You will always start from thisscreen with the MSK logo. To loginto HIS (Healthcare InformationSystem), go to the Start menu andchoose Clinical Applications, andthen Healthcare InformationSystem
. This light blue screen will open. Choose Clinical Information System. This is the system for orders, results, and MAR. You can also use it to find old chart information on your patients, as well as accessing the PACS radiology viewer.You will also notice that helpful references areavailable from this screen, such as the MSKPhone Directory, Lexi-Comp and UpToDate.
Once you enter CIS, you need to select apatient. To look up a patient not currentlyadmitted to M9, select the Find PatientIcon. Enter the patient’s name in the pop-up box to search.
Or, you can select the Identification taband enter the patient’s MRN, thenselect the Search button. Once thepatient’s name appears, double click tobring up a list of their visits. You canselect any visit to open the chart.
Patient Nicekid PATIENT, NICEKIDOnce the patient’s name appears underthe Search Results, double click to bring Resultsup a list of their visits. .
Patient Select any visit and click OK to enter the patient’s chart. .
If your patient is admitted to the Peds If your patient is admitted to the Peds Floor, set the Current List drop-down to Floor, set the Current List drop-down to “M09 Admitted.” This will display all of the “M09 Admitted.” This will display all of the patients currently on M9. Double click on patients currently on M9. Double click on your patient’s name to open their chart your patient’s name to open their chart (patients’ names and MRNs are hidden in this screen (patients’ names and MRNs are hidden in this screen for HIPAA compliance, but appear next to their room for HIPAA compliance, but appear next to their room number). number)..
When you open the patient’s chart,you will notice a row of tabs alongthe top; you can use these to changethe screen you are viewing withinthe same chart. Here, results isselected.
Defaults are set so that when youopen the patient’s chart, you willgo immediately to a Results screenwhich looks like this one. In thisview, lab results are chronological,with the most recent results at thetop of the screen.
These results are in the Report by Order DisplayFormat, which is useful for looking up daily ormost recent labs, but less helpful for comparingvalues or looking for trends. In this view, alllabs are displayed in chronologic order, with themost recent results at the top of the screen.
To view only selected types ofresults, such as Microbiologyor Radiology, use the drop- Radiologydown menu under ResultSelection to highlight the typeof result you wish to view.
Make sure to click Show Pendingso all received specimens aredisplayed; if this box is notchecked, only specimens withresults will be shown.
When a result has a [+] sign,clicking on the highlightedresult will bring up moreinformation.
Results will display as shown,and can be copied and pastedor printed out.
To compare results, selectTrend View in the DisplayFormat box.
You can select an individual resultand display a graph by highlightingthe desired result and clicking thebutton next to Graph.
The Summary view in Display Format allowsyou to view all of the tests which have beendone; clicking on the red and green flag iconsopens the desired result. You can alsohighlight an entire row (test) or column(date) to see all of those results.
To narrow results to see onlymore recent values, changethe Since field to the specifictime frame.
Selecting the Orders tab will display all orders placed for the patient.In this default view, all orders are shown,whether they are active or not, and orders areorganized by when they were placed, with themost recent orders at the top of the screen.
Use the Status/Priority drop- down box to change the status of orders listed; for most situations, it is helpful to set this to Active to avoid long lists of previous orders.When you change this setting,your new setting will beretained for other patients untilyou change it again.
Use the Display Format drop-down box to change how ordersare grouped; for most situations, itis helpful to set this to ByDepartment to show the sametype of orders together (Nursingorders in one section, Pharmacyorders in one section, etc).
To begin entering orders, chooseeither one of the order entry iconsin the upper left hand corner ofthe screen.
Clicking either icon will bring you tothis order entry screen. There areseveral different ways to enterorders. The best way is generally tochoose from the drop-down menuson the left-hand side of the screen.
Orders can be found under the PED-INPATIENT tab.Most of the time, residents working on the GreenTeam will select .Oncology; residents on the BlueTeam will select .BMT for order set options. In this example, to enter lab orders, the AM Lab Order Set is chosen by clicking on the selection in the drop-down. Once the order set is highlighted in the large box, it can be double-clicked, and it will open to allow details to be entered.
Once the order set opens, simply click to checkthe boxes next to the orders you would like tochoose. Once you have selected all of the ordersyou want, click on OK at the bottom of thescreen.
In most cases, you will receive warnings; this is warningsthe system alerting you to fields which must befilled in before the order can be submitted.Simply highlight and select the first order with awarning to complete the required information.
Any field with a * is a required field. In this case,you must fill in the date you would like the testdone. You can click on the calendar icon and it willexpand. In addition, Special Instructions is a free-text box where you can enter further comments.
Use the drop-down calendar to select the date onwhich you would like the test to be performed.
Only fields with * are mandatory. Other fields are defaulted or may be left blank; however, you must make sure that the defaults or blanks are what you want for the patient.In this example, you may wish to change the priority from“Per Requested Date” (Routine) to “STAT”; for medications,you might want to set a stop date, or other parameters.
You will be prompted to enter your CIS password in the pop-up box; once you do this and click OK, the order will be entered! Patient, Nicekid 123456789Notice that the patient’s name appears on both theSubmit Order button and the Password Required pop-up.This is a patient safety measure to help ensure that theorder you are submitting is for the correct patient.Always double-check these reminders! Patient, NiceKid
In some cases, you may want tobrowse available orders instead ofusing an order set. Under PED –INPATIENT, click the [+] buttons toexpand categories until you reach theorder you want; for example, click [+]next to Diet to see all diets that can beordered, and double click on the oneyou want for your patient.
You can also quickly change orders when you are inthe order viewing screen. Highlight the order youare interested in and then right-click to bring up amenu of options. You can easily discontinue anorder, reorder a discontinued order, or discontinueand reorder a current order. Don’t worry, you willhave a chance to modify the current order; this isgreat for daily IV fluids!
The hand-off tab allows you to keep updatedinformation about each patient in an easily printed,easily referenced format. Nicekid is a 4 y/o boy with Stage IV Neuroblastoma diagnosed in 6/07; s/p initial treatment with CAV x 5 cycles, thoracoabdominal resection completed without complication 8/12/07. Continues on CAV, but repeated episodes of F&N without positive cultures. Significant malnutrition, now on home TPN. The Oncological History box allows text to be entered about the patient which will remain throughout the admission, and for all future admissions; it can be changed at any time, and should be updated to provide a BRIEF overview of their evolving “big picture.”
The History of Present Illness tab is used to enter the problem list by SYSTEMS, and the patient’sNicekid is a 4 y/o boy with Stage IV Neuroblastoma diagnosed in 6/07; s/p initialtreatment with CAV x 5 cycles, thoracoabdominal resection completed without current status and problems. This should becomplication 8/12/07. Continues on CAV, but repeated episodes of F&N withoutpositive cultures. Significant malnutrition, nowIt does TPN. carry over from one regularly updated. on home not admission to the next.Nicekid is now admitted with nausea and vomiting x 3 days at home, decr UOP, nofevers. Abd mildly distended, no pain, AXR, CT neg for obstrxn. NPO, NGT togravity.-Low BPs O/N – follow, no boluses if MS normal, BPs >80s/45s-LE weakness: PT/OT following – FALL precautions!-Needs full dental exam when current illness resolved-Small, superficial ulcer on L scapula – RNs placing duoderm; monitor
Changing the Selection from Onc Hx/HPI to To Do Listwill allow you to enter a check list of items to followup. This should also be updated regularly, both onrounds, and at signout at the end of the day.
To add a new item to the To-Do list, simply choosethe Add button at the bottom of the screen, andthen free-text in the pop-up New Task box. Click boxOK, and your task will be added to the list. Schedule next pentamidine dose
Once you are viewing patients within your patient list,you can print your Hand Off List from any screen in theHand Off tab. Select the Reports button at the bottomof the screen. You will be asked if you want to forwardyour pager. What a silly question – just say no!
You may choose a report on all of the patients onyour list, or only a single patient; the report thatprints will include all of the information you haveput into the Hand Off section, as well as thecurrent list of all ordered medications and doses.
To access the MAR, choose the rainbow coloredicon along the top of the screen and click to open.
The Patient Info tab provides patient demographic information such ashome address, emergency contact information, etc.
Surgery Events provides information aboutall past surgeries at MSK for the patient.
The Hand-Off tab is used by clinicians to “hand off” patientinformation.
The Historical Chemo tab provides Chemo information for patientsbefore 9/13/2003.
For all chemo information after this date, go to Tools andselect Pharmacy Profile. Profile
To link to the Electronic Medical Record, go to Tools and select Go to E-Medical Records. Records
To Electronic Medical Record is opened for the patient selected in CIS. This isthe patient’s entire chart, all in optical scan. For Progress Notes, openAssessments by clicking on the [+] to the left of the green folder.