Here's a slide set that should help you optimize your Clinical Notes display by setting up defaults for expanded folders.
Wednesday, July 15, 2009
Friday, July 10, 2009
More email questions
As you might imagine, I receive a good deal of email containing questions on use and function of CIS. The following is a copy of such an email, one that contained a series of great questions wherein I tried to answer succinctly and honestly.
Feel free to send me your questions or post them here in the comments section.
___________________________________________________________________
My requests for CIS:
1-Please eliminate the warning that appears when we are doing prescriptions refills since it takes too many clicks and time to do refill of medications.
(In progress)
a-Only prescriptions orders available for modify on discharged patient, continue?
(The elimination of this needless alert is in progress)
b- Interaction checking cannot be performed for medical equipment (ex test strips, glucose monitor, lances, alcohol, etc). Please click Ok to continue placing the order.
(This errant form of a decision support alert is in the process of being sorted out and eliminated)
2-Please allow to use more than 1 macro in PE (ex by adding an other window) and if possible in HPI. The advantage is to be more time efficient since I can do w 2 clicks what I am currently doing w 5 clicks.
Note: The way HPI is set at present, you can't see what you had written in the window if you open a new window using macros or CISO old system.
(Macro functionality is “hard-coded” by Cerner. Autotext is the best way to work with this – see the bottom of this post for the JobAid that is also available at the CIS Info Site)
3- Allow for the pharmacy favorite to be put in alphabetical order like before.
(Use the new Favorites Folder system in the Prescription Writer window. This functions like a Windows-based folder hierarchy and will solve the issue. Unfortunately, I am finding that old favorites from EasyScript days are useless, if not corruptive, to the Rx process. You are best off starting new prescriptions and saving them as new favorites.)
4- Default the P/N to hide structure instead of show structure.
(This would defeat the purpose of structured templates since their guiding contents would be hidden from view. To begin free-texting, just click under the paragraph heading in the open field and the structure will be hidden at the same time that the cursor is enabled for free-texting. See my post from 6/26 that includes a slide set done on this very topic)
5-Allow for use of the existing macros in all different types of notes, e.g. ped and adults, by choosing a tab and alternating from macros of ped notes and macros from adults notes.
(Again, Autotext will solve this issue since these are not location or template dependent. The issue with macros crossing templates is that the templates have to “line up” identically with respect to paragraphs and if they don’t you won’t see the macros show up if made on a different template. Autotext can be used anywhere in any note)
6-When doing refills add an option to pick for 30 days supply & 5 refills.
(Redesign in progress)
7-Allow to correct P/N again instead of giving modify as the only option.
(We needed to pull this because of the medicolegal vulnerabilities it created. Suboptimal design by the vendor that we are hoping will be fixed in the future. See my brief post of 5/27)
8-Allow for an option of autopopulate the statement of problem is reviewed.
(This can be done by a macro or autotext at the level of the Problem List)
9-Allow to deselect prob list, medication in each of the encounters. Sometimes you can only deselect today's results, v/s, medication list and system doesn't allow to deselect prob list in the autopopulate option.
(I’ve not heard this before. When presented the autopopulate window upon opening a template, you should be able to deselect all of any particular section. A specific example would be helpful)
10-Allow to modify document medication by hx even if there is no fresh encounter. I was trying to update some medications list and the system didn't allow me to erase medications from document medication by hx. The message displayed was: Can't modify orders on discharged patient.
(This is a HUGE issue that has since been resolved since the sending of this email. Please let me know if the problem persists.)
11-Allow to pick more than one macro at the same time by hitting control key before they are pasted.
(As stated earlier, Macro function is Cerner code that we cannot change. Autotext, on the other hand, does not have this restriction and can be used multiple times in the same part of the note)
12-Allow to copy and paste results in other window w/n results in P/N again
(sometimes it doesn't allow it). (You can only copy/paste once into each OTHER window. In order to copy/paste more info, you need to open a second OTHER window)
_________________________________________________________________________________________________
_____________________________________________________________________________________
WHAT IS AUTO TEXT?
When documenting in CIS, Auto text will store text you use again and again, such as standard phrases or statements. Each selection of text can be recorded as an auto text entry and be assigned a unique name to identify it. Unlike Macros, auto text can be inserted within any paragraph of any CIS note. There are two ways to create auto text in a note.
CREATE AUTO TEXT OPTION 1
This option allows you to create auto text while in the process of writing a note. From an open note:
1. Select Hide Structure or open a free text box
2. Click on the text field and type in desired text
3. Highlight the text by dragging your mouse over it
4. Right-click on the highlighted text and select “Save as Auto text”
In the Manage Auto Text window that displays:
5. Enter the abbreviation you wish to use. The abbreviation should be the first 3 letters of the phrase or statement
6. Enter a description of the text
7. Click on Add Text
8. Click Create
CREATE AUTO TEXT OPTION 2
This method allows you to create auto text ahead of time. From an open note:
1. Select Hide Structure or open a free text box
2. Click the auto text button on the toolbar
In the Manage Auto Text window:
3. Enter the abbreviation you wish to use. The abbreviation should be the first 3 letters of the phrase or statement
4. Enter a description of the text
5. Click on Add Text
6. Type the text entry you wish to create
7. Click Create
8. To create additional auto text, click Create again
9. Click Close when done
USING AUTO TEXT
1. Type the first 3 letters or abbreviation of the text
2. The abbreviation will display
3. Left click on it and hit Enter or use the down arrow on your keyboard to select it and hit Enter
The auto text statement will display.
OR
1. Right-click in any free text field and select Insert Auto text
2. Select desired auto text from the Select Phrase to Insert window
Feel free to send me your questions or post them here in the comments section.
___________________________________________________________________
My requests for CIS:
1-Please eliminate the warning that appears when we are doing prescriptions refills since it takes too many clicks and time to do refill of medications.
(In progress)
a-Only prescriptions orders available for modify on discharged patient, continue?
(The elimination of this needless alert is in progress)
b- Interaction checking cannot be performed for medical equipment (ex test strips, glucose monitor, lances, alcohol, etc). Please click Ok to continue placing the order.
(This errant form of a decision support alert is in the process of being sorted out and eliminated)
2-Please allow to use more than 1 macro in PE (ex by adding an other window) and if possible in HPI. The advantage is to be more time efficient since I can do w 2 clicks what I am currently doing w 5 clicks.
Note: The way HPI is set at present, you can't see what you had written in the window if you open a new window using macros or CISO old system.
(Macro functionality is “hard-coded” by Cerner. Autotext is the best way to work with this – see the bottom of this post for the JobAid that is also available at the CIS Info Site)
3- Allow for the pharmacy favorite to be put in alphabetical order like before.
(Use the new Favorites Folder system in the Prescription Writer window. This functions like a Windows-based folder hierarchy and will solve the issue. Unfortunately, I am finding that old favorites from EasyScript days are useless, if not corruptive, to the Rx process. You are best off starting new prescriptions and saving them as new favorites.)
4- Default the P/N to hide structure instead of show structure.
(This would defeat the purpose of structured templates since their guiding contents would be hidden from view. To begin free-texting, just click under the paragraph heading in the open field and the structure will be hidden at the same time that the cursor is enabled for free-texting. See my post from 6/26 that includes a slide set done on this very topic)
5-Allow for use of the existing macros in all different types of notes, e.g. ped and adults, by choosing a tab and alternating from macros of ped notes and macros from adults notes.
(Again, Autotext will solve this issue since these are not location or template dependent. The issue with macros crossing templates is that the templates have to “line up” identically with respect to paragraphs and if they don’t you won’t see the macros show up if made on a different template. Autotext can be used anywhere in any note)
6-When doing refills add an option to pick for 30 days supply & 5 refills.
(Redesign in progress)
7-Allow to correct P/N again instead of giving modify as the only option.
(We needed to pull this because of the medicolegal vulnerabilities it created. Suboptimal design by the vendor that we are hoping will be fixed in the future. See my brief post of 5/27)
8-Allow for an option of autopopulate the statement of problem is reviewed.
(This can be done by a macro or autotext at the level of the Problem List)
9-Allow to deselect prob list, medication in each of the encounters. Sometimes you can only deselect today's results, v/s, medication list and system doesn't allow to deselect prob list in the autopopulate option.
(I’ve not heard this before. When presented the autopopulate window upon opening a template, you should be able to deselect all of any particular section. A specific example would be helpful)
10-Allow to modify document medication by hx even if there is no fresh encounter. I was trying to update some medications list and the system didn't allow me to erase medications from document medication by hx. The message displayed was: Can't modify orders on discharged patient.
(This is a HUGE issue that has since been resolved since the sending of this email. Please let me know if the problem persists.)
11-Allow to pick more than one macro at the same time by hitting control key before they are pasted.
(As stated earlier, Macro function is Cerner code that we cannot change. Autotext, on the other hand, does not have this restriction and can be used multiple times in the same part of the note)
12-Allow to copy and paste results in other window w/n results in P/N again
(sometimes it doesn't allow it). (You can only copy/paste once into each OTHER window. In order to copy/paste more info, you need to open a second OTHER window)
_________________________________________________________________________________________________
_____________________________________________________________________________________
WHAT IS AUTO TEXT?
When documenting in CIS, Auto text will store text you use again and again, such as standard phrases or statements. Each selection of text can be recorded as an auto text entry and be assigned a unique name to identify it. Unlike Macros, auto text can be inserted within any paragraph of any CIS note. There are two ways to create auto text in a note.
CREATE AUTO TEXT OPTION 1
This option allows you to create auto text while in the process of writing a note. From an open note:
1. Select Hide Structure or open a free text box
2. Click on the text field and type in desired text
3. Highlight the text by dragging your mouse over it
4. Right-click on the highlighted text and select “Save as Auto text”
In the Manage Auto Text window that displays:
5. Enter the abbreviation you wish to use. The abbreviation should be the first 3 letters of the phrase or statement
6. Enter a description of the text
7. Click on Add Text
8. Click Create
CREATE AUTO TEXT OPTION 2
This method allows you to create auto text ahead of time. From an open note:
1. Select Hide Structure or open a free text box
2. Click the auto text button on the toolbar
In the Manage Auto Text window:
3. Enter the abbreviation you wish to use. The abbreviation should be the first 3 letters of the phrase or statement
4. Enter a description of the text
5. Click on Add Text
6. Type the text entry you wish to create
7. Click Create
8. To create additional auto text, click Create again
9. Click Close when done
USING AUTO TEXT
1. Type the first 3 letters or abbreviation of the text
2. The abbreviation will display
3. Left click on it and hit Enter or use the down arrow on your keyboard to select it and hit Enter
The auto text statement will display.
OR
1. Right-click in any free text field and select Insert Auto text
2. Select desired auto text from the Select Phrase to Insert window
Thursday, July 9, 2009
Great question on system performance
Question by email:
Just had a patient who is Director of IS at (a local hospital). They use the same Cerner CIS system there as we do both in the hospital and in the outpatient clinics (all across the country in 22 states, etc.) with their main “server” in Tennessee. He said to me “is it always that slow”? There were lots of half second to one second pauses etc. I said "yes, (no different than is has been for years)." He said, “they would have me by the … if the system were that slow at (my hospital).
What could possibly be the issue with our product?
Answer:
At Baystate, we "host" Cerner on our own servers whereas the aforementioned hospital system likely uses what is called an ASP version, or application service provider, such that their Cerner products are web-based. Furthermore, the perceived lack of snappy responsiveness is not only because we use our own local servers, but, as a system, we use the Cerner product that allows us to customize its various tools to our needs. These require more time and juice to operate. Customization is neither offered nor available with the ASP version of the Cerner EMR.
As tough as it might seem in its current state, we, as a physician group, would not be happy if we had to use Cerner contents "out-of-the-box". In addition to our customized PowerNotes, there are other fixed designs that would have you scratching your head as to whether there had been enough clinical input during development.
Another likely factor is that this other system is not able to do nearly as much as we do at BH with our EMR. While the rest of the country is struggling to come to terms with the reality of HIT (health information technology), Baystate is in the 99th percentile with regard to EMR adoption and expansion. We are excelling at CPOE, electronic documentation, data storage and retrieval, and the list goes on.
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