What’s new, What’s changed

EHR Patch Updates EHRv1.1p9

IHS-Office of Information TechnologyEHR Program

FIXES

FixesComponent Issue

Allergy/ADR -Properly filters out “Other Reaction” for both reactant and sign/symptom

CCD viewer -No longer hangings on VPN session-PDF generation with IE9 fixed-No longer allows query if no patient selected-Print/Save button disabled until processing complete

Chart Review -Adding problem from Visit Diagnosis or Historical Diagnosis now stores Reviewed and Updated

CSV -ICD9 look up now returns long narrative text

Immunizations

-No longer populate CPT codes-Education now stores properly when “Patient/Family Counselled by provider” checked.

FixesComponent Issue

Notifications -Flagged OI Expiring notifications work properly now-Now honors BEHOPTCX REQUIRES HRN parameter and if set will not allow user to process a notification for patient not registered in logged in division.

Order Checks

-Height and Weight limits now honored for CT and MRI order checks

Outside Med Details

-Documented by now displays logged in user rather than visit context provider

Quick Order -Now honors default Clinical Indication set in Quick Order

Patient Education

-Text now properly wraps when viewing standards

FixesComponent Issue

Reminder dialogs

-Measurements “done elsewhere” now store the correct date/time

Reminder dialogs

-No longer creates second Primary Provider when processing reminder dialogs on inpatients

Reports -Requestor no longer displays on Outside Medication entries in the Order Summary Reports

Suicide Form -Updated to current Behavioral Health GUI

Visit Context -Now excludes ancillary inpatients when selecting visit

Windows 7 -Superbill and Patient Education check box behavior resolved

NEW FEATURES/CHANGES

New FeaturesFunctionality Features

Med Order Dialog Clinical Indication PromptMed Order Field RestrictionsPharmacy type settings

InternalInternal/ExternalExternal

Controlled substance prescribing parameters

Pre-placed for future useCII prescribingExamples

New FeaturesFunctionality Features

Printing prescriptions and medication orders

Queue PrintRx Print Format (template) editorRx Printer Configuration

RPMS parametersRx Printer Preferences editor

Configuration Summary

All sitesInternal set upInternal/external set upExternal set up

Screen shots Med Order ExamplesPharmacy Search ExamplesPrinting examples

MED ORDER DIALOG

Clinical Indication prompt• ICD9 coded clinical indication now required for medication

orders• *** The changes for Med Orders were done to comply with

eRx requirements ***• You must select an indication for each med order• New med order will display a blank clinical indication

– Not pre-populated with the last entered – This is a change, please alert your providers

• Offers Problems, POV’s after filtering out un-coded diagnoses, “Other” – “Other” search returns only coded entries for selection

• Renew, Copy and Change pre-populates with clinical indication of the original order*** Tip ***Encourage maintenance of clean problem listsEncourage selection of POV prior to ordering medications

Once a clinical indication is chosen, the indication “follows” the medication order through its lifecycle (refill, renew, change, copy)

Clinical Indication prompt

Med order field restrictions

• Character limit is 140 characters for transmitted prescriptions.

• Character limit for comments is 210 characters for transmitted prescriptions.*** Tip ***Recommend setting APSP AUTO RX ADD PRV COMMENT to No at the system level

Add “Comments” to the bottom of Prescription template to communicate comments to outside pharmacist

Setting Pharmacy type

• The APSP AUTO RX parameter sets the type of pharmacy you have.

• You will be required to set this for electronic prescribing.

*** Tip ***The APSP AUTO RX setting and associated parameters are designed for use in advance of electronic prescribing and provide enhanced Med Order dialog and Prescription/CII order printing capability.

Benefits of setting APSP AUTO RX

1. Enhanced Med Order dialog with pick up locations presented to prescriber based on facility type and other configurable settings.

2. Can enable “Internal/External” and “External” without using ePrescribing:

– Meds for outside fill are auto-finished and queued for printing– Can help sort out workflow issues prior to eRx

3. Enhanced printing:– CII order for signature, CII prescriptions, Non CII prescriptions and

receipts for electronically transmitted prescriptions “queued”– Configurable default settings for formats and printers.– Click sends all jobs to appropriate printers.

*** Tip ***There is now a “P” (for print) for pick up location in Quick Orders

Pharmacy Type Settings

APSP AUTO RX Setting

Internal Patients only fill Rx written by in house providers at in-house pharmacy1.In house options for Clinic, Mail, Window retained2.CII order for signature queued to print

Internal/External

Patients fill Rx written by in-house providers at in-house and outside pharmacies

1. In house options for Clinic, Mail, Window retained- CII order for signature queued to print

2. Prior to Surescripts® set up/deployment enables the “Outside Pharmacy – Print” functionality

- Auto-finishes meds upon signature and queues prescription for printing3. After Surescripts® set up/deployment enables the “Outside Pharmacy – eRx

functionality - Auto-finished meds upon signature, transmits and queues receipt for printing

External No in-house pharmacy1. All med orders auto-finish upon signature2. Prior to Surescripts® set up/deployment enables the “Outside Pharmacy – Print”

functionality - Auto-finishes meds upon signature and queues prescription for printing

3. After Surescripts® set up/deployment enables the “Outside Pharmacy – eRx functionality

- Auto-finished meds upon signature, transmits and queues receipt for printing

Pick up locationsMed order dialog has up to 5 pick up locations exposed

to the user depending on APSP AUTO RX parameter settings

Pick up location APSP AUTO RX SPI* Status on signature

Clinic InternalInternal/ExternalExternal

N/A PendingPendingActive

MailWindow

InternalInternal/External

N/A PendingPending

Outside Pharmacy – eRx **Requires Surescripts® implementation and population of SPI

Internal/ExternalExternal

YesYes

ActiveActive

Outside Pharmacy – Print Internal/ExternalExternal

N/AN/A

ActiveActive

Setting Pharmacy Type

APSP AUTO RX - set at division or system

CII-V electronic prescribing parameters

APSP AUTO RX ERX OF CII• Pre-placed for eventual allowance of electronic

transmission• Defaulted to “null” which disallows transmission• Not editable at this timeAPSP AUTO RX SCHEDULE RESTRICT• Pre-placed for eventual allowance of electronic

transmission• Defaulted to schedules 2,3,4 & 5 to disallow

transmission• Not editable at this time

Med Order Dialog examples:Pick up locations

Internal – Legend and Controlled drugs

Pick up locationsInternal/External – non CII, provider has SPI

Internal/External – CII orNon CII and provider has no SPI

Pick up locationsExternal – non CII, provider has SPI

External – CII and/or provider has no SPI

CII prescribingAPSP AUTO RX CII

PRESCRIBING You may now restrict CII

ordering at the following levels ***– User– Class– Division– System

*** Tip ***When set the “CII ordering disabled” dialog pops up when a user selects a CII drug from the Medication Order dialog

*** This works for meds ordered via Medication Order (ie. “other meds”) and not quick order menus. EHRp10 will add this functionality

PRINTING FUNCTIONALITY

Printing functionality• “Smart logic” is used to determine which

order requires a print job and if so which type based on:– Status (Active or Pending)– Pick up location – Type of drug (Controlled or not)

• “Queues” the print jobs for printing.• Formats may be defaulted to specific

templates.• Formats may be defaulted to specific

printers at the User, Location, Division, and System level.

Queue PrintFacility type

Pick up location Status after signing

CII?

Print format Icon

Internal

ClinicMailWindow

ClinicWindow

PendingPendingPending

PendingPending

NoNoNo

YesYes

N/AN/AN/A

CII Order for SigCII Order for Sig

External

Clinic

Outside Pharmacy – eRx

Outside Pharmacy - Print

Active

Active

Active

NoYes

No

NoYes

N/APrescription (CII)

Receipt (Non CII)

Prescription (Non CII)Prescription (CII)

Queue PrintFacility type

Pick up location Status after signing

CII?

Print format Icon

Internal/ External

ClinicMailWindow

PendingPendingPending

NoNoNo

N/AN/AN/A

ClinicWindow

PendingPending

YesYes

CII Order for SigCII Order for Sig

Outside Pharmacy – eRx

Outside Pharmacy - Print

Active

Active

No

NoYes

Receipt (Non CII)

Prescription (Non CII)Prescription (CII)

Queue Print

After signing, the meds that have print jobs are highlighted and the Queue Print button is active.

Queue Print

Click the Queue Print button and the print jobs are displayed, associated with pre-defined templates for each format and default printer (user may change).

Reprinting

If you need to print a prescription due to failed transmission, or re-print due to printer failure or destruction of prescription you may do so. You may only print the day the prescription was finished and must put in a reason. Reasons for re-printing are logged.1.Highlight med you wish to reprint.

2.Click PRINT.

3.Select Prescription (New Format).

4.Click PRINT.

5.Select reason.

6.Enter comment (optional).

7.Select printer (or accept default).

8.Click OK.

Order Detail

Rx Print Format (Template) editor

Set up:1. Design mode> Desktop Properties> Custom Menus2. Add Menu item “Rx Template Editor”3. Add the following in Action (lightening bolt)

$(BEHRXGENERATORSERVICE.RXGENERATOR.edittemplates)

4. Click Apply and Ok5. Make sure you have BEH Rx Generator Service

checked under “required services”6. Only place on EHR GUI templates of those who are

responsible for editing Prescription formats (ie. CAC, pharmacy Ad Pac)

Rx Print Format (Template) Editor

Design Mode Rx Template Editor

Rx Print Format (Template) Editor

• Template type (format)– Prescription (Non-CII)– Prescription (CII)– Order for signature (CII)– Order for signature (Non-CII)– Receipt (Non-CII)– Receipt (CII)

• Template– Default template for each

template type delivered with EHRp9

Rx Print Format (Template) Editor

Importing template: The files are .ptxml files

1. Save the files to a local drive.2. Open Rx template editor.3. Select template type.4. Click Import.5. Change the name if desired, click OK.5. Click active on.6. Select Yesterday at 6:00 am, then OK.7. Now you may edit the template.8. Click OK to store

Rx Print Format (Template) Editor

• Active on – set activation date (usually Yesterday at 6:00am)

• Preview – Display preview of current template

• Import – import template• Export – export template• Add Free Text – you may add as

many as you like. May include header info for format, alternate signature lines, etc.

• Mark Inactive – inactivates template so users cannot select

*** Tip ***To Copy a template - export, save and import:- Change to a local name on imports. - Set “active on” to Yesterday at 6:00 am.- Make changes then click OK

Highly recommend using the copy process and creating local templates rather than editing nationally delivered default templates ***

Rx Print Format (Template) Editor

• Change font • Set fields for

inclusion, change print labels, and set columns in the Fields section

Rx Printer Configuration

In RPMS set the BEHORX PRINT FORMATS parameter• Associates the Format

type with the Format (Template)

• May set at User, Class, Location, Division and System level

• Most commonly will be set at System or Division level

Select Format Type: ?? Instance values are (Commonly set

format types) : PC:RX CII PN:RX NON-CII OC:ORDER CII ON:ORDER NON-CII RC:RECEIPT CII RN:RECEIPT NON-CII LC:LABEL CII LN:LABEL NON-CII

Rx Printer Configuration

Rx Printer Configuration

Populate the BEHORX PRINT FORMAT TYPEThis associates the Format type: •Order for signature (CII)•Prescription (CII)•Prescription (Non-CII)•Receipt (Non-CII) with a default printer. •Set at User, Location, Division or System level•In RPMS or in EHR Printer Preferences tool

Rx Printer Preferences Editor

Set up:1. Design mode> Desktop Properties> Custom Menus2. Add Menu item “Rx Printer Config”3. Add the following in Action (lightening bolt)

$(BEHRXGENERATORSERVICE.RXGENERATOR.EditPrinterPreferences)

4. Click Apply and Ok5. Make sure you have BEH Rx Generator Service

checked under “required services”6. Users will only be able to set their own defaults7. Assign the BEHORX PRINT key for CAC/IT staff who

will set Location, Division, System settings

Rx Printer Preferences Editor

Design Mode Printer Preferences

Rx Printer Preferences Editor

Use dropdown to select level, template type, printer settings.Click APPY to store the parameter.To remove a parameter level, bring up the level and click REMOVE

Rx Printer Preferences Editor

RPMS display parameterBEHORX PRINT FORMAT TYPE

RPMS enter/edit parameterBEHORX PRINT FORMAT TYPE

CONFIGURATION SUMMARY

Configuration steps – All Sites

*** This is in addition to pharmacy package optimization for eRx and Surescripts® credentialing/set up/deployment ***

Parameter Setting

APSP AUTO RX Appropriate facility type

APSP AUTO RX ERX OF CII Verify is set to Null at System Level

APSP AUTO RX ADD PRV COMMENTS

Set to NO at the System Level (recommended)

*** Tip ***DO NOT TOUCH ANY OF THE OTHER APSP AUTO RX PARAMETERS. The majority of these are for use in eRx configuration for Surescripts®. This is a separate set up and deployment!

Configuration steps – All Sites

*** This is in addition to pharmacy package optimization for eRx and Surescripts® credentialing/set up/deployment ***

- Review Formats (Templates) for Prescriptions, CII order for sigs and Receipts using the Prescription Print service Template Editor tool and copy/edit accordingly

- Set BEHORX PRINT FORMATS parameter to set default format (template) for print Format types

- Determine printers for system, division and/or locations and set using Prescription Print Service Printer Preferences tool or the BEHORX PRINT FORMAT TYPE parameter.*** Tip ***

This is a business process review. Review current processes and optimize with new features.

Internal Set UpAPSP AUTO RX

Internal Internal pharmacy only. Able to print “Order for Signature (CII)” using Queue Print button

BEHORX PRINT key

Assign to CAC, Site Manager

Allows GUI configuration of Rx printing

BEHORX PRINT FORMATS

Set default Template forOrder for Signature (CII)

BEHORX PRINT FORMAT TYPE

Set default Printer for Order for Signature (CII)

Depends on workflow

Internal/External Set UpAPSP AUTO RX

Internal /External Internal pharmacy that also sends prescriptions out.Auto finishes on signature med orders with “Outside Pharmacy Print” pick up location.Enables printing of “Order for Signature (CII)”

BEHORX PRINT key

Assign to CAC, Site Manager

Allows GUI configuration of Rx printing

BEHORX PRINT FORMATS

Set default Template for: Order for Signature (CII)Prescription (CII)Prescription (Non CII)

BEHORX PRINT FORMAT TYPE

Set default Printer for the Order for Signature (CII)Prescription (CII)Prescription (Non CII)

Depends on workflow

External Set UpAPSP AUTO RX

External External pharmacy – sends prescriptions out. Auto finishes on signature med orders with “Outside Pharmacy Print” pick up location.

BEHORX PRINT key

Assign to CAC, Site Manager

Allows GUI configuration of Rx printing

BEHORX PRINT FORMATS

Set default Template for: Prescription (CII)Prescription (Non CII)

BEHORX PRINT FORMAT TYPE

Set default Printer for thePrescription (CII)Prescription (Non CII)

Depends on workflow

SCREEN SHOTS

Med order examples

Med order examples

Med order examples

• Click on Outside Pharmacy – eRx

• Click on search button to locate pharmacy

Pharmacy search

Pharmacy search

Pharmacy Search

Highlight chosen pharmacy and click OK

Printing

Printing

ResourcesEHRv1.1p9 guideftp://ftp.ihs.gov/rpms/patches/ehr_0110.09o.pdf