prepared for the patient to fill out upon check-in per the organization’s protocol. This could include demographic, insurance or Health Insurance Portability and Accountability Act (HIPAA) forms, patient medical history information, and so on. This information is typically prepared by either the Medical Records or Front Desk roles.3) If the appointment is for an existing patient, it is important to understand whether a paper chart exists. If a paper chart does not exist or has already been scanned, no work to pull the chart is needed. Many organizations use a field within their Practice Management System or a chart tracking system as a method to track whether a paper chart has been scanned. This makes it easy for staff to quickly know if they need to pull a chart for the visit.4) If a paper chart exists, your organization’s scanning procedure will impact this workflow in terms of timing. Allscripts recommends that the scanning of paper charts be done optimally at least 2 weeks prior to the patient visit if possible. This ensures that needed documentation is available for the visit within the system. Please refer to workflow (P1) Scanning Active Charts for the Certified Workflow steps.5) Once the necessary information is prepared for the patient appointment, the next step within the patient visit is appointment check-in. Proceed to workflow (C) Appointment Check-In for the Certified Workflow steps.11/18/2009 12 Allscripts Enterprise EHR Certified Workflows
  • 13. (C) Appointment Check-InThe day of the appointment arrives and the patient comes to the clinic. The purpose of the followingAppointment Check-In workflow is to achieve a basic understanding of when the patient checks-infor the visit and the impact of that process for the Front Desk and the data sent to AllscriptsEnterprise EHR. Figure 6 (C) Appointment Check-InTo prepare for a patient check-in, do the following:1) The patient typically registers at the front desk, a defined check-in area, or at a reception area.2) The data collection process may differ depending on whether the patient is a new or an established patient.3) If the patient is new, the patient is given the new patient packet to complete.4) Front Desk updates the required information in the Practice Management System. If a “mini registration” was done at the time the appointment was made, this step may also include assigning a permanent medical record number to the patient. It is important to validate the change from a “mini reg” to a permanent medical record in your registration/schedule interface.5) For an established patient, the Front Desk verifies demographic and insurance information, and updates as needed. Patient updates should be entered immediately into the Practice Management System to allow for accurate and timely data flow into Allscripts Enterprise EHR.6) The final step is to change the appointment status in the Practice Management System to “Arrived.”11/18/2009 13 Allscripts Enterprise EHR Certified Workflows
  • 14. 7) The patient demographic and insurance data entered in the Practice Management System is sent via the registration/scheduling interface to Allscripts Enterprise EHR. This includes the updated appointment status and comments, which enables the clinical staff to see when patients have arrived and why they are coming in.8) Front Desk scans documents as appropriate. This may include the new patient packet, patient’s insurance card or driver’s license, and so on. Your organization needs to consider all instances where “loose” correspondence is received and has to be scanned into the electronic health record. Please refer to workflow (P2) Scanning Correspondence for the Certified Workflow steps.9) Front Desk updates the patient location and status. To set the patient location and status, follow these steps: a) Front Desk should be logged into Allscripts Enterprise EHR. If not logged in, launch the application by double-clicking on the Allscripts Enterprise EHR desktop icon. b) From the Chart menu, the daily Schedule tab should be active. Make sure the appropriate schedule is displaying. Adjust the provider or date where appropriate. c) Review the schedule and single-click on the desired patient. The Clinical Toolbar enables. d) From the Clinical Toolbar, click the Patient Location drop-down list. A list of available locations displays. e) Select the appropriate location. f) To set the status, click the Status drop-down list. A list of available statuses displays. g) Select the appropriate status.10) Staff uses Allscripts Enterprise EHR to monitor the arrival status of patients on their schedule.11) Once the patient is checked-in, proceed to workflow (D) Patient Visit Overview to review the high-level Certified Workflow steps for the entire patient visit.11/18/2009 14 Allscripts Enterprise EHR Certified Workflows
  • 15. (D) Patient Visit OverviewThe purpose of the following Patient Visit Overview workflow is to achieve a high-levelunderstanding of the steps involved in the overall patient visit process including the steps performedby the nurse and provider during a typical visit. See the corresponding workflows as indicated in thefollowing diagram, for more detailed instructions concerning each process. Figure 7 (D) Patient Visit Overview D: Patient Visit Overview C E (1) (3) Intake (2) Clinical Staff escorts Clinical Staff sets Clinical Staff D patient to exam area exam room indicator, completes intake to begin intake patient ready for process process provider F Retrieve (5) (4) Provider completes Provider begins review of patient patient visit data G Document (7) (6) Provider completes Provider goes to all note sections as note, updating chief appropriate for complaint as needed encounter H Order & Plan (8) (9) (10) Does an order Yes Provider creates Provider completes need to be order plan created? No J Finalize & Charge (11) (12) (13) Provider reviews Provider signs Note Provider reviews & Note Output(s) Output(s) submits charges Follow-up & K Checkout (15) (14) Clinical Staff Provider updates (16) completes required End Patient Status, if Patient checks out patient follow-up as needed appropriate11/18/2009 15 Allscripts Enterprise EHR Certified Workflows
  • 16. Patient Visit Overview:1) The first step of the patient visit process is for the clinical staff to bring the patient back from the waiting area to the exam area to begin the patient intake process. Typically, the staff monitors the Schedule screen in Allscripts Enterprise EHR and is notified the patient is there when the status of the appointment is updated to “Arrived.” Regardless of the physical location, a PC, Tablet PC, or other means of data entry should be available. The patient’s arrival status must be updated in the Practice Management System before the encounter documentation can be started.2) The intake process is usually done either outside the exam room at a pre-determined “vitals” area or in the exam room itself. Either way, the exact order of when the staff takes vital signs vs. collecting current medications or the chief complaint is determined by the physical location of the patient, taking into consideration HIPAA regulations and discussions with the patient that must be kept private. Follow the collection of (E) Intake Process workflows for the Certified Workflow steps depending on the type of visit.3) The final step prior to the clinical staff transitioning the patient to the provider is to indicate that the patient is ready for the provider. You can do this using the Patient Location and Status fields in Allscripts Enterprise EHR or using a visual exam room indicator such as lights, flags, or a card system. Your organization could choose to continue using a visual indictor or simply switch to using the electronic equivalent by utilizing the Patient Location and Status fields. An additional option is to use both methods.4) The provider is now ready to begin the visit.5) As the provider begins the patient visit, they usually review the chart prior to entering the exam room. The device in use (Tablet PC, PC, laptop, and so on) typically determines the location of this review. This review, prior to engaging the patient, is to familiarize themselves with the details regarding the patient. This data could include prior medical records for a new patient, results, orders, prescriptions, and so on. Allscripts Enterprise EHR has many components located on the Clinical Desktop to help facilitate this type of clinical “retrieval” of information. Follow the collection of (F) Retrieve workflows for the Certified Workflow steps.6) Once the provider completes the clinical review and begins the patient visit, they either begin the note or go to a note if one was started by the clinical staff.7) Once the note is opened, the note sections and note forms defined for the visit type selected will automatically compile based on administrative defaults and setup. Follow the collection of (G) Document workflows for the Certified Workflow steps on documenting the patient visit. The documentation process changes depending on the type of visit, such as an acute or chronic visit, a procedure visit, an HMP visit, or a visit that includes dictation, and so on.8) During the visit, the provider determines if an order needs to be placed. If no order is necessary, the provider may want to document what was discussed within the Discussion/Summary section of the note.9) If an order needs to be created, the provider creates the desired order, which is typically done by order type such as a prescription, laboratory, radiology, supply, follow-up appointment, referral, immunization, or a request for an administration. Follow the collection of (H) Order and Plan workflows for the Certified Workflow steps. These workflows contain certified steps for creating both ad hoc and problem-based orders.11/18/2009 16 Allscripts Enterprise EHR Certified Workflows
  • 17. 10) Documenting the plan is part of ordering and typically involves all the orders that make up the patient “Careplan” for the assessed problem(s).11) Prior to signing the note, the provider makes one final review of the completed note by viewing all output documents and carbon copy recipients. A note can be associated to a single or to multiple output documents. Any additional note inputs should be done from the Note Authoring or Accumulator workspaces.12) Once the note is ready, the provider signs the note outputs. This can be done by either viewing and signing each individual output or using the Sign action in the Note Authoring workspace to sign all output documents simultaneously.13) After completing the patient visit, the provider is ready to submit charges for the encounter. Follow the collection of (J) Finalize & Charge workflows for the Certified Workflow steps.14) Once the provider has completed the patient visit, the final step is to update the Patient Location and Status fields. This enables all staff to know the visit is completed and whether the patient is departed, ready for transport, or if follow-up is needed. A system preference can be set to automatically clear the Patient Location field after a certain length of time defined by the organization. This would eliminate the user requirement to clear this field.15) Additional tasks may be required of staff members prior to the patient leaving the office. These tasks could include such items as scheduling a follow-up or referral appointment, having orders pending to be collected or completed, and so on. Follow the collection of (K) Follow-Up and Checkout workflows for the Certified Workflow steps.16) Once the required follow-up is completed, the patient checks out.11/18/2009 17 Allscripts Enterprise EHR Certified Workflows
  • 18. (E) Intake IntroductionThe patient intake process involves the gathering of patient information by the clinical staff inpreparation for seeing the provider. The intake process is usually done either outside the examroom at a pre-determined “vitals” area or in the exam room itself. The specific order of taking vitalsigns, collecting relevant patient history (such as allergies, medication history, and so on) andindicating the chief complaint will be determined by the physical location of the patient.It may also be common for the clinical staff to begin the note for the provider. The decision for theclinical staff to begin a note is typically organizationally driven and is presented as a decision pointwithin each Intake workflow. Figure 8 (E) Intake Introduction D Acute or E established patient Yes E1 visit? No Chronic or new E2 Yes patient visit? No Patient visit with E3 Yes an order? No End11/18/2009 18 Allscripts Enterprise EHR Certified Workflows
  • 19. The following workflows in this section address the most common intake types, as defined below: Intake Type Description Basic Typically associated with an acute care visit or with an established patient returning for a simple check-up or problem. See workflow (E1) Intake Process – Basic. Detailed Is commonly associated with a new patient who requires a thorough examination of past medical information, a chronic patient visit, or a patient that is having multiple problems. See workflow (E2) Intake Process – Detailed. With Order Used for a patient visit that requires an order (typically a nursing order by protocol) placed as part of the Intake Process. See workflow (E3) Intake Process – With Order.11/18/2009 19 Allscripts Enterprise EHR Certified Workflows
  • 20. (E1) Intake Process – BasicThe clinical staff brings the patient back to an exam room to begin the intake process. This workflowis to achieve an understanding of what information is typically reviewed and updated within AllscriptsEnterprise EHR during a basic intake process. Figure 9 (E1) Intake Process - BasicTo perform a basic intake, follow these steps:1) The clinical staff begins the Intake process by selecting a patient with a status of “Arrived” from the Schedule within Allscripts Enterprise EHR. To bring a patient into context from the daily schedule, do the following: a) Clinical staff should be logged into Allscripts Enterprise EHR. If not logged in, launch the application by double-clicking on the Allscripts Enterprise EHR desktop icon. b) From the Chart menu, the daily Schedule tab should be active. Make sure the appropriate schedule is displaying. Adjust the provider or date where appropriate. c) Review the schedule and double-click on the desired patient. The Clinical Desktop displays.11/18/2009 20 Allscripts Enterprise EHR Certified Workflows
  • 21. 2) The clinical staff sets the patient location and status to reflect where the patient is. To set the patient location and status, follow these steps: a) From the Clinical Toolbar, click the Patient Location drop-down list. A list of available locations displays. b) Select the appropriate location. c) To set the status, click the Status drop-down list. A list of available statuses displays. d) Select the appropriate status.3) The clinical staff is now ready to collect the patient’s vital signs. To enter a patient’s vital signs into Allscripts Enterprise EHR, follow these steps: a) From the Clinical Toolbar, click on the Add Vital Signs icon. The default vital signs view displays within the Order Details page. b) Enter all the necessary vital sign information for that patient. c) When finished, click OK.4) From the Clinical Desktop, the clinical staff reviews the patient’s allergies and current medications under the respective component. Allergies and medications are the common patient history components that are typically reviewed as part of a basic visit type.5) Do allergies and/or medications need to be updated? If no updates are needed, proceed to step 7.6) If updates are needed, the clinical staff updates the patient’s history within the Add Clinical Item (ACI) workspace. The ACI is the principal workspace where they can update the patient’s allergies and medications without having to go to multiple places. a) To add a new allergy, do the following: i) Under the Allergies component, click New on the action toolbar to launch the Add Clinical Item workspace. The ACI displays with the History Builder and Allergies tabs active. ii) To search for a medication allergen, click the Medication option; to search for a non- medication allergen, click the Non-medication option. iii) Find an allergy using Specialty or Personal Favorites, QuickList, or by Master search. iv) Select an allergy by entering a checkmark in the appropriate box or double-click on the desired allergy to add details. v) Repeat steps ii – iv as needed. Clinical staff can specify that a patient has no known allergies where appropriate by selecting No Known Drug Allergies or No Known Allergies. b) To add a new medication history, do the following: i) Click on the Med Hx tab. ii) Select the Active Problem view from within the “Problem” section of the patient pane (located at the top on the left-hand side), if needed. iii) Highlight the appropriate problem by single-clicking on the problem name.11/18/2009 21 Allscripts Enterprise EHR Certified Workflows
  • 22. iv) Find the medication using Specialty or Personal Favorites, QuickList, or by Master search. v) Select a medication by entering a checkmark in the appropriate box or double-click on the desired medication to add details, such as SIG information. vi) Repeat steps iii – v as needed. Best Practice is to link medication histories to the appropriate problems. This will automatically add that medication to the health management plan for that problem as well as aid in building of QuickSets.7) Once they have reviewed those items with the patient, the clinical staff selects the patient’s chief complaint (primary complaint that triggered the appointment). Follow these steps to select the chief complaint: a) From within the Add Clinical Item workspace, click on the Chief Complaint secondary tab. If not within the ACI, click on the Add New Problem icon from the Clinical Toolbar. b) Find the appropriate chief complaint using an incremental or alphabetical search. For a chief complaint to appear within the Add Clinical Item workspace there must be an associated published symptom form. c) Select the chief complaint by entering a checkmark in the appropriate box. The items display in the problem section of the patient pane. d) Click OK when finished. The Clinical Desktop displays.8) Does the clinical staff begin the note? Some organizations allow the clinical staff to begin the note and document designated pieces of the patient visit.9) If yes, the clinical staff starts the note. Follow these steps to begin a note: a) From the Clinical Toolbar, click on the Note Authoring icon to start a new note. The Note Selector screen displays. b) Validate the Note Style selected is Note. c) Select the appropriate Specialty, if needed. Clinical staff can determine which specialty to default within the Note Selector page by setting the “Default Specialty ID” preference. d) Select the appropriate Visit Type and/or Visit Sub-Type. e) Review the Chief Complaint(s). Click OK to continue with no changes or click on the Add/Remove Chief Complaint link to modify. Once complete, click OK. f) The Note Authoring workspace (NAW) displays. The system compiles the correct note forms based on the specialty, visit type, chief complaint(s) and the patient’s age and sex. g) Clinical staff updates the appropriate note sections per the organization’s protocol.10) Clinical staff reviews all the information that was entered for the encounter. a) If the clinical staff began a note, the encounter review takes place within the Note Authoring workspace. To review the encounter information, use any of the following:11/18/2009 22 Allscripts Enterprise EHR Certified Workflows
  • 23.  Click on the Encounter Summary icon from the Clinical Toolbar. The Encounter Summary page displays.  Click on the desired Note Section from the table of contents.  Select the desired output and click View. b) If no note was created, follow these steps to review the encounter information: i) From the Clinical Toolbar, click on the Encounter Summary icon. The Encounter Summary page displays. ii) All unsaved information will appear in magenta-colored text. iii) Clinical staff reviews the encounter information and edits, if necessary.11) Clinical staff updates the patient status to reflect the next step within the patient visit and commits the data. a) To set the patient status and commit the encounter information from the Note Authoring workspace (NAW), follow these steps: i) Click the Status drop-down list from the Clinical Toolbar. ii) Select the appropriate status. iii) Click Sign. The Note Signature page displays. iv) Enter your password and click OK. All unsaved data is committed when the note is signed. b) To set the patient status and commit the encounter information from the Encounter Summary, follow these steps: i) Click the Status drop-down list. A list of available statuses displays. ii) Select the appropriate status. iii) Click Save and Continue.12) Clinical staff returns to the daily schedule to prepare for the next patient. To return to the daily schedule, click on the Schedule horizontal toolbar. For the instances where the clinical staff begins the note, administrators can set the Note preference “Default Navigation After Signing” to Schedule to automatically take them to the daily Schedule after signing the note to prepare for the next patient.13) Once the patient intake process is complete, proceed to the (F) Retrieve workflows for the Certified Workflow steps.11/18/2009 23 Allscripts Enterprise EHR Certified Workflows
  • 24. (E2) Intake Process – DetailedThe clinical staff has brought the patient back to an exam room to begin the intake process. Thepurpose of the following workflow is to achieve an understanding of what information is typicallyreviewed and updated within Allscripts Enterprise EHR during a more detailed intake process. Thisusually involves a more in depth look at the patient’s overall history. Figure 10 (E2) Intake Process - Detailed E (2) (3) (1) Clinical Staff sets Clinical Staff (4) E2 Clinical Staff selects Yes the patient location collects patient Is patient new? patient off schedule & status vitals No (5) (6) (7) Clinical Staff Does patient hx Clinical Staff Yes PMH reviews patient need to be updates patient history updated? history PSH Fam Hx No Social Hx Allergies Med Hx (8) Clinical Staff selects Immun Hx chief complaint (9) (10) Clinical Staff begins Yes Clinical Staff starts note? note (12) (13) (11) Clinical Staff Clinical Staff returns Clinical Staff F No updates patient to schedule to reviews encounter status & commits prepare for next information data patientTo perform a detailed intake process, follow these steps:1) The clinical staff begins by selecting a patient with a status of “Arrived” from the Schedule within Allscripts Enterprise EHR. To bring a patient into context from the daily schedule, do the following: a) Clinical staff should be logged into Allscripts Enterprise EHR. If not logged in, launch the application by double-clicking on the Allscripts Enterprise EHR desktop icon. b) From the Chart menu, the daily Schedule tab should be active. Make sure the appropriate schedule is displaying. Adjust the provider or date where appropriate. c) Review the schedule and double-click on the desired patient. The Clinical Desktop displays.2) The clinical staff sets the patient location and status to reflect where the patient is. To set the patient location and status, follow these steps: a) From the Clinical Toolbar, click the Patient Location drop-down list. A list of available locations displays. b) Select the appropriate location. c) To set the status, click the Status drop-down list. A list of available statuses displays.11/18/2009 24 Allscripts Enterprise EHR Certified Workflows
  • 25. d) Select the appropriate status.3) The next step is to collect the patient’s vital signs. Follow these steps to enter a patient’s vital signs into Allscripts Enterprise EHR: a) From the Clinical Toolbar, click on the Add Vital Signs icon. The default vital signs view displays within the Order Details page. b) Enter all the necessary vital signs information for the patient. c) When finished, click OK.4) Is the patient new? The intake process may differ depending on whether the patient is a new or an established patient. If the visit is for a new patient, proceed to step 7.5) For an established patient, the clinical staff begins by reviewing the patient’s history from the Clinical Desktop with the patient to ensure that the information is accurate and up-to-date.6) Does any of the patient’s information need to be updated?7) Clinical staff updates the patient’s history within the Add Clinical Item (ACI) workspace. The ACI is the principal workspace where they can update the patient’s past medical history, past surgical history, family history, social history, allergies, medication and immunization without having to go to multiple places. a) To add a new problem and/or update problem history, follow these steps: i) From the Clinical Toolbar, click on the Add New Problem icon. The Add Clinical Item workspace displays with the History Builder tab active. ii) Click on the corresponding secondary tab to add problem information: ▪ PMH ─ Past Medical History ▪ PSH ─ Past Surgical History ▪ Fam Hx ─ Family History ▪ Social Hx ─ Social History Some organizations choose not to have clinical staff enter problems as part of the intake process. Instead, all problems are managed by the provider. Allscripts enables the clinical staff to enter problem history as “unverified” and have the provider verify them while seeing the patient. iii) Find the desired problem using Specialty or Personal Favorites, QuickList, or by Master search. iv) Select a problem by entering a checkmark in the appropriate box or double-click on the desired problem to add details. v) Repeat steps ii – v as needed. b) To add a new allergy, do the following: i) Click on the Allergies tab. ii) To search for a medication allergen, click the Medication option; to search for a non- medication allergen, click the Non-medication option. iii) Find an allergy using Specialty or Personal Favorites, QuickList, or by Master search. iv) Select an allergy by entering a checkmark in the appropriate box or double-click on the desired allergy to add details.11/18/2009 25 Allscripts Enterprise EHR Certified Workflows
  • 26. v) Repeat steps ii – iv as needed. Clinical staff can specify that a patient has no known allergies where appropriate by selecting No Known Drug Allergies or No Known Allergies. c) To add a new medication history, do the following: i) Click on the Med Hx tab. ii) Select the Active Problem view from within the “Problem” section of the patient pane (located at the top on the left-hand side), if needed. iii) Highlight the appropriate problem by single-clicking on the problem name. iv) Find the medication using Specialty or Personal Favorites, QuickList, or by Master search. v) Select a medication by entering a checkmark in the appropriate box or double-click on the desired medication to add details, such as SIG information. vi) Repeat steps iii – v as needed. Best Practice is to link medication histories to the appropriate problems. This will automatically add that medication to the health management plan for that problem as well as aid in building of QuickSets. d) To add a new immunization history, do the following: i) Click on the Immun Hx tab. ii) Select the Active Problem view from within the “Problem” section of the patient pane (located at the top on the left-hand side), if needed. iii) Highlight the ‘Health Maintenance’ problem by single-clicking on the problem name. iv) Find an immunization using Specialty or Personal Favorites, QuickList, or by Master search. v) Select an immunization by entering a checkmark in the appropriate box. The Immunization Details page displays. vi) Enter a Date (required) by clicking on the Calendar icon. The Select a Date dialog displays. vii) Select a date or a fuzzy date. viii) Click OK. ix) Repeat steps iii – viii as needed.8) Once they have reviewed those items with the patient, the clinical staff selects the patient’s chief complaint (primary complaint that triggered the appointment). Follow these steps to select the chief complaint: a) From within the Add Clinical Item workspace, click on the Chief Complaint secondary tab. If not within the ACI, click on the Add New Problem icon from the Clinical Toolbar. b) Find the appropriate chief complaint using an incremental or alphabetical search.11/18/2009 26 Allscripts Enterprise EHR Certified Workflows
  • 27. For a chief complaint to appear within the Add Clinical Item workspace there must be an associated published symptom form. c) Select the chief complaint by entering a checkmark in the appropriate box. The items display in the problem section of the patient pane. d) Click OK when finished. The Clinical Desktop displays.9) Does the clinical staff begin the note? Some organizations allow the clinical staff to begin the note and document designated pieces of the patient visit.10) If yes, the clinical staff starts the note. Follow these steps to begin a note: a) From the Clinical Toolbar, click on the Note Authoring icon to start a new note. The Note Selector screen displays. b) Validate the Note Style selected is Note. c) Select the appropriate Specialty, if needed. Clinical staff can determine which specialty to default within the Note Selector page by setting the “Default Specialty ID” preference. d) Select the appropriate Visit Type and/or Visit Sub-Type. e) Review the Chief Complaint(s). Click OK to continue with no changes or click on the Add/Remove Chief Complaint link to modify. Once complete, click OK. f) The Note Authoring workspace (NAW) displays. The system compiles the correct note forms based on the specialty, visit type, chief complaint(s) and the patient’s age and sex. g) Clinical staff updates the appropriate note sections per the organization’s protocol.11) Clinical staff reviews all the information that was entered for the encounter. a) If the clinical staff began a note, the encounter review takes place within the Note Authoring workspace. To review the encounter information, use any of the following:  Click on the Encounter Summary icon from the Clinical Toolbar. The Encounter Summary page displays.  Click on the desired Note Section from the table of contents.  Select the desired output and click View. b) If no note was created, follow these steps to review the encounter information: i) From the Clinical Toolbar, click on the Encounter Summary icon. The Encounter Summary page displays. ii) All unsaved information will appear in magenta-colored text. iii) Clinical staff reviews the encounter information and edits it, if necessary.12) Clinical staff updates the patient status to reflect the next step within the patient visit and commits the data. a) To set the patient status and commit the encounter information from the Note Authoring workspace, follow these steps: i) Click the Status drop-down list from the Clinical Toolbar.11/18/2009 27 Allscripts Enterprise EHR Certified Workflows
  • 28. ii) Select the appropriate status. iii) Click Sign. The Note Signature page displays. iv) Enter your password and click OK. All unsaved data is committed when the note is signed. b) To set the patient status and commit the encounter information from the Encounter Summary, follow these steps: i) Click the Status drop-down list. A list of available statuses displays. ii) Select the appropriate status. iii) Click Save and Continue.13) Clinical staff returns to the daily schedule to prepare for the next patient. To return to the daily schedule, click on the Schedule horizontal toolbar. In the cases where the clinical staff begins the note, administrators can set the Note preference “Default Navigation After Signing” to Schedule to automatically take them to the daily Schedule after signing the note to prepare for the next patient.14) Once the patient intake process is complete, proceed to the (F) Retrieve workflows for the Certified Workflow steps.11/18/2009 28 Allscripts Enterprise EHR Certified Workflows
  • 29. (E3) Intake Process – With OrderThe clinical staff brings the patient back to an exam room to begin the intake process. This workflowis to achieve an understanding of what information is typically reviewed and updated within AllscriptsEnterprise EHR during the intake process where an order is placed per protocol for the patient visit. Figure 11 (E3) Intake Process – With Order E (4) (2) (3) (1) Clinical Staff (5) Clinical Staff sets Clinical Staff E3 Clinical Staff selects reviews patient Clinical Staff selects the patient location collects patient patient off schedule history and updates chief complaint and status vitals as appropriate H (6) (7) Is order required Yes Clinical Staff per protocol? completes order (8) (9) No Clinical Staff begins Yes Clinical Staff starts note? note (10) (12) (11) Clinical Staff Clinical Staff returns Clinical Staff F No reviews and saves to schedule to updates patient encounter prepare for next status information patientTo perform an intake process with an order, follow these steps:1) The clinical staff begins the Intake process by selecting a patient with a status of “Arrived” from the Schedule within Allscripts Enterprise EHR. To bring a patient into context from the daily schedule, follow these steps: a) Clinical staff should be logged into Allscripts Enterprise EHR. If not logged in, launch the application by double-clicking the Allscripts Enterprise EHR desktop icon. b) From the Chart menu, the daily Schedule tab should be active. Make sure the appropriate schedule is displaying. Adjust the provider or date where appropriate. c) Review the schedule and double-click on the desired patient. The Clinical Desktop displays.2) The clinical staff sets the patient location and status to reflect where the patient is. To set the patient location and status, follow these steps: a) From the Clinical Toolbar, click the Patient Location drop-down list. A list of available locations displays. b) Select the appropriate location. c) To set the status, click the Status drop-down list. A list of available statuses displays.11/18/2009 29 Allscripts Enterprise EHR Certified Workflows
  • 30. d) Select the appropriate status.3) The clinical staff is ready to collect the patient’s vital signs. To enter a patient’s vital signs into Allscripts Enterprise EHR, follow these steps: a) From the Clinical Toolbar, click the Add Vital Signs icon. The default vital signs view displays within the Order Details page. b) Enter all the necessary vital signs information for that patient. c) When finished, click OK.4) The clinical staff begins reviewing the patient’s history from the Clinical Desktop with the patient and updates it as appropriate. a) To update an existing chart item, do the following: i) From the Clinical Desktop, right-click on an item and select Edit from the context menu. ii) Add the necessary details. iii) Click OK. b) To add a new problem and/or update problem history, follow these steps: i) From the Clinical Toolbar, click on the Add New Problem icon. The Add Clinical Item workspace displays with the History Builder tab active. ii) Click on the corresponding secondary tab to add problem information: ▪ Active ─ Active Problems ▪ PMH ─ Past Medical History ▪ PSH ─ Past Surgical History ▪ Fam Hx ─ Family History ▪ Social Hx ─ Social History Some organizations choose not to have clinical staff enter problems as part of the intake process. Instead, all problems are managed by the provider. Allscripts enables the clinical staff to enter active problems and problem history as “unverified” and have the provider verify them while seeing the patient. iii) Find the desired problem using Specialty or Personal Favorites, QuickList, or by Master search. iv) Select a problem by entering a checkmark in the appropriate box or double-click on the desired problem to add details. v) Repeat steps ii – v as needed. c) To add a new allergy, do the following: i) Click on the Allergies tab. ii) To search for a medication allergen, click the Medication option; to search for a non- medication allergen, click the Non-medication option. iii) Find an allergy using Specialty or Personal Favorites, QuickList, or by Master search. iv) Select an allergy by entering a checkmark in the appropriate box or double-click on the desired allergy to add details.11/18/2009 30 Allscripts Enterprise EHR Certified Workflows
  • 31. v) Repeat steps ii – iv as needed. Clinical staff can specify that a patient has no known allergies where appropriate by selecting No Known Drug Allergies or No Known Allergies. d) To add a new medication history, do the following: i) Click on the Med Hx tab. ii) Select the Active Problem view from within the “Problem” section of the patient pane (located at the top on the left-hand side), if needed. iii) Highlight the appropriate problem by single-clicking on the problem name. iv) Find the medication using Specialty or Personal Favorites, QuickList, or by Master search. v) Select a medication by entering a checkmark in the appropriate box or double-click on the desired medication to add details, such as SIG information. vi) Repeat steps iii – v as needed. Best Practice is to link medication histories to the appropriate problems. This will automatically add that medication to the health management plan for that problem as well as aid in building of QuickSets. e) To add a new immunization history, do the following: i) Click on the Immun Hx tab. ii) Select the Active Problem view from within the “Problem” section of the patient pane (located at the top on the left-hand side), if needed. iii) Highlight the ‘Health Maintenance’ problem by single-clicking on the problem name. iv) Find an immunization using Specialty or Personal Favorites, QuickList, or by Master search. v) Select an immunization by entering a checkmark in the appropriate box. The Immunization Details page displays. vi) Enter a Date (required) by clicking on the Calendar icon. The Select a Date dialog displays. vii) Select a date or a fuzzy date. viii) Click OK. ix) Repeat steps iii – viii as needed5) Once they have reviewed those items with the patient, the clinical staff selects the patient’s chief complaint (primary complaint that triggered the appointment). Follow these steps to select the chief complaint: a) From within the Add Clinical Item workspace, click on the Chief Complaint secondary tab. If not within the ACI, click on the Add New Problem icon from the Clinical Toolbar. b) Find the appropriate chief complaint using an incremental or alphabetical search.11/18/2009 31 Allscripts Enterprise EHR Certified Workflows
  • 32. For a chief complaint to appear within the Add Clinical Item workspace there must be an associated published symptom form. c) Select the chief complaint by entering a checkmark in the appropriate box. The items display in the problem section of the patient pane. d) Click OK when finished. The Clinical Desktop displays.6) Is an order required per protocol? If an order is not required, the clinical staff closes the Add Clinical Item workspace by clicking OK.7) If an order is required, clinical staff places an order. Clinical staff remains within the Add Clinical Item workspace (after documenting the chief complaint) and clicks on the corresponding primary tab (Rx/Orders or Problem-based) specific to their ordering behavior. Refer to the (H) Order & Plan workflows for the Certified Workflow steps for ordering.8) Does the clinical staff begin the note? Some organizations allow the clinical staff to begin the note and document designated pieces of the patient visit.9) If yes, the clinical staff starts the note. Follow these steps to begin a note: a) From the Clinical Toolbar, click on the Note Authoring icon to start a new note. The Note Selector screen displays. b) Validate the Note Style selected is Note. c) Select the appropriate Specialty, if needed. Clinical staff can determine which specialty to default within the Note Selector page by setting the “Default Specialty ID” preference. d) Select the appropriate Visit Type and/or Visit Sub-Type. e) Review the Chief Complaint(s). Click OK to continue with no changes or click on the Add/Remove Chief Complaint link to modify. Once complete, click OK. f) The Note Authoring workspace displays. The system compiles the correct note forms based on the specialty, visit type, chief complaint(s) and the patient’s age and sex. g) Clinical staff updates the appropriate note sections per the organization’s protocol.10) Clinical staff reviews all the information that was entered for the encounter. a) If the clinical staff began a note, the encounter review takes place within the Note Authoring workspace (NAW). To review the encounter information, use any of the following:  Click on the Encounter Summary icon from the Clinical Toolbar. The Encounter Summary page displays.  Click on the desired note section from the table of contents.  Select the desired output and click View. b) If no note was created, follow these steps to review the encounter information: i) From the Clinical Toolbar, click on the Encounter Summary icon. The Encounter Summary page displays. ii) All unsaved information will appear in magenta-colored text.11/18/2009 32 Allscripts Enterprise EHR Certified Workflows
  • 33. iii) Clinical staff reviews the encounter information and edits, if necessary.11) Clinical staff updates the patient status to reflect the next step within the patient visit and commits the data. a) To set the patient status and commit the encounter information from the Note Authoring workspace, follow these steps: i) Click the Status drop-down list from the Clinical Toolbar. ii) Select the appropriate status. iii) Click Sign. The Note Signature page displays. iv) Enter your password and click OK. All unsaved data is committed when the note is signed. b) To set the patient status and commit the encounter information from the Encounter Summary, follow these steps: i) Click the Status drop-down list. A list of available statuses displays. ii) Select the appropriate status. iii) Click Save and Continue.12) Clinical staff returns to the daily schedule to prepare for the next patient. To return to the daily schedule, click on the Schedule horizontal toolbar. In the instances where the clinical staff begins the note, administrators can set the Note preference “Default Navigation After Signing” to Schedule to automatically take them to the daily Schedule after signing the note to prepare for the next patient.13) Once the patient intake process is complete, proceed to the (F) Retrieve workflows for the Certified Workflow steps.11/18/2009 33 Allscripts Enterprise EHR Certified Workflows
  • 34. (F) Retrieve IntroductionAs part of the patient visit, the provider reviews information regarding the patient either just prior toentering the exam room or during the first few minutes of the exam. The specific type of datareviewed may vary depending on why the patient is there, but the provider can greatly enhance theusefulness of the information they retrieve by using any of the following three fundamental methodsfor viewing information: ▪ Automated patient summaries ▪ Trends, graphs, or flow sheets ▪ Customized viewsEach of these methods enables the provider to choose how to view the contents of the electronichealth record, whether they are reviewing office notes, lab tests, imaging results, consultations,nursing notes, visit slips, or insurance forms. The purpose of retrieving and viewing chartinformation is to provide a better level of patient care and to do so with as little effort as possible. Figure 12 (F) Retrieve Information D E1 E2 E3 Acute or F Established Patient Yes F1 Visit? No Chronic or New F2 Yes Patient Visit? No EndThe following documents describe the steps to view or retrieve patient chart information for either abasic chart review or a detailed chart review.11/18/2009 34 Allscripts Enterprise EHR Certified Workflows
  • 35. Visit Type Description Basic Visit The basic visit type is defined as typically associated with an acute Type care visit for simple self-limited problems, such as would be seen in an urgent or primary care facility or with an established patient returning for a simple check-up or problem. See (F1) Chart Review - Basic workflow for more information. Detailed The detailed visit type is directed more toward management of one Visit Type or more chronic problems as seen in internal medicine or specialty medicine, or for a new patient who requires a more in-depth viewing of historical data or is presenting with complex or multiple problems. See (F2) Chart Review - Detailed workflow for more information.The provider has access to all areas of a patient’s record from the Clinical Desktop. It is importantto understand how the Clinical Desktop is set up in order to optimize workflow. The followingillustration is an example of a suggested starter configuration of the Clinical Desktop for efficientreview of adult patient data:Adult Patient View – Clinical Desktop View:This Clinical Desktop View (Adult Patient View) is an Allscripts delivered view which has been set upas follows:Layout = View 3Component Group #1 (Upper Left Pane):11/18/2009 35 Allscripts Enterprise EHR Certified Workflows
  • 36. ▪ Problem – default view to Active Problems with secondary sort set to Type ▪ Encounter – default view set to All by AppointmentComponent Group #2 (Lower Left Pane): ▪ Meds – default view set to Current Medications secondary sort set to Alpha ▪ Allergies – default view set to All with secondary sort set to Urgency ▪ Orders – default view set to Current Orders with secondary sort set to StatusComponent Group #3 (Right Pane): ▪ Health Management Plan – default view to Health Management with secondary sort set to Problem ▪ ChartViewer – default view to All by Section by Sub-Section ▪ Patient Worklist – default to provider preferred Worklist ViewThe Health Management Plan component is the principal workspace where providers can view andmanage numerous aspects of patient data. It allows providers to quickly review current medicationsand orders, HMP reminders and recent results for the selected patient without having to go tomultiple workspaces. Use the Hide VTB (Hide Vertical Toolbar) and Full Screen controls to maximize the Clinical Desktop and Component workspace.The previous view is an excellent starting point for most specialties whether the patient visit is abasic or detailed visit type. An exception is for the Pediatrics specialty, for which the followingAllscripts delivered view is defined as:Pediatric Patient View – Clinical Desktop View:11/18/2009 36 Allscripts Enterprise EHR Certified Workflows
  • 37. Pediatric Patient View:Layout = View 3Component Group #1 (Upper Left Pane): ▪ Problem – default view to Active Problems with secondary sort set to Type ▪ Encounter – default view set to All by Appointment ▪ Patient Worklist – default to provider preferred Worklist ViewComponent Group #2 (Lower Left Pane): ▪ Meds – default view set to Current Medications secondary sort set to Alpha ▪ Allergies – default view set to All with secondary sort set to Urgency ▪ Orders – default view set to Current Orders with secondary sort set to StatusComponent Group #3 (Right Pane): ▪ Growth Charts – Set to display Flowsheets for Normative Growth ▪ Immuns – Set to display Immunization Series ▪ ChartViewer – default view to All Section by Sub-Section ▪ Health Management Plan – default view to Health Management with secondary sort set to Problem11/18/2009 37 Allscripts Enterprise EHR Certified Workflows
  • 38. (F1) Chart Review – BasicThe purpose of the following workflow is to achieve an understanding of what information is typicallyreviewed by the provider just prior to entering the exam room or during those first few minutes of theexam for a basic visit type. The main goal of retrieve or chart review is to allow the provider to viewand interact with as much data regarding the patient as possible. A basic visit is typically associatedwith an acute care visit for simple self-limited problems, such as would be seen in an urgent orprimary care facility or with an established patient returning for a routine follow-up. The followingillustration depicts a basic chart review process. Figure 13 (F1) Chart Review - Basic F (1) (2) Has note been F1 Yes Provider selects started by Clinical note from schedule Staff? (3) (4) Provider selects Provider reviews No patient from today’s encounter Schedule summary (5) Provider reviews patient’s clinical Problems information & updates as needed Medications Allergies (7) (8) (6) Need to review Provider reviews Vital Signs Provider reviews Yes previous or scanned most recent chart recent results notes? notes No GTo retrieve information for a basic chart review, do the following:1) Has the note been started by the clinical staff? As part of the intake process some practices have the clinical staff begin the note and document various note sections defined by the organization.2) If yes, the provider selects the note from the schedule for the patient being seen. To select a note from the schedule, follow these steps: a) Provider should be logged into Allscripts Enterprise EHR. If not logged in, launch the application by double-clicking on the Allscripts Enterprise EHR desktop icon. b) From the Chart vertical toolbar, the daily Schedule horizontal toolbar should be active. c) Review the schedule and click on the note icon next to the desired patient’s name. The Note Authoring workspace (NAW) displays.3) If the note was not started by the clinical staff, the provider selects the patient from the schedule and brings the patient encounter into context. To bring a patient into context from the daily schedule, follow these steps:11/18/2009 38 Allscripts Enterprise EHR Certified Workflows
  • 39. a) The provider should be logged into Allscripts Enterprise EHR. If not logged in, launch the application by double-clicking on the Allscripts Enterprise EHR desktop icon. b) From the Chart vertical toolbar, the daily Schedule horizontal toolbar should be active. c) Review the schedule and double-click on the desired patient. The Clinical Desktop displays.4) Provider opens today’s encounter summary to review the data entered by the clinical staff as well as view any alerts and/or reminders. a) To review the encounter information from within the Note Authoring workspace or from the Clinical Desktop, click on the Encounter Summary icon from the Clinical Toolbar. The Encounter Summary page displays.5) Provider reviews the patient’s clinical information and updates as needed. In addition, the provider will ‘Verify and Add’ for any of the newly entered patient history that was entered by the clinical staff, as appropriate. The common components of patient data typically reviewed as part of a basic visit type are: ▪ Active Problems ▪ Current Medications ▪ Allergies ▪ Vital Signs a) To review the patient’s clinical information from within the Note Authoring workspace, use any of the following: ▪ Click on the corresponding Note Section from the table of contents to review Active Problems, Current Medications, Allergies and Vital Signs information. ▪ Click on the corresponding component (tab) within the NAW to review Active Problems (Problem), Current Medications (Meds/Orders), Allergies (Allergies) and Vital Signs information (HMP – VitalSigns/Findings). b) To review the patient’s clinical information from the Clinical Desktop, do the following: click on the corresponding component (tab) within the Clinical Desktop to review Active Problems (Problem), Current Medications (Meds), Allergies (Allergies) and Vital Signs information (HMP – VitalSigns/Findings). c) To ‘Verify and Add’ any of the newly entered patient history that was entered, do the following: i) From the corresponding component, select Type as the secondary sort. ii) Under the Unverified section, highlight the chart item by single-clicking. iii) Click on Add/Verify. Providers can also right-click on the item and select Add and Verify from the context menu.6) The provider reviews recent results. To review all recent results from the ChartViewer component, do the following: a) Click on the ChartViewer component (tab). b) Select the “Recent Data” View from the drop-down list. c) Double-click to view any relevant results data. Allscripts recommends creating a “Recent Data” view that looks at all recent chart information for the patient within the past two years. This includes all the relevant11/18/2009 39 Allscripts Enterprise EHR Certified Workflows
  • 40. patient information that a provider would need to review during the retrieve process.7) Does the provider need to review any previously entered documentation, including scanned documents?8) If the provider needs to review previous or other recent clinical documentation, remain within the ChartViewer component and do the following: a) Under the Recent Data View, double-click on the desired document to open in a single Viewer. b) Single-click items, select View and View in New Window to open multiple items. These can then be tiled as desired to view multiple items at once. Component groups can be resized by “dragging” the edge of the component with the mouse.9) Once the provider has completed the retrieve process, they are then ready to begin the patient visit. Refer to the (G) Document workflows for the Certified Workflow steps for documenting the patient visit.11/18/2009 40 Allscripts Enterprise EHR Certified Workflows
  • 41. (F2) Chart Review – DetailedThe purpose of the following workflow is to achieve an understanding of what information is typicallyreviewed by the provider just prior to entering the exam room or during those first few minutes of theexam for a detailed visit type. The main goal of retrieve or chart review is to allow the provider toview and interact with as much data regarding the patient as possible. A detailed visit is directedmore toward management of one or more chronic problems as seen in internal medicine or specialtymedicine, or for a new patient who requires a more in-depth viewing of historical data or ispresenting with complex or multiple problems. Figure 14 (F2) Chart Review - Detailed1) Has the note been started by the clinical staff? As part of the intake process some practices have the clinical staff begin the note and document various note sections defined by the organization.2) If yes, the provider selects the note from the schedule for the patient being seen. To select a note from the schedule, follow these steps: a) Provider should be logged into Allscripts Enterprise EHR. If not logged in, launch the application by double-clicking on the Allscripts Enterprise EHR desktop icon. b) From the Chart vertical toolbar, the daily Schedule horizontal toolbar should be active. c) Review the schedule and click on the note icon next to the desired patient’s name. The Note Authoring workspace (NAW) displays.3) If the note was not started by the clinical staff, the provider selects the patient from the schedule and brings the patient encounter into context. To bring a patient into context from the daily schedule, follow these steps: a) The provider should be logged into Allscripts Enterprise EHR. If not logged in, launch the application by double-clicking on the Allscripts Enterprise EHR desktop icon.11/18/2009 41 Allscripts Enterprise EHR Certified Workflows
  • 42. b) From the Chart vertical toolbar, the daily Schedule horizontal toolbar should be active. c) Review the schedule and double-click on the desired patient. The Clinical Desktop displays.4) Provider opens today’s encounter summary to review the data entered by the clinical staff as well as view any alerts and/or reminders. a) To review the encounter information from within the Note Authoring workspace (NAW) or from the Clinical Desktop, click on the Encounter Summary icon from the Clinical Toolbar. The Encounter Summary page displays.5) Provider reviews the patient’s clinical information and updates as needed. In addition, the provider will ‘Verify and Add’ any of the newly entered patient history that was entered by the clinical staff, as appropriate. The common components of patient data typically reviewed as part of a detailed visit type are: ▪ Active Problems and Problem History ▪ Current Medications ▪ Allergies a) To review the patient’s clinical information from within the Note Authoring workspace (NAW), use any of the following: ▪ Click on the corresponding Note Section from the table of contents to review Active Problems, Current Medications, Allergies and Vital Signs information. ▪ Click on the corresponding component (tab) within the NAW to review Active Problems (Problem), Current Medications (Meds/Orders), Allergies (Allergies) and Vital Signs information (HMP – VitalSigns/Findings). b) To review the patient’s clinical information from the Clinical Desktop, do the following: i) Click on the corresponding component (tab) within the Clinical Desktop to review Active Problems (Problem), Current Medications (Meds), Allergies (Allergies) and Vital Signs information (HMP – VitalSigns/Findings). c) To ‘Verify and Add’ any of the newly entered patient history that was entered, do the following: i) From the corresponding component, select Type as the secondary sort. ii) Under the Unverified section, highlight the chart item by single-clicking. iii) Click on Add/Verify. Providers can also right-click on the item and select Add and Verify from the context menu.6) The provider reviews patient’s health management plan (HMP). The common components typically reviewed are as follows: ▪ Vital Signs ▪ Flowsheets & Graphs ▪ Alerts & Reminders a) To review a patient’s Health Management Plan, do the following: i) Click on the HMP component (tab). ii) Select the desired View from the component view drop-down list.7) The provider reviews recent results. To review all recent results from the ChartViewer component, do the following: a) Click on the ChartViewer component (tab).11/18/2009 42 Allscripts Enterprise EHR Certified Workflows
  • 43. b) Select the “Recent Data” View from the drop-down list. c) Double-click to view any relevant results data. Allscripts recommends creating a “Recent Data” view that looks at all recent chart information for the patient within the past year. This would include all the relevant patient information that a provider would need to review.8) Does the provider need to review any previously entered documentation, including scanned documents?9) If the provider needs to review previous or other recent clinical documentation, remain within the ChartViewer component and do the following: a) Under the Recent Data View, double-click on the desired document to open in a single Viewer. b) Single-click items, select View and Viewer in New Window to open multiple items. These can then be tiled as desired to view multiple items at once. Component groups can be resized by “dragging” the edge of the component with the mouse.10) Provider checks for pending orders and takes appropriate action. Depending on where the provider is performing the chart review, this can be done within the Patient Worklist component from the Clinical Desktop or within the Meds/Orders component from the Note Authoring workspace. a) To access the Patient Worklist component from the Clinical Desktop, do the following: i) Click on the Patient Worklist component tab. ii) Select the desired Worklist View from the drop-down list that contains all the order items for the patient in context. iii) Right-click on the appropriate order and select the necessary action from the context menu as appropriate. b) To access the Meds/Order component from the NAW, do the following: i) Click on the Meds/Orders component (tab). ii) Validate that the view is Current Meds/Orders and it is sorted by Status. iii) Right-click on the appropriate order and select the necessary action from the context menu as appropriate.11) Once the provider has completed the retrieve process, they are then ready to begin the patient visit. Refer to the (G) Document workflows for the Certified Workflow steps for documenting the patient visit.11/18/2009 43 Allscripts Enterprise EHR Certified Workflows
  • 44. (G) Document IntroductionHistorically, documenting the patient encounter is one of the most time intensive tasks in clinicalpractice. Documenting lets providers capture their thoughts and actions during a patient encounterand assemble them into a formal clinical document or office note. Documenting is also used forpatient notification tasks, sending consultative letters and reports, and other purposes within theoffice. Clinical documentation using a computer with an electronic health record can make thisprocess just as quick (or quicker), more complete, and more accurate than the older, paper-basedmethod.This section presents workflows that “flow” across many workflows; all of which can be used to“document” the patient visit. These could include dictating as part of the documentation process,creating a prescription or laboratory order, reviewing results, or creating and finalizing a charge aspart of the patient visit encounter.The office workflow for the different visit types has a critical impact on note design and usage. Thissection discusses the more common, higher-level workflows. However, one of the useful features ofAllscripts Enterprise EHR is the significant amount of flexibility it gives to providers. Some providerswill want to continue to dictate 100 percent of the time. Some will be satisfied if they can reducetheir transcription costs by 50 percent. Others will be motivated to complete all their documentationbefore leaving the exam room. For others, brevity and speed will be the most important issues.Allscripts Enterprise EHR enables all of these scenarios.Each organization should also consider how to approach “prototypical” visit types. Examples includethe patient presenting with a single, acute, self-limited problem; patients with a combination ofchronic problems for follow-up and at least one acute problem; patients in for routine follow-up of asingle problem; patients presenting for a surgical procedure; the brand new patient in for a complete,routine workup. Each of these visit types could be treated as highly unique workflows with specificnote design considerations. It is also possible to design highly generic notes that could aggregatemany of these visit types together into a small number of visit types for the purpose of documentingan encounter.The workflows in this section discuss the most common visit types, as defined in the following list: Acute Visit—Typically associated with an acute self-limited problem, such as would be seen in a primary care facility or with an established patient returning for a simple check-up or problem. Acute visit types are typically symptom (or chief complaint) driven and can be both highly specific (templates built for specific common complaints) or generic (templates built for multiple symptoms) to accommodate multiple combinations of symptoms and more non- predictable visits. New or Chronic Visit—This visit type is directed toward a patient with highly complex or multiple chronic problems. Due to the more in-depth documentation and review required for a new patient, they are also included in this category. These types of visits are typically problem driven, rather than symptom driven, with a high level of specificity and apply to specialties such as Internal Medicine, Cardiology, Urology, and so on. Procedure Visit—Associated with a visit type that includes a procedure. Procedure visit types require templates with a higher level of specificity for efficient documentation, such as seen in the surgical specialties. Health Maintenance Visit—Associated with routine well child or adult check-up health maintenance visit. These visit types are typically of medium complexity, of high specificity,11/18/2009 44 Allscripts Enterprise EHR Certified Workflows
  • 45. and are driven by patient’s age and gender. Common specialties with health maintenance visit types are Pediatrics, Family Practice, and OB-GYN. Results Note—Associated with a note created as part of the result verification process. Dictation—Includes details for utilizing dictation as part of the clinical documentation process. This workflow includes variations of inserting dictation markers into the note or generating letters or reports after the patient has left. Admin Forms—Includes details for utilizing forms built from the Allscripts Enterprise EHR Forms module as part of the clinical documentation process.Utilizing Structured Notes – General Note ConceptsThere may be times when the provider requires Note Forms or other information to be inserted intothe Note that is not included as part of the default Note setup. Follow these general guidelines forany Note workflow on using a variety of functions to add information to an existing note:Inserting a New Note SectionIf the appropriate Note Section is not present, follow these steps to insert a new one:1) Right-click on the Note Section header located either above or below where the new section should be located.2) Select Add Section Above or Add Section Below (top or bottom determines placement of the form in the section). The system displays the Note Sections selector screen.3) Select the desired Note Section(s).4) Click OK.Inserting Note FormsIf the appropriate Note Form is not present, follow these steps to insert a new one:1) Right-click on a note section header in the table of content on the left.2) Select Add Form Top or Add Form Bottom (top or bottom determines placement of the form in the section). The system displays the Form Selector screen.3) Select the desired form(s).4) Click OK. The selected Note Form inserts into the appropriate note section.Inserting ImagesFollow these steps to add an illustration to a note section:1) Right-click on the desired Note Section header.2) Select Add Image Top or Add Image Bottom (top or bottom determines placement of Illustration in section). The system displays the Image Selector screen. A local picture of the patient can also be selected.3) Select the desired General Image or Patient Specific Image.4) Click OK.11/18/2009 45 Allscripts Enterprise EHR Certified Workflows
  • 46. 5) Edit / mark on image as desired.6) Select Commit to save changes to the drawing.Renaming a Note Section HeaderFollow the below steps to rename a Note Section Header for the existing note (only):1) Right-click on the desired Note Section Header.2) Select Rename Section.3) Type in the new Note Section Header name.4) Press Enter (on the keyboard).Inserting a Dictation MarkerFollow these steps to insert a dictation marker within a note section that does not have a defaultdictation marker already associated:1) Select the desired Note Section. This will quickly display the desired Note Section in the Note Accumulator workspace (NAW).2) From the NAW, right-click the section header and select one of the following (as needed): a) Insert Dictation Marker at Section Top b) Insert Dictation Marker at Section Bottom c) Insert Dictation Marker at Form Top d) Insert Dictation Marker at Form Bottom3) The dictation marker identification number will be inserted into the selected accumulator note section.4) Complete dictation as desired and continue with the patient visit encounter.RecompileThere may be instances where the provider needs to add a Chief Complaint after the initialcompilation of the Note has been done. In this instance, the action of “Recompile” needs to be doneto add the associated Note Forms to the Note. Follow these steps to add a Chief Complaint andRecompile:1) From the Chief Complaint Note Section, click New.2) The Add Clinical Item screen will display with the Chief Complaint secondary tab selected.3) Select the desired new Chief Complaint(s).4) Click OK.5) Click on Recompile.6) Resume documentation of the encounter.Carbon CopyFollow the below steps to add a carbon copy recipient for a Note:1) From the Note Authorizing Workspace (NAW) select an Output Template by clicking View.2) Select the appropriate Output document tab (Individual or All).11/18/2009 46 Allscripts Enterprise EHR Certified Workflows
  • 47. 3) Click the Carbon Copy icon .4) Select the appropriate recipient: ▪ By Role: Place a checkmark next to the appropriate provider or current patient selection in the box located in the Role column. ▪ Manual: Click on the Manual tab and select either a provider or referring provider from the corresponding dictionary lookup. ▪ Ad Hoc: Click Ad Hoc and manually type in the recipient’s name and select the method of communication: Print or Fax. Finish by typing in optional information of address, city, state, Zip Code, and fax number.5) Click OK. The selected recipients display in the Note Output header.Patient Education Materials – Print ActionsMany of the workflows listed in this chapter reference the printing of patient education materials.Patient education materials may be produced when an ad hoc order or CareGuide template isselected during the encounter. The system can be set up to print these automatically upon savingthe encounter, or printing can be “turned off.” This enables the provider to print as needed for eachpatient. As this may potentially impact each workflow, it is important to understand the variousbehaviors of the system in relationship to this when certain user actions are taken.There is a system preference located on the TWAdmin, Preferences page that controls PatientEducation Materials and when they print. The Print Patient Education Always preference field hasthe following options: ▪ Always—This setting causes the patient education material to always print regardless of whether a CareGuide template is associated to a problem within the encounter. ▪ Only if CareGuide Associated—This setting causes the patient education materials (reflecting both items created from within a CareGuide template or from ad hoc orders) to only print if there is a CareGuide template associated during the patient encounter. Note: CareGuides must be purchased separately to enable this functionality to work. If CareGuides have not been purchased and this setting is utilized, it would be the equivalent of selecting to “never” print any patient education materials.The Print Patient Education Always preference is typically set by the System Administrator at asystem level. However, users can override this preference setting from within Allscripts EnterpriseEHR by changing the preference from any .NET Personalize workspace.Additionally, the following table defines the system response to user actions in relationship to thetiming of when the patient education materials may print. System Response toScenario User Action System Printing Actions User Prompt Selection(1.) Care Guide Does not print. Systemtemplate is stores all the CG and adassociated and/or ad Clicks Commit. N/A hoc orders for the sessionhoc orders – are for printing.unsaved Clicks Save or Does not print. Cancel or N/A continues on System stores all the CG11/18/2009 47 Allscripts Enterprise EHR Certified Workflows
  • 48. System Response toScenario User Action System Printing Actions User Prompt Selection Encounter and ad hoc orders for the Summary. session for printing. Prints patient education Clicks Print based on ad hoc print Patient Ed on preferences and the N/A Encounter explicit print check box Summary. selections. Prints patient education based on ad hoc print Changes Patient preferences and the N/A Encounter. explicit print check box selections. Prints patient education based on ad hoc print Changes patient. preferences and the N/A explicit print check box selections. Prints patient education based on ad hoc print Logs off. preferences and the N/A explicit print check box selections.(2.) Care Guidetemplate and/or adhoc orders previouslysaved AND printed – Clicks Commit. Does not print. N/ANo new orders or CGtemplates areassociated. Clicks Save or Cancel or continues on Does not print. N/A Encounter Summary. Before printing, system If ‘Yes,’ the system Clicks Print prompts the user “Do you reprints everything. Patient Ed on wish to reprint materials Encounter […] previously printed Summary. during this section? If ‘No,’ the system Yes/No.” cancels the printing.11/18/2009 48 Allscripts Enterprise EHR Certified Workflows
  • 49. System Response toScenario User Action System Printing Actions User Prompt Selection Changes patient Does not print. N/A encounter. Changes patient. Does not print. N/A Logs off. Does not print N/A(3.) Care Guidetemplate and/or ad Does not print.hoc orders previouslysaved – printed or not Clicks Commit. System stores all the CG N/A– and user has added and ad hoc orders for thenew orders or CG session for printing.template associated. Clicks Save or Does not print. Cancel or continues on System stores all the CG N/A Encounter and ad hoc orders for the Summary. session for printing. If ‘Yes,’ the system If previously printed – reprints everything – before printing (based on adding the new orders / check boxes) system CG monographs. prompts the user “You Clicks Print have new patient Patient Ed on If ‘No,’ the system prints education materials to Encounter only the newly added print. Do you wish to Summary. orders / CG reprint materials […] monographs. previously printed during this session? (Yes / No / Cancel).” If ‘Cancel,’ the system cancels the printing. If previously printed – If ‘Yes,’ the system before printing (based on reprints everything – check boxes) system adding the new orders / prompts the user “You CG monographs. have new patient Changes patient education materials to If ‘No,’ the system prints encounter. print. Do you wish to only the newly added reprint materials […] orders / CG previously printed during monographs. this session? (Yes / No / Cancel).” If ‘Cancel,’ the system11/18/2009 49 Allscripts Enterprise EHR Certified Workflows
  • 50. System Response toScenario User Action System Printing Actions User Prompt Selection cancels the patient encounter change. If ‘Yes,’ the system reprints everything – If previously printed – adding the new orders / before printing (based on CG monographs. check boxes) system prompts the user “You have new patient If ‘No,’ the system prints Changes patient. education materials to only the newly added print. Do you wish to orders / CG reprint materials […] monographs. previously printed during this session? (Yes / No / If ‘Cancel,’ the system Cancel).” cancels the change of patients. If ‘Yes,’ the system If previously printed – reprints everything – before printing (based on adding the new orders / check boxes) system CG monographs. prompts the user “You have new patient If ‘No,’ the system prints Logs off. education materials to only the newly added print. Do you wish to orders / CG reprint materials […] monographs. previously printed during this session? (Yes / No / Cancel).” If ‘Cancel,’ the system cancels the logoff. Print options & Print Patient Education button on the Encounter Summary11/18/2009 50 Allscripts Enterprise EHR Certified Workflows
  • 51. Figure 15 (G) Document11/18/2009 51 Allscripts Enterprise EHR Certified Workflows
  • 52. (G1) Note: Acute VisitThis workflow defines the steps for documenting an acute visit patient encounter. This visit type istypically associated with an acute self-limited problem, such as with an established patient returningfor a simple check-up or problem. This type of visit is typically symptom (or chief complaint) drivenand can be both highly specific (templates built for specific common complaints) or generic(templates built for multiple symptoms) to accommodate multiple combinations of symptoms andmore non-predictable visits. Figure 16 (G1) Note: Acute VisitTo document an acute visit patient encounter, follow these steps:1) Has the note been started by the clinical staff? As part of the intake process some practices have the clinical staff begin the note and document various note sections defined by the organization. If the note was started, the provider should already be within the note as part of the Retrieve process and should proceed to step 3.2) If the note was not started by the clinical staff, the provider starts the note. All information collected by the clinical staff during the Intake Process will populate the various note sections, as defined for the specific visit type selected to document the visit. Follow these steps to begin a note: a) The provider should already be logged into Allscripts Enterprise EHR and have the desired patient in context (appears within the Patient Banner) since previously completing the Retrieve workflow.11/18/2009 52 Allscripts Enterprise EHR Certified Workflows
  • 53. b) From the Clinical Toolbar, click on the Note Authoring icon. The Note Selector displays. c) Validate the Style selected is Note. d) The provider’s specialty should default. Adjust as appropriate. e) Select the appropriate Visit Type and/or Visit Sub-Type.3) Provider reviews the Chief Complaint(s) and updates as needed. To add or remove chief complaints, follow these steps: a) From within the Note Authoring workspace (NAW), click on the Chief Complaint note section to review the chief complaints entered during the intake process. i) To add a new chief complaint, click New on the action toolbar. Select the desired chief complaint(s) and click OK. ii) To remove a chief complaint, deselect the chief complaint by clicking on the check box next to the item. iii) If updates were made, click Recompile. b) From the Note Selector page, review the chief complaints entered during the intake process under the Chief Complaint section. i) To accept with no changes, click OK. The Note Authoring workspace displays. ii) To modify, click on the Add/Remove Chief Complaint link. Once the chief complaint(s) are correct, click OK to return to the note selector. Click OK. The Note Authoring workspace displays.4) The system compiles the correct Note Forms based on the specialty, visit type, chief complaint(s) and the patient’s age and sex.5) Provider completes the associated Note Form(s) for the History of Present Illness (HPI) section as appropriate. HPI should be set to auto-configure Note Forms based on the chief complaint or chief complaints selected.6) Provider completes the associated Note Form(s) for the Review of Systems (ROS) section as appropriate. ROS should have standard review of system Note Forms automatically defaulted as part of the input template. You can either delete or clear Note Forms by right-clicking on the Form and selecting Delete Form or Clear Form.7) Provider completes the associated Note Form(s) for the Physical Exam (PE) section as appropriate. The PE section should have standard physical exam Note Forms automatically defaulted as part of the input template. Click on the “carrot” symbol to quickly navigate to the next section in a long Note Form.8) Provider assesses the patient’s problems as appropriate. Problems are assessed not only for clinical documentation purposes, but for billing purposes as well. Follow these steps to assess a problem under the Assessment note section:11/18/2009 53 Allscripts Enterprise EHR Certified Workflows
  • 54. a) To assess an existing problem, do the following: i) Click on the box next to the desired problem. A checkmark appears within the box indicating the problem is assessed. The problem will change to magenta-colored text. b) To add a new problem, do the following: i) Click New on the action toolbar. The system launches the Add Clinical Item workspace with the History Builder primary tab and Active (problem) secondary tab active. ii) Find the desired problem using Specialty or Personal Favorites, QuickList, or by Master search. iii) Select a problem by entering a checkmark in the appropriate box or double-click on the desired problem to add details. iv) Repeat steps ii – iii, as needed v) When finished, click OK. The system returns to the Note Authoring workspace. The first assessed diagnosis is marked as the primary diagnosis for billing purposes by default: the order of the diagnoses can be changed in the assessment section by right-clicking and selecting the appropriate option from the context menu.9) Is there an order needed for this patient visit? This could include any order type, such as a prescription, a laboratory or radiology order, an order for medication administration or immunization, and so on.10) If an order is needed, the provider creates the necessary orders and completes the plan for the patient. Follow the (H) Order & Plan workflows for more information and review the certified workflow steps for ordering. The Plan note section displays the new orders entered for the encounter.11) Provider adjusts patient education materials, if needed. Patient education materials should be set to print automatically for an ad hoc order or CareGuide template that is selected during an encounter. However, a provider may need to occasionally modify when or what patient education materials should print that differs from his/her default. Refer to the Printing Education Materials section in the Document Introduction workflow for further details. To adjust when or what patient education materials print, follow these steps: a) From the Clinical Toolbar, click the Encounter Summary icon. b) Review the orders that are listed in the Encounter Summary workspace. c) Select (or de-select) the appropriate Patient Education options: i) Patient Instructions (CareGuide) (1) Monographs – (if the patient has received this monograph a few times in the past, the provider may decide to not print again) (2) Instructions (3) Spanish ii) Patient Instructions (Ad Hoc) d) Click Print Pt. Ed. The Print Dialog box displays. e) Validate the printer information. Adjust if necessary.11/18/2009 54 Allscripts Enterprise EHR Certified Workflows
  • 55. f) Click OK. The system will return you to the Encounter Summary workspace. g) Click Continue. Any adjustments made to the print selections will be adhered to until the encounter information is saved.12) The provider documents the Discussion and Summary for the visit. Information for this particular note section can be documented within a specific Note Form, dictated, or directly entered into the Note Accumulator.13) Provider reviews note output(s). Allscripts recommends that prior to signing the note, the provider review the output or outputs for the encounter. Output templates determine how, where, and what information from the note input will appear within each output. Follow these steps to review an output: a) From the Note Authoring workspace, validate the desired output or outputs are checked and select View (bottom left corner). b) The Note Output workspace displays. c) Click on the corresponding tab to see a specific output. Default is the ‘All’ view.14) Are carbon copies needed? The provider may need to send carbon copies of certain outputs to other providers or to the patient.15) If carbon copies are needed, follow these steps to select the appropriate recipients: a) From within the Note Output workspace, click on the Carbon Copies icon (upper left corner). b) Select the appropriate Output document tab (Individual or All). c) Select the appropriate recipient: ▪ By Role: Place a checkmark next to the appropriate provider or current patient selection in the box located in the Role column. ▪ Manual: Click on the Manual tab and select either a provider or referring provider from the corresponding dictionary lookup. ▪ Ad Hoc: Click Ad Hoc and manually type in the recipient’s name and select the method of communication: Print or Fax. Finish by typing in optional information of address, city, state, Zip Code, and fax number. d) Click OK. The selected recipients display in the Note Output header. Carbon Copy functionality must first be set up within Auto Print Defaults and enabled for the desired outputs.16) Once complete, the provider is ready to sign and finalize the note information. To sign and finalize note output documents, do the following: a) From the Note Output workspace, click Sign. The Note Signature dialog box displays. b) Enter the appropriate password. c) If the note should be made “final,” verify the checkmark is in the Make Final box. Otherwise, if it should not be finalized at this time, uncheck the box. d) Click OK.11/18/2009 55 Allscripts Enterprise EHR Certified Workflows
  • 56. The system displays the following note icon on the daily Schedule next to the patient’s name to indicate that the Note was signed and finalized17) Once the encounter information has been committed, any patient education materials set up to print automatically will print.18) Will the provider need to submit charges for the patient visit?19) If yes, the provider charges for the visit. Follow workflow (J2) Charging from Note for the Certified Workflow detailed steps.20) Provider updates the patient status and directs the patient to check-out. To set the patient status from the Clinical Toolbar, follow these steps: a) Click the Status drop-down list. A list of available statuses displays. b) Select the appropriate status.21) Refer to the (K) Follow-up and Check-out workflows for the Certified Workflow detailed steps.11/18/2009 56 Allscripts Enterprise EHR Certified Workflows
  • 57. (G2) Note: New or Chronic VisitThis workflow defines the steps for documenting a new or chronic visit patient encounter. This visittype is typically associated with a patient with highly complex or multiple chronic problems. Newpatients are also included in this category due to the more in-depth documentation and reviewrequired. This type of visit is typically problem driven, rather than symptom driven, with a high levelof specificity and applies to specialties such as Internal Medicine, Cardiology, Urology, and so forth. Figure 17 (G2) Note: New or Chronic Visit G (1) (2) (3) G2 Provider assesses Has note already Yes Provider H problems been started? recompiles note (11) (12) Provider creates Provider adjusts Yes No order(s) & patient education completes plan materials if needed (5) (6) (8) (9) (7) (4) Note complies Provider Provider performs Provider reviews Provider (10) Provider starts the Note Forms documents History and documents assessed documents Review Order needed? note based on of Present Illness Physical Exam problems & of Systems (ROS) problem(s) (HPI) (PE) updates if needed (13) Provider No documents Discussion/ Summary (14) (15) (16) Provider reviews Carbon Copies Yes Provider identifies Note Output(s) Required? Carbon Copy list J2 (18) (17) Patient (19) (20) No Provider Signs Education Provider charging Yes Provider charges Note Output(s) Materials print, for visit? for visit as defined (21) Provider updates No patient status & K directs patient to checkoutTo document a chronic or new visit patient encounter, follow these steps:1) The provider begins by assessing the problems for the patient. These may be preliminary problems that will be confirmed once the visit is complete. However, assessing the problems at this stage will allow the note to compile the necessary Note Forms based on the assessed problems. a) To assess an existing problem, follow these steps: i) The provider should already be logged into Allscripts Enterprise EHR and have the desired patient in context (appears within the Patient Banner) since previously completing the Retrieve workflow. ii) Click on the Problem component tab. iii) Place a checkmark in the box next to the appropriate problem. b) To add a new problem, follow these steps:11/18/2009 57 Allscripts Enterprise EHR Certified Workflows
  • 58. i) The provider should already be logged into Allscripts Enterprise EHR and have the desired patient in context (appears within the Patient Banner) since previously completing the Retrieve workflow. ii) From the Clinical Toolbar, click on the Add New Problem icon. The Add Clinical Item workspace displays with the History Builder primary tab and Active (problem) secondary tab active. iii) Find the desired problem using Specialty or Personal Favorites, QuickList, or by Master search. iv) Select a problem by entering a checkmark in the appropriate box or double-click on the desired problem to add details. v) Click OK.2) Has the note been started by the clinical staff? As part of the intake process some practices have the clinical staff begin the note and document various note sections defined by the organization.3) If the note was started, the provider recompiles the note to pull in any additional Note Forms based on the newly assessed problems. To recompile a note, do the following: a) From the Note Authoring workspace, click on Recompile on the action toolbar (at the bottom of the page). b) Proceed to step 5.4) If the note was not started by the clinical staff, the provider starts the note. All information collected by the clinical staff during the Intake Process will populate the various note sections, as defined for the specific visit type selected to document the visit. Follow these steps to begin a note: a) From the Clinical Toolbar, click on the Note Authoring icon. The Note Selector displays. b) Validate the Note Style selected is Note. c) The provider’s specialty should default. Adjust as appropriate. d) Select the appropriate Visit Type and/or Visit Sub-Type. e) Click OK.5) The system compiles the correct Note Forms based on the specialty, visit type, problems assessed, and the patient’s age and sex.6) Provider completes the associated Note Form(s) for the History of Present Illness (HPI) section as appropriate. HPI should be set to auto-configure Note Forms based on the chief complaint or chief complaints selected.7) Provider completes the associated Note Form(s) for the Review of Systems (ROS) section as appropriate. ROS should have standard review of system Note Forms automatically defaulted as part of the Input template. Note Forms can be either deleted or cleared by right-clicking on the form and selecting Delete Form or Clear Form.11/18/2009 58 Allscripts Enterprise EHR Certified Workflows
  • 59. 8) Provider completes the associated Note Form(s) for the Physical Exam (PE) section as appropriate. The PE section should have standard physical exam Note Forms automatically defaulted as part of the input template. Click on the “carrot” symbol to quickly navigate to the next section in a long Note Form.9) Provider reviews the assessed problems and updates if needed. Follow these steps to update a problem under the Assessment note section: a) To assess an existing problem, do the following: i) Click on the box next to the desired problem. A checkmark appears within the box indicating the problem is assessed. The problem will change to magenta-colored text. b) To add a new problem, do the following: i) Click New on the action toolbar. The system launches the Add Clinical Item workspace with the History Builder primary tab and Active (problem) secondary tab active. ii) Find the desired problem using Specialty or Personal Favorites, QuickList, or by Master search. iii) Select a problem by entering a checkmark in the appropriate box or double-click on the desired problem to add details. iv) Repeat steps ii – iii, as needed. v) When finished, click OK. The system returns to the Note Authoring workspace.10) Is there an order needed for this patient visit? This could include any order type, such as a prescription, a laboratory or radiology order, an order for medication administration or immunization, and so on.11) If an order is needed, the provider creates necessary orders and completes plan for the patient. Follow the (H) Order & Plan workflows for more information and review the certified workflow steps for ordering. The Plan note section displays the new orders entered for the encounter.12) Provider adjusts patient education materials, if needed. Patient education materials should be set to print automatically for an ad hoc order or CareGuide template that is selected during an encounter. However, a provider may need to occasionally modify when or what patient education materials should print that differs from his/her default. Refer to the Printing Education Materials section in the Document Introduction workflow for further details. To adjust when or what patient education materials, follow these steps: a) From the Clinical Toolbar, click the Encounter Summary icon. b) Review the orders that are listed in the Encounter Summary workspace. c) Select (or de-select) the appropriate Patient Education options: i) Patient Instructions (CareGuide) (1) Monographs – (if the patient has received this monograph a few times in the past, the provider may decide to not print again) (2) Instructions (3) Spanish11/18/2009 59 Allscripts Enterprise EHR Certified Workflows
  • 60. ii) Patient Instructions (Ad Hoc) d) Click Print Pt. Ed. The Print Dialog box displays. e) Validate the printer information. Adjust if necessary. f) Click OK. The system returns you to the Encounter Summary workspace. g) Click Continue. Any adjustments made to the print selections will be adhered until the encounter information is saved.13) The provider documents the Discussion & Summary for the visit. Information for this particular note section can be documented within a specific Note Form, dictated, or directly entered into the Note Accumulator.14) Provider reviews the Note Output(s). Allscripts recommends that prior to signing the note, the provider review the output or outputs for the encounter. Output templates determine how, where, and what information from the note input will appear within each output. Follow these steps to review an output: a) From the Note Authoring workspace, validate the desired output or outputs are checked and select View (bottom left corner). b) The Note Output workspace displays. c) Click on the corresponding tab to see a specific output. The default is the ‘All’ view.15) Are carbon copies needed? The provider may need to send carbon copies of certain outputs to other providers or to the patient.16) If carbon copies are needed, follow these steps to select the appropriate recipients: a) From within the Note Output workspace, click on the Carbon Copies icon (upper left corner). b) Select the appropriate Output document tab (Individual or All). c) Select the appropriate recipient: ▪ By Role: Place a checkmark next to the appropriate provider or current patient selection in the box located in the Role column. ▪ Manual: Click the Manual tab and select either a provider or referring provider from the corresponding dictionary lookup. ▪ Ad Hoc: Click Ad Hoc and manually type in the recipient’s name and select the method of communication: Print or Fax. Finish by typing in optional information of address, city, state, Zip Code, and fax number. d) Click OK. The selected recipients display in the Note Output header. Carbon Copy functionality must first be set up within Auto Print Defaults and enabled for the desired outputs.17) Once complete, the provider is ready to sign and finalize the note information. To sign and finalize note output documents, do the following: a) From the Note Output workspace, click Sign. The Note Signature dialog box displays. b) Enter in the appropriate password. c) If the note should be made “final,” verify the checkmark is in the Make Final box. Otherwise, if it should not be made finalized at this time, uncheck the box.11/18/2009 60 Allscripts Enterprise EHR Certified Workflows
  • 61. d) Click OK. The system displays the following note icon on the daily Schedule next to the patient’s name to indicate that the note was signed and finalized18) Once the encounter information has been committed, any patient education materials set up to print automatically will print.19) Will the provider need to submit charges for the patient visit?20) If yes, the provider charges for the visit. Follow workflow (J2) Charging from Note for the Certified Workflow detailed steps.21) Provider updates the patient status and directs the patient to check-out. To set the patient status from the Clinical Toolbar, follow these steps: a) Click the Status drop-down list. A list of available statuses displays. b) Select the appropriate status.22) Refer to the (K) Follow-up and Check-out workflows for the Certified Workflow detailed steps.11/18/2009 61 Allscripts Enterprise EHR Certified Workflows
  • 62. (G3) Note: Procedure VisitThis workflow defines the steps for documenting a procedure visit. This type of visit is associatedwith an encounter that includes a procedure. This visit type requires templates with a higher level ofspecificity for efficient documentation, such as seen in the surgical specialties. Figure 18 (G3) Note: Procedure VisitTo document a procedure visit patient encounter, follow these steps:1) Has the note been started by the clinical staff? As part of the intake process some practices have the clinical staff begin the note and document various note sections defined by the organization. If the note was started, the provider should already be within the note as part of the Retrieve process and should proceed to step 4.2) If the note was not started by the clinical staff, the provider starts the note. All information collected by the clinical staff during the Intake Process will populate the various note sections, as defined for the specific visit type selected to document the visit. Follow these steps to begin a note: a) The provider should already be logged into Allscripts Enterprise EHR and have the desired patient in context (appears within the Patient Banner) since previously completing the Retrieve workflow. b) From the Clinical Toolbar, click on the Note Authoring icon. The Note Selector displays. c) Validate the Note Style selected is Note.11/18/2009 62 Allscripts Enterprise EHR Certified Workflows
  • 63. d) The provider’s specialty should default. Adjust as appropriate. e) Select the appropriate Visit Type and/or Visit Sub-Type. f) Click OK.3) The system compiles the correct Note Forms based on the specialty, visit type selected, and the patient’s age and gender.4) Provider documents the appropriate note sections. The note sections that require documentation will vary based on the procedure being performed. Providers may also right-click on an existing note form within the Table of Contents and add an image or another note form above or below the highlighted note form.5) Provider performs and documents the procedure as appropriate.6) Provider assesses the patient’s problems as appropriate. Problems are assessed not only for clinical documentation purposes, but for billing purposes as well. Follow these steps to assess a problem under the Assessment note section: a) To assess an existing problem, do the following: i) Click on the box next to the desired problem. A checkmark appears within the box indicating the problem is assessed. The problem will change to magenta-colored text. b) To add a new problem, do the following: i) Click New on the action toolbar. The system launches the Add Clinical Item workspace with the History Builder primary tab and Active (problem) secondary tab active. ii) Find the desired problem using Specialty or Personal Favorites, QuickList, or by Master search. iii) Select a problem by entering a checkmark in the appropriate box or double-click on the desired problem to add details. iv) Repeat steps ii – iii, as needed. v) When finished, click OK. The system returns to the Note Authoring workspace. The first assessed diagnosis is marked as the primary diagnosis for billing purposes by default: the order of the diagnoses can be changed in the assessment section by right-clicking and selecting the appropriate option from the context menu.7) Is there an order needed for this patient visit? This could include any order type, such as a prescription, a laboratory or radiology order, an order for medication administration or immunization, and so on.8) If an order is needed, the provider creates the necessary orders and completes the plan for the patient. Follow the (H) Order & Plan workflows for more information and review the certified detailed workflow steps for ordering. The Plan note section displays the new orders entered for the encounter.9) Provider adjusts patient education materials, if needed. Patient education materials should be set to print automatically for an ad hoc order or CareGuide template that is selected during an encounter. However, a provider may need to occasionally modify when or what patient11/18/2009 63 Allscripts Enterprise EHR Certified Workflows
  • 64. education materials should print that differs from his/her default. Refer to the Printing Education Materials section in the Document Introduction workflow for further details. To adjust when or what patient education materials, follow these steps: a) From the Clinical Toolbar, click the Encounter Summary icon. b) Review the orders that are listed in the Encounter Summary workspace. c) Select (or de-select) the appropriate Patient Education options: i) Patient Instructions (CareGuide) (1) Monographs – (if the patient has received this monograph a few times in the past, the provider may decide to not print again) (2) Instructions (3) Spanish ii) Patient Instructions (Ad Hoc) d) Click Print Pt. Ed. The Print Dialog box displays. e) Validate the printer information. Adjust if necessary. f) Click OK. The system returns you to the Encounter Summary workspace. g) Click Continue. Any adjustments made to the print selections will be adhered until the encounter information is saved.10) The provider documents the Discussion & Summary for the visit. Information for this particular note section can be documented within a specific Note Form, dictated, or directly entered into the Note Accumulator.11) Provider reviews Note Output(s). Allscripts recommends that prior to signing the note, the provider review the output or outputs for the encounter. Output templates determine how, where, and what information from the note input will appear within each output. Follow these steps to review an output: a) From the Note Authoring workspace, validate the desired output or outputs are checked and select View (bottom left corner). b) The Note Output workspace displays. c) Click on the corresponding tab to see a specific output. Default is the ‘All’ view.12) Are carbon copies needed? The provider may need to send carbon copies of certain outputs to other providers or to the patient.13) If carbon copies are needed, follow these steps to select the appropriate recipients: a) From within the Note Output workspace, click on the Carbon Copies icon (upper left corner). b) Select the appropriate Output document tab (Individual or All). c) Select the appropriate recipient: ▪ By Role: Place a checkmark next to the appropriate provider or current patient selection in the box located in the Role column. ▪ Manual: Click on the Manual tab and select either a provider or referring provider from the corresponding dictionary lookup.11/18/2009 64 Allscripts Enterprise EHR Certified Workflows
  • 65. ▪ Ad Hoc: Click Ad Hoc and manually type in the recipient’s name and select the method of communication: Print or Fax. Finish by typing in optional information of address, city, state, Zip Code, and fax number. d) Click OK. The selected recipients display in the Note Output header. Carbon Copy functionality must first be set up within Auto Print Defaults and enabled for the desired outputs.14) Once complete, the provider is ready to sign and finalize the note information. To sign and finalize note output documents, do the following: a) From the Note Output workspace, click Sign. The Note Signature dialog box displays. b) Enter the appropriate password. c) If the note should be made “final,” verify the checkmark is in the Make Final box. Otherwise, if it should not be made finalized at this time, uncheck the box. d) Click OK. The system displays the following note icon on the daily Schedule next to the patient’s name to indicate that the note was signed and finalized.15) Once the encounter information has been committed, any patient education materials set up to print automatically will print.16) Will the provider need to submit charges for the patient visit?17) If yes, the provider charges for the visit. Follow workflow (J2) Charging from Note for the Certified Workflow detailed steps.18) Provider updates the patient status and directs the patient to check-out. To set the patient status from the Clinical Toolbar, follow these steps: a) Click the Status drop-down list. A list of available statuses displays. b) Select the appropriate status.19) Refer to the (K) Follow-up and Check-out workflows for the Certified Workflow detailed steps.11/18/2009 65 Allscripts Enterprise EHR Certified Workflows
  • 66. (G4) Note: Health MaintenanceThis workflow defines the steps for documenting a health maintenance visit. This type of visit istypically associated with a routine well child or adult check-up patient encounter. This visit type istypically of medium complexity, is of high specificity, and is driven by the patient’s age and gender.Common specialties with this type of visit are pediatrics, family practice, and OB-GYN. Figure 19 (G4) Note: Health MaintenanceTo document a health maintenance visit, follow these steps:1) Has the note been started by the clinical staff? As part of the intake process some practices have the clinical staff begin the note and document various note sections defined by the organization. If the note was started, the provider should already be within the note as part of the Retrieve process and should proceed to step 4.2) If the note was not started by the clinical staff, the provider starts the note. All information collected by the clinical staff during the Intake Process will populate the various note sections, as defined for the specific visit type selected to document the visit. Follow these steps to begin a note: a) The provider should already be logged into Allscripts Enterprise EHR and have the desired patient in context (appears within the Patient Banner) since previously completing the Retrieve workflow. b) From the Clinical Toolbar, click on the Note Authoring icon. The Note Selector displays. c) Validate the Note Style selected is Note.11/18/2009 66 Allscripts Enterprise EHR Certified Workflows
  • 67. d) The provider’s specialty should default. Adjust as appropriate. e) Select the appropriate Visit Type and/or Visit Sub-Type. f) Click OK.3) The system compiles the correct Note Forms based on the specialty, visit type selected, and the patient’s age and gender.4) Provider completes the associated Note Form(s) for the History of Present Illness (HPI) section as appropriate. HPI should be set to auto-configure Note Forms based on the chief complaint or chief complaints selected.5) Provider completes the associated Note Form(s) for the Review of Systems (ROS) section as appropriate. ROS should have standard review of system Note Forms automatically defaulted as part of the Input template. You can either delete or clear Note Forms by right-clicking on the Form and selecting Delete Form or Clear Form.6) Provider completes the associated Note Form(s) for the Physical Exam (PE) section as appropriate. The PE section should have standard physical exam Note Forms automatically defaulted as part of the input template. Click on the “carrot” symbol to quickly navigate to the next section in a long note form.7) Provider assesses the patient’s problems as appropriate. Problems are assessed not only for clinical documentation purposes, but for billing purposes as well. Follow these steps to assess a problem under the Assessment note section: a) To assess an existing problem, click on the box next to the desired problem. A checkmark appears within the box indicating the problem is assessed. The problem will change to magenta-colored text. b) To add a new problem, do the following: i) Click New on the action toolbar. The system launches the Add Clinical Item workspace with the History Builder primary tab and Active (problem) secondary tab active. ii) Find the desired problem using Specialty or Personal Favorites, QuickList, or by Master search. iii) Select a problem by entering a checkmark in the appropriate box or double-click on the desired problem to add details. iv) Repeat steps ii – iii, as needed v) When finished, click OK. The system returns to the Note Authoring workspace. The first assessed diagnosis is marked as the primary diagnosis for billing purposes by default: the order of the diagnoses can be changed in the assessment section.11/18/2009 67 Allscripts Enterprise EHR Certified Workflows
  • 68. 8) Is there an order or an order reminder needed for this patient visit? This may include placing actual orders or setting up reminders to have orders done at a later time.9) If an order is needed, the provider creates the necessary orders and completes the plan for the patient. Follow the (H) Order & Plan workflows for more information and review the certified detailed workflow steps for ordering. The Plan note section displays the new orders entered for the encounter.10) Provider adjusts patient education materials, if needed. Patient education materials should be set to print automatically for an ad hoc order or CareGuide template that is selected during an encounter. However, a provider may need to occasionally modify when or what patient education materials should print that differs from his/her default. Refer to the Printing Education Materials section in the Document Introduction workflow for further details. To adjust when or what patient education materials, follow these steps: a) From the Clinical Toolbar, click the Encounter Summary icon. b) Review the orders that are listed in the Encounter Summary workspace. c) Select (or de-select) the appropriate Patient Education options: i) Patient Instructions (CareGuide) (1) Monographs – (if the patient has received this monograph a few times in the past, the provider may decide to not print again) (2) Instructions (3) Spanish ii) Patient Instructions (Ad Hoc) d) Click Print Pt. Ed. The Print Dialog box displays. e) Validate the printer information. Adjust if necessary. f) Click OK. The system returns you to the Encounter Summary workspace. g) Click Continue. Any adjustments made to the print selections will be adhered until the encounter information is saved.11) The provider documents the Discussion & Summary for the visit. Information for this particular note section can be documented within a specific Note Form, dictated, or directly entered into the Note Accumulator.12) Provider reviews Note Output(s). Allscripts recommends that prior to signing the note, the provider review the output or outputs for the encounter. Output templates determine how, where, and what information from the note input will appear within each output. Follow these steps to review an output: a) From the Note Authoring workspace, validate the desired output or outputs are checked and select View (bottom left corner). b) The Note Output workspace displays. c) Click on the corresponding tab to see a specific output. Default is the ‘All’ view.13) Are carbon copies needed? The provider may need to send carbon copies of certain outputs to other providers or to the patient.14) If carbon copies are needed, follow these steps to select the appropriate recipients: a) From within the Note Output workspace, click on the Carbon Copies icon (upper left corner).11/18/2009 68 Allscripts Enterprise EHR Certified Workflows
  • 69. b) Select the appropriate Output document tab (Individual or All). c) Select the appropriate recipient: ▪ By Role: Place a checkmark next to the appropriate provider or current patient selection in the box located in the Role column. ▪ Manual: Click on the Manual tab and select either a provider or referring provider from the corresponding dictionary lookup. ▪ Ad Hoc: Click Ad Hoc and manually type in the recipient’s name and select the method of communication: Print or Fax. Finish by typing in optional information of address, city, state, Zip Code, and fax number. a. Click OK. The selected recipients display in the Note Output header. Carbon Copy functionality must first be set up within Auto Print Defaults and enabled for the desired outputs.15) Once complete, the provider is ready to sign and finalize the note information. To sign and finalize note output documents, do the following: a) From the Note Output workspace, click Sign. The Note Signature dialog box displays. b) Enter the appropriate password. c) If the note should be made “final,” verify the checkmark is in the Make Final box. Otherwise, if it should not be made finalized at this time, uncheck the box. d) Click OK. The system displays the following note icon on the daily Schedule next to the patient’s name to indicate that the note was signed and finalized16) Once the encounter information has been committed, any patient education materials set up to print automatically will print.17) Will the provider need to submit charges for the patient visit?18) If yes, the provider charges for the visit. Follow workflow (J2) Charging from Note for the certified workflow detailed steps.19) Provider updates the patient status and directs the patient to check-out. To set the patient status from the Clinical Toolbar, follow these steps: a) Click the Status drop-down list. A list of available statuses displays. b) Select the appropriate status.20) Refer to the (K) Follow-up and Check-out workflows for certified workflow detailed steps.11/18/2009 69 Allscripts Enterprise EHR Certified Workflows
  • 70. (G5) Note: Results ReviewThis Note workflow defines the steps for documenting the necessary information or actions thatcorrespond with reviewing patient results. Figure 20 (G5) Note: Results ReviewTo document the review of patient results, follow these steps:1) Is the note part of result verification? Providers can default note information as part of results verification.2) If yes, the system compiles the correct visit type and note forms based on the result verification defaults.3) If not, the provider starts a results review note. Follow these steps to begin a note: a) The provider should already be logged into Allscripts Enterprise EHR and have the desired patient in context (appears within the Patient Banner). b) From the Clinical Toolbar, click on the Note Authoring icon. The Note Selector displays. c) Validate the Note Style selected is Note. d) The provider’s specialty should default. Adjust as appropriate. e) Select the appropriate Results Note from the Visit Type drop-down list. f) Click OK.11/18/2009 70 Allscripts Enterprise EHR Certified Workflows
  • 71. 4) The system compiles the correct Note Forms based on the specialty, visit type selected, and the patient’s age and gender.5) Provider enters comments to staff in the Message note section as appropriate.6) Is there an order or an order reminder needed for this patient visit? This may include placing actual orders or setting up reminders to have orders done at a later time.7) If an order is needed, the provider creates necessary orders and completes the plan for the patient. Follow the (H) Order & Plan workflows for more information and review the Certified Workflow steps for ordering. The Plan note section displays the new orders entered for the encounter.8) Provider adjusts patient education materials, if needed. Patient education materials should be set to print automatically for an ad hoc order or CareGuide template that is selected during an encounter. However, a provider may need to occasionally modify when or what patient education materials should print that differs from his/her default. Refer to the Printing Education Materials section in the Document Introduction section for further details. To adjust when or what patient education materials, follow these steps: a) From the Clinical Toolbar, click the Encounter Summary icon. b) Review the orders that are listed in the Encounter Summary workspace. c) Select (or de-select) the appropriate Patient Education options: i) Patient Instructions (CareGuide) (1) Monographs – (if the patient has received this monograph a few times in the past, the provider may decide to not print again) (2) Instructions (3) Spanish ii) Patient Instructions (Ad Hoc) d) Click Print Pt. Ed. The Print Dialog box displays. e) Validate the printer information. Adjust if necessary. f) Click OK. The system returns you to the Encounter Summary workspace. g) Click Continue. Any adjustments made to the print selections will be adhered until the encounter information is saved.9) The provider documents the Discussion & Summary for the visit. Information for this particular note section can be documented within a specific Note Form, dictated, or directly entered into the Note Accumulator.10) Provider reviews note output(s). Allscripts recommends that prior to signing the note, the provider review the output or outputs for the encounter. Output templates determine how, where, and what information from the note input will appear within each output. Follow these steps to review an output: a) From the Note Authoring workspace, validate the desired output or outputs are checked and select View (bottom left corner). b) The Note Output workspace displays. c) Click on the corresponding tab to see a specific output. Default is the All view.11/18/2009 71 Allscripts Enterprise EHR Certified Workflows
  • 72. 11) Are carbon copies needed? The provider may need to send carbon copies of certain outputs to other providers or to the patient.12) If carbon copies are needed, follow these steps to select the appropriate recipients: a) From within the Note Output workspace, click on the Carbon Copies icon (upper left corner). b) Select the appropriate Output document tab (Individual or All). c) Select the appropriate recipient: ▪ By Role: Place a checkmark next to the appropriate provider or current patient selection in the box located in the Role column. ▪ Manual: Click on the Manual tab and select either a provider or referring provider from the corresponding dictionary lookup. ▪ Ad Hoc: Click Ad Hoc and manually type in the recipient’s name and select the method of communication: Print or Fax. Finish by typing in optional information of address, city, state, Zip Code, and fax number. d) Click OK. The selected recipients display in the Note Output header. Carbon Copy functionality must first be set up within Auto Print Defaults and enabled for the desired outputs.13) Once complete, the provider is ready to sign and finalize the note information. To sign and finalize note output documents, do the following: a) From the Note Output workspace, click Sign. The Note Signature dialog box displays. b) Enter the appropriate password. c) If the note should be made “final,” verify the checkmark is in the Make Final box. Otherwise, if it should not be made finalized at this time, uncheck the box. d) Click OK.14) Once the encounter information has been committed, any patient education materials set up to print automatically will print.11/18/2009 72 Allscripts Enterprise EHR Certified Workflows
  • 73. (G6) DictationThis workflow defines the steps for completing a dictation for a patient encounter. A dictation iswhen the provider records patient-specific information that needs to be typed or transcribed for agiven encounter. Providers can insert dictations within a structured clinical note or dictate an entireunstructured document, such as a Discharge Summary.This workflow supports Allscripts Enterprise EHR Dictate being used with either Allscripts EnterpriseEHR Transcribe (no interface required) or directly to a transcription vendor (interface required). Inaddition, providers can also use Dragon’s Naturally Speaking (Dragon) voice recognition software asa mode of data entry into Allscripts Enterprise EHR. Dragon enables providers the ability totranslate speech into text for information that they would otherwise dictate. Figure 21 (G6) DictationTo complete a dictation, follow these steps:1) The provider determines that a dictation is needed for the patient encounter. To bring a patient into context for the encounter, do the following: a) The provider should already be logged into Allscripts Enterprise EHR and have the desired patient in context (appears within the Patient Banner) since previously completing the Retrieve workflow.2) Is the dictation part of a “structured” note?3) If yes, will the provider be using Dragon Naturally Speaking software? This functionality is often referred to as “speech to text.”4) If the provider is using Dragon, they dictate directly into the note section. To dictate into a note section using Dragon, complete the following:11/18/2009 73 Allscripts Enterprise EHR Certified Workflows
  • 74. a) Make sure that Dragon is installed and configured properly on the Allscripts Enterprise EHR workstation. b) From the Note Authoring workspace (NAW), click on the desired note section within the table of contents. c) Place the cursor in the Note Accumulator workspace under the desired note section. d) Dictate text as appropriate.5) Once the note is complete, it is ready to be signed and finalized by the provider. To sign and finalize a document, follow these steps: a) On the Note Authoring workspace (NAW), verify that all the appropriate output templates are checked in the lower left pane. b) Click View. The system displays a preview of the individual documents. Providers can view all documents simultaneously or page through them individually. c) Review desired outputs. d) When ready, click Sign. The Note Signature page displays. e) Enter the password and make sure that the Make Final option is checked. f) Click OK.6) If not using Dragon, the provider dictates the note section using a “dictation marker.” When the completed dictation is returned as text, it will automatically be inserted in the proper location within the note. Follow these steps to dictate a note section via dictation marker: a) On the Note Authoring workspace (NAW), click on the desired note section in the table of contents. b) Click on the microphone icon next to the desired note section. A dictation marker is inserted within the Note Accumulator for that note section. The marker is a combination of the dictating provider code, the current date and sequence number (for example, JMED- 063007-1). c) Verify that the correct dictation marker is in context on the Dictation toolbar. If the dictation marker is not displayed, double-click on the dictation marker within the Note Accumulator to bring it into context. d) Click Record to start recording your dictation. When the provider begins recording, the status bar indicates “Recording…”, the sound meter reflects incoming sound, and the Record button changes to a Pause button. e) Click Pause to stop the recording. f) Access the Dictation menu to mark the dictation as Stat, if necessary. g) When complete, click Done to submit the dictation to the server for transcription. Placeholders can only be dictated in a Note Section that has been identified with a “Dictation Placeholder.” A Dictation Placeholder is inserted into a given Note Type during the input template creation process or can be inserted “on the fly”. Refer to detailed instructions in the (G) Document Introduction Section on how to insert a Dictation Marker.11/18/2009 74 Allscripts Enterprise EHR Certified Workflows
  • 75. 7) The status of the note changes to “Needs Input” to reflect that the note is waiting for additional information before it should be finalized by the provider. In addition, a “Waiting for Transcription” (delegated) task is created, which can be used for tracking purposes.8) If the dictation is not part of a structured note, the provider dictates the entire document for the patient in context. These unstructured dictations are created from the Schedule or a Patient List. To create an unstructured dictation, complete the following steps: a) The provider should be logged into Allscripts Enterprise EHR. If not logged in, launch the application by double-clicking on the Allscripts Enterprise EHR desktop icon and log in. b) From the Schedule or Patient List, select a patient. The patient displays on the Patient Banner. Providers (especially those using Tablet PCs) who will be dictating either from the Schedule or Patient List should be set up to automatically have the patient banner update when they single-click on a given patient. This functionality is defined by the web framework preferences “Patient List Update Pt Banner” and “Schedule Update Pt Banner,” which can be set at a system or user level. c) Select the appropriate WorkType from the drop-down list on the Dictation toolbar. This is to indicate the document type that will result from the transcribed dictation. d) Click Record to start recording your dictation. When the provider begins recording, the status bar indicates “Recording…,” the sound meter reflects incoming sound, and the Record button changes to a Pause button. e) Click Pause to stop the recording. f) Access the Dictation menu to mark the dictation as Stat, if necessary. g) When complete, click Done to submit the dictation to the server for transcription.9) Is Allscripts Enterprise EHR Transcribe being utilized to transcribe dictations?10) If yes, the voice file from the dictation server becomes available in the Internet Typist. This application is used by the transcriptionist to access jobs waiting to be transcribed.11) The assigned transcriptionist transcribes the voice file into the appropriate document. Follow workflow (N1) Transcribe Basics for the Certified Workflow steps.12) Once the transcriptionist is finished typing the document, the completed document is sent to Allscripts Enterprise EHR.13) If Allscripts Enterprise EHR Transcribe is not used, the voice file is sent via an outbound voice interface to the designated transcription vendor. Installation, configuration, and testing of this interface are required to complete this step.14) The assigned transcription vendor is responsible for transcribing the voice file into the appropriate document.15) The completed document is sent from the transcription vendor via an inbound document interface to Allscripts Enterprise EHR. Installation, configuration, and testing of this interface are required to complete this step.16) Follow the (M) Document Management workflow to learn about how inbound transcriptions are handled once received in Allscripts Enterprise EHR.11/18/2009 75 Allscripts Enterprise EHR Certified Workflows
  • 76. (G7) Admin FormsThis workflow discusses the steps for opening, completing, signing, and finalizing an Admin Form fora patient encounter. Allscripts Enterprise EHR Forms is a separate application where Admin Formsare built and maintained. The Allscripts Enterprise EHR Forms module works in conjunction withAllscripts Enterprise EHR Scan. Figure 22 (G7) Admin FormsTo process an Admin form, follow these steps:1) The staff decides to use an Admin Form.2) Follow these steps to select the appropriate Form: a) The staff should already be logged into Allscripts Enterprise EHR and have the desired patient in context (appears within the Patient Banner). b) From the Clinical Toolbar, click on the Note Authoring icon. The Note Selector displays. c) Validate the Note Style selected is Admin Forms. d) Select the desired Admin Form under Visit Type. e) Click OK.3) The staff completes the Admin Form as appropriate.4) Once the form is complete, the staff needs to determine if further edits should be allowed.5) If no further edits should be allowed, the Admin Form should be signed and finalized. To sign and finalize an Admin Form, do the following: a) Click Sign. The Note Signature dialog box displays. b) Enter in the appropriate password. c) Make sure that the Make Final option is checked. d) Click OK.11/18/2009 76 Allscripts Enterprise EHR Certified Workflows
  • 77. 6) The Admin Form is only available as a ‘Read-Only’ document (no further edits are allowed).7) If further edits are required to the Admin Form, the form should be signed but not made final. Therefore, in the future edits can occur as needed. If the staff would like the Admin Form to be available for future additions or editing, do the following: a) Click Sign. The Note Signature dialog box displays. b) Enter in the appropriate password. c) Make sure that the Make Final option is not checked. d) Click OK.8) The Admin Form is available to add additional information and/or edit in future encounters.11/18/2009 77 Allscripts Enterprise EHR Certified Workflows
  • 78. (H) Order and Plan IntroductionA core function of an electronic health record is the ability to “transact” or to support the clinicalprocess of creating electronic orders, prescriptions, referrals, medical supplies, and otheradministrative tools that support therapeutic medicine. With a paper record, these transactionstypically begin with users filling out forms and end in a manual communication of some kind. By anymeasure, transact is a critical part of medical care. In the pre-electronic paper world, it is wheremost medical errors begin and so is the major source of potential harm to patients. It is also thestarting point of most medical costs.Transact is also where decision-support is most critical and electronic decision support the mostsuccessful. The most opportune time for clinicians to refer to best practices is when they arepreparing to write orders or prescriptions, or proposing a diagnostic or therapeutic procedure.This section contains workflow details to enable the clinician the opportunity to receive thesebenefits, for example:Receive medication formulary checking feedback for prescriptionsProduce accurate and legible prescriptions and ordersReceive medical necessity checking for orders and chargesBuild patient care plans via problems and CareGuidesThe workflows contained in this section are organized by the type of order a provider may create,including:Ad Hoc Prescription—This workflow includes creating any type of prescription that is not initiatedfrom a CareGuide or QuickSet. These can include prescriptions that may be linked to a problem.Medications Management—This workflow includes guidance on the variety of actions a providermay take during the patient visit on existing prescriptions. This could include renewing, continuing,discontinuing, completing, or replacing currently active medication orders.Medication Administrations—This workflow includes the steps a provider takes to order amedication that requires administration to the patient during their office visit. This workflow includesdetails about ordering a recurring schedule for the administration.Immunizations—This workflow includes the steps a provider takes to order an immunization thatrequires administration to the patient during their office visit. This workflow includes details aboutordering a recurring scheduling for the immunization.Future Orders—This workflow details the nuances of creating laboratory, radiology, or anydiagnostic test that must be done sometime in the future. For the purposes of this workflow, a futureorder is defined as one or more future orders for the same date (does not include recurring orscheduled orders).Ad Hoc Diagnostic Orders—This workflow includes creating any type of laboratory, radiology, ordiagnostic testing order that is not initiated from a CareGuide or QuickSet.Follow-up or Referrals Orders—This workflow includes steps to create an order for a follow-upappointment or a referral appointment.Instruction or Supply Orders—This workflow includes steps to create an order for patientinstructions or supplies. This workflow also contains details for the clinical staff to utilize Worklists tomanage the order status.11/18/2009 78 Allscripts Enterprise EHR Certified Workflows
  • 79. Order Reminders—This workflow includes steps to creating an order reminder.QuickSets—This workflow includes steps to utilize a QuickSet to order a combination of aprescription and other order types, such as a laboratory or radiology order.CareGuides—This workflow includes steps to utilize a CareGuide to order medications and anyother type of order, such as a laboratory or radiology order, supplies, equipment, health maintenanceitems or patient instructions. CareGuide functionality may require additional fees. Figure 22 (H) Order and Plan D E3 G1 G2G3 G4 G5 J3 Creating an Ad Hoc H1 H Yes New Rx? Yes Prescription? Meds H2 No Yes No Management? Med H3 No Yes Creating an Ad Hoc Administration? Yes Future Order? Yes H5 Order? No Immunization? Yes H4 No No Diagnostic Test? Yes H6 Utilizing QuckSets? Yes H10 Follow-Up or H7 No Yes Referral? No Instructions or H8 No No Yes Supplies? Utilizing H11 Yes CareGuides? No Order Reminder? Yes H9 No No End11/18/2009 79 Allscripts Enterprise EHR Certified Workflows
  • 80. (H1) Ad Hoc PrescriptionThe provider has determined a new prescription needs to be created as part of the patient’sencounter. The following workflow defines the steps to create a new, ad hoc prescription. The termad hoc refers to the method of creating an order outside of using a CareGuide or QuickSet. Figure 24 (H1) Ad Hoc Prescription H L2 (1) (3) (4) Provider determines (2) Provider responds (5) Provider selects (6) H1 a prescription is Provider selects to formulary and Does Rx need to Yes SIG, days supply Provider splits Rx required for a medication allergy prompts, if be split? and other Rx info problem needed No (7) Provider selects output action(s) for prescription(s) (8c) (8b) (8f) (8a) Provider completes (8d) (8e) (8) Provider selects Clinical Staff calls Yes Provider selects Rx & responds to Provider updates Call in Rx task Call Pharmacy? patient preferred Rx to retail action of Call Rx DUR warnings if Patient Status created retail pharmacy pharmacy needed No (9b) (9e) (9a) (9d) (9) Provider completes (9c) Clinical Staff Provider selects Dispense Dispense Yes Rx & responds to Provider updates provides patient action of Dispense Sample task Sample? DUR warnings if Patient Status with medication Sample created needed sample No (10b) (10d) (10e) (10a) Provider completes (10) (10c) Provider signs Provider/Clinical Yes Provider selects Rx & responds to Print Rx? Paper Rx prints paper Rx, if Staff gives printed action of Print Rx DUR warnings if required Rx to patient needed No (11a) (11b) (11c) (11e) (11d) (11) Provider selects Provider selects Provider Rx transmitted Provider Send to Mail Order either action of patient preferred completes Rx & Yes via SureScripts Electronically or Retail Send to Mail Order mail order or responds to DUR or RxHub to enrolled? or Send to Retail pharmacy warnings if needed pharmacy No (11f) Rx transmitted via fax to End pharmacyTo create a new, ad hoc prescription order, do the following:1) During the patient visit, the provider determines that a prescription is needed for a problem. To link a problem to a medication order, do the following: a) The patient should already be in context in the Patient Banner having been selected from the Schedule. b) For an existing problem, click the box next to the problem name to assess or highlight the problem name to link without assessing from the problem component (on the Clinical Desktop or within the patient pane of the ACI). c) For a new problem, start by adding a new problem by clicking on the Add New Problem icon on the Clinical Toolbar to launch the Add Clinical Item (ACI) workspace.11/18/2009 80 Allscripts Enterprise EHR Certified Workflows
  • 81. d) From the History Builder primary tab and Active secondary tab, locate the desired item by checking the box next to the problem. The newly added problem will display in the Patient Pane in the ACI. e) Continue with the ordering process. Sending an associated ICD-9 code is usually a requirement with most diagnostic vendors. Best Practice is to require the selection of a problem for an order. This will also aid in the learning and usage of QuickSets.2) Provider selects a medication. To create a medication order, follow these steps: a) If not already in the ACI from adding a new Problem, click the Add New Medication icon from the Clinical Toolbar or click New from the Note Authoring workspace (NAW) under the Plan section, if needed. The Add Clinical Item workspace displays. Users can determine which primary tab to display (Rx/Orders or Problem-Based) when clicking the Add New Order icon by setting the ‘Add Clinical Item Order Selection Method Default’ order preference. i) From Rx/Orders, go to the Rx secondary tab for medication orders. ii) Find the order via Specialty or Personal Favorites, QuickList, or by Master search. If the provider is prescribing one or more medications that share the same prescription fulfillment action (for example, Send to Retail, Print, and so on), they have the ability to first define the action within the Add Clinical Item workspace prior to selecting any medications. b) Enter a checkmark in the box next to the medication name. This selects the medication and automatically launches the Medication Details screen to fill in required prescription information. Medication names may be found by either a brand or generic name. The search results display all variations of the drug searched on – brand drug names also display the equivalent generic name in parentheses.3) The provider may be required to respond to two prompts at this point; 1) insurance formulary alternatives, or 2) allergy warning if the medication being prescribed would interact. The provider always has the option to cancel these warnings, return to the previous screen to select an alternate medication or enter a reason for overriding the prompt if appropriate.4) From the Medication Details screen, the provider completes all required prescription information, including patient SIG, days supply, and quantity. The provider may also enter optional prescription information as desired, such as number of refills, Evaluate, Complete or Renew Status, DAW, and so forth. ▪ Use Evaluate: if the provider would like to prompt an evaluation prior to renewing the medication (form of notation). ▪ Use Renew: to indicate that the medication can be renewed without further evaluation (form of task).11/18/2009 81 Allscripts Enterprise EHR Certified Workflows
  • 82. ▪ Use Complete: to automatically remove medication from the current medication list once therapy is complete (medication will exist on past meds list). If using the Dose Calculator, the last height and weight entered for the patient will automatically default and can be updated if needed. The provider enters the Target Dose and Frequency and clicks Calculate to generate the ‘Calculated SIG’. In addition, providers can round the SIG by clicking the Round button.5) Does the prescription need to be split? Splitting is a way to easily create a second prescription of the same drug and dose form, but define separate quantity, days supply, number of refills, and prescription fulfillment action. This is commonly used for mail order prescriptions where the patient needs an initial prescription to take to a retail pharmacy while the mail order prescription is mailed in or where a sample medication is given and a second prescription is written for the patient to take to the pharmacy.6) If the prescription needs to be split, follow these steps: a) Enter a checkmark in the box next to Split Rx. Additional fields display. b) Indicate days supply, quantity, and desired number of refills.7) Once all the required information is entered, the provider selects the actions for the prescription or prescriptions when splitting (fulfillment action). The fulfillment action represent output options for the provider to select how the prescription is communicated to the pharmacy or recorded in the electronic chart. Each action produces a separate, unique “mini” workflow. Select one of the following actions: ▪ Phone the prescription into the pharmacy ▪ Dispense an office sample to the patient during the visit ▪ Print a paper copy of the prescription to give to the patient ▪ Record the prescription in the electronic chart ▪ Send the prescription to either a retail or mail order pharmacy8) Does the provider want the clinical staff to phone the prescription into the pharmacy? a) If yes, the provider selects the fulfillment action of Call Rx. A pharmacy field displays. b) Select the patient’s preferred pharmacy (if needed). Select from either the drop-down list or click on the binoculars to do a search. Click OK when finished (on both the Medication Details page and ACI). If the provider does not select a pharmacy the Order Status will be “Need Information” and the Order Status Reason will be “Pharmacy.” Any tasking dependent on this information will not be generated until the required information is supplied. A Worklist view can be setup to view these orders with missing pharmacy information. c) The provider may be required to respond to additional Drug Utilization Review (DUR) prompts at this point prior to saving or committing the data. i) These include Drug-Drug interaction warnings, Duplicate Therapy Warnings, or Drug- Health State (problem) warnings.11/18/2009 82 Allscripts Enterprise EHR Certified Workflows
  • 83. ii) The provider always has the option to cancel these warnings, return to the previous screen to select an alternate medication, or enter a reason for overriding the prompt if appropriate. d) The provider updates the patient status to “Orders Pending” to indicate to the clinical staff that actions need to be completed for the patient. To set the patient status from the Clinical Toolbar, do the following: i) Click the Status drop-down list. A list of available statuses displays. ii) Select the appropriate status e) Once the data is committed, the system creates a “Call in Rx” task to notify the clinical staff that a prescription needs to be called into the pharmacy. f) The clinical staff calls in the prescription to the pharmacy and completes the task. To complete this step, follow these steps: i) Clinical staff should be logged into Allscripts Enterprise EHR. If not logged in, launch the application by double-clicking on the Allscripts Enterprise EHR desktop icon. ii) From the Chart menu, click on the Task List horizontal toolbar. iii) Select the View that looks at all tasks for the current patient encounter, including the Call in Rx tasks. iv) Double-click on the desired Call in Rx task. The Medication Viewer displays with the information needed to call the prescription into the pharmacy. v) Clinical staff calls the prescription into the appropriate pharmacy and then closes the window when call is completed. vi) With the Call in Rx task still highlighted, click Done to complete the task.9) Will the provider dispense an office sample to the patient during the visit? a) If yes, the provider selects the fulfillment action of Dispense Sample and clicks OK (on both the Medication Details page and ACI). b) The provider may be required to respond to additional Drug Utilization Review (DUR) prompts at this point prior to saving or committing the data. i) These include Drug-Drug interaction warnings, Duplicate Therapy Warnings, or Drug- Health State (problem) warnings. ii) The provider always has the option to cancel these warnings, return to the previous screen to select an alternate medication, or enter a reason for overriding the prompt if appropriate. c) The provider updates the patient status to “Orders Pending” to indicate to the clinical staff that actions need to be completed for the patient. To set the patient status from the Clinical Toolbar, do the following: i) Click the Status drop-down list. A list of available statuses displays. ii) Select the appropriate status d) Once the data is committed, the system creates a “Dispense Sample” task to notify clinical staff that a sample needs to be dispensed. e) Clinical staff provides the patient with the sample medication and completes the task. To complete this step:11/18/2009 83 Allscripts Enterprise EHR Certified Workflows
  • 84. i) Clinical staff should be logged into Allscripts Enterprise EHR. If not logged in, launch the application by double-clicking on the Allscripts Enterprise EHR desktop icon. ii) From the Chart menu, click on the Task List horizontal toolbar. iii) Select the View that looks at all tasks for the current patient encounter, including the Dispense Sample tasks. iv) Double-click on the desired Dispense Sample task. The Medication Details page displays with the Record Sample workspace selected. v) Enter the needed sample information such as quantity, Lot #, expiration date, dispensed by, manufacturer, dispense date, and therapy started date. vi) Click OK. The Dispense Sample task auto-clears from the Task List.10) Will the provider print a paper copy of the prescription to give to the patient? a) If yes, the provider selects the fulfillment action of Print Rx and clicks OK (on both the Medication Details page and ACI). b) The provider may be required to respond to additional Drug Utilization Review (DUR) prompts at this point prior to saving or committing the data. i) These include Drug-Drug interaction warnings, Duplicate Therapy Warnings, or Drug- Health State (problem) warnings. ii) The provider always has the option to cancel these warnings, return to the previous screen to select an alternate medication, or enter a reason for overriding the prompt if appropriate. c) Once the data is committed, the system prints a paper copy of the prescription. d) The provider signs the paper prescription, if required. Refer to Federal and State regulations for when handwritten signatures are required for electronic prescriptions. Rules may vary per state. It is the responsibility of each organization to know their applicable laws! e) Provider or clinical staff provides the printed prescription to the patient.11) The remaining fulfillment actions that the provider may use are to send the prescription to either a retail or mail order pharmacy. a) The provider selects the fulfillment action of either Send to Retail or Send to Mail Order. b) Select the patient’s preferred pharmacy (if needed). Select from either the drop-down list or click on the binoculars to do a search. Click OK when finished (on both the Medication Details page and ACI). c) The provider may be required to respond to additional Drug Utilization Review (DUR) prompts at this point prior to saving or committing the data. i) These include Drug-Drug interaction warnings, Duplicate Therapy Warnings, or Drug- Health State (problem) warnings. ii) The provider always has the option to cancel these warnings, return to the previous screen to select an alternate medication, or enter a reason for overriding the prompt if appropriate.11/18/2009 84 Allscripts Enterprise EHR Certified Workflows
  • 85. d) Is the provider electronically enrolled in either Surescripts (retail pharmacies) or RxHub (mail order pharmacies)? e) If yes, once the data is committed the system will automatically send the prescription directly to the selected pharmacy utilizing either the Surescripts or RxHub connections. This process is transparent to the provider. f) If the provider is not electronically enrolled, once the data is committed the system will send the prescription to the selected pharmacy using traditional fax method. This process is transparent to the provider.11/18/2009 85 Allscripts Enterprise EHR Certified Workflows
  • 86. (H2) Meds ManagementThe provider typically reviews the patient’s existing medication list during the clinical visit. A varietyof actions may need to be taken concerning this list, depending on the patient’s specific situation.This workflow defines the steps that cover a variety of medication-related actions the provider canutilize during the patient’s visit. Figure 25 (H2) Meds Management H (3) Provider updates Yes medication & End changes status as (2) appropriate (1) Reported H2 Provider reviews changes to a patient medications medication? (4) (5a) Provider determines (5) Provider renews No Yes to take action on a Renew? medication with or medication without changes No (6a) (6) Yes Provider replaces Replace? medication No (7a) (7) Yes Provider adjusts Adjust Med? medication No (8a) (8) Provider Yes Discontinue? discontinues medication No (9a) (9) Yes Provider completes Complete? medication No (10a) (10) Yes Provider continues Continue? medication (12) (11) Provider creates (13) Task need to be Yes new task Go to Med task sent? associated to created selected medication No EndTo manage medication-related actions during the patient’s visit, do the following:1) The provider reviews a patient’s medications usually during the course of a visit encounter with the patient. The patient should be in context within the Patient Banner after being selected from the Schedule as part of the Retrieve workflow. If not in context, follow these steps to bring a patient into context: a) Provider should be logged into Allscripts Enterprise EHR. If not logged in, launch the application by double-clicking on the Allscripts Enterprise EHR desktop icon. b. From the Chart menu, click on the daily Schedule horizontal toolbar. c. Review the schedule and double-click on the desired patient. If the desired patient is not on the Schedule, click Select Patient to do a search.2) Did the provider receive any reported changes to a medication?11/18/2009 86 Allscripts Enterprise EHR Certified Workflows
  • 87. 3) If there was a reported change to an order that does not need to be reflected in the Note, the provider updates the medication and changes the status as appropriate. To update a medication with a reported change, do the following: a) Right-click on the desired medication and select Edit. The Medication Details page displays. b) Place a check within the Record without Ordering box. c) Click Status… The Change Status dialog box displays. d) Select the appropriate status from the drop-down list and click OK. e) Update the medication information as appropriate. f) When finished, click OK. g) Click Commit on the Clinical Toolbar to save changes to the database. i) The following elements of a prescription may be changed when utilizing the Edit action: ▪ Expected Action (Complete, Evaluate, Renew) ▪ Expected Action Date ▪ Managed by (provider) ▪ Therapy Start Date ▪ Therapy End Date ▪ Annotations A medication entered originally as a Med Hx entry will allow the additional fields of SIG, Days, Qty, Refill, DAW, Pharmacy Instructions, Ordered By, Rx Date, Expires Date and Replaced to be changed when utilizing the Edit action4) Provider completes the appropriate action for the patient’s existing medications as required to satisfy their specific needs. The provider can select from one or more of the following medication actions: ▪ Renew a prescription ▪ Replace a medication ▪ Adjust a prescription ▪ Discontinue a prescription ▪ Complete a prescription ▪ Continue a medication as directed ▪ Send task regarding medication5) Does a prescription need to be renewed? To renew a prescription, follow these steps: a) Right-click on the medication name and select either of the following: i) Renew to renew with no changes. ii) Renew with changes to renew with changes to any of the associated prescription information, such as days supply, quantity, number of refills, and so on. The Medication Details page displays.11/18/2009 87 Allscripts Enterprise EHR Certified Workflows
  • 88. (1) Change the appropriate prescription details. (2) Click OK on the Medication Details page.6) Does a medication need to be replaced? To replace a medication, do the following: a) Click the Add New Medication icon on the Clinical Toolbar or New on the Meds/Orders component. The Add Clinical Item workspace displays. b) From the Rx/Orders primary tab, click on the Rx secondary tab, if needed c) Using the patient’s active problems list within the Patient pane (upper-left corner of the ACI), link a problem to a medication. To link a problem to a medication: i) To assess and link the problem, enter a checkmark in the box (this assesses the problem for the visit and links the problem to the medication). ii) To only link the problem to the order, single-click on the problem name to highlight. d) Find the order via Specialty or Personal Favorites, QuickList, or by Master search. e) Enter a checkmark in the box next to the medication name. This selects the medication and automatically launches the Medication Details page to fill in required prescription information. f) Respond to the following two prompts, if needed; 1) insurance formulary alternatives, or 2) allergy warning if the medication being prescribed would interact. g) Select the desired SIG, Days supply, Quantity, number of refills, and other prescription details as appropriate. h) Under the Additional Details section, click the Replaced drop-down list. i) Select the appropriate medication that is being replaced with this new medication. j) Click OK (on both the Medication Details page and ACI). k) Respond to any DUR prompts, if needed. l) The new medication is added to the patient’s Current Medications and the replaced medication is moved to the Past Meds.7) Does a medication need to be adjusted? If there was a reported change to an order that needs to be reflected in the Note, follow these steps: a) Right-click on the medication name and select Edit. The Medication Details page displays. b) Make changes to the prescription as needed. i) The following elements of a prescription may be changed when utilizing the Edit action: ▪ Expected Action (Complete, Evaluate, Renew) ▪ Expected Action Date ▪ Managed by (provider) ▪ Therapy Start Date ▪ Therapy End Date ▪ Annotations c) Click OK on the medication details page. d) The entry displays in magenta-colored text until it has been saved to the patient record.11/18/2009 88 Allscripts Enterprise EHR Certified Workflows
  • 89. 8) Does the prescription need to be discontinued? The purpose of this action is to indicate the medication therapy is being stopped (usually mid-course) for the patient. An example of this is maybe the patient is having an adverse reaction to the medication or the medication therapy is not having the desired affect and another course of medication will be given. To discontinue a medication, follow these steps: a) Right-click on the appropriate medication and select D/C. b) The medication is moved from Current Medications to the Past Medications view. The entry displays in magenta-colored text until it has been saved to the patient record.9) Does the prescription need to be completed? The purpose of this action is to indicate the patient has completed the course of therapy and will no longer be taking the medication. To complete a prescription, follow these steps: a) Right-click on the medication name and select Complete. b) The medication is moved from the Current Medications to the Past Medications view. The entry displays in magenta-colored text until it has been saved to the patient record.10) Does the prescription need to be continued? A provider may need to document that a prescription was discussed with the patient and indicate that the medication will be continued as directed. No new or renewal prescription is generated from this action. To continue a prescription, do the following: a) Right-click on the medication name and select Continue. b) The entry displays in magenta-colored text until it has been saved to the patient record.11) Does the provider need to send a medication-related task? While reviewing the medications with a patient, the provider may want some follow-up done by the clinical staff.12) If yes, the provider creates a task to document what needs to be done for a specific medication. To send a medication-related task, follow these steps: a) Single-click on the desired medication name. b) Click on the New Task icon. The Task Detail dialog box displays. c) Select the Task type of “Go to Med” from the drop-down list. d) Select the desired button (User or Team) to whom the task should be assigned. e) Select the appropriate user or team from the drop-down list or by searching. To search for a user, click All. f) In the Comments section, enter in the necessary details. Users may enter text either manually or with the use of text templates. g) Alter the Activate and Overdue Date, if necessary. h) Enter information for a Notify Task, if appropriate. i) Click OK.13) The system creates a “Go to Med” task to notify that some follow-up is needed for the selected medication.11/18/2009 89 Allscripts Enterprise EHR Certified Workflows
  • 90. (H3) Med AdministrationThis workflow defines the steps for ordering medications that require administration during a patientvisit. It specifically focuses on any medications that are administered within the office or practice,such as singular shots, pills, drops, and so on.The medication administration workflow typically involves two different roles: ▪ Provider – individual who orders the medication. ▪ Clinical staff – individual who administers and records the med administration data. Figure 26 (H3) Med Administration H (1) Provider determines (2) (3) H3 medication needs Will administration Yes Provider creates administration for a be recurring? order with schedule problem No (5) (4) Provider changes Provider creates Patient status to single order “Order Pending” & saves encounter data (7) (6) (8) (9) Clinical Staff J4 Med Admin Clinical Staff records Is administration Yes administers task created administration data chargeable? medication to patient No EndTo administer a medication during the patient’s visit, do the following:1) During the patient’s visit, the provider determines that a medication requiring administration is needed for a problem. To link a problem to a medication administration order, do the following: a) The patient should already be in context in the Patient Banner having been selected from the Schedule. b) For an existing problem, click the box next to the problem name to assess or highlight the problem name to link without assessing from the problem component (on the Clinical Desktop or within the patient pane of the ACI). c) For a new problem, start by adding a new problem by clicking on the Add New Problem icon on the Clinical Toolbar to launch the Add Clinical Item (ACI) workspace. d) From the History Builder primary tab and Active secondary tab, locate the desired item by checking the box next to the problem. The newly added problem will display in the Patient Pane in the ACI. e) Continue with the ordering process.2) Does the administration require multiple instances or a schedule to be created? These are typically referred to as recurring or standing orders.11/18/2009 90 Allscripts Enterprise EHR Certified Workflows
  • 91. 3) If yes, the provider creates a medication administration order with a schedule. To create an order with a schedule, follow these steps: a) If not already in the ACI from adding a new Problem, click on the Add New Medication icon on the Clinical Toolbar or click New from the Note Authoring workspace (NAW) under the Plan section. b) From the Rx/Orders primary tab, click on the Med Admin secondary tab. If all medications will have the same Schedule applied, click the Schedule button directly on the ACI workspace. This will apply the same schedule to all medications selected. Otherwise, select a schedule for each individual medication. c) Search the desired medication via Specialty or Personal Favorites, QuickList, or by Master search. d) Select a medication by placing a checkmark in the box next to the medication name. This selects the medication and automatically launches the Medication Details page to fill in the required information. e) Respond to the following two prompts, if needed; 1) insurance formulary alternatives, or 2) allergy warning if the medication being prescribed would interact. f) Select or enter the appropriate SIG. g) Click the Schedule button. The Scheduled Dialog box displays. h) Select one of the following scheduling options: ▪ Dates—allows the provider to manually select specific dates for administration. The user must manually select today’s date if the first administration is to be done today. Otherwise, the To Be Done date defaults to the first date manually selected by the user. ▪ Recurring—allows the provider to define a recurrence pattern for the administration. This pattern can be defined for a daily, weekly, monthly, or yearly administration. ▪ As Needed—allows the provider to create a scheduled order that enables the clinical staff to create a “child” order on an as needed (manual) basis. i) Specify the Scheduling Pattern as appropriate and click OK when finished to close the Scheduled Dialog box. The generated schedule will appear next to the schedule button. Users can hover over the schedule to display the full list of dates. j) Specify the order Priority (for example, Routine, ASAP, STAT, Today, Pre-Op) and other optional details (such as Critical, DAW, and so on), as needed. k) Click OK (on both the Medication Detail page and ACI when finished). The new med administration displays in magenta-colored text. l) Respond to any DUR prompts, as needed.4) If a schedule is not required, the provider creates a single medication order for administration: a) Click on the Add New Medication icon on the Clinical Toolbar or click New from Note Authoring workspace (NAW) under the Plan section.11/18/2009 91 Allscripts Enterprise EHR Certified Workflows
  • 92. b) From the Rx/Orders primary tab, click on the Med Admin secondary tab. c) Search the desired medication via Specialty or Personal Favorites, QuickList, or by Master search. d) Select a medication by placing a checkmark in the box next to the medication name. This selects the medication and automatically launches the Medication Details page to fill in the required information. e) Select or enter the appropriate SIG. f) Verify the To Be Done date (the default is today’s date). g) Specify the order Priority (for example, Routine, ASAP, STAT, Today) and other optional details (such as Critical, DAW, and so on), as needed. h) Click OK. The new med admin displays in magenta-colored text. i) Respond to any DUR prompts, as needed. j) Repeat steps c – i, as needed. k) When finished, click OK to close the ACI.5) Once all the medication administration orders are placed, the provider changes the patient status to “Orders Pending” to indicate to the clinical staff that actions need to be completed for the patient prior to saving the encounter data. To update the patient status and commit the encounter data, follow these steps: a) From the Clinical Toolbar, select the Orders Pending from the drop-down list next to the status. b) Click Commit to save changes to the database.6) Once the encounter information is saved, the system generates a “Med Admin” task. This is a delegated task that must have an enterprise task view set up and assigned to the appropriate clinical staff. The purpose of this task is to notify staff that an administration needs to be done.7) Clinical staff completes the administration of the medication to the patient.8) Clinical staff then records the details of the medication administration to complete the order. To record the administration details, do the following: a) Clinical staff should be logged into Allscripts Enterprise EHR. If not logged in, launch the application by double-clicking on the Allscripts Enterprise EHR desktop icon. b) From the Chart menu, click on the Task List horizontal toolbar. c) Select the View that looks at all tasks for the current patient encounter, including Med Admin tasks d) Double-click on the desired Med Admin task. The Medication Details page displays with the Record Administration tab active. e) Enter in the required administration details, such as dose, unit, route, site, manufacturer, lot number, expiration date, and so on. f) Click OK. The Med Admin task auto-clears from the Task List.9) Is the administration chargeable? Sometimes the administration of a medication during an office visit requires that the medication and administration fee be charged. Organizations that plan to charge for administrations should verify that the appropriate procedure charges are available within the system to bill against.11/18/2009 92 Allscripts Enterprise EHR Certified Workflows
  • 93. 10) If charging for administrations, proceed to workflow (J4) Charging for Administrations for the certified workflow steps.11/18/2009 93 Allscripts Enterprise EHR Certified Workflows
  • 94. (H4) ImmunizationsThis workflow defines the steps for ordering immunizations that require administration during apatient visit. It specifically focuses on immunizations administered during the visit, such as vaccines,flu shots, and so on.The immunization workflow typically involves two different roles: ▪ Provider – individual who orders the immunization. ▪ Clinical staff – individual who administers and records the immunization data Figure 27 (H4) ImmunizationsTo administer an immunization during the patient’s visit, do the following:1) During the patient’s visit, the provider determines that an immunization requiring administration is needed. Allscripts recommends that all immunizations be linked to the problem of “Health Maintenance.” To link the problem of health maintenance to an immunization order, do the following: a) The patient should already be in context in the Patient Banner having been selected from the Schedule. b) Click the box next to the problem name to assess or highlight the problem name to link without assessing from the problem component (on the Clinical Desktop or within the patient pane of the ACI).2) Does the immunization require multiple instances or a schedule to be created? These are typically referred to as recurring or standing orders.3) If yes, follow these steps to create a medication immunization order with a schedule: a) Click on the Add New Medication icon on the Clinical Toolbar or click New from the Note Authoring workspace (NAW) under the Plan section. b) From the Rx/Orders primary tab, click on the Immun secondary tab. c) Search for the desired immunization via Specialty or Personal Favorites, QuickList, or by Master search.11/18/2009 94 Allscripts Enterprise EHR Certified Workflows
  • 95. If all immunizations will have the same Schedule applied, click the Schedule button directly on the Immun workspace. This will apply the same schedule to all immunizations selected. Otherwise, select a schedule for each individual immunization. d) Place a checkmark in the box next to the medication name. This selects the immunization and automatically launches the Immunization Details page to fill in the required information. e) Select or enter the appropriate SIG. f) Click the Schedule button. The Scheduled Dialog box displays. g) Select one of the following scheduling options: ▪ Dates—allows the provider to manually select specific dates for administration. The user must manually select today’s date if the first administration is to be done today. Otherwise, the To Be Done date defaults to the first date manually selected by the user. ▪ Recurring—allows the provider to define a recurrence pattern for the administration. This pattern can be defined for a daily, weekly, monthly, or yearly administration. ▪ As Needed—allows the provider to create a scheduled order that enables the clinical staff to create a “child” order on an as needed (manual) basis. h) Specify the Scheduling Pattern as appropriate and click OK when finished to close the Scheduled Dialog box. The generated schedule will appear next to the schedule button. i) Specify the order Priority (for example, Routine, ASAP, STAT, Today, Pre-Op) and other optional details, as needed. j) Click OK. The immunization displays in magenta-colored text. k) When finished, click OK to close the ACI.4) If a schedule is not required, the provider creates a single immunization order for administration: a) Click on the Add New Medication icon on the Clinical Toolbar or click New from Note Authoring workspace (NAW) under the Plan section. b) From the Rx/Orders primary tab, click on the Immun secondary tab. c) Search for the desired immunization via Specialty or Personal Favorites, QuickList, or by Master search. d) Place a checkmark in the box next to the medication name. This selects the immunization and automatically launches the Immunization Details page to fill in the required information. e) Select or enter the appropriate SIG. f) Verify the order To Be Done Date (it should default to today). g) Specify the order Priority (for example, Routine, ASAP, STAT, Today) and other optional details, as needed. h) Click OK. The immunization displays in magenta-colored text. i) Repeat steps c – h, as needed.11/18/2009 95 Allscripts Enterprise EHR Certified Workflows
  • 96. j) When finished, click OK to close the ACI.5) Once all the immunization orders are placed, the provider changes the patient status to “Orders Pending” to indicate to the clinical staff that actions need to be completed for the patient prior to saving the encounter data. To update the patient status and commit the encounter data, follow these steps: a) From the Clinical Toolbar, select the Orders Pending from the drop-down list next to status. b) Click Commit to save changes to the database.6) Once the encounter information is saved, the system generates an Immunization Admin task. This is a delegated task that must have an enterprise task view set up and assigned to the appropriate clinical staff. The purpose of this task is to notify staff that an administration of an immunization needs to be done.7) Clinical staff completes the administration of the immunization to the patient.8) Clinical staff then records in Allscripts Enterprise EHR the details of the immunization administration. To record the administration details, do the following: a) Clinical staff should be logged into Allscripts Enterprise EHR. If not logged in, launch the application by double-clicking on the Allscripts Enterprise EHR desktop icon. b) From the Chart menu, click on the Task List horizontal toolbar. c) Select the View that looks at all tasks for the current patient encounter, including Immunization Admin tasks d) Double-click on the desired Immunization Admin task. The Immunization Details page displays with the Record Administration tab active. e) Enter in the required immunization administration information such as dose, route, site, manufacturer, lot number, series number, expiration date, and so on. f) Click OK. The Immunization Admin task auto-clears from the Task List.9) Is the administration chargeable? Sometimes the administration of an immunization during an office visit requires that the immunization and administration fee be charged. Organizations that plan to charge for administrations should verify that the appropriate procedure charges are available within the system to bill against.10) If charging for administrations, proceed to workflow (J4) Charging for Administrations for the certified workflow steps.11/18/2009 96 Allscripts Enterprise EHR Certified Workflows
  • 97. (H5) Future OrdersThis workflow provides detailed steps to place a future order for a laboratory, radiology, or in-houseprocedure during a patient’s visit. A future order is an order that needs to be done on any day in thefuture (other than today). Figure 28 (H5) Future OrdersTo create a future order, follow these steps:1) During the patient’s visit, the provider determines a future order is required for a problem. To link a problem to an order, do the following: a) The patient should already be in context in the Patient Banner having been selected from the Schedule. b) For an existing problem, click the box next to the problem name to assess or highlight the problem name to link without assessing from the problem component (on the Clinical Desktop or within the patient pane of the ACI). c) For a new problem, start by adding a new problem by clicking on the Add New Problem icon on the Clinical Toolbar to launch the Add Clinical Item (ACI) workspace.11/18/2009 97 Allscripts Enterprise EHR Certified Workflows
  • 98. d) From the History Builder primary tab and Active secondary tab, locate the desired item by checking the box next to the problem. The newly added problem will display in the Patient Pane in the ACI. e) Continue with the ordering process. Sending an associated ICD-9 code is usually a requirement with most diagnostic vendors. Best Practice is to require the selection of a problem for an order. This will also aid in the learning and usage of QuickSets.2) The provider creates one or more future orders for the same date. To create a future order, follow these steps: a) If not already in the ACI from adding a new Problem, click the Add New Order icon from the Clinical Toolbar or click New from Note Authoring workspace (NAW) under the Plan section. The Add Clinical Item workspace displays. Users can determine which primary tab to display (Rx/Orders or Problem-Based) when clicking the Add New Order icon by setting the “Add Clinical Item Order Selection Method Default” order preference. b) From Rx/Orders, select the appropriate secondary tab for the item you want to order: ▪ Lab/Diag for laboratory/diagnostic orders ▪ Imaging for radiology orders ▪ FU/Ref for follow-up or referral orders ▪ Supplies for supply orders c) Find the order via Specialty or Personal Favorites, QuickList, or by Master search. d) From the ACI, modify the order priority (for example, Routine, Stat, and so forth), if necessary. e) Specify the desired future To Be Done date on the ACI. To select a future date, complete the following: i) Click the Calendar icon. The Select a Date dialog box displays. ii) Select a date by picking an actual future date off the calendar or via “fuzzy” date (for example, interval postoperative 2 weeks). iii) Click OK. f) Select an order or orders by placing a checkmark within the box next to the desired order. If all required information is complete, the Order Details page will not display. Providers can right-click on the order and select Edit to modify order information, if necessary. g) Provider completes remainder of encounter and saves (commits) data.3) Does the order require financial authorization? Some orders may require financial authorization or approval from the patient’s insurance company prior to execution. If yes, proceed to workflow (Q3) Financial Authorization for the Certified Workflow steps. If no, continue to step 4.4) Does the order need any additional information? Some organizations may associate clinical questions to orders where they require additional information.11/18/2009 98 Allscripts Enterprise EHR Certified Workflows
  • 99. 5) If additional information is needed, the order’s status changes to “Need Information,” and clinical staff monitors these orders via the Worklist.6) Clinical staff completes the necessary order information and commits the data. To update an order via a Worklist item, do the following: a) From the Worklist horizontal toolbar (HTB), highlight the appropriate order by single-clicking it. b) Click Edit on the component action toolbar. Or right-click and select Edit from the menu. The Order Details page displays. c) Under the Clinical Questions sections, complete the required information as appropriate. d) Click OK. e) Click Commit to save updates to the database. Users can save and commit encounter information without reviewing the Encounter Summary page by clicking Commit on the Clinical Toolbar. This is controlled by the “Encounter Summary Review Before Save” user preference.7) Does the order require an appointment to be scheduled? Some orders may require an appointment to be scheduled in order for it to be performed. If yes, proceed to workflow (K1) Scheduling Order Appointments for the certified workflow steps. If no, continue to step 8.8) The Order status changes to “Active” once all necessary information and/or reasons for being held up are resolved and the system executes the communication method as defined.9) Will future orders be sent to the performing location via an outbound order interface or fax?10) If yes, the outbound order message or fax is sent to the appropriate performing location based on the defined “To Be Done” date specifications.11) A paper order requisition or hardcopy is printed and given to the patient. Administrators can set up automatic printing characteristics for order requisitions and/or specimen labels.12) Did the patient present for specimen or image collection? There are some instances that an order was placed, but the patient does not present to the designated draw station or location for specimen or image collection. If the patient did not present, follow (Q2) Tracking Overdue Orders for the certified workflow steps.13) If the patient presents, is the specimen or image collection being done in-office? If the specimen or image collection is being handled in-office during the visit, continue to step 15.14) If the specimen or image collection in not being handled on-site or in the office, the patient is directed to present to the appropriate performing location. This could be at a separate clinic or other performing facility approved by the patient’s insurance.15) The clinical or ancillary staff completes the necessary specimen or image collection.16) Will the order be resulted in-house? This will vary per organization. Some orders can be resulted in-house while others have to be couriered to the appropriate performing location for11/18/2009 99 Allscripts Enterprise EHR Certified Workflows
  • 100. execution of the result. If the order can be resulted in-house, follow the (R2) In-house Testing for the certified workflow steps.17) If the execution of the result is handled by another performing location, will the results be received electronically? If yes, follow (R3) Results Verification for how to verify the results once received from the performing location. If no, proceed to (R1) Entry of Paper Results for the certified workflow steps.11/18/2009 100 Allscripts Enterprise EHR Certified Workflows
  • 101. (H6) Ad Hoc Diagnostic OrdersThis workflow provides detailed steps for ordering an ad hoc laboratory, radiology, or an in-housetest during a patient’s visit. The term ad hoc refers to the method of creating an order outsideutilizing a CareGuide or QuickSet.These actions can be done in any context where an order needs to be placed for a patient. Forinstance, a patient may call in with specific symptoms that result in an order being placed or aprovider determines that a test is needed while reviewing a patient’s results. Ordering is typicallyhandled by the provider, however, some orders may be placed by clinical staff per protocol. Figure 29 (H6) Ad Hoc Diagnostic Orders H (1) Provider determines (2) (3) H6 a diagnostic order is Will order be Yes Provider creates a needed for a recurring? recurring order problem No (5) (4) Insurance Q3 Provider creates Yes verification single order for today required? No (8) (6) (7) Clinical Staff Order need Order status Yes completes necessary additional changes to Need order information & information? Information commits data (9) No Order require an Yes K1 appointment? (12) Order sent based No Yes on “To Be Done” date (10) Order changes to (11) Active & executes Sent via interface communication or fax? method (13) Paper Order No requisition printed & given to patient (17) (14) (15) Clinical or Ancillary (18) Patient presents for Specimen or Image R2 Yes Yes Staff completes Resulting Yes specimen or image collection done In specimen or image In-house? collection? Office? collection No No No Q2 (16) (19) Performing Location R3 Results received Yes completes collection electronically? & performs order No R1To create an ad hoc diagnostic order, follow these steps:1) During the patient visit, the provider determines that a diagnostic test (laboratory, radiology, or in-house) is needed for a problem. To link a problem to an order, do the following: a) The patient should already be in context in the Patient Banner having been selected from the Schedule. b) For an existing problem, click the box next to the problem name to assess or highlight the problem name to link without assessing from the problem component (on the Clinical Desktop or within the patient pane of the ACI). c) For a new problem, start by adding a new problem by clicking on the Add New Problem icon on the Clinical Toolbar to launch the Add Clinical Item (ACI) workspace.11/18/2009 101 Allscripts Enterprise EHR Certified Workflows
  • 102. d) From the History Builder primary tab and Active secondary tab, locate the desired item by checking the box next to the problem. The newly added problem will display in the Patient Pane in the ACI. e) Continue with the ordering process. Sending an associated ICD-9 code is usually a requirement with most diagnostic vendors. Best Practice is to require the selection of a problem for an order. This will also aid in the learning and usage of QuickSets.2) Will the order be recurring or require a schedule to be created?3) If yes, follow these steps to create a recurring order: a) If not already in the ACI from adding a new Problem, click the Add New Order icon from the Clinical Toolbar or click New from Note Authoring workspace (NAW) under the Plan section. The Add Clinical Item workspace displays. Users can determine which primary tab to display (Rx/Orders or Problem-Based) when clicking the Add New Order icon by setting the “Add Clinical Item Order Selection Method Default” order preference. b) From Rx/Orders, select the appropriate secondary tab for the item you want to order: ▪ Lab/Diag for laboratory/diagnostic orders ▪ Imaging for radiology orders c) Find the order via Specialty or Personal Favorites, QuickList, or by Master search. d) From the ACI, modify the order priority (for example, Routine, Stat, and so forth), if necessary. e) Select the Schedule option. f) Click Schedule. The Scheduled Dialog box displays. Providers can define a “Schedule” and apply it to a single order or multiple orders (of the same order type) by selecting the Schedule option directly from the ACI workspace. Once defined, the system will automatically associate that schedule to any order placed afterward. g) Select one of the following scheduling options: ▪ Dates—allows the provider to manually select specific dates for an order. The user must manually select today’s date if the first order is to be done today. Otherwise, the To Be Done date defaults to the first date manually selected by the user. ▪ Recurring—allows the provider to define a recurrence pattern for an order. This pattern can be defined for a daily, weekly, monthly, or yearly pattern. ▪ As Needed—allows the provider to create an initial “parent” order that allows clinical staff to create a “child” order on an as-needed (manual) basis.11/18/2009 102 Allscripts Enterprise EHR Certified Workflows
  • 103. h) Specify the Scheduling Pattern as appropriate and click OK when finished to close the Scheduled Dialog box. The generated schedule will appear next to the Schedule button. Users can hover over the schedule to display the full list of dates. i) Select an order by placing a checkmark within the box next to the desired order. If all required information is complete, the Order Details page will not display. Providers can right- click on the order and select Edit to modify order information, if necessary. j) The order appears in magenta-colored text. k) Click Commit on the Clinical Toolbar to save changes to the database.4) If the order is not recurring, the provider creates a single order for today. To create a single diagnostic order, follow these steps: a) Click the Add New Order icon from the Clinical Toolbar or click New from Note Authoring workspace (NAW) under the Plan section. The Add Clinical Item workspace displays. b) From Rx/Orders, select the appropriate secondary tab for the item you want to order: ▪ Lab/Diag for laboratory orders ▪ Imaging for radiology orders c) Find the order via Specialty or Personal Favorites, QuickList, or by Master search. d) From the ACI, modify the order priority (for example, Routine, Stat, and so forth), if necessary. e) Verify the To Be Done date (the default is today’s date). f) Select an order by placing a checkmark within the box next to the desired order. If all required information is complete, the Order Details page will not display. Providers can right- click on the order and select Edit to modify order information, if necessary. g) Repeat steps b – f, as needed. h) The order appears in magenta-colored text. i) Click Commit on the Clinical Toolbar to save changes to the database.5) Does the order require financial authorization? Some orders may require financial authorization or approval from the patient’s insurance company prior to execution. If yes, proceed to workflow (Q3) Financial Authorization for the Certified Workflow steps. If no, continue to step 6.6) Does the order need any additional information? Some organizations may associate clinical questions to orders where they require additional information.7) If additional information is needed, the order’s status changes to “Need Information,” and clinical staff monitors these orders via a Worklist.8) Clinical staff completes the necessary order information and commits the data. To update an order via a Worklist item, do the following: a) From the Worklist horizontal toolbar (HTB), highlight the appropriate order by single-clicking it. b) Click Edit on the component action toolbar. Or right-click and select Edit from the menu. The Order Details page displays. c) Under the Clinical Questions sections, complete the required information as appropriate. d) Click OK.11/18/2009 103 Allscripts Enterprise EHR Certified Workflows
  • 104. e) Click Commit to save updates to the database. Users can save and commit encounter information without reviewing the Encounter Summary page by clicking Commit on the Clinical Toolbar. This is controlled by the “Encounter Summary Review Before Save” user preference.9) Does the order require an appointment to be scheduled? Some orders may require an appointment to be scheduled in order for it to be performed. If yes, proceed to workflow (K1) Scheduling Order Appointments for the Certified Workflow steps. If no, continue to step 10.10) The order status changes to “Active” once all necessary information and/or reasons for being held up are resolved and the system executes the communication method as defined.11) Will future orders be sent to the performing location via an outbound order interface or fax?12) The outbound order message or fax is sent to the appropriate performing location based on the defined “To Be Done” date specifications.13) A paper order requisition or hardcopy is printed and given to the patient. Administrators can set up automatic printing characteristics for order requisitions and/or specimen labels.14) Did the patient present for specimen or image collection? There are some instances that an order was placed, but the patient does not present to the designated draw station or location for specimen or image collection. If the patient did not present, follow workflow (Q2) Tracking Overdue Orders for the Certified Workflow steps.15) If the patient presents, is the specimen or image collection being done in-office? If the specimen or image collection is being handled in-office during the visit, continue to step 17.16) If the specimen or image collection in not being handled on-site or in the office, the patient is directed to present to the appropriate performing location. This could be at a separate clinic or other performing facility approved by the patient’s insurance.17) The clinical or ancillary staff completes the necessary specimen or image collection.18) Will the order be resulted in-house? This will vary per organization. Some orders can be resulted in-house while others have to be couriered to the appropriate performing location for execution of the result. If the order can be resulted in-house, follow workflow (R2) In-house Testing for the Certified Workflow steps.19) If the execution of the result is handled by another performing location, will the results be received electronically? If yes, follow workflow (R3) Results Verification for how to verify the results once received from the performing location. If no, proceed to workflow (R1) Entry of Paper Results for the Certified Workflow steps.11/18/2009 104 Allscripts Enterprise EHR Certified Workflows
  • 105. (H7) Follow-up or Referral OrdersThis workflow defines the steps to order a referral or a follow-up order. A referral order is where aprovider directs the patient to another provider or source for evaluation and/or consultationpurposes. For instance, a provider may refer a patient to a specialist for additional care that they arenot equipped to provide or where the patient requires a second opinion. A follow-up order refers tothe evaluation visit that is needed after an initial encounter or previous procedure. Figure 30 (H7) Follow-up or Referral OrdersTo create a follow-up or referral order, follow these steps:1) The provider determines a follow-up or referral order is required for a problem. To link a problem to an order, do the following: a) The patient should already be in context in the Patient Banner having been selected from the Schedule. b) For an existing problem, click the box next to the problem name to assess or highlight the problem name to link without assessing from the problem component (on the Clinical Desktop or within the patient pane of the ACI). c) For a new problem, start by adding a new problem by clicking the Add New Problem icon on the Clinical Toolbar to launch the Add Clinical Item (ACI) workspace. d) From the History Builder primary tab and Active secondary tab, locate the desired item by checking the box next to the problem. The newly added problem will display in the Patient Pane in the ACI. e) Continue with the ordering process. Best Practice recommendation is to require the selection of a problem for an order. This will aid in the learning and usage of QuickSets.2) Does the patient need a follow-up visit?11/18/2009 105 Allscripts Enterprise EHR Certified Workflows
  • 106. 3) If yes, the provider creates an order for a follow-up visit. To create a follow-up order, follow these steps: a) If not already in the ACI from adding a new Problem, click the Add New Order icon from the Clinical Toolbar or click New from Note Authoring workspace (NAW) under the Plan section. The Add Clinical Item workspace displays. Users can determine which primary tab to display (Rx/Orders or Problem-Based) when clicking the Add New Order icon by setting the “Add Clinical Item Order Selection Method Default” order preference. b) From Rx/Orders, select the FU/Ref (Follow-up/Referral) secondary tab. c) Find the follow-up order via Specialty or Personal Favorites, QuickList, or by Master search. d) From the ACI, modify the order priority (for example, Routine, Stat, and so forth), if necessary. e) Specify the desired To Be Done date (the default is today’s date). To adjust the To Be Done date, do the following: i) Click the Calendar icon. The Select a Date dialog box displays. ii) Select a date by picking an actual date off the calendar or via “fuzzy” date (for example, approximately 2 weeks). iii) Click OK. f) Select a follow-up order by placing a checkmark within the box next to the desired order. If all required information is complete, the Order Details page will not display. Providers can right-click on the order and select Edit to modify order information, if necessary.4) The provider changes the patient status to “Orders Pending” to indicate that actions need to be completed for the patient prior to saving the encounter data. To update the patient status and commit the encounter data, follow these steps: a) From the Clinical Toolbar, select the Orders Pending from the drop-down list next to the status. b) Click Commit to save changes to the database.5) Does the order need any additional information? Some organizations may associate clinical questions to orders where they require additional information. If no, proceed to workflow (K1) Scheduling Order Appointments for the Certified Workflow steps.6) If additional information is needed, the order’s status changes to “Need Information,” and clinical staff monitors these orders via a Worklist.7) Clinical staff completes the necessary order information and commits the data. To update an order via a Worklist item, do the following: a) From the Worklist horizontal toolbar (HTB), highlight the appropriate order by single-clicking it. b) Click Edit on the component action toolbar. Or right-click and select Edit from the menu. The Order Details page displays. c) Under the Clinical Questions sections, complete the required information as appropriate. d) Click OK.11/18/2009 106 Allscripts Enterprise EHR Certified Workflows
  • 107. e) Click Commit to save updates to the database. Follow workflow (K1) Scheduling Order Appointments for the certified workflow steps to complete the scheduling of the follow-up appointment.8) The provider creates an order for a referral. To create a referral order, follow these steps: a) From Rx/Orders, select the FU/Ref (Follow-up/Referral) secondary tab. b) Find the referral order via Specialty or Personal Favorites, QuickList, or by Master search. c) From the ACI, modify the order priority (for example, Routine, Stat, and so forth), if necessary. d) Specify the desired To Be Done date (the default is today’s date). To adjust the To Be Done date, do the following: i) Click the Calendar icon. The Select a Date dialog box displays. ii) Select a date by picking an actual date off the calendar or via “fuzzy” date (for example, approximately 2 weeks). iii) Click OK. e) Select a referral order by placing a checkmark within the box next to the desired order. If all required information is complete, the Order Details page will not display. Providers can right- click on the order and select Edit to modify order information, if necessary.9) Does the order require financial authorization? Some orders may require financial authorization or approval from the patient’s insurance company prior to execution. If yes, proceed to workflow (Q3) Financial Authorization for the Certified Workflow steps. If no, follow workflow (K2) Referral Appointments for details on how to complete the scheduling of the referral appointment.11/18/2009 107 Allscripts Enterprise EHR Certified Workflows
  • 108. (H8) Instructions/Supplies OrdersThis workflow defines the steps to order an instruction or a supply during a patient’s visit:An instruction order is simply detailed directions, instructions, or education for a given patient. Forexample, a provider may want a patient to “avoid caffeine.”A supply order is typically an item that is needed as equipment or for maintenance. For instance, adiabetic patient may need an order for a glucometer or glucose monitoring strips. Figure 31 (H8) Instructions/Supplies OrdersTo order instructions or supplies, follow these steps:1) During the patient visit, the provider determines that an instruction or supply is needed for a problem. To link a problem to an order, do the following: a) The patient should already be in context in the Patient Banner having been selected from the Schedule. b) For an existing problem, click the box next to the problem name to assess or highlight the problem name to link without assessing from the problem component (on the Clinical Desktop or within the patient pane of the ACI). c) For a new problem, start by adding a new problem by clicking on the Add New Problem icon on the Clinical Toolbar to launch the Add Clinical Item (ACI) workspace. d) From the History Builder primary tab and Active secondary tab, locate the desired item by checking the box next to the problem. The newly added problem will display in the Patient Pane in the ACI. e) Continue with the ordering process. Best Practice recommendation is to require the selection of a problem for an order. This will aid in the learning and usage of QuickSets.11/18/2009 108 Allscripts Enterprise EHR Certified Workflows
  • 109. 2) Is the order for an instruction? The provider may be looking for an instruction or education materials for the patient.3) If yes, the provider selects an instruction. To order an instruction, follow these steps: a) If not already in the ACI from adding a new Problem, click the Add New Order icon from the Clinical Toolbar or click New from the Note Authoring workspace (NAW) under the Plan section. The Add Clinical Item workspace displays. b) Click the Instructions secondary tab. c) Find the instruction via Specialty or Personal Favorites, QuickList, or by Master search. d) Select the appropriate instruction order by checking the box. If the instruction contains one or more variables, the Order Details page will display. e) Complete the necessary required fields and click OK. f) Repeat steps c – e, as needed. g) Click OK to close the ACI. The order appears in magenta-colored text. h) Click Commit on the Clinical Toolbar to save changes to the database.4) The provider saves the encounter information. To save or commit the encounter information and make it a permanent part of the patient’s medical record, on the Clinical Toolbar, click Commit.5) The provider selects a supply. To create a supply order, follow these steps: a) If not already in the ACI from adding a new Problem, click the Add New Order icon from the Clinical Toolbar or click New from the Note Authoring workspace (NAW) under the Plan section. The Add Clinical Item workspace displays. b) Click the Supplies secondary tab. c) Find the supply via Specialty or Personal Favorites, QuickList, or by Master search. d) Select the appropriate supply order by checking the box. The Order Details page displays. e) Complete the necessary required fields and click OK. f) Repeat steps c – e, as needed. g) Click OK to close the ACI. The order appears in magenta-colored text. h) Click Commit on the Clinical Toolbar to save changes to the database.6) Does the Order require financial authorization? Some orders may require financial authorization or approval from the patient’s insurance company prior to execution. If yes, proceed to workflow (Q3) Financial Authorization for the Certified Workflow steps. If no, continue to step 7.7) Does the order need any additional information? Some organizations may associate clinical questions to orders where they require additional information. Organization can apply additional information questions to supply orders to capture necessary order details, such as the supply’s manufacturer and serial number.8) If additional information is needed, the order’s status changes to “Need Information,” and clinical staff monitors these orders via a Worklist.11/18/2009 109 Allscripts Enterprise EHR Certified Workflows
  • 110. 9) Clinical staff completes the necessary order information and commits the data. To update an order via a Worklist item, do the following: a) From the Worklist horizontal toolbar, highlight the appropriate order by single-clicking it. b) Click Edit on the component action toolbar. Or right-click and select Edit from the menu. The Order Details page displays. c) Under the Clinical Questions sections, complete the required information as appropriate. d) Click OK. e) Click Commit to save updates to the database.10) Once the encounter information is saved and all necessary information is resolved, the system automatically prints the patient instructions or education materials, if specified. When Patient Education materials print is controlled by the System Preference “Print Patient Education.” This can be set to Always or If CareGuide Only in TWAdmin, Preferences, and General Category. See the Preferences manual for more information about this preference setting.11) The provider or staff provides the education materials or supply order to the patient.11/18/2009 110 Allscripts Enterprise EHR Certified Workflows
  • 111. (H9) Order RemindersThis workflow is to achieve an understanding of how to create an order reminder for an orderableitem during a patient’s visit. An order reminder can help providers remember that a particular orderis needed for a patient problem. Figure 32 (H9) Order Reminders H (1) (3) (4) Provider determines (2) Provider selects Provider selects H9 an order reminder is CareGuide being Yes appropriate desired Order needed for a used? CareGuide Reminders problem No (6) (5) Provider defines Provider selects Order Reminder End desired Order details as Reminder from ACI appropriateTo create an order reminder, follow these steps:1) During the patient visit, the provider determines that an order reminder is needed for a problem. a) The patient should already be in context in the Patient Banner having been selected from the Schedule. b) For an existing problem, click the box next to the problem name to assess or highlight the problem name to link without assessing from the problem component (on the Clinical Desktop or within the patient pane of the ACI). c) For a new problem, start by adding a new problem by clicking on the Add New Problem icon on the Clinical Toolbar to launch the Add Clinical Item (ACI) workspace. d) From the History Builder primary tab and Active secondary tab, locate the desired item by checking the box next to the problem. The newly added problem will display in the Patient Pane in the ACI. e) Continue with the ordering process.2) Is a CareGuide being used?3) If yes, the provider selects the appropriate CareGuide.4) From the CareGuide, the provider selects the desired order reminders. To select an order reminder from a CareGuide, do the following:11/18/2009 111 Allscripts Enterprise EHR Certified Workflows
  • 112. a) If not already in the ACI from adding a new Problem, click the Add New Order icon from the Clinical Toolbar or click New from the Note Authoring workspace (NAW) under the Plan section. The Add Clinical Item workspace displays. b) From Problem-based Orders, click on the CareGuide secondary tab. c) If there is one or more CareGuide templates associated with the assessed problem, the CareGuide drop-down list will be enabled indicating that templates are available. d) The provider selects the appropriate CareGuide template by clicking on the drop-down arrow. The system displays the contents of the template on the CareGuide secondary tab. e) Click the Orders option (to filter the template to only show the orders section). f) Under Order Reminders, select an order reminder by placing a checkmark within the box next to the desired order or double-click on the reminder to add/edit details.5) If the reminder is not part of a CareGuide, the provider selects the desired order from the Add Clinical Item (ACI) workspace. To find an order, follow these steps: a) If not already in the ACI from adding a new Problem, click the Add New Order icon from the Clinical Toolbar or click New from the Note Authoring workspace (NAW) under the Plan section. The Add Clinical Item workspace displays. b) From Rx/Orders, select the appropriate secondary tab for the order you want the reminder: ▪ Lab/Diag for laboratory/diagnostic orders ▪ Imaging for radiology orders ▪ FU/Ref for follow-up or referral orders ▪ Instructions for instruction orders ▪ Immun for immunization orders ▪ Supplies for supply orders ▪ Med Admin for med administration orders c) Find the order using Specialty, Personal Favorites, QuickList, or by Master search.6) Provider defines order reminder details as appropriate. To create an order reminder for the desired order, do the following: a) Right-click on the desired order and select Reminder from the context menu. The Health Management Reminder Details page displays. b) Define the frequency settings for the order reminder. Order reminders can be set up by recurrence or based on age. i) To define an order reminder by recurrence (default), do the following: (1) Select the desired occurrence and frequency (for example, Monthly – Every 3 months) (2) Select the Start Date. The start date defaults to today’s date. (3) Determine the appropriate end date, if necessary. (4) Click OK. ii) To define an order reminder by age based, do the following: (1) Select the Age Based option.11/18/2009 112 Allscripts Enterprise EHR Certified Workflows
  • 113. (2) Select the desired occurrence by Years. (3) Click OK. c) If an order needs to be placed for the item today, the provider can check the Order First Instance by clicking on the check box.11/18/2009 113 Allscripts Enterprise EHR Certified Workflows
  • 114. (H10) QuickSetsThis workflow defines the steps when placing orders using a QuickSet. QuickSets are groups ofpreviously ordered medications and non-medication orders (such as laboratory or radiology tests)associated to a specific problem (or ICD-9 code). QuickSets provide an efficient way of enteringproblem-related orders quickly. QuickSets are automatically “learned” and created by the systemper user any time they associate a problem to a medication or non-medication order. Figure 33 (H10) QuickSets H (2) (3) (4) (1) Provider determines (5) Provider confirms Provider selects H10 Provider selects a QuickSet can be Provider selects prescription desired problem used with patient desired order(s) fulfillment actions prescription(s) problem (7) (8) (9) (6) System System Provider/Staff Provider saves executes executes order provides Rx/Order End encounter data prescription communication materials to patient action method as neededTo place an order using QuickSets, follow these steps:1) The provider selects a problem. You can select a problem directly from the Problem Component on the Clinical Desktop or add a problem using the Add Clinical Item (ACI) workspace. To add a new problem, follow these steps: a) The patient should already be in context in the Patient Banner having been selected from the Schedule. b) For an existing problem, click the box next to the problem name to assess or highlight the problem name to link without assessing from the problem component (on the Clinical Desktop or within the patient pane of the ACI). c) For a new problem, start by adding a new problem by clicking the Add New Problem icon on the Clinical Toolbar to launch the Add Clinical Item (ACI) workspace. d) From the History Builder primary tab and Active secondary tab, locate the desired item by checking the box next to the problem. The newly added problem will display in the Patient Pane in the ACI. e) Continue with the ordering process.2) The provider determines that multiple orders need to be placed for the given problem using a QuickSet. To enter orders using a QuickSet, do the following:11/18/2009 114 Allscripts Enterprise EHR Certified Workflows
  • 115. a) If not already in the ACI from adding a new Problem, click the Add New Order icon from the Clinical Toolbar or click New from the Note Authoring workspace (NAW) under the Plan section. The Add Clinical Item workspace displays. b) From Problem-based Orders, select the QSets secondary tab. The QuickSets for the ‘Assessed’ problems display in the right pane. Problem-based providers that consistently utilize QuickSets when ordering can have their selection method automatically default to be taken to “Problem-based Orders” within the ACI. This is defined by the “Add Clinical Item Order Selection Method Default” user preference. See the Preferences manual for more information about this preference setting.3) The provider confirms the necessary prescription fulfillment actions and updates as needed. The provider can adjust the fulfillment action, pharmacy (if required), and the Rx Benefit prior to selecting a medication.4) The provider selects the desired prescription(s). To select a prescription, follow these steps: a) Under Rx, select the desired prescriptions by placing a checkmark in the box next to the medication. b) If the prescription requires modification, the provider can right-click on the medication and select Edit. The Medication Details page displays where the provider can adjust the prescription as needed.5) The provider selects the desired non-medication order(s). To select an order, follow these steps: a) Under Order, select the desired non-medication orders by placing a checkmark in the box next to the order. b) If the order requires modification, the provider can right-click on the item and select Edit. The Order Details page displays where the provider can adjust the order as needed. Once built, QuickSets can be copied to multiple providers using the Starter Set Migration Tool (SSMT). These will provide a “starter set” of QuickSets for providers to order from and encourage their use.6) The provider saves and commits the encounter information. To save or commit the encounter information and make it a permanent part of the patient’s medical record, complete the following steps: a) On the Clinical Toolbar, click the Encounter Summary icon. The Encounter Summary page displays. b) Review the information that was entered and update as needed. c) When finished, click Save and continue. Users can save and commit encounter information without reviewing the Encounter Summary page by clicking Commit on the Clinical Toolbar. This is defined with the “Encounter Summary Review Before Save” user preference. See the Preferences manual for more information about this preference setting.11/18/2009 115 Allscripts Enterprise EHR Certified Workflows
  • 116. 7) Once the encounter information has been committed, the system executes the prescription fulfillment action(s). For instance, a prescription that was set to “Send to Retail” would automatically be sent to the designated retail pharmacy.8) In addition, the system executes any order communication methods as defined for non- medication orders.9) The provider or staff provides any prescription and/or order materials to the patient as needed.11/18/2009 116 Allscripts Enterprise EHR Certified Workflows
  • 117. (H11) CareGuidesThis workflow defines the steps when placing orders using a CareGuide. CareGuides are problem-based order sets developed from evidence-based guidelines that enable a user to quickly create aplan of care and build the health management plan for a specific problem. CareGuides facilitate therapid creation of prescriptions, orders, and updates to the chart and Note documentation. This problem-basedordering process dynamically creates customized patient education materials for the patient that reflectthe selected orders, as well as information about the condition or health maintenance issue that the templateaddresses. Included in the printout are patient education details for the medications, orderable items, homeinstructions, and precautions ordered. Figure 34 (H11) CareGuidesTo place an order using CareGuides, follow these steps:1) The provider selects a problem. To select a problem, do the following: a) The patient should already be in context in the Patient Banner having been selected from the Schedule. b) For an existing problem, click the box next to the problem name to assess or highlight the problem name to link from the problem component (on the Clinical Desktop or within the patient pane of the ACI). c) For a new problem, start by adding a new problem by clicking the Add New Problem icon on the Clinical Toolbar to launch the Add Clinical Item (ACI) workspace. d) From the History Builder primary tab and Active secondary tab, locate the desired item by checking the box next to the problem. The newly added problem will display in the Patient Pane in the ACI. e) Continue with the ordering process.11/18/2009 117 Allscripts Enterprise EHR Certified Workflows
  • 118. 2) The provider determines that a CareGuide can be used with patient problem. When a provider adds a new diagnosis or assesses a current problem for a patient, typically the provider will also want to create a plan of care for that problem. If there is one or more CareGuides templates associated with the problem, the CareGuide drop-down list will be enabled indicating that templates are available. To view if CareGuide templates are available for a problem, do the following: a) The problem should already be selected (completed in step 1). b) View that the CareGuide button becomes active, from the Problem-Patient Pane within the ACI, or c) View that the CareGuide button becomes active on the toolbar, from the Problem component of the Clinical Desktop,3) The provider selects the appropriate template from the CareGuide list. The system only displays CareGuide templates that are defined for the patient’s active problems. To select a CareGuide template, do the following: a) Click on the drop-down arrow next to the CareGuide action button. b) Select the appropriate template from the list. c) Once the user selects the appropriate CareGuide template, the system displays the Add Clinical Item workspace with the contents of the template on the CareGuide secondary tab.4) The provider confirms the necessary prescription fulfillment actions and updates as needed. The provider can adjust the fulfillment action, pharmacy (if required), and the Rx Benefit prior to selecting a medication.5) The provider selects the desired medications(s). To select a medication, do the following: a) Select the desired prescriptions by placing a checkmark in the box next to the medication. b) If the prescription requires modification, the provider can right-click on the medication and select Edit. The Medication Details page displays where the provider can adjust the prescription as needed. Each CareGuide is comprised of a combination of medications, orders, patient instructions, and follow-up and referral information. Use the options at the top of the CareGuide secondary tab to control which items are displayed.6) The provider selects the desired non-medication order(s). To select a order, do the following: a) Select the desired non-medication orders by placing a checkmark in the box next to the order. b) If the order requires modification, the provider can right-click on the item and select Edit. The Order Details page displays where the provider can adjust the order as needed.7) The provider selects the desired precaution(s). To select a precaution, do the following: a) Select the desired precaution by placing a checkmark in the box next to the order. b) If the precaution requires modification, the provider can right-click on the item and select Edit. The Order Details page displays where the provider can adjust the order as needed.8) The provider selects the desired instruction(s). To select an instruction, do the following:11/18/2009 118 Allscripts Enterprise EHR Certified Workflows
  • 119. a) Select the desired instruction by placing a checkmark in the box next to the order. b) If the instruction requires modification, the provider can right-click on the item and select Edit. The Order Details page displays where the provider can adjust the order as needed.9) The provider selects the desired follow-up and/or referral orders. To select a follow-up or referral order, do the following: a) Select the follow-up and/or referral order by placing a checkmark in the box next to the order. b) If the follow-up and/or referral order requires modification, right-click and select Edit. The Order Details page displays where the provider can adjust the order as needed. Providers can select items in a CareGuide and save them as a personal template. Then, the next time they use that template all the items will already be selected (defaulted) allowing a user to complete a patient’s Careplan with ease.10) The provider saves and commits the encounter information. To save or commit the encounter information and make it a permanent part of the patient’s medical record, complete the following: a) Once all desired CareGuides orders have been selected, click OK (from the ACI). b) On the Clinical Toolbar, click the Encounter Summary icon. The Encounter Summary page displays. c) Review the information that was entered and update as needed. d) When finished, click Save and continue. Users can save and commit encounter information without reviewing the Encounter Summary page by clicking Commit on the Clinical Toolbar. This is defined by the “Encounter Summary Review Before Save” user preference.11) Once the encounter information has been committed, the system executes the prescription fulfillment action(s). For instance, a prescription that was set to “Send to Retail” would automatically be sent to the designated retail pharmacy.12) In addition, the system executes any order communication methods as defined for non- medication orders.13) The system automatically prints the CareGuide patient instructions, as specified.14) The provider or staff provides the CareGuide materials to the patient.11/18/2009 119 Allscripts Enterprise EHR Certified Workflows
  • 120. (J) Finalize and Charge IntroductionManaging daily charges generated from the patient’s visit and easily sending them to the PracticeManagement System for billing is another critical function of an electronic health record. Thesecould be charges for the visit, procedure charges, and charges for supplies or administration ofmedications. Each of these charges must be associated to the correct, billable diagnosis and haveany appropriate modifiers applied. There are many aspects to sending appropriate billing charges tothe Practice Management System to assure the maximum level of reimbursement from insurancecompanies. Revenues from ambulatory visits can be enhanced by reductions in missing charges,denied claims, and improper ABN notices.Organizations today face multiple challenges in obtaining the maximum levels of reimbursement.Clinicians face a difficult challenge in trying to provide the appropriate documentation for theappropriate level of care. In general, the more highly compensated interactions require the moststringent documentation. Providers often lack confidence in their documentation and, as a result,often “down code,” that is, select the less restrictive reimbursement codes, thereby causingsignificant losses for their practices.These workflows will enable the clinician to receive benefits from utilizing an electronic health recordto support the charge submission process: ▪ Receive medical necessity checking for orders and charges. ▪ Ability to identify and track ABN notices. ▪ Access from within a structured note or from the charge workspaces to an evaluation & management (E&M) coding wizard to assist in determining the proper level of coding based on the documentation for the visit. ▪ Receive CCI (Correct Coding Initiative) checking for charges. ▪ Ability to identify “billable” vs. “non-billable” ICD-9 diagnoses codes. ▪ Ability to identify and track HCC (Hierarchical Care Categories) billable diagnoses.In addition, organizations can determine on a user or provider basis whether charges are sentdirectly to the billing system or if they should be reviewed first (such as, an attending physicianreviewing a resident’s charges, or a coder reviewing an attending physician’s charges).The workflows contained in this section include the following: ▪ Basic Ambulatory Charges—This is a basic workflow that defines the steps for submitting charges for an ambulatory visit. This workflow is for providers first starting to use the EHR, who may not be documenting all their patient visits with a Note but need to submit charges for all their visits. ▪ Charging from Note—This workflow defines the steps for submitting charges after creating a visit Note. This is an integrated workflow that combines the steps for creating a Note and then progresses into the Charge workspaces to finish submitting charges for the visit. ▪ Charging for Orders—This workflow defines the steps for submitting charges for a billable orderable item. This is an integrated workflow that combines the steps for creating orders and then progresses into the Charge workspaces to finish submitting charges for the ordered item. ▪ Charging for Administration—This workflow defines the steps for submitting charges for a billable administration. This is an integrated workflow that combines the steps for creating an order for administration and then progresses into the Charge workspaces to submit charges for the administration and any supplies involved with it. ▪ Review Encounter Charges—Billing staff reviews charges submitted for accuracy based on receiving a task from the submitting provider and / or nursing staff. This review11/18/2009 120 Allscripts Enterprise EHR Certified Workflows
  • 121. is done in Allscripts Enterprise EHR prior to finalizing and sending across to the Practice Management System (PMS). Figure 35 (J) Finalize and Charge D Entering charges J for a basic Yes J1 ambulatory visit? No Entering charges when documenting a Yes J2 Note? No Entering charges for a chargeable Yes J3 order? No Entering charges for med/immun Yes J4 administrations? No Review charges submitted for Yes J5 encounter? No End11/18/2009 121 Allscripts Enterprise EHR Certified Workflows
  • 122. (J1) Basic Ambulatory ChargesThis workflow provides detailed steps to manually complete a charge encounter form for anappointment or ambulatory encounter. Providers can enter specific diagnoses, visit, andprocedure charges for patient encounters. These may be automatically generated based onpreviously entered information, using the E/M expert, or manually selected from a list suppliedwithin Allscripts Enterprise EHR. Figure 36 (J1) Basic Ambulatory ChargesTo complete a charge encounter form for an ambulatory encounter, follow these steps:1) The provider determines that charges need to be billed for the appointment encounter.2) The provider selects the arrived patient from the Schedule within Allscripts Enterprise EHR, if necessary. The patient may already be in context if the provider just completed documenting the visit. If the appropriate patient is not in context, follow these steps to bring a patient into context from the daily schedule: a) The provider should be logged into Allscripts Enterprise EHR. If not logged in, launch the application by double-clicking on the Allscripts Enterprise EHR desktop icon and login. b) From the Chart vertical toolbar, the daily Schedule tab should be active. Make sure the appropriate schedule is displaying. Adjust the provider or date where appropriate. c) Review the schedule and double-click on the desired patient. The Clinical Desktop displays.11/18/2009 122 Allscripts Enterprise EHR Certified Workflows
  • 123. Providers should be selecting patients from the Schedule when entering charges for a given encounter to prevent lost charges. If providers do not begin from the schedule, they will be prompted to select an encounter from the Encounter Selector page. The type of encounter selected determines whether charges can be submitted against it.3) Provider selects a diagnosis for the appointment. To enter a diagnosis (ICD-9 code), do the following: a) On the horizontal toolbar, click Diagnosis. The system displays the Diagnosis Selector page. b) Select the appropriate View from the drop-down list. Select items from your favorites list, assigned groupings (Group/Sub-Group), the patient’s past diagnoses, or master list. Providers can personalize their ‘Default Selection Method’ upon entering the Diagnosis Selector screen. c) Search for a diagnosis by name or ICD-9 code. To search for a diagnosis, do the following: i) Enter the first few characters of the name or the ICD-9 code of the desired diagnosis. ii) Click Go to begin a search. The system displays a list of diagnoses matching the search criteria. iii) Click the More link to move to additional pages of results, if needed. d) Select the desired diagnosis by single-clicking. A checkmark appears to the left of the selected diagnosis and is listed within the Summary pane at the bottom of the page. Click Add to Favorites to add the selected item to your ‘My Favorites’ list. e) Select additional diagnoses if appropriate. f) To identify the primary diagnosis on the Encounter Form when multiple diagnoses are chosen, select the desired diagnosis from the Summary pane and click Set Primary Dx. The selected diagnosis displays at the top of the list with a “1” under the # column. g) Click Next… .4) Provider selects a visit charge for the encounter. To enter a visit charge, do the following: a) On the horizontal toolbar, click Visit Charges (if the user did not use Next… button on the Diagnosis Selector page). b) Select the appropriate View from the drop-down list. Select items from your favorites list, assigned groupings (Group/Sub-Group), or master list. Providers can personalize their ‘Default Selection Method’ upon entering the Visit Charge Selector page. c) Search for a visit code by name or CPT code. To search for a visit charge, do the following:11/18/2009 123 Allscripts Enterprise EHR Certified Workflows
  • 124. i) Enter the first few characters of the name or the CPT code of the desired visit charge ii) Click Go to begin a search. The system displays a list of visit charges matching the search criteria. iii) Click the More link to move to additional pages of results, if needed. d) Click on the desired visit charge(s) to select. A checkmark appears to the left of the selected visit charge and is listed within the Summary pane at the bottom of the page. e) Update diagnosis linking, as needed. You can use the ‘E/M Expert…’ to help generate a suggested visit charge. The tool guides the user through a series of steps assessing each aspect of the patient’s encounter.5) Is a visit modifier needed? If no modifier is needed, proceed to step 7.6) If a modifier is needed, the provider selects the appropriate visit modifier. To select a modifier, do the following: a) From the Modifier Group pane, select the appropriate View from the drop-down list. b) Select the check box to the left of each desired modifier. The code for each selected modifier displays in the Modifier column for the associated visit charge. Staff can also click Charge Details from the Encounter Form to display the Charge Details page and view details for the selected visit charge to add/edit modifiers.7) Was a procedure performed as part of the encounter? If no procedure was performed during the encounter, proceed to step 11.8) If a procedure was performed, the provider selects a procedure charge for the encounter. To enter a procedure charge, do the following: a) On the horizontal toolbar, click Procedure Charges. Or click Next… on the bottom of the Visit Charge Selector page. The Procedure Charge Selector page displays. b) Select the appropriate View from the drop-down list. Select items from your favorites list, assigned groupings (Group/Sub-Group), or master list. Providers can personalize their ‘Default Selection Method’ upon entering the Procedure Charge Selector page. c) Search for a procedure code by name or CPT code. To search for a procedure charge, do the following: i) Enter the first few characters of the name or the CPT code of the desired procedure charge ii) Click Go to begin a search. The system displays a list of procedure charges matching the search criteria. iii) Click the More link to move to additional pages of results, if needed.11/18/2009 124 Allscripts Enterprise EHR Certified Workflows
  • 125. a. Click on the desired procedure charge to select. A checkmark appears to the left of the selected procedure charge and is listed within the Summary pane at the bottom of the page. Click Add to Favorites to add the selected diagnosis to the My Favorites list. d) If a procedure was performed multiple times within a given encounter, the user may select the procedure again. A ‘2x’ (or corresponding value selected) appears to the left of the selected procedure charge and is listed again within the Summary pane at the bottom of the page. e) Update diagnosis linking for each procedure, as needed. f) Select additional procedure charges if appropriate.9) Is a procedure modifier needed? If no modifier is needed, proceed to step 11.10) If a modifier is needed, the provider selects the appropriate procedure modifier. To select a modifier, do the following: a) From the Modifier Group pane, select the appropriate View from the drop-down list. b) Select the check box to the left of each desired modifier. The code for each selected modifier displays in the Modifier column for the associated procedure charge.11) The provider reviews and validates the encounter form. To review and validate the encounter form, do the following: a) On the horizontal toolbar, click Encounter Form. Or click Next on the Procedure Charge Selector to display the Encounter Form. b) Verify that the appropriate information is within the Billing Provider, Performing Provider, Referring Provider (if necessary), Division (if necessary), Billing Area (if necessary) and Location fields. Make adjustments if necessary. c) Review the order of the diagnoses within the Diagnosis Summary pane and make adjustments as necessary. d) Review the visit and procedure charges within the Charges Summary pane: ▪ All Charge codes have been added. ▪ The diagnosis linking is appropriate. ▪ The number of units listed is accurate, if applicable. ▪ Any modifiers are selected, if necessary. ▪ The order is correct (using the up and down arrows below the listing for optimal reimbursement based on RVU). ▪ Allscripts Enterprise EHR provides a variety of charge edits. If a charge triggers an edit, an alert with a hyperlink will appear on the Encounter Form next to the corresponding Charge. ▪ Click on the hyperlink to review the charge edit information and possible resolution. Providers can still submit charges without addressing charge edits which will result in a task for the billing staff to review.12) Once all the information has been verified, the provider submits the charge encounter form by clicking Submit.11/18/2009 125 Allscripts Enterprise EHR Certified Workflows
  • 126. Providers can default where they will be taken next within the system (for example, Schedule, Tasks, and so forth) by setting the “Display When Submit Button is Activated” preference under the Personalize link.13) Are the charges being reviewed by the Billing staff before being sent to the billing system? If yes, proceed to workflow (J5) Review Encounter Charges for the Certified Workflow steps.14) If the charges are not being reviewed and there are no outstanding charge edits (no further attention is required), the charges are sent to the billing system. The status changes to “Submitted.” Once charges have been submitted for a given appointment encounter, a $ dollar sign icon appears on the Schedule.11/18/2009 126 Allscripts Enterprise EHR Certified Workflows
  • 127. (J2) Charging from NoteThis workflow provides detailed steps to complete a charge encounter form for an appointment orambulatory encounter once a note has been created for a patient visit. Figure 37 (J2) Charging from Note J G1 G2 G3 G4 (2) (3) (1) Problem added Diagnosis code Provider documents J2 or assessed Yes (ICD9) patient visit within (associated to an populates the Note ICD9)? encounter form No (4) Problem does (5) not populate Billable order Yes J3 charge added? encounter form No (8) (9) (6) (7) Provider reviews Approved Visit Order does not E/M Coder used to Yes suggested level of Charge Code generate a calculate Visit service & adjusts as populates the billable charge charge? appropriate encounter form (11) (10) (12) (13) Provider reviews & J5 No Provider manually Provider submits Do charges need Yes validates encounter selects Visit Charge charges review? form No (14) Charges sent to billing End system1) As the provider is documenting the patient’s visit within the note, certain note sections they are utilizing may populate the charge encounter form.2) Did the provider add or assess a problem that was associated to an ICD-9 code? The following sections are potential locations for placing a diagnosis code to the charge encounter form: ▪ Assessment—adding a new problem or assessing an existing problem with an associated diagnosis code places the problem in the assessment section of the note and populates the diagnosis code on the charge encounter form. In addition, selecting a Medcin Diagnosis with an ICD-9 code from an Assessment note form posts the problem to the Active Problems list and places the diagnosis code on the charge encounter form.3) If yes, once the encounter information has been saved and committed to the database, the associated diagnosis (ICD-9) code will populate the charge encounter form.4) If no problem was added or assessed, no diagnosis populates the charge encounter form.5) Did the provider place any orders that were billable? If yes, proceed to workflow (J3) Charging for Orders for the certified workflows steps for capturing charges for billable orders.6) If no chargeable order was placed, no billable charge will be generated on the encounter form.7) Is the E/M Coder being used to calculate the visit charge? The E/M Coder utility provides decision support for the appropriate level of service. It suggests the calculated E&M code that is based on the patient’s documented encounter data and allows the provider to override this code11/18/2009 127 Allscripts Enterprise EHR Certified Workflows
  • 128. by adjusting the level of any of the twelve components computed from the patients encounter data.8) If yes, the provider reviews the suggested level of service and updates as appropriate. To launch the E/M Coder and review the level of service, follow these steps: a) The patient and note should already be in context because the provider has been documenting the visit. If not in context, return to the schedule and click on the Note icon next to the appropriate patient. b) From the Note Authoring workspace (NAW), click E/M Coder. The E/M Coder window displays. c) The provider reviews the suggested code (derived from data already documented in the note) in the Calculated from Abstracted Levels field. d) Provider can go to the Medical Decision Making tab and enter additional information that impacts the level of service as appropriate. Providers can add the following:  Diagnosis and Management Options (Problems & Qualifiers)  Complexity of Data  Mark History Reviewed e) The provider can perform any of the following: i) Accept the first value. To accept the first value, select the option button next to Calculated from Abstracted Levels and click OK. ii) Override (that is, change or adjust) the general encounter information or documentation levels, and Re-Calculate to derive a (possibly) different E/M code. The system displays this code in the With User Override Levels field. iii) Accept the overridden value. To accept the recalculated value, select the option button next to With User Override Levels, and click OK.9) The approved Visit Charge Code populates the encounter form once the provider has completed documenting the visit, signed and finalized the note (which commits any unsaved data).10) If the E/M Coder is not being used or the provider decides not to use either of the suggested values, the provider can manually select a Visit Charge. The provider completes documenting the visit, signs and finalizes the note before entering the visit charge. To enter a visit charge manually, follow these steps: a) Go to the Visit Charges horizontal toolbar. b) Search for a visit charge using My Favorites, Group/Sub-Group, or the Master by selecting the appropriate View from the drop-down list. c) Select the desired visit charge by single-clicking. A checkmark appears to the left of the selected visit charge and is listed within the Summary pane at the bottom of the page.11) The provider reviews and validates the encounter form. To do this, perform the following steps: a) Go to the Encounter Form horizontal toolbar. b) Verify that the appropriate information is within the Billing Provider, Performing Provider, Referring Provider (if necessary), Division (if necessary), Billing Area (if necessary) and Location fields. Make adjustments if necessary.11/18/2009 128 Allscripts Enterprise EHR Certified Workflows
  • 129. c) Review the order of the diagnoses within the Diagnosis Summary pane and make adjustments as necessary. d) Review the visit and procedure charges within the Charges Summary pane for any of the following: ▪ All Charge codes have been added. ▪ The diagnosis linking is appropriate. ▪ The number of units listed is accurate, if applicable. ▪ Any modifiers are selected, if necessary. ▪ The order is correct (using the up and down arrows below the listing for optimal reimbursement based on RVU). ▪ Allscripts Enterprise EHR provides a variety of charge edits. If a charge triggers an edit, an alert with a hyperlink will appear on the Encounter Form next to the corresponding Charge. ▪ Click on the hyperlink to review the charge edit information and possible resolution. Providers can still submit charges without addressing charge edits which will result in a task for the billing staff to review.12) Once all the information has been verified, the provider submits the encounter form by clicking Submit. Providers can default where they will be taken next within the system (for example, to the Schedule, Tasks, and so forth) by setting the “Display When Submit Button is Activated” preference under the Personalize link.13) Are the charges being reviewed by the Billing staff before being sent to the billing system? If yes, proceed to workflow (J5) Review Encounter Charges for the Certified Workflow steps.14) If the charges are not being reviewed and there are no outstanding charge edits (no further attention is required), the charges are sent to the billing system. The status changes to “Submitted.” Once charges have been submitted for a given appointment encounter, a $ dollar sign icon appears on the Schedule.11/18/2009 129 Allscripts Enterprise EHR Certified Workflows
  • 130. (J3) Charging for OrdersThis workflow provides the detailed steps to complete a charge encounter form for a chargeable orbillable order selected for a patient visit. Figure 38 (J3) Charging for OrdersTo understand chargeable orders, review the following:1) During a patient encounter, the provider selects an order that is chargeable for a problem. Please refer to the (H) Order and Plan workflows for more information about ordering.2) Is the order that was selected chargeable on order? There may be orders that are available within an organization that may be billed immediately after being ordered by the provider.3) If yes, once the encounter information has been saved and the order is in an active status, the charge code(s) will populate a charge encounter form. The charges for the specified order will populate the encounter in context if the date of service, billing provider, and billing location all match. If any of the information is different, the charges will populate a new “Result Charge” encounter.4) If no, is the order that was selected chargeable on collection? Some orders that require specimen or image collection by the organization can be set up to charge once the specimen or image is collected.5) If the order is chargeable on collection, the clinical or ancillary staff completes the necessary specimen or image collection required for the order.11/18/2009 130 Allscripts Enterprise EHR Certified Workflows
  • 131. ▪ An enterprise worklist view should be set up for the appropriate staff to work and monitor these items. The enterprise worklist view should contain orders that are in a status of “Hold for” with an order status reason of “Specimen/data collection” as well as other organization- specific workflow considerations (such as site, requested performing location, and so on). a) To update an order that requires specimen or image collection via worklist, do the following: b) Ancillary/clinical staff should be logged into Allscripts Enterprise EHR. If not logged in, launch the application by double-clicking on the Allscripts Enterprise EHR desktop icon. c) From the Chart vertical toolbar, click on the Worklist horizontal toolbar. The “Cross-Patient” Worklist displays. d) Select the appropriate worklist View from the drop-down list that contains the necessary orders that require specimen collection (for example, Specimen Collection). e) Highlight the patient’s name from the left pane. All items that exist for that patient will display to the right. f) Right-click on the appropriate order and select Edit. The Order Details page displays. g) Under the Additional Details section, click on the Specimen Collection button. The Collection Dialog box displays. h) In the Orders requiring collection field, indicate the date/time that the specimen was collected or click Now. i) Click Encounter to specify the appropriate encounter. The Encounter Selector dialog box displays. j) Select the appropriate encounter that the charges are to be submitted against and click OK. k) To close the Collection Dialog box, click OK. l) Click OK when finished. m) Click Commit on the Clinical Toolbar to save the changes to the database.6) If yes, once the encounter information has been saved and the order is in an active status, the charge code(s) will populate a charge encounter form.7) Is the order chargeable when resulted? Some organizations require that results are received for an order before submitting charges. Submitting charges too soon could result in fraud in the event that the patient never presented for the test or the specimen was ruined before the test was run.8) If yes, once the order has been resulted within the system (either manually or via an interface) the charge code(s) will populate a charge encounter form.9) The order is set up to charge upon completion. This setting may be used for those orderable items where an organization requires the provider to verify the results (considering the verification the final stage of the order) before charging or where no result is expected.10) Is verification required?11) If yes, the provider verifies the results for the order. Follow workflow (R3) Results Verification for the Certified Workflow steps.11/18/2009 131 Allscripts Enterprise EHR Certified Workflows
  • 132. 12) Once the order has been completed (either manually or upon verification) the charge code(s) populates a charge encounter form.13) The provider reviews and validates the encounter form. To do this, perform the following steps: a) Go to the Encounter Form horizontal toolbar. b) Verify that the appropriate information is within the Billing Provider, Performing Provider, Referring Provider (if necessary), Division (if necessary), Billing Area (if necessary) and Location fields. Make adjustments if necessary. c) Review the order of the diagnoses within the Diagnosis Summary pane and make adjustments as necessary. d) Review the visit and procedure charges within the Charges Summary pane for any of the following: ▪ All Charge codes have been added. ▪ The diagnosis linking is appropriate. ▪ The number of units listed is accurate, if applicable. ▪ Any modifiers are selected, if necessary. ▪ The order is correct (using the up and down arrows below the listing for optimal reimbursement based on RVU). ▪ Allscripts Enterprise EHR provides a variety of charge edits. If a charge triggers an edit, an alert with a hyperlink will appear on the Encounter Form next to the corresponding Charge. ▪ Click on the hyperlink to review the charge edit information and possible resolution. Providers can still submit charges without addressing charge edits which will result in a task for the billing staff to review. You cannot submit Encounter Form charges until at least one charge is linked to one diagnosis code and all required fields have an entry.14) Once all the information has been verified, the provider submits the encounter form by clicking Submit. Providers can default where they will be taken next within the system (for example, to the Schedule, Tasks, and so forth) by setting the “Display When Submit Button is Activated” preference under the Personalize link.15) Are the charges being reviewed by the Billing staff before being sent to the billing system? If yes, proceed to workflow (J5) Review Encounter Charges for the Certified Workflow steps.16) If the charges are not being reviewed and there are no outstanding charge edits (no further attention is required), the charges are sent to the billing system. The status changes to “Submitted.” Once charges have been submitted for a given appointment encounter, a $ dollar sign icon appears on the Schedule.11/18/2009 132 Allscripts Enterprise EHR Certified Workflows
  • 133. (J4) Charging for AdministrationsThis workflow provides the detailed steps to complete a charge encounter form for a chargeable orbillable administration selected for a patient visit. Figure 39 (J4) Charging for AdministrationsTo understand chargeable administrations, review the following:1) During a patient encounter, the provider selects an order that requires administration for a problem that is chargeable. Please refer to the (H3 & H4) Order and Plan workflows for more information about ordering administrations.2) Is the order that was selected chargeable on order?3) If yes, once the encounter information has been saved and the order is in an active status, the charge code(s) will populate a charge encounter form. The charges for the specified order will populate the encounter in context if the date of service, billing provider, and billing location all match. If any of the information is different, the charges will populate a new “Result Charge” encounter.4) The order is set up to charge upon completion.5) Once the order has been completed the charge code(s) will populate a charge encounter form.6) The provider reviews and validates the encounter form. To do this, perform the following steps: a) Go to the Encounter Form horizontal toolbar.11/18/2009 133 Allscripts Enterprise EHR Certified Workflows
  • 134. b) Verify that the appropriate information is within the Billing Provider, Performing Provider, Referring Provider (if necessary), Division (if necessary), Billing Area (if necessary) and Location fields. Make adjustments if necessary. c) Review the order of the diagnoses within the Diagnosis Summary pane and make adjustments as necessary. d) Review the visit and procedure charges within the Charges Summary pane for any of the following: ▪ All Charge codes have been added. ▪ The diagnosis linking is appropriate. ▪ The number of units listed is accurate, if applicable. ▪ Any modifiers are selected, if necessary. ▪ The order is correct (using the up and down arrows below the listing for optimal reimbursement based on RVU). ▪ Allscripts Enterprise EHR provides a variety of charge edits. If a charge triggers an edit, an alert with a hyperlink will appear on the Encounter Form next to the corresponding Charge. ▪ Click on the hyperlink to review the charge edit information and possible resolution. Providers can still submit charges without addressing charge edits which will result in a task for the billing staff to review. You cannot submit Encounter Form charges until at least one charge is linked to one diagnosis code and all required fields have an entry.7) Once all the information has been verified, the provider submits the encounter form by clicking Submit. Providers can default where they will be taken next within the system (for example, to the Schedule, Tasks, and so forth) by setting the “Display When Submit Button is Activated” preference under the Personalize link.8) Are the charges being reviewed by the Billing staff before being sent to the billing system? If yes, proceed to workflow (J5) Review Encounter Charges for the Certified Workflow steps.9) If the charges are not being reviewed and there are no outstanding charge edits (no further attention is required), the charges are sent to the billing system. The status changes to “Submitted.” Once charges have been submitted for a given appointment encounter, a $ dollar sign icon appears on the Schedule.11/18/2009 134 Allscripts Enterprise EHR Certified Workflows
  • 135. (J5) Review Encounter ChargesThis workflow describes the detailed steps for reviewing a charge encounter form before it issubmitted and officially sent to the billing system. Most organizations prefer having the billingpersonnel review all encounter charges to ensure accurate coding and that the information meetsthe level of care being provided. Figure 40 (J5) Review Encounter ChargesTo review encounter charges, follow these steps:1) A charge-related task is received. There are three charge tasks that require review of the charge encounter form, which are as follows: ▪ Review Encounter Form (Review Enc Form) ▪ Manage Charge Edits (Mng Chg Edits) ▪ Adjust Charges (Adjust Charges)2) Billing staff monitors the task list and selects a charge-related task. To select a task, follow these steps: a) The user should be logged into Allscripts Enterprise EHR. If not logged in, launch the application by double-clicking on the Allscripts Enterprise EHR desktop icon and login. b) From the Billing vertical toolbar, make sure you are on the Task List horizontal toolbar. c) At the View drop-down list, select the appropriate task view from the drop-down list that contains the necessary charge tasks to be worked. d) Select the desired task by double-clicking on it. The corresponding charge Encounter Form for the selected patient displays.11/18/2009 135 Allscripts Enterprise EHR Certified Workflows
  • 136. 3) Billing staff reviews the charge details on the Encounter Form. To review the Encounter Form details, do the following: a) Verify that the appropriate Billing information is correct and make necessary adjustments as appropriate. ▪ Billing Provider ▪ Performing Provider ▪ Referring Provider (if applicable) ▪ Billing Location ▪ Division (if applicable) ▪ Billing Area (if applicable) ▪ Compliance Code (if applicable) b) Within the Diagnosis Summary pane, verify the diagnoses listed and the order is appropriate. Make adjustments as necessary. c) Within the Charges Summary pane, verify the visit and procedure charges information is appropriate. Make adjustments as necessary: ▪ All Charge codes have been added. ▪ The diagnosis linking is appropriate. ▪ The number of units listed is accurate (if applicable). ▪ Any modifiers are selected, if necessary. ▪ The order is correct (using the up and down arrows below the listing for optimal reimbursement based on RVU). ▪ Resolve all edits. If a charge triggers an edit, an alert with a hyperlink will appear on the Encounter Form next to the corresponding Charge. o To resolve the status of these items, click on the icon. The system displays the Charge Edits page with a list of missing information or a warning related to the selected charge. d) Verify that the Special Billing information and other encounter details are appropriate. Adjust as needed.4) Do the charges require editing? If no editing is required, proceed to step 9.5) If yes, do any of the edits require the billing provider’s input? If the necessary edits do not require input from the billing provider, proceed to step 8. Users can save an Encounter Form as draft for completion at a later time.6) If the edits do require the billing provider’s input, the billing staff tasks the provider with the question. To create a task, follow these steps: a) From the Encounter Form horizontal toolbar, click the New Task… button. The Task Detail dialog box displays. b) Select the User option. c) Select the appropriate billing provider from the drop-down list to whom the task should be assigned. To search for a user, select All (if necessary). d) Select the Task Type of Go to Enc Form.11/18/2009 136 Allscripts Enterprise EHR Certified Workflows
  • 137. e) Update the Priority, if necessary. f) Enter the question within the Comment section. You can use text templates to add comments. Click the Text Templates button to view a list of available templates. g) Alter the Activate and Overdue Date, if necessary. h) Enter information for a Notify task, if appropriate. i) Click OK.7) The provider replies to the task with the necessary details. To reply to a task, follow these steps: a) From the Task List horizontal toolbar, select the appropriate task by single-clicking it. b) Click the Reply… button. The Task Reply dialog box displays. c) Enter the necessary details within the Comments section. d) Click OK.8) The billing staff completes necessary edits.9) Once the information is complete, the billing staff submits the Encounter Form by clicking Submit.10) The status changes to “Submitted,” and charges are sent to the billing system.11/18/2009 137 Allscripts Enterprise EHR Certified Workflows
  • 138. (K) Follow-Up and Checkout IntroductionJust as the Electronic Healthcare Record (EHR) can enhance the provider and nursingcommunications with patients and vice versa, it also can improve the team’s internal coordination.Efficient communication from the provider to the support staff to finalize follow-up care required forthe patient prior to check-out is an important component of the overall patient care experience.Communication via the EHR of needed follow-up activities for the patient prior to checking out furthereliminates the need for paper and manual steps. Tasking and/ or Worklists are an effective methodto utilize to facilitate this communication.The workflows contained in this section are focused on those activities support staff may need toperform as part of the patient check-out process: ▪ Scheduling Order Appointments—This workflow provides the steps to update an order that requires an appointment to be scheduled. The front desk staff works the item via a Worklist to schedule an appointment as the next step in completion of the provider’s order. ▪ Scheduling a Referral Appointment—This workflow provides the steps to update a referral order that was created as part of the (H7) Referral workflow and schedule the necessary appointment for the referral. The front desk or referral staff works the item via a Worklist to schedule a patient referral appointment as ordered by the provider. Figure 41 (K) Follow-up and Checkout D G1 G2 G3 G4 Appointment K needed for an Yes K1 order? No Referral appointment Yes K2 needed? No End11/18/2009 138 Allscripts Enterprise EHR Certified Workflows
  • 139. (K1) Scheduling Order AppointmentsThis workflow provides detailed steps for completing an order that requires an appointment or follow-up visit. This is typically done using an enterprise Worklist View that is set up for the appropriatestaff, such as the front desk, clinical staff, or other role responsible for scheduling patientappointments for orders. Figure 42 (K1) Scheduling Order Appointments H5 H6 H7 K (4) (2) (3) (5) (1) Staff schedules Staff monitors Schedule Staff updates order K1 Orders on Hold Yes appointment & gives Worklist & selects appointment status & commits For-Scheduling patient reminder appropriate item now? data card No (7) (6) Staff updates the Will Patient Yes order status & schedule? commits data No (8) (9) (10) Staff calls patient Staff updates order Order status and makes status & commits changes to appointment data Active (11) Staff completes (12) checkout Are results R process as expected? appropriate (13) Order status changes to End Complete1) When an appointment is needed for an order, the status of the order changes to “Hold For” because scheduling is needed. Staff monitors these items via a Worklist. Administrators should create an enterprise Worklist View that looks at all orders that require additional information (Order Status = Required Information) and are being held for scheduling (Order Status Reason = Scheduling) for Staff to work from.2) Staff monitors the Worklist and selects a patient Worklist item. To select a Worklist item, follow these steps: a) Clinical staff should be logged into Allscripts Enterprise EHR. If not logged in, launch the application by double-clicking on the Allscripts Enterprise EHR desktop icon. b) From the Chart vertical toolbar, click on the Worklist horizontal toolbar. The “Cross-Patient” Worklist displays.11/18/2009 139 Allscripts Enterprise EHR Certified Workflows
  • 140. c) Select the appropriate Worklist View from the drop-down list that contains the necessary orders to review. d) Single-click on the patient’s name within the left pane to expand all items that exist for that patient.3) Is an appointment being scheduled now for the order?4) Typically the staff works with the patient and tries to schedule the appointment during the check- out process. If an appointment can be scheduled now, the staff provides the patient with a reminder card or visit documentation that outlines the scheduled appointment. If the appointment for the order is within the organization, the staff typically would schedule the appointment within the Practice Management System.5) The staff updates the order with the appointment information and commits the data. To update an order with the appointment information via a Worklist item, follow these steps: a) Highlight the appropriate order by single-clicking it. b) Click Edit on the component action toolbar. Or right-click and select Edit from the menu. The Order Details page displays. c) Expand the Additional Details section. d) From the Appointment Status drop-down list, select Appointment Scheduled. e) Add encounter-specific information for the scheduled appointment under the Associated Encounter section, if appropriate. To associate an encounter for when an order is scheduled for, do the following: i) Within the Order Details page, expand the Associated Encounter section. ii) Click the Encounter… button next to the Scheduled For option. The Encounter Selector displays. An appointment that was scheduled within the Practice Management System will be available for selection under the ‘Existing Encounters’. iii) Select the appropriate encounter. iv) Click OK. The encounter selected populates the Order Details page. f) Click OK. g) Click Commit to save updates to the database.6) If not scheduling the appointment now, will the patient be calling to schedule at a later time?7) If the patient will call to schedule, staff updates the order’s appointment status to reflect that and commits the data. To update an order with the appointment information via a Worklist item, follow these steps: a) Highlight the appropriate order by single-clicking it. b) Click Edit on the component action toolbar. Or right-click and select Edit from the menu. The Order Details page displays.11/18/2009 140 Allscripts Enterprise EHR Certified Workflows
  • 141. c) Expand the Additional Details section. d) From the Appointment Status drop-down list, select Patient Will Schedule. e) Click OK. f) Click Commit to save updates to the database.8) If an appointment is needed and not scheduled initially or by the patient, the staff typically calls the patient to make the necessary follow-up appointment. Users can enter comments under the Order Annotations section of the Order Details page.9) Once an appointment has been scheduled with the patient, the staff updates the order’s appointment status and commits the data. To update the appointment status of an order via a Worklist item, follow these steps: a) Highlight the appropriate order by single-clicking it. b) Click Edit on the component action toolbar. Or right-click and select Edit from the menu. The Order Details page displays. c) Expand the Additional Details section. d) From the Appointment Status drop-down list, select Appointment Scheduled. e) Add encounter-specific information for the scheduled appointment under the Associated Encounter section, if appropriate. To associate an encounter for when an order is scheduled for, do the following: i) Within the Order Details page, expand the Associated Encounter section. ii) Click the Encounter… button next to the Scheduled For option. The Encounter Selector displays. iii) Select the appropriate encounter. iv) Click OK. The encounter selected populates the Order Details page. f) Click OK. g) Click Commit to save updates to the database.10) The Order status changes to “Active” once all necessary information and/or reasons for being held up are resolved (as applicable). Organizations can set up orders where no result is expected to automatically complete once they become active or monitor them within Allscripts Enterprise EHR (see workflow Q2 – Tracking Overdue Orders for more details).11) Staff completes the follow-up and checkout process as appropriate per organization’s protocol.11/18/2009 141 Allscripts Enterprise EHR Certified Workflows
  • 142. (K2) Referral AppointmentsThis workflow provides detailed steps for completing a referral order. Typically, this is done throughan enterprise Worklist View that is set up for the appropriate staff, such as the front desk, clinicalstaff, or other role responsible for working referral orders and making patient appointments. Figure 43 (K2) Referral Appointments H7 K (3) (4) Order status Staff completes Yes changes to necessary referral Needs order information & Information commits data (1) (2) Staff monitors Referral Order K2 Worklist & selects need additional patient referral item information? (6) (8) (5) (7) Order status Staff schedules Referral Order Schedule No Yes changes to Yes referral appointment, require an appointment Hold For- updates order status appointment? now? Scheduling & commits data No (10) (9) Staff updates the Will Patient Yes order status & schedule? commits data No (11) (12) Staff calls patient Staff updates order and makes referral status & commits appointment data (13) Order status changes to Active (14) Staff completes referral & checkout process as appropriate (15) Have referral R4 Yes results been received? No Q2To complete a referral order, follow these steps:1) Staff monitors the Worklist and selects a patient item. To select an item, follow these steps: a) Staff should be logged into Allscripts Enterprise EHR. If not logged in, launch the application by double-clicking on the Allscripts Enterprise EHR desktop icon. b) From the Chart vertical toolbar, click on the Worklist horizontal toolbar. The “Cross-Patient” Worklist displays. c) Select the appropriate Worklist View from the drop-down list that contains the necessary orders to review. d) Single-click on the patient’s name within the left pane to expand all items that exist for that patient.2) Does the referral order need any additional information? Some organizations may associate clinical questions to referral orders where they require additional information.11/18/2009 142 Allscripts Enterprise EHR Certified Workflows
  • 143. 3) If yes, the referral order status changes to “Need Information” since required information is needed. Staff monitors these items to work.4) Staff completes the necessary referral order information and commits the data. To update an order via a Worklist item, do the following: a) Click on the appropriate order to highlight it. b) Click Edit on the component action toolbar. Or Right-Click on the order and select ‘Edit’ from the menu. The Order Details page displays. c) Under the Clinical Questions sections, complete the required information as appropriate. d) Click OK. e) Click Commit to save updates to the database Users can save and commit encounter information without reviewing the Encounter Summary page by clicking Commit on the Clinical Toolbar. This is controlled by the “Encounter Summary Review Before Save” user preference.5) Does the referral order require an appointment to be scheduled?6) If yes, the status of the referral order changes to “Hold For” since scheduling is needed. The appropriate staff monitors these items to work. Administrators should create an enterprise Worklist View that looks at all orders that require additional information (Order Status Reason = Required Information) and are being held for scheduling (Order Status Reason = Scheduling) for staff to work from.7) Is an appointment being scheduled now for the referral?8) Typically the staff works with the patient and tries to schedule the appointment during the check- out process. If an appointment can be scheduled now, the staff schedules the referral appointment and updates the order with the appointment information before committing the data. To update an order with the appointment information via a Worklist item, follow these steps: a) Click on the appropriate order to highlight it. b) Click Edit on the component action toolbar. Or Right-Click and select Edit from the menu. The Order Details page displays. c) Expand the Additional Details section. d) From the Appointment Status drop-down list, select Appointment Scheduled. e) Add encounter-specific information for the scheduled appointment under the Associated Encounter section, if appropriate. To associate an encounter for when an order is scheduled for, do the following: i) Within the Order Details page, expand the Associated Encounter section. ii) Click the Encounter… button next to the Scheduled For option. The Encounter Selector displays. iii) Select the appropriate encounter. iv) Click OK. The encounter selected populates the Order Details page.11/18/2009 143 Allscripts Enterprise EHR Certified Workflows
  • 144. f) Click OK. g) Click Commit to save updates to the database.9) If not scheduling the appointment now, will the patient be calling to schedule at a later time?10) If the patient will be calling to schedule, staff updates the order’s appointment status to reflect that and commits the data. To update an order with the appointment information via a Worklist item, follow these steps: a) Click on the appropriate order to highlight it. b) Click Edit on the component action toolbar. Or Right-Click and select Edit from the menu. The Order Details page displays. c) Expand the Additional Details section. d) From the Appointment Status drop-down list, select Patient Will Schedule. e) Click OK. f) Click Commit to save updates to the database.11) If an appointment is needed and not scheduled initially or by the patient, the staff typically calls the patient to make the necessary referral appointment. Users can enter comments under the Order Annotations section of the Order Details page.12) Once an appointment has been determined, the staff updates the order’s appointment status and commits the data. To update the appointment status of an order via a Worklist item, follow these steps: a) Highlight the appropriate order by single-clicking it. b) Click Edit on the component action toolbar. Or Right-Click and select Edit from the menu. The Order Details page displays. c) Expand the Additional Details section. d) From the Appointment Status drop-down list, select Appointment Scheduled. e) Add encounter-specific information for the scheduled appointment under the Associated Encounter section, if appropriate. To associate an encounter for when an order is scheduled for, do the following: i) Within the Order Details page, expand the Associated Encounter section. ii) Click the Encounter… button next to the Scheduled For option. The Encounter Selector displays. iii) Select the appropriate encounter. iv) Click OK. The encounter selected populates the Order Details page. f) Click OK. g) Click Commit to save updates to the database.13) The order status changes to “Active” once all necessary information and/or reasons for being held up are resolved (as applicable).11/18/2009 144 Allscripts Enterprise EHR Certified Workflows
  • 145. 14) Staff completes the referral and checkout process as appropriate per organization’s protocol.15) Have the referral results been received? Typically, ordering providers will receive consult documentation or results once the patient has completed the referral visit. If the ordering provider does receive results, proceed to workflow (R4) Results Referral for Certified Workflow steps. If no results have been received, follow (Q2) Tracking Overdue Orders for next steps.11/18/2009 145 Allscripts Enterprise EHR Certified Workflows
  • 146. (L) Renewal Management IntroductionRenewal management refers to the decision making process that extends to the long-termmanagement of a patient’s medications. Historically, the prescription renewal management processhas consumed a significant portion of the clinical staff’s time. Everything from pulling paper charts,to transporting them and attaching paper routing/ fax requests, to the provider approving or denyingthe manual requests, to the staff waiting on the phone to speak with a pharmacist or handling manycallbacks for formulary alternative questions, this process is one that most organizations struggle toimprove and make more cost effective and patient care oriented.Introduction of an electronic health record assists with drastically improving many of the challengesorganizations face in this area. This section contains details that will provide organizations theopportunity to receive many benefits, for example: ▪ Receive medication formulary checking feedback for medication renewal requests. ▪ Produce accurate and legible prescriptions with associated comments back to the retail or mail order pharmacies. ▪ Send and receive direct, electronic communication via Surescripts to retail pharmacies. ▪ Send and receive direct, electronic communication via RxHub to mail order pharmacies. ▪ Maintain a centralized, paperless medication list for every patient. ▪ Utilize Tasking and Worklist workflows to further eliminate paper and manual processes.The workflows contained in this section discuss the following two areas:Prescription Renewals—This workflow includes managing “traditional” renewal requests that arereceived via a fax or phone call from a pharmacy or from the patient.Surescripts Renewals—This workflow includes managing the electronic transmissions of inboundrenewal requests (received in Allscripts Enterprise EHR via tasks) from retail pharmacies. Enrollment with Surescripts is required prior to utilizing this workflow. There is no additional cost to use Surescripts as part of Rx+. Please work with your Allscripts project manager to enroll in this program.11/18/2009 146 Allscripts Enterprise EHR Certified Workflows
  • 147. Figure 44 (L) Renewal Management Renewal request L1 L Yes phoned or faxed in? No Utilizing L2 Yes SureScripts? No End11/18/2009 147 Allscripts Enterprise EHR Certified Workflows
  • 148. (L1) Prescription RenewalsThis workflow defines the steps for managing prescription renewal requests received directly fromthe patient or from the pharmacy. This workflow assumes that the renewal request is being receivedfrom either a phone call or via a faxed paper request. Figure 45 (L1) Prescription RenewalsTo respond to a phoned/faxed in renewal request, follow these steps:1) The prescription renewal request is received in the office. These requests may be received by a Call Center via phone or within Medical Records via fax. Depending on your organization, the request is typically routed per protocol to a clinical staff member to review prior to the request being sent to the provider for authorization.2) Can the staff member create the prescription? Depending on if the staff member receiving the initial renewal request is a clinical versus a non-clinical staff member, will determine if call processing is utilized. Most clients usually do not give non-clinical staff members the security privilege to create or renew prescriptions.3) If no, the non-clinical staff member (such as a front desk role) uses call processing to document the renewal request and routes to the appropriate clinical staff. Follow these steps to create a call processing task:11/18/2009 148 Allscripts Enterprise EHR Certified Workflows
  • 149. a) Staff should be logged into Allscripts Enterprise EHR. If not logged in, launch the application by double-clicking on the Allscripts Enterprise EHR desktop icon. b) Go to the Call Processing workspace. c) Click the Select Pt… button. The Select Patient dialog box displays. d) Search for the appropriate patient using any of the patient search options. e) Select the correct patient by double-clicking. The selected patient populates the Call Processing page and the patient banner. When a user selects a patient, the system displays the patient’s most recent appointment and the next scheduled appointment on the Call Processing page. f) Click Patient is Caller or enter in caller’s name as appropriate. g) Select the appropriate relationship to the patient from the Relation drop-down list, if necessary. When the patient is the caller, their information will automatically populate. h) Verify the caller’s phone numbers. i) Select Renew Medication from the Reason for Call drop-down list. j) Click Text Template and select the appropriate Rx Renewal template. Text templates allow organizations to create predefined or “canned” text that can be inserted into a text box, which saves the user from having to type in the same information over and over again. k) Click OK. l) Click Copy to Task. m) Validate that the Med Renewal Request Task type defaulted. Organizations can associate a Task type to each Reason for Call entry to streamline the workflow. Then, when users click Copy to Task, the designated task will automatically default. n) Select the appropriate Clinical Staff from the Assign To (User) drop-down list to whom the renewal should be routed or click All to do a search. o) Alter the Activate and Overdue Date, if necessary. p) Enter information for a Notify Task, if appropriate. q) Click OK. r) Click Clear Form and enter another request or proceed to the next activity4) The task is sent to the clinical staff member for pre-screening.5) The clinical staff member receives the renewal request either directly via phone/fax or via a task sent from the non-clinical staff member. In either case, the clinical staff member then takes the first steps to review the request and create the renewal.11/18/2009 149 Allscripts Enterprise EHR Certified Workflows
  • 150. An enterprise task view needs to be set up for the clinical staff responsible for pre- screening medication renewal requests for a provider or group of providers. a) To review the renewal information received via task, follow these steps: i) Clinical staff should be logged into Allscripts Enterprise EHR. If not logged in, launch the application by double-clicking on the Allscripts Enterprise EHR desktop icon. ii) Go to the Chart menu and then the Task List horizontal toolbar. iii) Select the appropriate View that contains the Medication Renewal tasks. iv) Select the desired task or double-click to open the Task Detail dialog box. v) All entered information can be found under Comments. vi) Continue to “b” (see below) for steps on how to renew a prescription (steps ii – vii). vii) Once finished, click Done to complete the task. b) To create a renewal prescription, follow these steps: i) Clinical staff should be logged into Allscripts Enterprise EHR. If not logged in, launch the application by double-clicking on the Allscripts Enterprise EHR desktop icon. ii) Verify the appropriate patient is in context (either by selecting the task or using Select Patient to do a search). iii) Go to the Clinical Desktop horizontal toolbar or click on the qChart icon on the Clinical Toolbar if coming from the Task List. iv) From the Meds component, select the desired medication. If multiple prescriptions need to be renewed, the user can multi-select (using CTRL and/or SHIFT options) the appropriate medications, right-click and select Renew from the context menu. v) Click Renew for medications that are being renewed with no changes. Or, click Renew with Changes for medications that are being renewed, but will require changes to drug strength, SIG, days supply, quantity, or refill numbers. The Encounter Selector dialog box displays. vi) Select the appropriate encounter. If Renew with Changes was selected, the Medication Details page displays first and then the Encounter Select screen will display. vii) Complete desired changes from the Medication Details page if renewing with changes. Click OK.6) Does the clinical staff that is performing the renewal have the security to prescribe by protocol? For those organizations that have standing protocols in place to allow clinical staff (typically RNs) to prescribe certain medications, an additional security code is available that enables the clinical staff members to update the authorization status of a medication from prospective to retrospective. This allows the renewal to be generated without having to wait for the provider to authorize it. Therefore, if the clinical staff has the proper authority they could renew by protocol. An Order11/18/2009 150 Allscripts Enterprise EHR Certified Workflows
  • 151. Notification task is sent to the ordering provider to notify them a prescription was renewed “by protocol.” To renew by protocol, follow these steps: a) Clinical staff has selected Renew with Changes (as outlined in step 5). b) Under Additional Details, click on the Auth drop-down list. c) Select either Per Protocol or Per Verbal Order, as appropriate. Medication Order Details page Authorization field d) Complete all other details for the prescription, as appropriate. e) Click OK when finished. f) Click Commit to save changes to the database. g) Proceed to step 15.7) If not prescribing by protocol, the clinical staff clicks Commit to save all renewed medication(s). The order status changes to “Requires Authorization.”8) The provider reviews the orders requiring authorization via the Patient Worklist component on the Clinical Desktop. a) Provider should be logged into Allscripts Enterprise EHR. If not logged in, launch the application by double-clicking on the Allscripts Enterprise EHR desktop icon. b) From the Chart menu, click on the Task List horizontal toolbar. If a patient is already in context in the Banner, the provider may skip this step and go directly to the Patient Worklist Component on the Clinical Desktop to view Worklist items. c) Select the View that filters on Authorize Order tasks (typically a combined order-result management view). d) Select the desired task by double-clicking. The patient will be put in context in the Banner and the system will navigate to the Worklist Component within the Clinical Desktop. e) Verify the appropriate worklist View from the drop-down list that contains the necessary medication orders requiring authorization (typically a combined order-result management view) is selected.9) Will the prescription renewal request be authorized?10) If yes, are any changes to the prescription needed? There are some instances that the provider may need to modify the prescription when granting or approving a renewal request. If no modifications are needed, the provider would simply authorize the prescription as is. a) To authorize an order where no medication change is needed, do the following: i) Click on the desired prescription to highlight it.11/18/2009 151 Allscripts Enterprise EHR Certified Workflows
  • 152. ii) Click Authorize on the action toolbar. Or providers can right-click on the medication and select Authorize from the context menu. iii) Respond to any DUR alerts, as appropriate. Once authorized, the prescription will auto- clear from the Worklist. iv) Click on the left or right Next Patient button to advance to the next patient on the list. Click Next Patient. It is not necessary to return to the Task List workspace to complete items for multiple patients. Any Authorize Order task associated to a Worklist item will be auto-completed once the item is responded to within the Worklist workspace. v) Proceed to step 15.11) If changes are needed to the prescription that is to be authorized, the provider first edits the medication. To edit a prescription, follow these steps: a) Click on the desired prescription to highlight it. b) Click Edit on the action toolbar. Or providers can right-click on the medication and select Edit from the context menu. c) From the Medication Details page update the prescription, as necessary. Click OK. d) Respond to any DUR alerts, as appropriate. e) Click Commit to save changes to the database. Once saved, the prescription will auto-clear from the Worklist. The action of Authorize will automatically commit or “save” changes to the database. All other actions (such as Edit, Reject, Annotate, and so on.) must be committed for the changes to be saved to the database. If acting on multiple orders, any item edited or rejected prior to authorizing an item will also be saved once the action of Authorize is performed. f) Proceed to step 15.12) If the prescription is not going to be authorized, the provider may have various reasons for refusing the request. For instance, the provider may want to see the patient first, “switch” the patient to a new medication, or maybe the patient was never prescribed the medication being requested. Does the provider want the patient to stop or discontinue the medication?13) If yes, will the prescription be replaced with a new medication?11/18/2009 152 Allscripts Enterprise EHR Certified Workflows
  • 153. 14) If yes, the provider creates a new prescription to replace the requested medication. To discontinue and replace a medication, do the following: a) Click Add New Medication icon on the Clinical Toolbar. The Add Clinical Item workspace displays. b) From the Rx/Orders primary tab, click on the Rx secondary tab, if needed. c) Using the patient’s active problems list within the Patient Pane (upper-left corner), click on the appropriate problem name to link the highlighted problem to the new medication. d) Find the new medication via Specialty or Personal Favorites, QuickList, or by Master search. e) Select a medication by placing a checkmark in the box. The Medication Details page displays. f) Respond to the following two prompts, if needed; 1) insurance formulary alternatives, or 2) allergy warning if the medication being prescribed would interact. g) Select the desired SIG, Days supply, Quantity, number of refills, and other prescription details as appropriate. h) Under the Additional Details section, enter comments within the Pharmacy Instructions field to indicate that the new prescription is replacing a recent request, if necessary. i) Click the Replaced drop-down list and select the appropriate medication that is being replaced with this new medication. j) Click OK (on both the Medication Details page and ACI). k) Respond to any DUR prompts, if needed. l) Click Commit to save changes to the database. m) The new medication is added to the patient’s Current Medications and the replaced medication is moved to the Past Meds. n) Proceed to step 15.15) The prescription is generated, as defined by the fulfillment action (communication method).16) Where no replacement is going to be issued but the provider would like to stop or discontinue the medication, the provider annotates and rejects (voids) the renewal. To annotate and void the renewal, follow these steps: a) Click the appropriate medication and select Annotate. The Add Annotation dialog box displays. b) Enter necessary information for clinical staff and click OK. The Encounter Selector displays. c) Select the appropriate encounter. d) With medication still highlighted, click Reject to void. Or right-click and select Void from the context menu. e) From the Change Status screen, verify the status is Voided. Click OK.11/18/2009 153 Allscripts Enterprise EHR Certified Workflows
  • 154. f) Click Commit to save changes to the database.17) The system automatically creates a Rejected Rx task.18) Even though a provider refuses a renewal request, they still may want the patient to continue taking the current medication that was requested. This keeps the medication on the patient’s current medication list to participate in future DUR alerts. The provider documents the refusal reason and necessary actions for the specific medication to be completed by the clinical staff. To create a medication-related task, follow these steps: a) With the medication highlighted, click on the New Task icon. The Task Detail dialog box displays. b) Select the Task type of Go to Med from the drop-down list. c) Select the Assign To (User or Team) for whom the task should be sent to. Typically this is the provider sending a task to a clinical staff resource. d) Select the appropriate user or team from the drop-down list or by searching. To search for a user, click All. e) In the Comments section, enter in the necessary details directly or via text template. f) Alter the Activate and Overdue Date, if necessary. g) Enter information for a Notify Task, if appropriate. h) Click OK. i) Provider leaves the authorize order request on the Worklist until the requested follow-up for reason for refusal is met. At that point, the Provider should authorize or reject the request based on the results of the follow-up.19) The system creates a “Go to Med” task to notify the clinical staff that some follow-up is needed for the selected medication.20) Clinical staff notifies the patient of the outcome by monitoring an enterprise task list that includes the appropriate medication tasks (for example, Rejected Rx, Go to Med, and so on) and responding to the patient accordingly. To complete the desired task, follow these steps: a) Clinical staff should be logged into Allscripts Enterprise EHR. If not logged in, launch the application by double-clicking on the Allscripts Enterprise EHR desktop icon. b) From the Chart menu, go to the Task List horizontal toolbar. c) Select the appropriate View that contains the necessary tasks to work. d) For a Go to Med Task, single click the task to view the task comments in the bottom left Comments pane. The Medication Viewer may be opened (by double clicking) if additional information regarding the medication is desired. e) For a Rejected Rx task, double-click on the desired task to open the Medication Viewer window. f) Review the medication details and any provider comments under the Annotation section. g) Complete the communication to the patient or the pharmacy, as appropriate.11/18/2009 154 Allscripts Enterprise EHR Certified Workflows
  • 155. h) Click Annotate on the action toolbar to enter additional comments, if needed. Click OK. i) Close the Medication Viewer window. j) When finished, click Done to mark either task type complete.11/18/2009 155 Allscripts Enterprise EHR Certified Workflows
  • 156. (L2) Surescripts RenewalsThis workflow discusses the process of managing inbound prescription renewal requests receivedfrom retail pharmacies via a Surescripts transmission. Surescripts is a third-party “connection”vendor providing services to electronically connect physician offices to retail pharmacies. Thetransmissions are a bidirectional, direct, electronic communication (no faxes involved).There are many benefits to utilizing Surescripts over a traditional fax method: ▪ Further eliminates paper ▪ Increases efficiency of the process as the inbound requests automatically create tasks in Allscripts Enterprise EHR ▪ Uses less technical server resources to transmit prescriptionsEnrollment with Surescripts is required prior to utilizing this functionality. There is no additional costto use Surescripts. Please work with your Allscripts project manager to enroll in this program. Figure 46 (L2) Surescripts RenewalsTo process a Surescripts renewal, follow these steps:1) A pharmacist enters a renewal request for a specified patient and provider (from their pharmacy software). The retail pharmacy then transmits the renewal request electronically via Surescripts connectivity to Allscripts Enterprise EHR.2) Once the renewal request is received by Allscripts Enterprise EHR, the system automatically creates an “Rx Renew Request” for the ordering provider (the ordering provider is indicated and selected by the pharmacist).3) Provider monitors the task list and views the renewal request. To review the renewal request via an Rx Renew Request task, follow these steps: a) The provider should be logged into Allscripts Enterprise EHR. If not logged in, launch the application by double-clicking on the Allscripts Enterprise EHR desktop icon and login.11/18/2009 156 Allscripts Enterprise EHR Certified Workflows
  • 157. b) From the Chart menu, go to the Task List horizontal toolbar. c) Select the appropriate task View, which includes the Rx Renew Request tasks. d) Double-click on an Rx Renew Request task. The Script Message task dialog window displays.4) Will the prescription renewal request be granted?5) If yes, the provider grants the prescription renewal request. To grant the renewal, follow these steps: a) Verify that the Patient Info in Request (name, DOB, address and MRN) displayed on the left matches to the correct patient in Allscripts Enterprise EHR, which is listed just to the right under Patient Info in Allscripts Enterprise EHR. i) If the fields under Patient Info in Allscripts Enterprise EHR are blank, this means the incoming message was unable to find a patient match in the Allscripts Enterprise EHR database. ii) Click the Patient Info in Allscripts Enterprise EHR button to perform a patient search and match the incoming message to the correct Allscripts Enterprise EHR patient. b) Verify the Rx Info from Pharmacy drug information (name and dose) matches correctly to the drug information displayed next to Drug Name in Allscripts Enterprise EHR. i) If the Drug Name in Allscripts Enterprise EHR fields are blank, this means the incoming message was unable to find a drug match in the Allscripts Enterprise EHR database. ii) Click Drug Name in Allscripts Enterprise EHR to perform a drug search and select the correct drug information. c) Under the Rx Info in Request section, verify the Days Supply, Qty (quantity) SIG, and Refills values. These values may be changed as needed. d) The Rx By field lists the ordering provider name. Change only as needed. e) Enter in a free text Message to Pharmacy, as appropriate. f) View the patient’s Active Medications and Active Allergies listed on the right-side of the page, as needed as part of the clinical decision making process. g) Click Grant. The task auto-completes.6) The request is transmitted back to the retail pharmacy via Surescripts with an approval status indicated.7) If the request is not granted, the provider refuses the request and selects the appropriate refusal reason. To refuse a renewal request, follow these steps: a) Provider should already be within the Script Message task dialog window. Patient name and drug in Allscripts Enterprise EHR are not required to match the request if it is refused. b) Enter in a free text Message to Pharmacy, if necessary. c) Click Refuse. A Refuse Reason dialog box displays.11/18/2009 157 Allscripts Enterprise EHR Certified Workflows
  • 158. d) Select an appropriate refusal reason from the pre-defined selections or click Other with Free Text and type in a reason. e) Click Save. If the reason for refusal is because the medication will be substituted, indicate this reason in the comments field so the pharmacist can expect a separate prescription to be sent.8) The request is transmitted back to the retail pharmacy via Surescripts with the refusal status indicated. Allscripts Enterprise EHR does not automatically document the refusal in a patient’s chart. This must be done manually if desired.9) Does the prescription that was refused require a substitute prescription? Often, a prescription may be refused because the provider wants to “switch” the patient to a new medication. In this instance, the recommended Best Practice is to first refuse the request (as outlined above).10) The provider then creates a new prescription. Typically the provider changes an existing medication’s dose form, selects an equivalent medication, or replaces the rejected medication. Please refer to workflow (H1) Ad Hoc Prescription for the Certified Workflow steps for creating a new prescription.11) The same retail pharmacy should default (be selected) as part of the prescribing process for the new medication, therefore the substitution prescription will be transmitted to the same retail pharmacy via Surescripts.11/18/2009 158 Allscripts Enterprise EHR Certified Workflows
  • 159. (M) Document Management IntroductionDocument Management in regards to a non-patient visit focuses on documents that have beendictated by the provider. Dictation can originate from many sources, such as from within AllscriptsEnterprise EHR or through the use of a separate phone or hospital-based dictation system. Thedocument is then transcribed (translating the voice recording into text) and when complete becomesavailable within Allscripts Enterprise EHR (through an inbound interface from a third-partytranscription vendor or via Allscripts Enterprise EHR Transcribe). Once the document is received, itmay require the provider to review and sign the document before being finalized.These types of inbound documents are often referred to as “unstructured” documents. Thesedocuments are not the same as structured Notes, which workflow details are discussed separately inthe (G) Document (Patient Visit) workflows.There are many nuances when it comes to the overall document management strategy. Theworkflows contained in this section are as follows:Inbound Transcription—This workflow discusses how the unstructured document is presented tothe provider for review via a task. This workflow also describes the steps a provider may need totake when edits or corrections to the document are needed prior to making it final. The workflowassumes only a single signature is needed from a provider (typically one who represents both theauthor and the owner of the document) to make the document final.Transcription with Dual Signature—This workflow discusses the situation where an unstructureddocument requires the signature of two providers prior to the document being considered final. Thefirst provider begins the review, signs the document when complete (not making it final), and is thenprompted to route the document to a second provider for review and finalization. This workflowtypically applies to a resident/preceptor scenario where the resident receives the transcribeddocument first, reviews and signs it (usually as the author of the document) and then forwards it totheir Preceptor (MD) for review and finalization signature (usually as the owner of the document).Document Reconciliation—This workflow defines the steps to complete reconciliation on aninbound transcription or unstructured documents where a provider requests a correction.11/18/2009 159 Allscripts Enterprise EHR Certified Workflows
  • 160. Figure 47 (M) Document Management G6 Inbound transcription M1 M Yes received? No Inbound document requiring dual Yes M2 signatures? No Unstructured document M3 Yes requiring correction? No End11/18/2009 160 Allscripts Enterprise EHR Certified Workflows
  • 161. (M1) Inbound TranscriptionThis Document workflow defines the Certified Workflow steps to complete the review, edit, and sign-off of unstructured documents associated to Sign Note tasks. These may have been received froman inbound document interface from a transcription vendor or filed back in from Allscripts EnterpriseEHR Transcribe. Figure 48 (M1) Inbound Transcription M (1) (2) (3) Transcribed (5) (6) Document part of Provider part of M1 document Yes Yes Sign Note Provider reviews Electronic Electronic received in task created document Workflow? Workflow? TouchWorks No (4) Document No End filed into TouchWorks (9) (10) (11) (7) Yes Can provider Yes Provider completes Provider signs and End Are edits needed? complete edits? edits to document finalizes document No (13) (16) (14) (15) (17) (12) Provider invalidates Medical Records CorrectNote Provider dictates Transcription Do edits require Yes document & monitors Admin task is edits or re-dictates completes further dictation? provides brief document’s No created entire document necessary edits explanation revision M3 (18) (19) Provider requests (20) CorrectNote No correction & Medical Records Admin task is comments on corrects Document created changes needed (8) Provider signs and makes document End finalTo complete the review, edit, and sign off of documents associated to Sign Note tasks, do thefollowing:1) The completed document is received in Allscripts Enterprise EHR.2) Is the document part of the electronic workflow? When a document is received in Allscripts Enterprise EHR, the system first confirms that the document is participating in electronic workflow in order to process the document. If the document was not set up for electronic workflow, proceed to step 4.3) If the document is part of the electronic workflow, the system next verifies whether the owner (that is, the author of the document) is participating in electronic workflow. The setup is necessary to allow providers the ability to review, edit (if necessary), and sign-off on documents.4) If either the document or the user does not participate in electronic workflow, then the document’s status is changed to “Final-Receipt” and no document-related tasks are generated.11/18/2009 161 Allscripts Enterprise EHR Certified Workflows
  • 162. 5) If both the document and provider participate in electronic workflow, a “Sign Note” task is created. This system-generated task is placed on the provider’s task list for further action.6) The provider reviews the document. To review a document via a Sign Note task, follow these steps: a) The provider should be logged into Allscripts Enterprise EHR. If not logged in, launch the application by double-clicking on the Allscripts Enterprise EHR desktop icon and login. b) From the Chart menu, click Documents (Batch Sign). The Document Completion Tasks screen displays. This page enables the provider to quickly and efficiently review and sign-off on documents from one workspace. c) Select the appropriate patient name from the left column. d) Review the corresponding document on the right side of the page. If there are multiple documents concerning a patient to be reviewed, the actual number displays at the top of the document viewer pane. Click on the drop-down arrow (on the far right) to display the additional documents to be reviewed.7) From the Review step above, the provider determines if edits are needed for the document. If edits are needed, the provider proceeds to step 9.8) If no edits are needed, the document is ready to be signed and finalized by the provider. To sign and finalize a document, follow these steps: a) From the Document Completion Tasks screen, verify the appropriate patient and document are still in context. b) Review and verify the document is ready for signature. c) Validate the Final check box is checked. d) Click Sign. If it is the first document in the list being signed, the Note Signature screen will display for the user to type in their password. For all subsequent notes being signed, this screen will not appear as long as the user remains within the workspace.9) If edits are needed, are they minor enough that the provider can manually complete them? If the provider cannot complete the edits, proceed to step 12.10) The provider determines that they can complete the necessary edits before signing and finalizing the document. Follow these steps to edit a document in Allscripts Enterprise EHR: a) From the Document Completion Tasks screen, verify that the appropriate patient and document are still in context within the Patient Banner. b) Click Edit. c) Make the appropriate changes.11) Once the document edits are done, it is ready to be signed and finalized by the provider. To sign and finalize a document, follow these steps: a) From the Document Completion Tasks screen, verify the appropriate patient and document are still in context.11/18/2009 162 Allscripts Enterprise EHR Certified Workflows
  • 163. b) Validate the Final check box is checked and click Sign from the Document Completion Tasks screen. c) Click OK.12) If the edits to the document are extensive and too time consuming for the provider to complete, creating an additional dictation is a recommended option. Providers can choose to dictate corrections to the previously transcribed document or re-dictate the entire document. Documents that contain incorrect “Header” information, including Author, Owner, Patient, Text, or Document Type can be monitored and corrected within Allscripts Enterprise EHR by utilizing the Req Corr…. action.13) If creating a “correction” dictation is desired, the provider should first invalidate the existing document and provide a brief explanation. To invalidate an inbound document, follow these steps: a) From the Document Completion Tasks screen, verify that the appropriate patient and document are in still context. b) Click Req Corr… (Request Correction). The Request Correction page displays. c) Select the appropriate Priority: Routine, ASAP, or Urgent. d) The Recipient should default to Medical Records Team. e) Check Invalidate – Do Not Correct. The purpose for invalidation is to remove the incorrect document out of view within ChartViewer until it is accurate. f) Under Comments, enter the reason why the document needs to be invalidated (For example, “Necessary edits to document required another dictation.”) g) Click OK.14) A CorrectNote Admin task is automatically created and the status of the document changes to “Request Correction.”15) To dictate corrections to a document or re-dictate an entire document, follow these steps: a) From the Document Completion Tasks screen, verify that the appropriate patient is still in context within the Patient Banner. b) Using the (floating) Clinical Toolbar, begin recording the new dictation. It is very important that the provider indicate in the dictation a message to the transcriptionist that the recording is a correction to a previous transcribed document. This will allow the transcriptionist to locate the previously transcribed document to insert the corrections being dictated in the current recording. c) The provider should validate the patient name and the encounter information as part of the recording. For example: “This is a dictated correction for patient Jason Test, DOB 9/2/82 of a previous dictation submitted for date of service on July 7, 2006.” d) The provider completes the recording with all corrections. e) Click Done.16) Medical Records monitors the document’s revision process.11/18/2009 163 Allscripts Enterprise EHR Certified Workflows
  • 164. 17) The transcriptionist completes the necessary edits and re-files the document. Once the edits are complete, the document files back into Allscripts Enterprise EHR for the provider to review (repeat from step #6).18) If edits are needed that do not require an additional dictation, the provider can request a correction and comment on the changes that are needed. Follow these steps to request a correction: a) From the Document Completion Tasks screen, verify that the appropriate patient and document are still in context within the Patient Banner. b) Click Req Corr…. The Request Correction page displays. c) Select the appropriate Priority: Routine, ASAP, or Urgent. d) The Recipient should default to Medical Records Team. e) Check the appropriate field that requires correction (For example, Correct Author or Correct Patient.) f) Enter the necessary information in the Comments field to allow the corrections to be completed (For example, “Please change Author to Dr. Smith, Please correct Patient - should be Sue Berry MRN 1234567.”) g) Click OK.19) A CorrectNote Admin task is automatically created. The status of the document changes to “Request Correction” and remains within the provider’s Document Completion Tasks workspace until the necessary corrections are complete. The CorrectNoteAdmin task is automatically assigned to the Med Rec Team. An Enterprise Task View must be set up and assigned to the desired medical records user(s).20) Medical Records or the transcription supervisor role monitors all the request corrections using an enterprise task view. Follow these steps to respond to this type of task (CorrectNote Admin): a) Medical Records or the Transcription Supervisor should be logged into Allscripts Enterprise EHR. If not logged in, launch the application by double-clicking on the Allscripts Enterprise EHR desktop icon and login. b) From the Chart menu, click Task List. c) Select the appropriate task view from the View drop-down list (for example, Request Correction view.) d) Double click on the appropriate CorrectNote Admin task. The Manage Document workspace displays. e) Complete the necessary changes as requested. f) Click OK. The task is automatically removed from the task list when completed. The status of the document will change back to “Unsigned’ once the changes are complete. All users that will be reconciling documents must have “Document Management” security privileges.11/18/2009 164 Allscripts Enterprise EHR Certified Workflows
  • 165. (M2) Transcription with Dual SignatureThis Document workflow defines the Certified Workflow steps to complete the review and sign-off ondocuments where a dual signature is required from an initial provider to an attending (or supervising)provider to finalize the document. Additional details are also included about utilizing carbon copy.This scenario may apply to organizations with Nurse Practitioners (NP), Physician Assistants (PA) orResidents on staff. Figure 49 (M2) Transcription with Dual SignatureTo complete the review and sign-off of documents and understand the steps to utilize carbon copy,do the following:1) The completed document is received in Allscripts Enterprise EHR. This can be received from an inbound document interface from a transcription vendor or filed back in from Allscripts Enterprise EHR Transcribe.2) Is the document part of electronic workflow? When a document is received in Allscripts Enterprise EHR, the system first confirms that the document is participating in electronic workflow to process the document. If the document was not set up for electronic workflow, proceed to step 4.3) If the document is part of electronic workflow, the system next verifies whether the owner (that is, the author of the document) is participating in electronic workflow. This setup is necessary to enable providers to review, edit (if necessary), and sign-off on documents.11/18/2009 165 Allscripts Enterprise EHR Certified Workflows
  • 166. 4) If either the document or the user does not participate in electronic workflow, then the document’s status is changed to “Final-Receipt” and no document-related tasks are generated.5) If both the document and provider participate in electronic workflow, a “Sign Note” task is created. This system-generated task is placed on the provider’s task list for further action.6) The provider reviews the document. To review a document using a Sign Note task, follow these steps: a) The provider should be logged into Allscripts Enterprise EHR. If not logged in, launch the application by double-clicking on the Allscripts Enterprise EHR desktop icon and login. b) From the Chart menu, click Documents (Batch Sign). The Document Completion Tasks screen displays. This page enables the provider to quickly and efficiently review and sign-off on documents from one workspace. c) Select the appropriate patient name from the left column. d) Review the corresponding document on the right side of the page. If there are multiple documents concerning a patient to be reviewed, the actual number displays at the top of the document viewer pane. Click on the drop-down arrow (on the far right) to display the additional documents to be reviewed.7) Are carbon copies required to be sent for this document? If carbon copies are not needed, proceed to step 9.8) If carbon copies are required, follow these steps to create a carbon copy list: a) On the Document Completion Tasks screen, verify that the appropriate patient and document are in context within the Patient Banner. b) Click CC…. The system displays the Recipients page. The Orig. Note tab defaults unless recipients already exist. If recipients have already been added, the Recipients tab displays. c) On the Orig. Note tab, check all appropriate recipients and specify the method of distribution. d) If a name does not appear next to a designation (for example, Referring Provider), a new recipient can be added. To add a new recipient, follow these steps: i) Click Add. If a user selects Provider or Referring Provider, the system prompts the user to search for the appropriate recipient. ii) Select the appropriate distribution method. iii) Click OK when finished. AutoPrint default values must be set up correctly for the Method Destination to be enabled for a given document.9) The document is now ready to be signed by the initial provider or author. To sign a document, follow these steps: a) On the Document Completion Tasks screen, verify that the appropriate patient and document are in context. b) Review and verify that the document is ready for signature.11/18/2009 166 Allscripts Enterprise EHR Certified Workflows
  • 167. c) Click Sign. d) The Task Detail window displays. The task name defaults to CoSign Note. e) Select the appropriate Assign To user. This should represent the attending or supervising provider. f) Add comments or any additional task window optional settings (for example, priority, overdue, and so on.) g) Click OK. If it is the first document in the list being signed, the Note Signature screen will display for the user to type in their password. For all subsequent notes being signed, this screen will not appear as long as the user remains within the workspace10) A task is sent to the attending (or supervising) provider for review and signature. It is important to set the primary provider to a lower finalization authority level than the document when utilizing the “Prompt User to Route for Further Signature” workflow. Therefore, any time a user without sufficient authority to finalize a document signs that document, they are automatically prompted to route the document to the provider with sufficient authority to sign and finalize it.11) The attending provider reviews the document. To review a document using a CoSign Note task, follow these steps: a) The provider should be logged into Allscripts Enterprise EHR. If not logged in, launch the application by double-clicking on the Allscripts Enterprise EHR desktop icon and login. b) From the Chart menu, click Documents (Batch Sign). The Document Completion Tasks screen displays. This page enables the provider to quickly and efficiently review and sign- off on documents from one workspace. c) Select the appropriate patient name from the left column. d) Review the corresponding document on the right side of the page.12) Does the attending provider want to add or create a Carbon Copy listing? If not, proceed to step 14.13) If carbon copies are required, follow these steps to create a carbon copy list: a) On the Document Completion Tasks screen, verify that the appropriate patient and document are in context. b) Click CC…. The system displays the Recipients page. The Orig. Note tab defaults unless the recipients already exist. If the recipients have already been added by the initial provider, the Recipients tab displays. c) Review the specified recipients and update the carbon copy list if needed. To edit or add CC recipients, do the following: i) Click on the Orig. Note tab. ii) Check the appropriate recipient(s) and specify the method of distribution. iii) If any recipients listed should not receive a copy, uncheck the desired recipient.11/18/2009 167 Allscripts Enterprise EHR Certified Workflows
  • 168. iv) If a name does not appear next to a designation, a new recipient can be added. To add a new recipient, follow these steps: v) Click on the Recipient Type drop-down list, and select the appropriate designation. vi) Click Add. If a user selects Provider or Referring Provider, the system prompts the user to search for the appropriate recipient. vii) Select the appropriate distribution method. d) Click OK when finished.14) The document is now ready to be signed and finalized by the attending (or supervising) provider. To sign and finalize a document, follow these steps: a) On the Document Completion Tasks screen, verify that the appropriate patient and document are still in context. b) Validate that the Final check box is checked. c) Click Sign. d) The system automatically removes the document once it is signed and advanced to the next document for review and signature. The ability to remove documents automatically once they have been signed or verified is a user preference that is available using the Personalize link.11/18/2009 168 Allscripts Enterprise EHR Certified Workflows
  • 169. (M3) Document ReconciliationThis workflow defines the steps to complete reconciliation on an inbound transcription orunstructured documents where a provider requests a correction. The provider may request any offollowing actions to be taken with respect to the document: ▪ Correct Document Type – indicates that the document type is not correct. ▪ Correct Owner – indicates that the document owner is not correct. ▪ Correct Patient – indicates that the patient associated with the document is not correct. ▪ Correct Author – indicates that the user who is described as the document author is not correct. ▪ Correct Text – indicates that the content of the document is not correct. ▪ Invalidate-Do Not Correct – invalidates the document as it does not belong in any chart. This is commonly requested for duplicate records, incomplete dictations, and so on. Figure 50 (M3) Document ReconciliationTo complete a Correct Note Admin task, do the following:1) A CorrectNote Admin task is received and assigned to the Medical Records team. These tasks can be viewed within the “Document Management Tasks” enterprise task view that comes delivered with the system. Administrators need to assign this view to the appropriate medical records users.2) Medical Records monitors all the requests via a task list and selects a task to work. To complete a CorrectNote Admin task, follow these steps:11/18/2009 169 Allscripts Enterprise EHR Certified Workflows
  • 170. a) Medical Records should be logged into Allscripts Enterprise EHR. If not logged in, launch the application by double-clicking on the Allscripts Enterprise EHR desktop icon and login. b) Go to the Task List horizontal toolbar. c) Select the appropriate task view from the View drop-down list that contains the CorrectNote Admin tasks to work. d) Click on the appropriate CorrectNote Admin task to view the comments that were entered by the provider. e) Click Go To… . The Manage Document workspace displays. f) Click OK. The task is automatically removed from the task list when completed. The status of the document will change back to “Unsigned’ once the changes are complete. All users that will be reconciling documents must have “Document Management” security privileges.3) Is the document associated to the wrong or incorrect author or owner?4) Medical Records corrects the document with the appropriate author or owner. To correct a document’s author or owner, do the following: a) Next to the respective field (in the upper-right), click on All. The search dialog box displays. b) Search for appropriate author/owner (Last Name, First Name). c) Double-click on the correct author/owner to select.5) Is the document associated to the wrong or incorrect patient?6) Medical Records corrects the document with the appropriate patient. To correct that patient associated to a document, do the following: a) From the Patient field, click on the patient icon . The Select Patient dialog box displays. b) Search for the appropriate patient using any of the patient search options. c) Double-click on the correct patient to select.7) Is the document associated to the wrong or incorrect Allscripts Enterprise EHR Document Type?8) Medical Records corrects the document with the appropriate document type. To correct the document type associated to the document, do the following: a) From the Type field, click on drop-down arrow. b) Select the appropriate document type from the list.9) Is the document associated to the wrong or incorrect Encounter?10) Medical Records corrects the document with the appropriate encounter. To correct the encounter associated to the document, do the following: a) From the For (encounter) field, click on the patient icon . The Encounter Selector dialog box displays. b) Select the appropriate encounter.11/18/2009 170 Allscripts Enterprise EHR Certified Workflows
  • 171. 11) Does the document contain errors the text of the document that needs to be corrected? If no additional corrections are needed, Medical Records clicks OK. The task is automatically removed from the task list when completed and the status of the document changes back to “Unsigned.”12) If additional edits are needed, Medical Records completes any necessary edits to the document. This may include editing the text of the document or invalidating a document where the provider specified not to correct. a) To edit the text of a document, do the following: i) Click Edit. The Note Workspace displays. ii) Make necessary edits to the document, as appropriate. iii) Click Close next to Note from the Patient Banner when complete. iv) The task is automatically removed from the task list when completed and the status of the document changes back to “Unsigned.” b) To invalidate a document, do the following: i) Click Invalidate. The user will be prompted with a warning message. Invalidate warning message. ii) Click OK to continue. c) The task is automatically removed from the task list when completed and the status of the document changes back to “Unsigned.” When any of this information is changed, the changes are reflected in the Batch Signing (Document Completion Tasks) workspace. However, if the Owner of the document is updated, the task stays with the originally assigned user. The user must forward the task from the Task List workspace.11/18/2009 171 Allscripts Enterprise EHR Certified Workflows
  • 172. (N) Transcribe IntroductionAs it pertains to the electronic health record, transcription is the conversion of a dictation (voicerecording) into an electronic typewritten document that is sent to Allscripts Enterprise EHR. The actof transcribing may be performed with the use of Allscripts Enterprise EHR Transcribe, as describedin this section, or handled by a third-party transcription vendor that arrives in Allscripts EnterpriseEHR via an inbound interface.Allscripts Enterprise EHR Transcribe allows organizations to perform “in-house” transcription ofunstructured documents, increasing the accuracy and efficiency of transcribing in a cost effectivemanner. There is no interface required with Allscripts Enterprise EHR Transcribe. The twoprograms that are utilized by the transcriptionists to manage and transcribe the received voice filesare as follows: ▪ Internet Typist—This application is used by the transcriptionist to access jobs waiting to be transcribed. ▪ Text Input Utility (TIU)—This application is used for the actual transcription. Based in Microsoft Word, the TIU uses document templates and macros to automate much of the work done by a transcriptionist.The workflow included in this section outlines the basic steps for utilizing these programs. Figure 51 (N) Transcribe Utilizing N1 N Yes Transcribe? No End11/18/2009 172 Allscripts Enterprise EHR Certified Workflows
  • 173. (N1) Transcribe BasicsThis workflow defines the basic steps for transcribing a dictation received within Allscripts EnterpriseEHR Transcribe. The Transcribe module involves the use of the Internet Typist and Text Input Utility(TIU) applications for transcription. These applications are included with the Transcribe module.Dictation jobs are sent to the job queue in Internet Typist where they are selected by atranscriptionist and typed in the TIU application. Examples of this workflow include the following: ▪ A provider has dictated by searching the database for the patient, from the Schedule or from a Patient List. A document “work type” is also selected such as a letter, report, progress note, and so on. ▪ A provider has dictated against a dictation marker in one or more note sections. ▪ Data flow between the Transcribe utilities and the Allscripts Enterprise EHR application are integrated at the application level and no Interface is used. Figure 52 (N1) Transcribe BasicsTo transcribe a dictation using Transcribe, follow these steps:1) The Transcriptionist logs into the Internet Typist application11/18/2009 173 Allscripts Enterprise EHR Certified Workflows
  • 174. Login screen2) The Transcriptionist locates the appropriate job in the Server Jobs queue to begin transcription. The Transcriptionist optionally, but only if they have been assigned the right to select jobs to transcribe, can select multiple jobs in the “My Server Jobs” window by selecting one and holding down the Ctrl key and selecting others to move them to their “My Local Jobs” window by dragging and dropping them into the top window. The Transcriptionist can also use the Windows convention of selecting one, holding down the Shift key, and using the arrow or mouse to select adjacent jobs in series and move those jobs.3) To launch the appropriate job, double-click on the desired job in the queue, press F2, or use the foot pedal if a button was assigned to this feature. Starting a job will bring up the media toolbar. Media toolbar11/18/2009 174 Allscripts Enterprise EHR Certified Workflows
  • 175. The TIU application login screen will also appear if the user is not already logged into the TIU. Text Input Utility (TIU) login screen The first time a user selects a job they will be prompted to login to TIU. For subsequent jobs where the Transcriptionist is already logged into TIU, they will not be prompted to login again4) Will a normal or predefined template be utilized?5) If yes, then click the Normal button located on the TIU toolbar at the top of the workspace, otherwise place the cursor at the beginning of the page and proceed to launch the job Browse the Windows folder for the appropriate Normal file and then click OK to insert the Normal template into the document6) Play the voice file associated to the job by clicking on the Play button located on the media toolbar. On the media toolbar pictured above, the black arrow is the Play button, the green check icon is “Job Complete,” the floppy disk icon is “Job Incomplete,” and the green check icon with the black Play button is “Job Complete & Start Next Job.”11/18/2009 175 Allscripts Enterprise EHR Certified Workflows
  • 176. 7) Transcribe against the voice file being played and replay and navigate the voice file as needed.8) Is the job complete?9) When the dictation file has been fully completed and the job is done, click the Complete button.10) The document is saved and filed it into Allscripts Enterprise EHR.11) If needed, a job can be placed on hold to complete at a later time by clicking the Job Incomplete icon on the media toolbar. a) If the user wants to re-start a job that was on hold they simply double-click the job in the Internet Typist and the partially completed job is automatically opened with the voice file ready to be played. If additional jobs need to be transcribed, instead of clicking the Complete button, go to the Job Complete & Start Next Job button located on the media toolbar.  Once the completed document files back to Allscripts Enterprise EHR, this will activate the appropriate Document tasking workflows automatically.12) When all jobs have been completed the transcriptionist should log out of the TIU application and then log out of the Internet Typist application.11/18/2009 176 Allscripts Enterprise EHR Certified Workflows
  • 177. (P) Scanning IntroductionScanning is the process of creating a digital image from a paper document. An integrated scanningand document imaging solution is an essential component for creating a paperless electronic healthrecord at your organization. Allscripts Enterprise EHR Scan includes a utility (separate application)to perform the act of scanning paper documents, indexing, and filing them in Allscripts EnterpriseEHR for users to view and interact with.One of the first decisions an organization must make is to identify the scanning strategy that best fitstheir organization. There are two scanning approaches that are discussed within this section asfollows: ▪ Scanning Active Charts: This workflow discusses the process of scanning a patient’s “Active Chart” and making the chart information electronically available for providers and staff within Allscripts Enterprise EHR. This could encompass scanning the entire chart or a defined portion of a chart. ▪ Scanning Correspondence: This workflow discusses the scanning of loose paper received and making it available within the electronic health record. Some organizations select to not scan active charts at all, but go directly to only scanning correspondence from a specific date forward.Answering some of the following questions will assist your organization to determine which strategyis best suited to your requirements: ▪ How many paper charts are there to be scanned? ▪ How many pieces of paper are contained within the average chart? ▪ What is the condition of the average chart? Will it be easy to breakdown and scan or will there be a lot of preparation tasks to do in removing staples, “dog-eared” pages that will be difficult to scan, or messy charts that will be hard to organize? ▪ How many years of data are contained in the average chart? ▪ How important to the providers and staff is it to have paper chart history contained within the new Electronic Health Record? ▪ What is the cost to benefit ratio for scanning your chart history? ▪ How many resources are available to perform the needed preparation and scanning tasks? ▪ What resources are available to perform the indexing of scanned documents? ▪ What space is available to install high-speed scanners and allow for proper paper chart preparation?Allscripts recommends that the details in both workflows be analyzed thoroughly (along with thedetails from this introduction) to determine which approach or strategy is best suited for yourorganization. Some organizations may determine it is cost or resource prohibitive to attempt to scanall paper chart history. As a result, most organizations decide to scan at least a portion of the paperchart or charts that have been active for a 3-5 year period. Other organizations may opt to only scanfrom a selected date and then forward.Additional decisions and recommendations include: ▪ Determine where the scanning will be done. Will it be done centrally at one location, at each clinic, or will it be outsourced? Allscripts recommends that active chart history scanning and indexing be performed only by dedicated staff to reduce errors. ▪ Network bandwidth is a key consideration when scanning. After each batch is scanned it is held at the local workstation until the client is closed, at which point the entire set of scanned documents is sent to the Allscripts Enterprise EHR/ Scan Server(s) as fast as11/18/2009 177 Allscripts Enterprise EHR Certified Workflows
  • 178. the network will take it. On a slow network connection, this can dramatically impact downstream users and may take an extended period of time.Active Chart Scanning StrategiesThe Active Chart Scanning (also referred to as Historical Scanning) approach focuses on eliminatingmanual paper chart pulls, and making chart information faster and easier for providers and staff toaccess directly in the electronic health record.The following are general recommendations and decision points each organization should take intoconsideration when designing their active chart history scanning strategy: ▪ Decide if the entire chart will be scanned or just a portion of the chart. This is typically an organizational decision that is driven by the preferences of the physicians and clinical staff. Other factors to keep in mind are time and cost. Studies have shown that scanning the entire chart vs. filtering what to scan is a significantly cheaper approach due to the drastically increased resource time it takes to review a chart prior to scanning. ▪ The process of breaking down and making a chart ready to be scanned always takes longer than expected. Breakdown the chart by removing any prongs or staples, sorting all the paper in reverse chronological order (which typically it should have been). It may also be necessary to tape small pieces of paper to larger ones to pass them through a high-speed scanner. ▪ Frequently, portions of the chart are discarded because they are not really part of the chart—such as copies of patient education materials. Organizations should perform a thorough analysis to determine what documents or portion of the chart should be scanned into Allscripts Enterprise EHR and which items should be discarded. ▪ Determine if each individual document being scanned will be assigned a true encounter date (date of the document) or whether a single date in the past (prior to the use of Allscripts Enterprise EHR) will be used to scan all chart documents to. Many organizations have provided feedback that assigning individual document dates takes more resource time than the return it provides. An alternate method is to set a single date in the past to set the computer’s time to that is being used to scan from a date several years in the past which will in turn assign that date to all documents being scanned. ▪ If scanning the entire chart, create a Allscripts Enterprise EHR document type and Scan folder that matches the name on each tab on the patient chart. ▪ If the paper chart needs to be circulated during the Provider Rollout Go-Live period (where some providers will be live on Allscripts Enterprise EHR and some will not be), Allscripts recommends that as the paper chart is scanned, a divider be placed to the point where all paper has been scanned with a notice to not place any new paper behind the divider and then each individual new piece of paper placed in front of the divider that is individually stamped “scanned” until all providers are live and the entire paper chart can be archived.Decide on the “timing” strategy to use when scanning active chart history: ▪ Prior to the scheduled appointment—This approach allows the provider to view all chart information from Allscripts Enterprise EHR electronically at the time of the patient visit. The challenge to this approach is keeping the scanning efforts ahead of the schedule and accommodating walk-in appointments. This approach is not recommended for organizations with limited resources, limited scanning equipment, or11/18/2009 178 Allscripts Enterprise EHR Certified Workflows
  • 179. an extremely high volume of patient appointments. If your organization is going to use this approach, allow approximately 2-8 weeks in advance of the upcoming appointment to complete the scanning task. This is a general guideline; each organization must determine the correct amount of lead time required for their environment. ▪ After the scheduled appointment—With this approach, the provider completes the patient visit initially with the paper chart. Once the visit is complete, the paper chart is scanned and is then available electronically in Allscripts Enterprise EHR from that point forward. This approach allows for a somewhat “softer” transition from paper chart to electronic chart by easing the pressure on support staff to have the paper chart scanned in time for the appointment and it also eases the provider from a change management perspective into using an electronic chart. This “final” hands-on with the paper chart is also sometimes used for the provider to identify which documents he/she wants indexed. ▪ Scan the Chart Room from “A-Z”—With this approach, the provider completes the patient visit with or without a paper chart depending on whether the chart has already been scanned and whether the provider is already live on Allscripts Enterprise EHR.Regardless of the strategy you select, each organization will go through an interim period wheresome paper charts have been scanned and some have not. Many organizations use their MedicalRecording Tracking software or Practice Management System (PMS) to indicate whether a paperchart has been scanned. This method enables all staff, when preparing for a patient visit, todetermine whether they need to pull a paper chart of whether no chart pull is required because it hasalready been scanned.Scanning Correspondence ApproachOrganizations need to consider all instances where “loose” correspondence is received and has tobe scanned into the electronic health record, which may include any of the following:▪ An organization selects not to scan active chart histories, but rather determines a live date and has all new loose paper scanned and electronically filed into the chart. Then a date is determined after which the organization will no longer provide paper charts. Paper chart processing occurs in medical records as normal during the ramp-up phase of this approach.▪ Scanning of active chart histories is complete and the organization only needs to scan ongoing correspondence into the electronic health record.▪ Consideration of scanner placement, or determining localized scanning locations, should also be considered. Smaller scanners may be placed at the front desk to accommodate certain correspondence as part of the patient check-in process while mid-sized or larger scanners may be placed in Medical Records for larger batches, such as incoming mail or batches of paper results that require scanning.Lessons Learned Statements from Allscripts ClientsThe following are some statements from Allscripts clients about lessons learned about active chartscanning:“…Scanning speed is highly dependent on how complete the offices have prepped their charts.Currently, a three-person scan team can average between 100 to 150 charts scanned per day.” -CCP“...To pull an average size chart off the shelf and break it down and scan it in took us an averagebetween 10-12 minutes.” - Central Utah11/18/2009 179 Allscripts Enterprise EHR Certified Workflows
  • 180. “…We are currently scanning at about 1200–1500 loose pages per day with 6 FTE’s, but that is nowhere a full day’s job. At the height of our scanning days, we were scanning and filing about 22,000pages per day. That was with about 16 FTE’s.” – Central Utah“…Our time and motion studies showed we could file about 80 documents on average in about 10minutes.” - Central Utah Figure 53 (P) Scanning11/18/2009 180 Allscripts Enterprise EHR Certified Workflows
  • 181. (P1) Scanning Active ChartsThe Scanning Active Charts (also referred to as Historical Scanning) approach focuses oneliminating manual paper chart pulls, and making chart information faster and easier for providersand staff to access directly in the electronic health record. Due to the large volume of chartsinvolved in scanning an entire organization’s chart room, an interim “historical” scanning process istypically put in place to accommodate scheduled visits, same day visits, or any other need for pullinga chart while continuing to provide quality patient care. The ultimate goal is to scan the paper chart,archive it, and then all future “paper” for a patient’s chart would be scanned in Allscripts EnterpriseEHR to maintain the new electronic record.Refer to the Scan Introduction section for additional details and Certified Workflow details onscanning active charts. Allscripts Enterprise EHR Scan involves the use of the Allscripts Enterprise EHR Scan Client for all scanning tasks. This client is included as part of Allscripts Enterprise EHR Scan, and must be accessed separately. Figure 54 (P1) Scanning Active Charts B P (3) (5) (2) (1) Medical Records (4) Clinical Staff routes Paper chart P1 Medical Records Yes sends paper chart Provider completes paper chart to needed for pulls patient chart for use during patient encounter Medical Records for appointment? visit scanning (7) Medical Records (6) routes paper No Centralized Yes chart to Scanning? predefined location (8) Medical Records No preps chart for scanning, per protocol (10) Medical Records/ (9) Clinical Staff Patient history Yes enters patient being entered? history in TW, as appropriate (14) (12) (11) (13) Medical Records Medical Records No Medical Records Chart Tracking Yes updates software indexes chart per scans paper chart software used? that chart has been protocol scanned No (16) (15) Medical Records Medical Records archives or End marks paper chart as destroys chart per scanned protocol11/18/2009 181 Allscripts Enterprise EHR Certified Workflows
  • 182. To perform active chart scanning, do the following:1) Medical Records pulls the paper chart per the protocol decision of the organization. Many organizations select different strategies for determining the order in which they pull paper charts for scanning.2) Is the paper chart needed for an appointment? The paper chart might be needed for a scheduled appointment or walk-in encounter, where there was not adequate time to scan in advance of the appointment.3) If yes, the Medical Records staff sends the paper chart for use during the patient visit. In this scenario, using the paper chart for the appointment encounter ensures proper patient care and the least amount of disruption to the provider and staff. This also alleviates time constraints for the Medical Records staff in attempting to scan paper charts prior to same-day appointments by scanning the chart after the appointment.4) The provider uses the paper chart to complete the appointment encounter.5) Clinical staff routes the paper chart back to Medical Records to then complete the scanning process.6) Will the organization have a centralized scanning location? Some organizations purchase larger, higher speed scanners and route charts to a centralized location where dedicated staff perform the chart prep and scanning process.7) If yes, Medical Records packages and sends the paper chart(s) to the predefined scanning location for processing per protocol.8) Once received at the central scanning location, Medical Records preps the chart for scanning per protocol: a) Remove all paper from any retaining mechanisms in the chart such as prongs or rings. b) Sort the paper within the chart in reverse chronological order and pull out any documents that are not going to be scanned. c) Remove all tape and staples; unfold any folded paper.9) Will patient history data be entered in Allscripts Enterprise EHR? Some organizations prefer to begin populating the electronic health record with certain elements of discrete data, such as medication lists, allergies and problem history rather than simply scanning the associated paper chart records. Typically, the role tasked to perform this is a clinical role – either a Medical Records role with clinical experience or a clinical staff member.10) Follow these steps to enter patient history in Allscripts Enterprise EHR: a) The Medical Records resource should be logged into Allscripts Enterprise EHR. If not logged in, launch the application by double-clicking on the Allscripts Enterprise EHR desktop icon and login. b) Click on Select Patient and Search from the Banner. c) From the Select Patient screen, locate the desired patient. d) From the Chart menu, go to the Clinical Desktop. e) Click on the New Problem icon located on the Clinical Toolbar.11/18/2009 182 Allscripts Enterprise EHR Certified Workflows
  • 183. f) From the Add Clinical Item (ACI) workspace begin by entering in the following areas (each may differ depending on each organization): i) Past Medical History ii) Past Surgical History iii) Family History iv) Social History v) Allergies vi) Med Hx vii) Immun Hx g) Once the first item has been selected, the Encounter Selector screen will display. Select the appropriate encounter type setup for data entry and click OK. h) Once all data has been entered, click OK. i) From the Clinical Desktop, click Commit to save all entries.11) The Medical Records staff performing the scanning logs into the Allscripts Enterprise EHR Scan application to select a patient and begin the scanning process: a) To log into the Scan application, double-click on the Allscripts Enterprise EHR Scan icon. b) Enter a username and password and click OK. c) The patient’s demographic information displays in the first pane to the left and the Chart Group displays in the middle pane. d) The person performing the scan selects a patient. e) To select a patient, access the Search menu and select Patient Charts. f) In the patient search window, enter search criteria for a patient. You can search for patients based on Name, MRN, DOB, and Phone. g) Select the Type drop-down list to make your selection (partial strings may be used in some of the searches). h) Click Search and a list of patients that meet your search criteria displays. i) Once you find the correct patient, select from the list and click Select to open the patient’s chart. j) Once the patient is in context, the chart is ready to be scanned. k) To scan a patient’s chart, select the Archives folder from the Chart Group. l) Click on the Scan icon located at the bottom left-hand corner of the window. m) The patient’s information defaults into the first three fields. n) The Folder indicates the Chart Group folder into which the documents are scanned - Archives. o) The Document Name and Date fields default to the system date and Folder. p) Check the Duplex option if the scan job includes double-sided documents or the Flatbed option and the scanner will be prompted to continue scanning after each page. q) Place the documents to scan in the scanner and click Scan.11/18/2009 183 Allscripts Enterprise EHR Certified Workflows
  • 184. r) Images appear in the right-hand panel as they are scanned. s) Once scanning is complete, the application returns to the patient chart. The Archives folder in the Chart Group now contains the scan job. Documents filed into the Archive folder are not accessible in ChartViewer within Allscripts Enterprise EHR until the documents are filed to the appropriate destination folder.12) The Medical Records Filer indexes the chart within Allscripts Enterprise EHR. a) Search for the desired patient if not already in context. b) Select the Archives folder from the Chart Group. c) Click on the Filer icon located at the lower-left hand corner of the window. d) With the first scanned image displaying, change the date to the document date or appropriate date of service. e) Select the appropriate filer button to file the document to the final document folder. Once the documents are filed into their final destination folders, they are viewable within Allscripts Enterprise EHR ChartViewer real-time.13) Is an electronic chart tracking system being used to track the location of the paper chart?14) If yes, indicate within the chart tracking software that the chart has been scanned. This enables all staff members to easily identify whether a paper chart has been scanned or not during this interim process. If it has been scanned, staff know to look in Allscripts Enterprise EHR for patient’s medical records. If the paper chart has not been scanned, then staff know that a paper chart is out there that must be located for the current need.15) If an electronic chart is not being used, indicate on the cover of the chart that it has been scanned and should not be modified by the addition of loose paper after that process is complete.16) Once the chart has been marked as scanned, it can be archived or destroyed per your organization’s protocol. The legal retention requirements vary by state and specialty. Organizations must completely understand the state regulations for the keeping, storing, and destroying of paper chart information to ensure that they are adhering to those requirements.Certified Workflow TipsThe following are two Certified Workflow tips for performing active chart scanning: Review and assess each site in order to determine their readiness for change. The recommended Best Practice is to identify a “showcase” site, which becomes the early adopters. From the Lessons Learned, additional prioritization criteria can be applied when determining the order of remaining locations.11/18/2009 184 Allscripts Enterprise EHR Certified Workflows
  • 185. Allscripts recommends that organizations begin by scanning all active charts based upon the site rollout schedule that is determined. Upon conclusion of the active chart scanning project, resources will be reallocated to continue to help other sites or begin converting the inactive charts.11/18/2009 185 Allscripts Enterprise EHR Certified Workflows
  • 186. (P2) Scanning CorrespondenceOrganizations need to consider all instances where “loose” correspondence is received and has tobe scanned into the electronic health record. The workflow steps covered in this document apply tothe following two scenarios:1) An organization selects not to scan active chart histories, but rather determines a live date and has all new loose paper scanned and electronically filed into the chart. Then a date is determined after which the organization will no longer provide paper charts. Paper chart processing occurs in medical records as normal during the ramp-up phase of this approach.2) Scanning of active chart histories is complete and the organization only needs to scan ongoing correspondence into the electronic health record. Allscripts Enterprise EHR Scan involves the use of the Allscripts Enterprise EHR Scan Client for all scanning tasks. This client is included as part of Allscripts Enterprise EHR Scan, and must be accessed separately. Figure 55 (P2) Scanning CorrespondenceTo scan correspondence, do the following:1) It is very common for a clinic or site to receive loose paper throughout a given day. For instance, a patient may bring in records from another office, a laboratory vendor may courier or mail results, consultation reports may be faxed or mailed from other providers and the front desk staff may have a new patient complete paper forms when they arrive. This step encompasses all the different ways in which a site’s staff may receive loose paper.2) Will the scanning be done at the local site? Typically, there are three common areas where scanning may be located to scan loose correspondence:11/18/2009 186 Allscripts Enterprise EHR Certified Workflows
  • 187. i) At the front desk ii) Localized by site in each Medical Records area iii) Centralized by the organization at a specific site3) Will the paper be scanned immediately in the area received or scanned later? Many organizations select to install smaller scanners in areas such as the front desk to handle immediate scanning requirements for patients checking in. Other loose correspondence would then be routed to Medical Records for scanning at a later time.4) If not scanning paper immediately, then the staff routes all loose papers to their site’s medical records department.5) Is the paper(s) for a single patient?6) If yes, the staff or Medical Records has the option to scan to an individual patient chart (vs. batch scanning described in step 9). Many times the front desk has received medical records from a patient checking in that need to be scanned immediately or Medical Records may have received multiple papers for a single patient for scanning. Follow the steps outlined below to scan to an individual patient’s chart: a) Staff or Medical Records logs into the Allscripts Enterprise EHR Scan application by double- clicking on the Allscripts Enterprise EHR Scan icon on their desktop. b) Staff or Medical Records enters their username and password and clicks OK. c) Staff or Medical Records then searches for the patient by selecting Patient Charts from under the Search menu. i) In the patient search window, the person performing the scanning enters search criteria for the patient. You can search for patients based on Name, MRN, DOB, and Phone. ii) Select the Type drop-down box to make your selection (Note: Partial strings may be used in some of the searches). iii) Click Search and a list of patients that meet your search criteria display. d) Once you find the correct patient, select from the list and click Select to open the patient’s chart. e) Once the patient is in context, the loose paper is ready to be scanned. f) Review the batch and determine if the batch contains multiple document types. If it does, the person performing the scan can select the Archives folder from the Chart Group to scan into. g) Click on the Scan icon located at the bottom left-hand corner of the window. i) The patient’s information defaults in the first three fields. ii) The Folder indicates the Chart Group folder into which the documents are scanned - Archives. iii) The Document Name and Date fields default to the system date and Folder. iv) Select the Duplex option if the scan job includes double-sided documents or the Flatbed option and the scanner will be prompted to continue scanning after each page. h) Place the documents to scan in the scanner and click Scan. The images appear in the right- hand panel as they are scanned. i) Once scanning is complete, the application returns to the patient chart. The Archives folder in the Chart Group now contains the scan job.11/18/2009 187 Allscripts Enterprise EHR Certified Workflows
  • 188. Documents filed into the Archive folder are not accessible in ChartViewer within Allscripts Enterprise EHR until the documents are filed to the appropriate destination folder. j) Select the Archives folder from the Chart Group. k) If multiple documents display within the document list pane, select the appropriate document that requires indexing. l) Click the Filer icon located at the lower-left hand corner of the window. m) With the first scanned image displaying, change the date to the document date or appropriate date of service. n) Click on the appropriate filer button to file the document to the final document folder. Documents filed into destination folders that are mapped to TW document types are immediately accessible in ChartViewer.7) If an organization does have a centralized scanning location, then the staff batches the papers together and has them couriered to that scanning location.8) The centralized scanning location receives the batch and begins preparing the loose papers to be scanned.9) Medical Records first sorts the batch by the different types of documents. For instance, they would sort all laboratory results together; all discharge summaries together; and so on.10) Once the batch has been sorted by document type, Medical Records can now scan the batch. Follow these steps to scan a batch: a) Medical Records logs into the Allscripts Enterprise EHR Scan application by double-clicking on the Allscripts Enterprise EHR Scan icon on their desktop. b) Medical Records enters their username and password and clicks OK. c) Medical Records clicks on the Batch icon on the top of the screen. The Batch Basket window displays. d) Click on the Scan icon. The Allscripts Enterprise EHR Scan: Batch Scan Documents window displays. e) Enter a name for the batch. The name of the batch should indicate the contents that are to be scanned, such as “Lab ABC Results – Date.” f) Assign a Default Document Name. This name should reflect the destination folder that is mapped to a corresponding Allscripts Enterprise EHR document type. g) Set the Default Document Date. This date defaults into the Date field when filing the documents. h) Select the Duplex option if the scan job includes double-sided documents or the Flatbed option and the person scanning will be prompted to continue scanning after each page. i) Place the documents to scan in the scanner and click Scan. The images appear in the right- hand panel as they are scanned. j) After the batch has been scanned, the application returns to the Batch Basket window. The newly created batch is listed here.11/18/2009 188 Allscripts Enterprise EHR Certified Workflows
  • 189. 11) The next step is to sort the batch to the appropriate patient chart. Follow these steps to index or sort to a patient’s chart: a) Highlight the batch to sort. b) Select Sort to Chart on the top menu. The Sort Documents to Charts window displays with page 1 in context within the right pane. c) Review the scanned image for the patient name and the date of service. d) Search for a patient in the lower-left corner. e) Highlight the appropriate patient. The highlighted patient information does not populate the search criteria below. Highlighting the patient is sufficient. f) Click the ellipsis (…) next to Current Folder to search on the final destination folder. g) Select the appropriate final destination folder and click OK. h) Change the Document Date to the appropriate encounter date or date of service. i) Click File Document. The document is now viewable in Allscripts Enterprise EHR.12) Does the document need to be routed for review within Allscripts Enterprise EHR?13) If yes, Medical Records creates a task for the appropriate document owner to review within Allscripts Enterprise EHR.14) Paper is then archived or destroyed per protocol.11/18/2009 189 Allscripts Enterprise EHR Certified Workflows
  • 190. (Q) Miscellaneous IntroductionAllscripts Enterprise EHR encompasses integrated task management tools and reporting capabilitiesthat are part of every installation. Some of the functionality that assists organizations withautomating and monitoring their medical practices can be accomplished through tasking and reports.Tasking plays an important role in supporting the communication of patient, clinical, and billinginformation in a physician’s office. Providers and their support staff can use tasking to quickly andeasily respond to incoming requests and maximize efficiency.Reports allow organizations to make better use of their clinical data as well as to understand anddrive business performance. Several application reports are available to display workflow-specificand system data within Allscripts Enterprise EHR. These may include the Chart reports (such asResults, Immunizations, Problems, and so on) or Prescription output. In addition, AllscriptsEnterprise EHR provides a number of administrative reports that can be used to monitor andmaintain a Allscripts Enterprise EHR system.The following workflows are discussed in this section: ▪ Call Processing—contains details about the Call Processing component that provides a mechanism for documenting incoming calls. This workspace is meant to facilitate the rapid entry of incoming requests and routing to the appropriate resources via tasking. Usage of Call Processing Text Templates is also discussed in this workflow. ▪ Tracking Overdue Orders—contains details about managing orders that have become overdue within the application and tracked through an outstanding orders report. Common reasons for an overdue order are the patient failed to present for an order, the result was never received for an order, or any reason where an order remains active and was never completed. ▪ Financial Authorization—contains details about managing orders that require financial authorization or approval from the patient’s insurance company.11/18/2009 190 Allscripts Enterprise EHR Certified Workflows
  • 191. Figure 56 (Q) Miscellaneous Q Call Processing? Yes Q1 No Tracking Overdue Q2 Yes Orders? No Order requiring Financial Yes Q3 Authorization? No End11/18/2009 191 Allscripts Enterprise EHR Certified Workflows
  • 192. (Q1) Call ProcessingThis workflow documents the certified steps for processing incoming patient telephone calls. TheCall Processing functionality in Allscripts Enterprise EHR is designed to allow staff to efficientlygather, route, communicate, and document patient phone calls. The primary method used to routecalls is via tasking.A few examples of potential patient calls are: ▪ Patient / Parent calls with a medical question. ▪ Patient / Parent calls with a prescription renewal request. ▪ Patient / Parent calls with a billing question. ▪ Patient / Parent calls with a medical/ sickness complaint. ▪ Patient / Parent calls with a test result question or request. ▪ Patient / Parent calls with a referral question or request. ▪ Pharmacy calls with a prescription renewal request. ▪ Nursing home calls with a patient report or question. ▪ Hospital calls with an inpatient report or question. Figure 57 (Q1) Call Processing1) The appropriate staff receives the incoming call. This may be a dedicated call center, front desk staff, or any role in your organization defined to answer calls.2) The staff selects a patient in Allscripts Enterprise EHR. To select a patient and bring them into context, follow these steps:11/18/2009 192 Allscripts Enterprise EHR Certified Workflows
  • 193. a) Staff should be logged into Allscripts Enterprise EHR. If not logged in, launch the application by double-clicking on the Allscripts Enterprise EHR desktop icon. b) Click on the Call Process horizontal toolbar. c) Click the Select Pt… button. The Select Patient dialog box displays. d) Search for the appropriate patient using any of the patient search options. e) Select the correct patient by double-clicking. The selected patient populates the Call Processing page and the patient banner. When a user selects a patient, the system displays the patient’s most recent appointment and the next scheduled appointment on the Call Processing page.3) Is the caller the patient?4) If not and another person is calling on behalf of the patient, the staff documents the caller’s information and relationship. To enter the caller and relationship information, follow these steps: a) Enter their name in the Caller field. b) Select the appropriate relationship to the patient from the Relation drop-down list. c) Enter up to two phone numbers for the caller. Specify the type of number, by selecting one of the options from the drop-down list (Day, Evening, Home, Mobile or Work).5) If the caller is the patient, the staff validates the patient information. Follow these steps: a) Check the Patient is Caller option. The patient’s information automatically populates the Caller, Relation, and Number fields. b) Verify that the information that populated is accurate. c) Add/edit phone numbers if necessary. Any modifications or additions you make to phone numbers within the Call Processing page in Allscripts Enterprise EHR will not update the patient’s profile within the Practice Management System.6) Are there near due or overdue order reminders for the patient?7) Staff discusses alerts with patient as defined by organization’s protocol.8) The staff documents the reason for the call. To document a call, do the following: a) Select a Reason for Call from the drop-down list. b) In the Comments section, enter the details of the call. Users may enter text either manually or with the use of Text Templates. i) If using a text template, click the Text Templates… button. ii) Select the appropriate text template from the list. iii) Click on and/ or enter the necessary information. iv) Click OK when finished.11/18/2009 193 Allscripts Enterprise EHR Certified Workflows
  • 194. Text templates allow organizations to create predefined or “canned” text that can be inserted into a text box, which saves the user from having to type in the same information over and over again.9) Does the user want to copy the call information to a task? If no, proceed to step 16.10) If yes, the staff copies the reason for call information to a task. Follow these steps: a) Click Copy To Task. Verify that the necessary information copied over correctly. b) Select a Task type, if necessary. Organizations can associate a Task type to each Reason for Call entry. Then, when users click Copy to Task, the task will automatically default based on the Reason for Call entry that was selected previously.11) Staff routes the task to the appropriate clinical user or team. Follow these steps to route a task to a user or team: a) Select the desired option button (User or Team) to whom the task should be assigned. b) Select the appropriate user or team from the drop-down list or by searching. To search for a user, click All, if necessary. c) Alter the Activate and Overdue Date, if necessary. d) Enter information for a Notify Task, if appropriate. e) Click OK. Users can specify a default destination (user or team) for tasks that are created from the Call Processing page using the Personalize link.12) Clinical staff/provider monitors their task list and selects a task. To select a task, follow these steps: a) User should be logged into Allscripts Enterprise EHR. If not logged in, launch the application by double-clicking on the Allscripts Enterprise EHR desktop icon and login. b) From the Chart menu, click the Task List horizontal toolbar and select the appropriate View from the drop-down list that contains the necessary tasks to review. c) Select the desired task by double-clicking it. The Task Detail dialog box displays. d) All necessary call information can be found under Comment History.13) After reviewing the call details, the clinical staff or provider determines if additional assistance is required. There may be instances where further guidance or information from another source regarding a patient problem is necessary. If additional input is required, the clinical staff/provider routes the information to the appropriate resource. If no assistance is needed, proceed to step 15.14) If additional input is needed, the clinical staff/provider updates the task details with the necessary information and routes it to the appropriate person. Follow these steps to update a task and reassign it:11/18/2009 194 Allscripts Enterprise EHR Certified Workflows
  • 195. a) The Task Detail dialog box should be open for the desired task. If not, select the desired task by double-clicking it. b) Select the desired option button (User or Team) to whom the task should be assigned. c) Select the appropriate user or team from the drop-down list or by searching. To search for a user, click All. d) In the Comments section, enter in the necessary details. Users may enter text either manually or with the use of text templates. e) Alter the Activate and Overdue Date, if necessary. f) Enter information for a Notify Task, if appropriate. g) Click OK. Steps 13-14 allow back and forth endless interaction between staff and providers.15) The clinical staff/provider updates task details as appropriate. Follow these steps to update a task: a) The Task Detail dialog box should be open for the desired task. If not, select the desired task by double-clicking. b) In the Comments section, enter in the necessary details. Users may enter text either manually or with the use of text templates. c) Click OK.16) Should the call information be copied to a note? Not every message will require a user to copy it to a note. Organizations should define the circumstances, especially for non-care related calls, when call information should be copied into a note. If a note is not needed, proceed to step 19. Only task history that should become an “official” part of the patient’s record/chart should be copied to a note. Organization should develop policies or procedures to guide staff on when it is appropriate to copy tasks to notes.17) If yes, the clinical staff or provider copies the call information to a note. Copy to Note is typically used when clinicians want to capture the detailed information, ongoing dialog, or further direction received regarding a patient’s problem or condition. This functionality can be utilized from the Task List or Call Processing page. To copy to a note, follow these steps: a) From the Task List: i) Highlight the appropriate task by single-clicking it. ii) Click Copy To Note. The Note Selector dialog box displays. iii) Update the Encounter information (if necessary) by clicking the binoculars icon to launch the Encounter Selector. iv) Select the appropriate Note type and Owner. v) Click OK. b) From Call Processing:11/18/2009 195 Allscripts Enterprise EHR Certified Workflows
  • 196. i) Complete documenting the reason for the call. ii) Click Copy To Note. The Note Selector dialog box displays. iii) Update the Encounter information (if necessary) by clicking the binoculars icon to launch the Encounter Selector. iv) Select the appropriate Note type and Owner. v) Click OK.18) The clinical staff or provider completes the note. To complete a note, follow these steps: a) With the note in context, the clinical staff or provider reviews the information that was copied into the note and documents any additional details as appropriate. b) Once complete, click Sign. The Note Signature dialog box displays. c) Enter the appropriate password. d) If the note should be made “final,” verify the checkmark is in the Make Final box. Otherwise, if it should not be made finalized at this time, uncheck the box. e) Click OK. Organizations should consider giving staff that have the ability to copy to note the appropriate signature authority level to make those documents final.19) Clinical staff or provider completes the necessary call details. This step refers to two different scenarios: a) The first, is when the staff member handling the incoming call cannot complete it after it has been started, yet plans to finish it later. i) To mark a call as Unfinished: (1) Complete documenting the reason for the call. (2) From the Call Process workspace, click Finish Later. The system adds the call information to the Unfinished Calls list (Unfinished Calls horizontal toolbar) for access later. b) The second is when the initial call information was copied to a task, routed to the appropriate person, and no further action is needed or required. i) To complete a task, do the following: (1) Highlight the appropriate task by single-clicking it. (2) Click Done.11/18/2009 196 Allscripts Enterprise EHR Certified Workflows
  • 197. (Q2) Tracking Overdue OrdersThis workflow describes the Certified Workflow steps for tracking overdue orders that originate inAllscripts Enterprise EHR. Organizations typically monitor the list of orders that become past dueclosely as it assists with identifying possible problems with missing results or patient complianceissues. Allscripts Enterprise EHR automatically creates an “Overdue Order” task for an active orderwhere the overdue date has passed. Figure 58 (Q2) Tracking Overdue OrdersTo track overdue orders, follow these steps:1) Overdue orders being reviewed by the clinical staff? Users can view a list of overdue orders within Allscripts Enterprise EHR or administrators can track orders through a report. If tracking orders will be handled administratively, proceed to step 4.2) If yes, clinical staff monitors overdue orders via a Worklist. To monitor the overdue orders via a Worklist, do the following: a) Clinical staff should be logged into Allscripts Enterprise EHR. If not logged in, launch the application by double-clicking on the Allscripts Enterprise EHR desktop icon. b) From the Chart menu, go to the Worklist horizontal toolbar. c) From the View drop-down list, select the appropriate enterprise Worklist View that contains the “Overdue Orders” to be worked.3) Clinical staff reviews an order and determines the appropriate action. To review the details of an overdue order, follow these steps: a) From the Overdue Orders Worklist View, select the appropriate patient by clicking on the patient’s name from the pane on the left side. The orders appear in expanded view in the right pane.11/18/2009 197 Allscripts Enterprise EHR Certified Workflows
  • 198. b) To see the necessary details for an order, do the following i) Double-click on the order to open the Order Details Viewer. c) To edit or update an order, do the following: i) Right-click on the order and select Edit from the context menu. Users can also highlight the order by single-clicking and click Edit from the action toolbar. d) To annotate an order, do the following: i) Right-click on the order and select Annotate from the context menu. Users can also highlight the order by single-clicking and click Annotate from the action toolbar.4) Administrator generates the Order Tracking report. To generate an order tracking report, follow these steps: a) Select the Reports vertical toolbar. The Reports tab should be active. b) Under the Reports Categories, expand Order by clicking on the plus sign. c) Click Order Tracking. d) Complete the necessary Filters and desired values as appropriate. The following filters are available in v11:  Ordered By  Authorized By  Patient Name  Ordered Test  Order Status  Order Status Reason  Order Age  Clinical Priority  Overdue Important  Overdue  To Be Done Date  Expiration Date  Requested Performing Location  Organization  Site e) Define a Primary or Secondary Sorts (if necessary). Listed below are the sort options that are available: Ordered By Authorized By Patient Name Ordered Test Clinical Priority Overdue Order Date To Be Done Date f) Place a checkmark in the Descending check box to change the sort order from Ascending (default) to Descending, if appropriate. g) Click Print to generate the report. The Print dialog box displays. h) Review the printer information and adjust if necessary.11/18/2009 198 Allscripts Enterprise EHR Certified Workflows
  • 199. i) Click OK.5) Administrator routes the Order Tracking Report per the organization’s protocol.6) The clinical staff completes any necessary order follow-up needed per organization’s protocol.11/18/2009 199 Allscripts Enterprise EHR Certified Workflows
  • 200. (Q3) Financial AuthorizationThis workflow provides detailed steps for completing an order that requires financial authorization.Some orders may require financial authorization or approval from the patient’s insurance companyprior to execution. This is typically done using an enterprise Worklist View that is set up for theappropriate staff, for working on the requests to insurance companies regarding orders placed forneeded approval. Figure 59 (Q3) Financial Authorization H5 H6 H7 H8 Q (1) (2) (3) Order status Staff completes Clinical Staff Q3 changes to insurance updates Financial Needs Info - verification Auth status as Financial Auth process appropriate (8) (4) (6) Provider voids or Was order Alternate or Yes Yes edits original order authorization edited order & determines new rejected? being placed? order if needed No No (5) (10) (7) (9) Clinical Staff Provider creates Provider voids Patient follow-up Yes notifies patient of task & indicates original order needed? outcome if needed appropriate action (11) Clinical staff monitors task list & completes necessary follow-up No End1) If financial authorization is required for a given order, the order goes to a “Needs Information” status pending the approval. ▪ An enterprise worklist view should be set up for the appropriate staff to work and monitor these items. The enterprise worklist view should contain orders that are in a status of “needs information” with an order status reason of “financial authorization” as well as other organization-specific workflow considerations (such as site, requested performing location, and so on). ▪ A financial authorization (Financial Auth) task is generated if active. Working orders via the worklist enables a user to update the order to reflect the appropriate status that would complete the worklist item as well as the associated task. Allscripts recommends keeping the ‘Financial Auth’ task active for tracking purposes.2) Staff completes the insurance verification process as outlined by their organization.11/18/2009 200 Allscripts Enterprise EHR Certified Workflows
  • 201. Obtaining financial authorization should be done per the organization’s protocol, with the status being tracked in Allscripts Enterprise EHR.3) The clinical staff updates the financial authorization status of the order to reflect the decision of the insurance company. To update an order’s financial authorization status via a worklist item, follow these steps: a) Clinical staff should be logged into Allscripts Enterprise EHR. If not logged in, launch the application by double-clicking on the Allscripts Enterprise EHR desktop icon. b) From the Chart vertical toolbar, click on the Worklist horizontal toolbar. The “Cross-Patient” Worklist displays. c) Select the appropriate worklist View from the drop-down list that contains the necessary financial authorization orders to review. d) Highlight the patient’s name from the left pane. All items that exist for that patient will display to the right. e) Right-click on the appropriate order and select Edit. The Order Details page displays. f) Under the Additional Details section, update the financial status (for example, Approved, Denied, and so on) as appropriate. g) Enter the Financial Authorization Number, if applicable. h) Click OK. i) Click Commit to save changes to the database. Some organizations may allow the clinical staff to perform minor edits to orders needing financial authorization in order to make it compliant and resubmit, such as number of treatments.4) Was the order authorization rejected by the patient’s insurance? Some reasons that orders are denied may be that the patients insurance does not cover that procedure, the order is not supported by the diagnosis, or it was against the health plan’s medical policy.5) If the order was authorized, the clinical staff communicates the outcome to the patient if needed.6) In the instance where the order was denied, is an alternate or edited order being placed? When an order’s financial authorization is denied, the order status reason changes to “Denial Response” and a “Denied Financial Authorization” task is created, if active.7) If no alternate order is placed, the provider voids the original order. To void an order, follow these steps: a) The provider should be logged into Allscripts Enterprise EHR. If not logged in, launch the application by double-clicking on the Allscripts Enterprise EHR desktop icon and login. b) Go to the Clinical Desktop horizontal toolbar. c) Select the “Worklist View” from the drop-down list. d) From the Patient Worklist component, select the appropriate Worklist View from the drop- down list that contains the necessary denied financial authorization orders to review.11/18/2009 201 Allscripts Enterprise EHR Certified Workflows
  • 202. e) Right-click on the appropriate order and select Void. The Change Status dialog box displays. f) Click OK. The Encounter Selector displays. g) Select the appropriate encounter. h) Click Commit to save changes to the database.8) If an alternate order is placed, the provider voids the original order and determines a new one. Providers could also modify some details of the original order and resubmit for approval. a) To void an order, follow these steps: i) The provider should be logged into Allscripts Enterprise EHR. If not logged in, launch the application by double-clicking on the Allscripts Enterprise EHR desktop icon and login. ii) Go to the Clinical Desktop horizontal toolbar. iii) Select the “Worklist View” from the drop-down list. iv) From the Patient Worklist component, select the appropriate Worklist View from the drop-down list that contains the necessary denied financial authorization orders to review. v) Right-click on the appropriate order and select Void. The Change Status dialog box displays. vi) Click OK. The Encounter Selector displays. vii) Select the appropriate encounter. viii) Click Commit to save changes to the database. b) To edit the original order, follow these steps: i) Go to the Clinical Desktop horizontal toolbar. ii) Select the “Worklist View” from the drop-down list. iii) From the Patient Worklist component, select the appropriate Worklist View from the drop-down list that contains the necessary denied financial authorization orders to review. iv) Right-click on the appropriate order and select Edit. The Order Details page displays. v) Update the order with the necessary details, as appropriate. vi) Under the Additional Details section, change Fin. Auth. Status back to Needed for approval. vii) Enter comments under the Order Annotations section, if necessary. viii) Click OK. The Encounter Selector displays. ix) Select the appropriate encounter. x) Click Commit to save changes to the database.9) Patient follow-up needed?10) Provider creates task and indicates the appropriate action. To create a task, follow these steps: a) Single-click on the desired order.11/18/2009 202 Allscripts Enterprise EHR Certified Workflows
  • 203. b) Click on the New Task icon. The Task Detail dialog box displays. c) Select the Task type of Go to Order from the drop-down list. d) Select the desired option button (User or Team) to whom the task should be assigned. e) Select the appropriate user or team from the drop-down list or by searching. To search for a user, click All. f) In the Comments section, enter in the necessary details. Users may enter text either manually or with the use of text templates. g) Alter the Activate and Overdue Date, if necessary. h) Enter information for a Notify Task, if appropriate. i) Click OK.11) Clinical staff monitors the task list and completes any necessary follow-up. To review and complete a task, follow these steps: a) User should be logged into Allscripts Enterprise EHR. If not logged in, launch the application by double-clicking on the Allscripts Enterprise EHR desktop icon and login. b) From the Task List horizontal toolbar, select the appropriate View from the drop-down list that contains the necessary tasks to review. c) Single-click on the desired Go to Order task. Review the provider comments under the Comments section (bottom left pane). To view additional information regarding the order, double-click the task to open the Order Details screen. d) Complete follow-up instructions and click Done when complete.11/18/2009 203 Allscripts Enterprise EHR Certified Workflows
  • 204. (R) Results IntroductionResults management is the review of laboratory and other diagnostic results, which is an importantcomponent of medicine and critical to providing quality patient care. Results can be presented inmultiple formats. Such formats may include electronically via an inbound results interface, receivedas a hardcopy report or paper result from a reference laboratory via courier, fax or designatedprinter, or captured as part of the medical history for new or existing patients from external records.Result is an integral part of the (H) Order and Plan (Patient Visit) Workflows and completes theorder lifecycle.The workflows contained in this section are organized as follows: ▪ Entry of Paper Results—provides detailed steps to handle the entry of paper results into the record that may be received from a diagnostic vendor where no result interface has been implemented or brought in by the patient from an external source. ▪ In-house Testing— provides detailed steps for managing the resulting of in-house tests or procedures. These results may be received as part of an organization’s protocol or as the result of a verbal order from the provider. ▪ Results Verification—provides detailed steps for managing and responding to electronic results that require verification. This workflow includes steps for the provider to review and act on the results, along with details to specify how results are to be communicated to patients, such as by calling or through the mail. ▪ Results Referral—provides instructions for receiving consultative results or reports from a referral order (for example, a consult letter from a specialist). This workflow includes steps for the referring provider receiving the consultative result back as a carbon copy (cc) from another provider who is also a user of Allscripts Enterprise EHR, as well as the steps if the provider is not a user of Allscripts Enterprise EHR and the consultative result comes back in as a paper report. ▪ Results Communication—describes the workflow steps for managing the requests from providers on how to communicate results to patients. This workflow completes the patient communication process started in the Results Verification workflow.11/18/2009 204 Allscripts Enterprise EHR Certified Workflows
  • 205. Figure 60 (R) Results K1 Entering paper R1 R Yes results? No Resulting an In- R2 Yes house test? No Results require electronic Yes R3 verification? No Results from R4 Yes a referral? No Communicating verified results to Yes R5 patient? No End11/18/2009 205 Allscripts Enterprise EHR Certified Workflows
  • 206. (R1) Entry of Paper ResultsThis workflow provides detailed steps to handle the entry of paper results. These paper results maybe received from a diagnostic vendor where no result interface has been implemented or brought inby the patient from an external source. Figure 61 (R1) Entry of Paper Results H5 H6 R (3) (4) (1) (2) Results received Clinical Staff enters R1 Paper results Is discreet data Yes Yes originate from a TW results against received required? Order? original order (5) Clinical Staff find (6) No the appropriate Result Verification Yes R3 No order & enter required? results No (7) (8) (9) Results data Results received Clinical Staff available End Yes originate from a TW updates the order within Order? status TouchWorks (10) Clinical Staff routes No paper results to ordering provider G5 (13) (11) (14) (12) Provider generates Ordering Provider Clinical Staff Is action Yes Results Note & reviews paper completes required required? initiates appropriate results and initials actions actions (15) Clinical Staff routes P2 No paper results for scanningTo enter paper results, follow these steps:1) A hardcopy paper result is received from a diagnostic vendor or external source. Organizations may receive hardcopy results from diagnostic vendors, reference labs, or hospitals where no result interface was implemented.2) Is discreet data required? Discreet results data allows additional functionality to be utilized, such as flowing or graphing/trending of results data over time.3) If yes, did results received originate from a Allscripts Enterprise EHR Order?4) If the results did originate from a Allscripts Enterprise EHR Order, the clinical staff enters the results against the original. To enter results against an order, follow these steps: a) Clinical staff should already be logged into Allscripts Enterprise EHR. If not logged in, launch the application by double-clicking on the Allscripts Enterprise EHR desktop icon. b) Click Select Patient. The Select Patient dialog box displays. c) Search for the appropriate patient using any of the patient search options.11/18/2009 206 Allscripts Enterprise EHR Certified Workflows
  • 207. d) Select the correct patient by double-clicking. The selected patient is brought into context and populates the Patient Banner. e) Go to the Clinical Desktop horizontal toolbar. f) Click on the Orders Component tab. The “Current Orders” by status displays for the patient. g) Right-click on the appropriate order and select Enter Result from the context menu. The Order Details page with the Result tab active displays. h) Select the appropriate Collected/Examined date or click Now. i) Validate the provider is accurate within the Ordered By field. j) Select the appropriate Performing Location. k) Select the appropriate Performed By Provider from the drop-down list or click on the binoculars icon to search. l) Enter the Collected/Examined date and time by clicking on the calendar icon or by clicking the Now button. m) Enter any Result Annotations (if necessary). n) Enter in Values for Result Item(s) and set Flag(s) as appropriate.5) If the order did not originate from a Allscripts Enterprise EHR order, the clinical staff searches for the order and enters the results. To enter results, follow these steps: a) Clinical staff should already be logged into Allscripts Enterprise EHR. If not logged in, launch the application by double-clicking on the Allscripts Enterprise EHR desktop icon. b) Click Select Patient. The Select Patient dialog box displays. c) Search for the appropriate patient using any of the patient search options. d) Select the correct patient by double-clicking. The selected patient is brought into context and populates the Patient Banner. e) From the Clinical Toolbar, click the Add New Order icon. The Add Clinical Item workspace displays. f) From Rx/Orders, select the appropriate secondary tab for the item you want to order: ▪ Lab/Diag for laboratory/diagnostic orders ▪ Imaging for radiology orders g) Find the order via Specialty or Personal Favorites, QuickList or Master search. h) Right-click on the order and select Enter Results from the context menu. The Encounter Selector dialog box displays. i) Select the appropriate Encounter. The Order Details page with the Result tab active displays. j) Select the appropriate ordering provider within the Ordered By field. k) Select the appropriate Performing Location. l) Select the appropriate Performed By Provider from the drop-down list or click on the binoculars icon to search. m) Enter the Collected/Examined date and time by clicking on the calendar icon or by clicking the Now button.11/18/2009 207 Allscripts Enterprise EHR Certified Workflows
  • 208. n) Enter any Result Annotations (if necessary). o) Enter in Values for Result Item(s) and set Flag(s) as appropriate.6) Is result verification required? If the ordering provider needs to verify the results, the user has the option to flag the order during results entry. To require results verification, follow these steps: a) When entering results (as outlined above), make sure a checkmark exists next to the Verification Required check box under the Results Details section. b) Click OK when finished on both the Order Details page and the ACI. c) Click Commit to save changes to the database. Administrators can default this field as checked (to require verification) by setting the “Results Verification Required” results preference. d) Proceed to workflow (R3) Results Verification for the Certified Workflow steps.7) If no tasking is needed, the discreet results data is available within Allscripts Enterprise EHR.8) Did the results received originate from a Allscripts Enterprise EHR order? Even though the paper results received are not going to be entered in as discrete data, the order may have originated from Allscripts Enterprise EHR.9) If yes, the clinical staff updates the order status to reflect that results were received. To update an order’s status, follow these steps: a) Clinical staff should already be logged into Allscripts Enterprise EHR. If not logged in, launch the application by double-clicking on the Allscripts Enterprise EHR desktop icon. b) Click Select Patient. The Select Patient dialog box displays. c) Search for the appropriate patient using any of the patient search options. d) Select the correct patient by double-clicking. The selected patient is brought into context and populates the Patient Banner. e) Go to the Clinical Desktop horizontal toolbar. f) Click on the Orders Component tab. The “Current Orders” by status displays for the patient. g) Right-click on the appropriate order and select the desired action from the context menu (such as Annotate, Complete, and so on). h) Update the order as appropriate and click OK when finished. i) Click Commit to save changes to the database.10) Clinical staff routes the paper results to the ordering provider for review.11) The ordering provider reviews the paper results and initials to signify verification.12) Is any action or follow up required?13) If yes, the provider creates a Results Note and initiates appropriate actions for the patient. Proceed to workflow (G5) Note – Results Review for the Certified Workflow steps.14) Clinical staff completes any required actions as appropriate.11/18/2009 208 Allscripts Enterprise EHR Certified Workflows
  • 209. 15) The provider or clinical staff routes the paper results to Medical Records to be scanned. Proceed to workflow (P2) Scanning Correspondence for the Certified Workflow steps for scanning loose paper.11/18/2009 209 Allscripts Enterprise EHR Certified Workflows
  • 210. (R2) In-House TestingThis workflow provides detailed steps for managing in-house tests or procedures. These orders maybe received as part of an organization’s protocol or as a verbal order from the provider to complete. Figure 62 (R2) In-House Testing H5 H6 R (1) (2) (3) R2 In-house order Verbal Order or Yes Clinical Staff selects received part of protocol? order & enters results No (4) (5) Ancillary/Clinical Staff (6) Ancillary/Cinical Staff R3 monitors Worklist & Result Verification Yes performs order & selects appropriate required? enter results Order No (7) Results data available within End TouchWorksTo manage tests performed in-house, follow these steps:1) In-house order is received.2) Was the order received as part of a protocol or a verbal order from the provider to complete?3) If yes, the clinical staff selects the appropriate order and enters results. To enter results for an order, follow these steps: a) Clinical staff should already be logged into Allscripts Enterprise EHR with the appropriate patient in context having been selected from the schedule. b) From the Clinical Toolbar, click the Add New Order icon. The Add Clinical Item (ACI) workspace displays. c) From Rx/Orders, select the appropriate secondary tab for the item you want to order: ▪ Lab/Diag for laboratory/diagnostic orders ▪ Imaging for radiology orders d) Find the order via Specialty or Personal Favorites, QuickList or Master search. e) Right-click on the order and select Enter Results from the context menu. The Order Details page with the Result tab active displays. f) Select the appropriate ordering provider within the Ordered By field. g) Select the appropriate Performing Location.11/18/2009 210 Allscripts Enterprise EHR Certified Workflows
  • 211. h) Select the appropriate Performed By Provider from the drop-down list or click on the binoculars icon to search. i) Enter the Collected/Examined date and time by clicking on the calendar icon or by clicking the Now button. j) Enter any Result Annotations (if necessary). k) Enter in Values for Result Item(s) and set Flag(s) as appropriate.4) Ancillary or clinical staff monitors the worklist for orders entered by the provider and selects the appropriate order for the patient. To select an order from the worklist, follow these steps: a) Ancillary or clinical staff should be logged into Allscripts Enterprise EHR. If not logged in, launch the application by double-clicking on the Allscripts Enterprise EHR desktop icon. b) From the Chart vertical toolbar, click on the Worklist horizontal toolbar. The “Cross-Patient” Worklist displays. c) Select the appropriate worklist View from the drop-down list that contains the necessary in- house orders to perform and result. d) Highlight the patient’s name from the left pane. All items that exist for that patient will display to the right.5) Ancillary or clinical staff performs the required order as appropriate and enters results. a) From the Worklist workspace, right-click on the appropriate order and select Enter Results. The Order Details page displays. b) Select the appropriate ordering provider within the Ordered By field. c) Select the appropriate Performing Location. d) Select the appropriate Performed By Provider from the drop-down list or click on the binoculars icon to search. e) Enter the Collected/Examined date and time by clicking on the calendar icon or by clicking the Now button. f) Enter any Result Annotations (if necessary). g) Enter in Values for Result Item(s) and set Flag(s) as appropriate.6) Is result verification required? If the ordering provider needs to verify the results, the user has the option to flag the order during results entry. To require results verification, follow these steps: a) When entering results (as outlined above), make sure a checkmark exists next to the Verification Required check box under the Results Details section. b) Click OK when finished on both the Order Details page and the ACI. c) Click Commit to save changes to the database. Administrators can default this field as checked (to require verification) by setting the “Results Verification Required” results preference. d) Proceed to workflow (R3) Results Verification for the Certified Workflow steps.11/18/2009 211 Allscripts Enterprise EHR Certified Workflows
  • 212. 7) If verification is not required, the results data becomes available within Allscripts Enterprise EHR once the information is committed to the database.11/18/2009 212 Allscripts Enterprise EHR Certified Workflows
  • 213. (R3) Results VerificationNote: This workflow is specific to Allscripts Enterprise EHR 11.1.7.This workflow provides the detailed steps to manage the verification of results. Users will need tohave the necessary security privileges assigned to be allowed to verify results (Results-Verify). Allresults requiring verification are managed from a Worklist. Additionally a task will exist for eachpatient that have results assigned to a provider that needs verification.It is important to understand the how each configuration element is set up in order to fully optimizethe desired workflow. For instance, with a few minor differences in the required configurations,providers that need their result verification activities supervised can rely on the result note to providetheir supervising provider the mechanism for reviewing and co-signing their work.1) Configuration Suggestions for Providers: a) Results Verification (RV) preferences have be setup as follows (which the user is able to update/override the defaults): ▪ RV Append Staff Message to Task Comment Default For Verify… = Y ▪ RV Disable To/CC = N ▪ RV If Did not Order = Warn ▪ RV Navigation After QVerify = Go To Next Patient ▪ RV Note Type For QVerify = Results Document FoS (Finalize on Save) – Option will be ignored if RV Note Use For QVerify = No Note ▪ RV Note Type For Verify… = Results Document FoS ▪ RV Note Use For QVerify = No Note ▪ RV Note Use For Verify… = Create New Note ▪ RV Pt Communication Methods For QVerify = No patient communication needed at this time ▪ RV Pt Communication Methods For Verify… = Mail Results to Patient ▪ RV Task Assignment = Ordering Provider ▪ RV Shows Verified Results in results document for QVerify = Y ▪ RV Shows Verified Results in results document for Verify… = Y b) General preferences have been setup as follows: ▪ Encounter Selection from Worklist = Create New Encounter ▪ Encounter Type For Worklist = Chart Update ▪ Workspace view for tasks that navigate to worklist = Worklist Desktop View2) Configuration Suggestions for Results Documents: a) Create two different Results document types. The reason for two document types is to assist with the different workflow expectations when utilizing one note versus another. One document would be setup so that it would finalize on save when verifying where users will not be required to sign any output. The other would be setup to require signature and could be used to prompt for further sign-off for those providers requiring supervision, if needed. i) Results Document FoS – Signature Not Required: ▪ Document Type ownership & finalization authorities need to be equal to the authority level of the lowest user role that is expected to verify results or update the note (e.g.11/18/2009 213 Allscripts Enterprise EHR Certified Workflows
  • 214. Nurse = Level 5). For instance, if nurses are going to update the note then they should have sufficient authority. ▪ Manifestation = NOTEFORM ▪ Workflow = Non Electronic ▪ Document type should be “Finalize Note on Save” ▪ Input & Output templates ownership & finalization authorities should mirror the document type ii) Results Note – Requires Signature ▪ Document Type ownership authority needs to equal to the authority level of the lowest user role that is expected to verify results (e.g. Resident = Level 6) ▪ Document Type finalization authority needs to be greater than the finalization authority of the resident & less than or equal to the finalization authority of the attending/supervising provider (e.g. Level 8) ▪ Manifestation = NOTEFORM ▪ Workflow = Electronic Signature ▪ Prompt to Route for Signature = Y (if wanting to route for further signature to finalize ▪ Input & Output templates ownership & finalization authorities should mirror the document type. ▪ Note Output for the Chart Note (mirror’s document type name) should be flagged (checked) to Create Task – Call Patient with Results when requested. ▪ Note Output for the patient (such as, Patient Results Summary) should be flagged (checked) to Create Task – Mail Results to Patient when requested.3) Create a Results Patient Summary Output document type: ▪ Document Type ownership & finalization authorities need to be equal to the authority level of the lowest user role that is expected to verify results (e.g. Nurse = Level 5) ▪ Manifestation = NOTEFORM ▪ Workflow = Non Electronic ▪ Output template ownership & finalization authorities should mirror the document type4) Configuration Suggestions for Worklists: a) The goal of worklist is to present all the order and result activities that need to be completed by the provider for a given patient. Worklist should include at least the following: ▪ Order Status Reasons = Requires Signature & Requires Verification ▪ Authorizing (Supervised by) Provider = Current Provider b) If the ordered by and the supervised by fields for the resulted order are different, set the Ordering Provider filter instead of the Authoring Provider to use Current Provider.11/18/2009 214 Allscripts Enterprise EHR Certified Workflows
  • 215. Figure 63: (R3) Results VerificationTo verify results, follow these steps:1) Results are received or manually resulted and require electronic verification.2) The provider reviews the results requiring verification via the Patient Worklist component on the Clinical Desktop. A provider will typically begin verifying their results either from the task list if re- entering Enterprise EHR or directly from the Clinical Desktop if already within the application: a) When starting from the task list, follow these steps: i) Provider begins by logging into Enterprise EHR. ii) From the Chart menu, click on the Task List horizontal toolbar. iii) Select the appropriate task view from the View dropdown list that contains Verify Patient Results tasks (such as, Order-Result Mgmt). iv) Double-click on the desired Verify Patient Results task. The patient is brought into context in the Banner and the system navigates to the user’s defined Clinical Desktop View (e.g. Worklist Desktop View). The general ‘Workspace view for tasks that navigate to worklist’ preference controls what Clinical Desktop View is defaulted for the user. It is highly recommended that administrators and/or end-users select a view that is patient worklist-centric. b) When starting from the Clinical Desktop horizontal toolbar, follow these steps: i) Select a Clinical Desktop View that is patient worklist-centric (such as, Worklist Desktop View) from the view dropdown list. Or users can go to the Patient Worklist component, if available on their current Clinical Desktop View.11/18/2009 215 Allscripts Enterprise EHR Certified Workflows
  • 216. c) Validate that the worklist view displays the necessary provider work to be done. If not the desired worklist view, select another view from the component dropdown list. It is recommended that administrators define a worklist default view for users that contain all the work that needs to be done for a patient (such as Order-Result Management). The default will always use the patient in context (even when the patient does not have any worklist items). Providers can click on the Next Patient arrow to go to the next patient on the worklist. Or they can select a specific patient from the dropdown list.3) Is the provider responsible for the results? There may be instances where a provider is working their worklist and encounters an order requiring verification that incorrectly lists them as the ordering provider. The provider can either bring the error to some else’s attention or fix it themselves.4) If the provider is not the responsible, does he/she know who is?5) If yes, the provider updates the results to the correct ordering provider. To update and reassign to the correct provider from the patient worklist, follow these steps: a) Right-click on the desired order and select Update Provider from the context menu. Or click on the Update Provider button on the component toolbar, if present. The Update Provider dialog displays. b) Select the appropriate ordering provider from the Ordered by drop-down list or click on the binoculars icon to do a search. c) Enter an annotation, if necessary. d) Click OK when finished.6) If the correct provider is unknown, the provider reassigns the order to the Unknown, Ordering Provider (system user) to be reconciled by the appropriate team within the organization. To update and reassign from the patient worklist, do the following: a) Right-click on the desired order and select Update Provider from the context menu. Or click on the Update Provider button on the component toolbar, if present. The Update Provider dialog displays. b) Select the Unknown, Ordering Provider from the Ordered by dropdown list or click on the binoculars icon to do a search. Administrators should create a dummy provider (such as Unknown, Ordering Provider) for providers to route orders that they have incorrectly received. This allows Medical Records or another team to monitor these items and complete the necessary action. c) Click OK when finished.7) The results and the Verify Patient Result task are reassigned to the updated ordering provider. a) Click on the Next Patient arrow to go to the next patient on the worklist. Or select a specific patient from the dropdown list.11/18/2009 216 Allscripts Enterprise EHR Certified Workflows
  • 217. 8) If the provider is responsible for the results, are they valid for the patient in context? If yes, proceed to step 11.9) If the results are not valid, the provider enters the results in error. To Enter in Error Results from the patient worklist component, do the following: a) Right-click on the desired order and select Enter in Error Results from the context menu. Or click on the EIE Results button on the component toolbar, if present. The Encounter Selector dialog displays. Users must have the appropriate security privileges assigned to be allowed to enter in error results, assuming that that security gate is locked. Administrators should assign the Results-Invalidate security code to the appropriate user roles’ security classifications to permit users to invalidate/enter in error results. b) Select an encounter and click OK. c) Click Commit to save changes.10) The system creates a Result Invalid task assigned to the Med Rec Team. Proceed to (R6) Results Monitoring workflow for more information and steps on monitoring result-related tasks (such as, Results Invalid).11) If the results are valid, does a clinical action need to be taken due to the results? The results received may prompt the provider to take clinical action and update the patient’s chart. For instance, the provider may want to re-order the test, adjust a current medication, or place new orders.12) If yes, the provider makes the necessary updates to the patient’s record and commits the data before verifying their results. This will bring all the updates into the Results Document, if defined. a) To re-order a test that was resulted, follow these steps: i) Right-click on the orderable item and select Order from the context menu. The Encounter Selector displays. ii) Select an encounter and click OK. The Order Details dialog displays with the same information that was previously used for that order. iii) Update any order information, as appropriate. iv) When finished, click OK to close the Order Details dialog. v) Click Commit to save changes to the database. Please refer to the (H) Order & Plan Certified Workflows for more information on creating orders.13) Does the provider want to add Staff or patient instructions and/or adjust their Results Verification (RV) default preferences? The provider can specify patient communication actions, tasks, notes, messages, and annotations for the verified results that would differ from the preferences set for verification.11/18/2009 217 Allscripts Enterprise EHR Certified Workflows
  • 218. The preferences for verification are already selected as the defaults when the form displays. These preferences can be set by an administrator or by the user through the Results tab of the Personalize form or by a system administrator through TW Admin-Preferences-Results.14) If no, the provider clicks QVerify All on the component toolbar (if present) to verify all results with their predefined RV defaults. If not present, the provider right-clicks on an order and selects QVerify All from the context menu. Users can QVerify results individually by selecting a result and selecting the QVerify option from the right-click context menu. a) The user will be taken to the place specified according to the “Result Verification Navigation After QVerify” personalize setting. The ‘Result Verification Navigation After QVerify’ personalize preference controls where the provider is brought next. They can be taken to the next patient in the work list; stay within the same patient’s record, or go to the note to add additional details to the results documentation.15) If the provider wants to add some instructions and/or make adjustments, the provider selects Verify All… to launch the Results Verification Dialog. The user’s default Verify… preferences will display. To add instructions or modify Results Verification preferences from the Patient Worklist, do the following: i) Right-click and select Verify All… from the context menu. Or select Verify All… from the Verify ▼component toolbar, if present. Users can add instructions and modify preferences for individual results by using the Verify… option from the right-click context menu.16) The provider completes the necessary actions, as appropriate. Some of these activities may include: a) Adjust the patient communications method and enter task comments: i) Place a checkmark in the box to select the desired patient communication method(s). The following patient communication options are available: ▪ Call Patient with Results – creates a task to call the patient and discuss the verified results. This option requires a Result Document. ▪ Schedule Results F/U – creates a task to schedule a follow-up visit with the patient to discuss the verified results. This option can be used with or without a results document. ▪ Mail Results to Patient – creates a task to mail the patient a printout of the verified results. This options requires a Results Document. ▪ No patient communication needed at this time – indicates that no patient communication for the verified results is required. This option does not create a task, but will uncheck (or deselect) all other patient communication options.11/18/2009 218 Allscripts Enterprise EHR Certified Workflows
  • 219. ▪ Discussed results with Patient – indicates that the verified results were discussed with the patient and no follow-up is needed. This option does not create a task nor will it disable other patient communication options. Administrators can create additional communication options that will behave similar to “Discussed results with Patient” within the Result Communications dictionary. These entries will appear within the pane along with the other available options that do not create tasks. ii) Once the checkbox is checked next to Call Pt with Results and/or Schedule Results FU, the user may include comments for the task assignee. To add comments, users can type directly in the text field or use a Text Template (TT) to select predefined text. (1) To use a Text Template, do the following: (a) Click the TT button. The Free Text dialog displays with the list of Result-Text Templates (if any). (b) Select the appropriate text template from the list. Select the necessary information. (c) Click OK when finished. b) Enter a message or instructions to the staff by typing directly in the text field or use a Text Template. Text entered in the Message to Staff field will appear in the Message section of the Note. i) If using a Text Template to enter comments, do the following: (1) Click the TT button. The Free Text dialog displays with the list of Result-Text Templates (if any). (2) Select the appropriate Text Template from the list. Select and/or enter the necessary information. (3) Click OK when finished. c) Enter a message or instructions for the patient by typing directly into the text field or use a Text Template. Text entered into the Message to Patient field displays in the Discussion/Summary section of the v11 Note. i) If using a text template to enter comments, do the following: (1) Click the TT button. The Free Text dialog displays with the list of Result-Text Templates (if any). (2) Select the appropriate Text Template from the list. Select and/or enter the necessary information. (3) Click OK when finished. When using v11 Note, at least one output document should be configured to include the Message section. d) Providers can also enter annotations to apply to all results being verified, by typing directly into the text field or use a Text Template, if appropriate. i) If using a Text Template to enter comments, do the following:11/18/2009 219 Allscripts Enterprise EHR Certified Workflows
  • 220. (1) Click the TT button. The Free Text dialog displays with the list of Result-Text Templates (if any). (2) Select the appropriate Text Template from the list. Select and/or enter the necessary information. (3) Click OK when finished.17) Does the provider want to update the specified default Results Document for Verify…? There may be instances where the provider wants to update the default Results Document to complete a particular workflow (see introduction for configuration options). For instance, a provider may need to send a referral letter, or a resident may need to route the note to their supervising provider for review.18) If yes, the provider adjusts the Results Document setting. Use one of the following: i) Incomplete – if using an existing incomplete note for the result document. This option is not recommended as the note type selected (if not results-specific) may not be setup to display the appropriate output when requested by a Result-Pt Communication task. (1) Select the Incomplete radio button and select the appropriate note from the dropdown list ii) New - to create and indicate a new note to use for results verification. (1) Click the Note Options icon to change or specify a note type. The RV Note Option Dialog displays. (2) Adjust the Style and/or Specialty, if needed. (3) From the Visit Type dropdown list, select the desired note type (such as, Results Note). (4) Update the Owner by selecting an appropriate provider from the dropdown list or click on the binoculars to do a search. (5) Click OK to save the note options selected and close the dialog. iii) To/CC – if wanting to send a copy of the note along with the verified results to other providers or referring providers. (1) Click on To/CC to open the Carbon Copies dialog to identify the appropriate recipients. Add a recipient using any of following options: ▪ Role: Place a checkmark next to the appropriate provider or current patient selection in the box located in the Role column.Manual: Click on the Manual tab and select either a provider or referring provider from thecorresponding dictionary lookup.Ad Hoc: Click Ad Hoc and manually enter in the recipient’s name and select the method ofcommunication: Print or Fax. Finish by typing in optional information of address, city, state, ZipCode, and fax number. (2) Click OK when finished to return to the RV Dialog.19) Does the provider want to go to Note? The note being utilized above should determine whether or not the provider goes to the note authoring workspace. a) If the provider selects a note that requires signature, they should go to note to complete any remaining activities.11/18/2009 220 Allscripts Enterprise EHR Certified Workflows
  • 221. b) If the provider is utilizing a note set to finalize on save, they do not need to go to note. If the provider performing results verification requires supervision then it is recommended they always use the Verify & Go To Note option so that they can sign the note and route it to their supervising provider for review and signature.20) If the provider needs to go to the note, they click Verify & Go to Note when on the RV dialog. The provider may also be taken to the Note Authoring Workspace automatically if they are using their default behavior for RV Navigation After QVerify and it is set to “Go To Note”. Please refer to the (G5) Note: Results Review workflow to learn more about documenting within a note. a) The Note Authoring Workspace (NAW) displays. b) Reviews the note and complete any remaining activities. c) When finished, click Sign. The Note Signature dialog displays. d) Enter required signature, and click OK. i) If the document type is setup to prompt for further signature, a dialog box is presented immediately after the first user signs the document to identify a second user to sign the note. This is typically checked if residents or mid-level providers are signing these documents. The dialog box will facilitate sending a task to the physician to review the note and sign. If the first signing user has the authority to finalize the note and does so, then this dialog box will not display. e) The user will then navigate to one of the following options based upon their ‘Note Default Navigation After Signing’ setting. ▪ No Navigation: The Note closes, is taken out of context, and the user navigates to the form from which they started before bringing the Note into context. ▪ Schedule: The Note closes, is taken out of context, and the user navigates to the Schedule. ▪ Task view: The Note closes, is taken out of context, and the user navigates to the Task view. ▪ MD Charges: The Note closes, is taken out of context, and the user navigates to Charges. f) Return to the Patient Worklist, and click the Next Patient to go to the next patient on the worklist.21) If the provider does not go to the note, they click Verify & Next Patient on the RV dialog. This closes the dialog and goes to the next patient on the worklist. The provider may also advance to the next patient on the worklist if they are using their default behavior for RV Navigation After QVerify and it is set to “Go To Next Patient”.22) Do the results need to be communicated to the patient or a follow up appointment scheduled? If yes, proceed to workflow (R5) Results Communication to learn about how the Clinical Staff manages the patient communication of results.11/18/2009 221 Allscripts Enterprise EHR Certified Workflows
  • 222. (R4) Results ReferralNote: This workflow is specific to Allscripts Enterprise EHR 11.1.7.This workflow provides the detailed steps to manage receipt of a consult report generated from areferral visit. This may be a paper report received from a consulting provider outside of yourorganization or the report may be received from a consulting provider inside of your organizationwho is a user of Allscripts Enterprise EHR. Figure 64 (R4) Results ReferralTo manage receipt of a consult report from a referral visit, do the following:1) Is the consulting provider a user of Allscripts Enterprise EHR?2) If yes, the consult report may be returned to the referring provider utilizing the CC (carbon copy) functionality within a document or note to send a task within Allscripts Enterprise EHR. The consulting provider completes the patient visit and consultation report/ documentation. Follow the (G) Document workflows for the Certified Workflow steps to create documentation. Documentation may be created from Note using Visit Types and Input Templates as appropriate or a dictated report can be done from the Schedule screen.3) The consulting provider then uses the CC (carbon copy) functionality during documentation to send a task to the ordering provider. Follow these steps to select a task for the document or note in carbon copy: a) The consulting provider logs in.Verify the correct patient is in context either from having created a note or reviewing a document(received back from dictation). b) Select the CC action. ▪ If the document was dictated or created as an unstructured document, the CC action is located within the Document workspace.11/18/2009 222 Allscripts Enterprise EHR Certified Workflows
  • 223. CC Action within the Document workspace ▪ If the document was created in Note as a structured document, the CC action is located within the Note Output workspace. CC Action within the Note Output workspace c) From the Orig. Note tab, select the appropriate referring provider. d) Validate the option button is under the clipboard icon. This is the selection that will generate a task. e) Click OK.4) For a dictated (unstructured) document a Review Document delegated task is generated. For a Note (structured) a Notify Provider of Note delegated task is generated.5) To allow the completion of the original referral order, this delegated task is reviewed by the clinical staff prior to releasing the task and consult document to the referring provider. Follow the steps below to review the appropriate task and change the referral order status: a) Clinical staff logs in. b) Go to the Chart menu and Task List workspace. c) Select the appropriate Task View for Results-Referral Orders. d) Select the desired task (single-click) only to highlight. It is not necessary to double-click the task. The single-click will put the correct patient in context in the Banner. These are notification tasks only to prompt the clinical staff resource to complete the associated referral order. e) Select the qChart icon from the floating Clinical Toolbar. f) Go to the Orders (or Meds/Orders) component. g) Locate the desired referral order, right-click and select Complete from the context menu. h) Click Commit from the floating Clinical Toolbar and close the Clinical Desktop (click on the Windows “x”).6) From the Task List workspace, verify the correct task is still highlighted and click on the Undelegate button. The task should disappear from the Task View and now be available for the referring provider to review.7) The referring provider receives the appropriate task with the associated consult documentation. Follow these steps to review and sign the consult document: a) The referring provider logs in.11/18/2009 223 Allscripts Enterprise EHR Certified Workflows
  • 224. b) Go to the Chart menu and the Documents workspace. c) Highlight the appropriate patient and review the consult documentation. d) For a dictated (unstructured) document when the review is complete, click the Done button. The task will auto-clear from the task window. e) For a Note (structured) when the review is complete, click the Sign button. Type in the appropriate password and verify the Sig. Type is set to Review. Click OK – the task will auto-clear from the task window. Selecting a patient who has a dictated (unstructured) consult document will display the text in the right viewer pane. However, selecting a patient who has a note (structured) consult document will open the Note Output Template workspace.8) If the consulting provider is not a user of Allscripts Enterprise EHR, a paper consult report will be received in the office. This report is typically received in the Medical Records department, but may be received as per protocol for your organization.9) Best practice is to route the paper consult report to the clinical staff of the referring provider.10) The clinical staff receives the paper consult report and updates the referral order status in Allscripts Enterprise EHR to “Complete.” Follow these steps to update the order status to Complete: a) Clinical staff logs in. b) Bring the correct patient into context. c) Go to the Chart menu and the Clinical Desktop workspace. d) Go to the Orders component. e) Locate the desired referral order, right-click and select Complete from the context menu. f) Click Commit.11) Once the order status is updated, the clinical staff then routes the paper report to the referring provider for review, potential follow up, and sign-off.12) The referring provider receives the paper consult report and reviews and initials per organizational protocols.13) The paper consult report is then routed back to Medical Records to be scanned in Allscripts Enterprise EHR. Follow the (P2) Scanning Correspondence workflow for the Certified Workflow steps.11/18/2009 224 Allscripts Enterprise EHR Certified Workflows
  • 225. (R5) Results CommunicationNote: This workflow is specific to Allscripts Enterprise EHR 11.1.7.This workflow provides detailed steps for handling the necessary communication to a patientregarding their results and completes the results verification process. These activities are workedusing an enterprise task view that is assigned to the appropriate staff, such as Clinical Staff or otherrole responsible for communicating results to patients. Figure 65 (R5) Results CommunicationTo review result communication tasks, follow these steps:1) A results communication task is received. There are three tasks that are can be created by the system based on the various communication method(s) specified when verifying results. These task types are as follows: ▪ Call Patient with Results ▪ Mail Results to Patient ▪ Schedule Result F/Up2) Clinical staff monitors their task list and sorts the list by patient. Providers can select up to three Patient Communication Methods when verifying patient results that generate tasks for staff to work. To monitor a task list and sort by patient, follow these steps: a. From the Task List horizontal toolbar, select the appropriate View from the drop- down list that contains the necessary result-communication tasks to review (e.g. Results Communication).11/18/2009 225 Allscripts Enterprise EHR Certified Workflows
  • 226. b. Click on the Patient column header to sort the table so that all the results tasks for a given patient are grouped together.3) Clinical Staff selects a results communication task(s) & marks “In Progress”. To select a task and mark it in progress, Highlight the desired task, and click In Progress. Allscripts recommends that where multiple individuals will be working off the same Task List to have users mark a task “In Progress” to indicate that the task is currently being worked or addressed.4) Does the task or tasks require the patient to be called? There are two tasks where calling the patient is needed. These are as follows: ▪ Schedule Results F/Up ▪ Call Patient with Results5) If yes, does a result follow-up appointment need to be scheduled for the patient?6) If yes, the clinical staff reads the Schedule Results F/Up task comments for additional details from the provider before calling the patient. To review task comments, follow these steps: a. With the task in context for the patient in context, review the Comments field (lower left) for any comments that were entered by the provider. The user can also double- click on the desired Schedule Result F/UP task to display the Task Details dialog.7) Will the clinical staff be discussing the verified results during the call with the patient?8) If yes, the clinical staff reads the Call Patient with Results task comments and reviews the Results Document for all necessary information from the provider before calling the patient. To review task comments and the Results Document, follow these steps: a. Highlight the Call Patient with Results task and review the Comments field (lower left) for any comments that have been entered by the provider. The user can also click on the Details…button to view the comments within the Task Details dialog. b. When finished, double-click on the task to open the Note Output to review any additional instructions left by the provider, as appropriate.11/18/2009 226 Allscripts Enterprise EHR Certified Workflows
  • 227. c. Under the Message note section, review the information and instructions given to the Staff concerning the patient’s verified results. It is important to understand what types of instructions a Clinical Staff may be asked to perform. For instance, will they be instructed to re-order tests or renew prescriptions on behalf of the provider? If that is true, the properties of the note should be considered as the newly add data may force an amendment to Results Document. d. Under the Discussion/Summary note section, review what information and instructions were entered for the Patient concerning their verified results.9) Clinical staff calls the patient to discuss their results and/or schedule a follow-up appointment as directed. If the appointment for the follow-up is within the organization, the staff typically schedules the appointment within their Practice Management System.10) If not directed to discuss the patient’s results, the clinical staff contacts the patient and schedules their results follow-up appointment.11) Next, the clinical staff documents the necessary patient follow-up per protocol and completes the task(s). Some organizations may have their staff document all follow-up attempts (both successful and unsuccessful) when calling the patient. This follow-up information could be added as a Note Annotation on the Results Document, or entered within the details of the task. a. To document with a Note Annotation, do the following: i. From within the Note Output Viewer, right-click and select Annotate to expand the Annotate section (bottom of the form). The cursor appears in the New Annotation field. ii. Enter the necessary follow-up information as directed per organization’s protocol. iii. Click Ok when finished. The annotation will now appear under the Existing Annotation section along with the user’s name, date and time that it was entered.  Click Close on the Note Output to display the task list. iv. With the task in context, click Done when finished to mark the task complete. b. To document within the Task Details, follow these steps: i. Click Close on the Note Output (if open) to display the task list. ii. With the task in context, click the Details… button. The Task Details dialog displays. iii. Enter text directly into the Comment field or use a text template, if appropriate. 1. If using a text template to enter comments, do the following: 2. Click the TT button. The Free Text dialog displays with the list of Task-Text Templates (if any).11/18/2009 227 Allscripts Enterprise EHR Certified Workflows
  • 228. 3. Select the appropriate text template from the list. Click on and/or enter the necessary information. 4. Click OK to close the Free Text dialog. iv. When finished, click OK to close the Task Details dialog. v. With the task in context, click Done when finished to mark the task complete.12) Do the results need to be mailed to the patient?13) If yes, will the clinical staff be utilizing the batch printing feature? Allscripts recommends that users utilize the batch printing feature to eliminate clicks and help streamline the process of mailing results to patients. Therefore, administrators should add the Printing Tasks HTB to the menu structures of those user roles that will need to perform batch printing.14) If yes, the clinical staff selects a series (one or more) of the Mail Results to Patient tasks and prints the necessary Results Outputs via the Printing Tasks horizontal toolbar. To print the Results Outputs for multiple Mail Results to Patient tasks via Printing Tasks horizontal toolbar, do the following: a. Click on the Printing Tasks horizontal toolbar. b. Select the appropriate View from the drop-down list that contains the necessary Mail Results to Patient tasks (e.g. Results Communication). c. Check the “Select All” tasks checkbox in the first column to check all tasks on the selected view. Or check the desired tasks individually. d. Click Print. The Print Dialog box displays. e. Review the printer information and adjust options as appropriate.Select the appropriate report template from the Document dropdown list, if needed.Click OK when finished. The system prints the documents that were selected to the designatedprinter and completes the Mail Results To tasks. Administrators can also setup auto-print defaults to avoid having the print dialog box appear (saving even more clicks).15) If no, the clinical staff prints the necessary Results Output for a single Mail Results to Patient task via the Task List. To print the Results Output for a Mail Results to patient task via the Task List, following these steps: a. Double-click on the desired Mail Results to Patient task. The Print Dialog box displays. b. Review the printer information and adjust options as appropriate. c. Select the appropriate report template from the Document dropdown list, if needed.11/18/2009 228 Allscripts Enterprise EHR Certified Workflows
  • 229. d. Click OK to print. The system prints the document to the designated printer and completes the Mail Results To task.16) Clinical staff mails results to the patients as directed per the organization’s protocol.11/18/2009 229 Allscripts Enterprise EHR Certified Workflows
  • 230. (S) Inpatient IntroductionIn addition to managing daily charges generated from ambulatory patient visits, many organizationsmust consider submitting charges for inpatient hospital encounters and other off-site locations.These types of visit charges may be entered in Allscripts Enterprise EHR to be sent to the practicemanagement billing system.Historically, it is common for organizations and providers to be faced with many challenges with theexisting paper process, including paper-based rounding lists, lack of a standardized charge fee ticketacross multiple hospitals or none at all and, the inability of most providers to submit their chargesimmediately as they are required to wait until the next time they return to their ambulatory clinicbefore submitting charges generated at the hospital. This can result in lost charges or delays insubmitting the charges for reimbursement.The benefits of utilizing an electronic health record system can also extend to capturing inpatientcharges. These include: ▪ Receive medical necessity checking for charges. ▪ Receive CCI (Correct Coding Initiative) checking for charges. ▪ Provide remote access to electronic rounding “service” lists. ▪ Ability to create inpatient service lists at a personal, organizational, or enterprise level. ▪ Manage service lists manually or via an interface to the hospital ADT system (requires that Registration/consulting physician data is shared between the hospital and the physicians’ office). ▪ Submit inpatient charges immediately if electronically connected at each rounding hospital. ▪ Flexibility to submit inpatient charges on an iPAQ or other hand-held device that the provider can use in either a network “connected” or “non-connected” mode. ▪ Ability to submit charges for a new hospital patient who has never been seen previously in the ambulatory setting by adding a “local” patient registration. ▪ Ability for the provider to “copy” previous encounter charges forward for easy charging on multiple, similar encounters for the same patient. ▪ Ability for coders to review inpatient charges before they are submitted to the practice management system. ▪ Increase lost revenue due to lost charges or delays in submitting inpatient charges.The workflow contained in this section is as follows: ▪ Inpatient Charges—describes the steps for utilizing inpatient charge capture.11/18/2009 230 Allscripts Enterprise EHR Certified Workflows
  • 231. Figure 65 (S) Inpatient Submitting S1 S Yes inpatient charges? No End11/18/2009 231 Allscripts Enterprise EHR Certified Workflows
  • 232. (S1) Inpatient ChargesThis workflow lists the detailed steps to complete a charge encounter form for an inpatient/hospitalor off-site encounter. The typical user for this process is the provider.There are many build options when it comes to charges. This section covers the most commonworkflow for entering charges for a basic inpatient visit. Figure 67 (S1) Inpatient ChargesTo complete a charge encounter form for an inpatient/hospital or off-site encounter:1) During the inpatient visit the provider determines that the encounter must be billed.2) Does the patient exist on a Service List? Additional charge functionality, such as being able to copy an existing encounter, is available if the charge is created from a patient selected from a Service List.3) If yes, locate the desired patient: If the provider is using the iPaq, follow these steps: a) Tap the View drop-down list and select the appropriate Service List. b) Search for the patient. c) Tap on the patient’s name. d) Tap on Charge, if necessary (if Charge is the only module installed on the iPaq, this step is not necessary). e) A list of existing encounter forms may or may not present to the user.If the provider is using the Web, follow these steps: f) Provider logs in. g) From the Chart menu, select the Patient Lists menu. h) From the List drop-down field, select the appropriate service list.11/18/2009 232 Allscripts Enterprise EHR Certified Workflows
  • 233. i) Locate (or search for) the patient. j) Double-click to select the desired patient. k) The Encounter Selector screen displays. To obtain the inpatient Encounter Selector screen when selecting patients from Service and Patient Lists, the double-click navigation user preference (under Personalize) on the Patient Lists screen must be set to “MD Charges.”4) Will the provider utilize the copy encounter feature for an existing encounter? If no, proceed to step 3 of the Charge Ambulatory Basic workflow (J1). If the providers will perform rounds at multiple locations, and cover for each other, Best Practice is to create service lists named after the locations of the off-site buildings (for example, Nursing Home Name) and add the specialty if multiple- specialists are to perform rounds in one building (for example, Hospital Name Pediatrics).5) The provider copies an existing encounter form. Often, visits to the patient in the hospital will have the same diagnosis and charges for each visit. Using the copy feature enables the provider to post repetitive charges across different encounters easily. Follow these steps to copy an existing encounter: If the provider is using the iPaq, follow these steps: a) Tap and hold on the encounter you want to copy from. b) Select Copy encounter. c) Select a date.If the provider is using the Web, follow these steps: d) From the Encounter Selector screen, highlight the Existing Encounter to copy from. e) From the Copy Encounter to section, select a date to copy to. f) Click the Copy Encounter button. g) Click OK. Only patients selected from a Service List have encounters available that can utilize the copy encounter feature.6) The provider validates the encounter form: If the provider is using the iPaq, follow these steps: a) On the Encounter Form menu, verify all data elements listed: i) Diagnosis ii) Visit charge (1) Diagnosis linking11/18/2009 233 Allscripts Enterprise EHR Certified Workflows
  • 234. (2) Modifier(s), if necessary vi. Procedure Charges 5. Diagnosis linking 6. Modifier(s), if necessary b) On the Billing tab, verify all data elements listed: i) Billing Provider ii) Performing Provider iii) Referring Provider (if necessary) iv) Division (if necessary) v) Billing Area (if necessary) vi) LocationIf the provider is using the Web, follow these steps: c) From the Encounter Form workspace, verify appropriate data elements: i) Billing Provider ii) Performing Provider iii) Referring Provider (if necessary) iv) Division (if necessary) v) Billing Area (if necessary) vi) Location vii) Diagnoses viii) Visit charge (1) Diagnoses linking (2) Modifier(s), if necessary ix) Procedure Charges (1) Diagnosis linking (2) Modifier(s), if necessary7) The provider submits the encounter form by clicking on the Submit button.8) If the patient does not exist on a Service List, does the provider have online access? If the provider is off-line (for example, not connected to the network), then go to Step 11.9) Does the patient exist (for example, registered to the organization?) in Allscripts Enterprise EHR? If the provider sees the patient for the first time as an inpatient hospital visit, the patient may not exist yet in the Practice Management System.10) If yes, the patient does exist in Allscripts Enterprise EHR, locate the desired patient by following these steps: If the provider is using the iPaq, follow these steps: a) Tap New at the bottom of the screen.11/18/2009 234 Allscripts Enterprise EHR Certified Workflows
  • 235. b) Enter a partial patient name (last name, first name). c) Select the desired patient. d) Enter the required and optional field details.If the provider is using the Web, follow these steps: e) From the Chart menu, select the Patient Lists menu. f) Select the appropriate Service List the patient should be added to. g) Click on the Add Pt (Patient) button. h) From the Select Patient screen, search and locate the desired patient. i) Click OK. j) From the Visit Selector screen, select the appropriate Existing Visits or a New Visit. k) Verify the appropriate Hospital and Visit Type are selected. l) Verify the appropriate Admit Date is selected. m) Click OK. n) From the Visit Details screen and Admission tab, fill in the appropriate required and optional fields. i) Required fields are typically Hospital, Visit Type and Visit Status. ii) Optional fields can include Referring Prov, Consulting Prov, Hospital MRN, Unit/Room, Discharge Date, Admitting Date, Admitting Prov, Current Attending, and Covering Attending. o) From the Visit Details screen and Billing tab, fill in the desired optional information: i) Visit Notes, Case Number, Authorization, and Study Number. p) Click Apply & Close if adding a single patient or Apply & Add New if adding multiple patients. q) The existing patient is added to the selected Service List and is ready to use to create charges.11) If no, the patient does not exist in Allscripts Enterprise EHR, then a local patient must be added by the provider. This is the same as adding a patient “on the fly.” This enables the provider to enter the minimum required information regarding the patient for identification and associate the appropriate charges to submit to the Billing office for review and submission. If the provider is using the iPaq, follow these steps: a) Tap New at the bottom of the screen. b) Enter data in all required fields (such as first initial, last name and date of birth). c) Tap Done. d) Enter any required data in the fields on the Providers screen (such as Current Attending). e) Tap on the Visit Details tab. f) Enter the appropriate admission date. g) Select the Hospital. h) Enter Unit/Room number information.11/18/2009 235 Allscripts Enterprise EHR Certified Workflows
  • 236. i) Tap Done.If the provider is using the Web, follow these steps: j) From the Chart menu, select the Patient Lists menu. k) Select the appropriate Service List the patient should be added to. l) Click on the Add Pt (Patient) button. m) Search to validate the patient does not exist in Allscripts Enterprise EHR. n) From the Select Patient screen, click Add Local Pt (Patient). o) From the Local Patient screen, enter the required and optional data (such as first initial, last name, date of birth, and so on). p) From the Add Patient screen, enter the required and optional data as needed (such as referring provider name, hospital, visit type, admit date, and so on). q) Click Apply & Close. r) The patient is added to the Service List selected. Any “local pt” added to a Service List will be displayed in italics. s) Double-click the patient to begin the process of entering the desired charges. Proceed to step 3 of the (J1) Basic Ambulatory Charges workflow to finish the workflow steps.12) For any “local” patient added, the system will generate a “Pt Merge-Enc” task. a) The purpose of a Pt Merge-Enc task is to notify staff that charges entered to a local patient must be reconciled to a “true” patient in Allscripts Enterprise EHR prior to the charges being submitted to the Practice Management System. b) Task is automatically assigned to the Local Pt Merge Team, which is typically assigned to a staff role such as the front desk. c) An Enterprise task view must be created and assigned to the appropriate staff to work these types of tasks.11/18/2009 236 Allscripts Enterprise EHR Certified Workflows