Major bummer for a handful of dedicated CIS users. For convoluted reasons, precompleted notes and macros that had been created on now defunct versions of PowerNote can get lost. The probable issue with the loss of the precompleted notes is that they were likely created on older templates that had been revised over time. We've seen folks lose notes that were created on the earliest templates.I am learning that the system can be quite sensitive to changes made in the content and code. Cerner, our EMR vendor, recently recommended:
Ensure that the precompleted note or the macro was not created before a recent content load. If new PowerNote content has been taken since the precompleted note or macro were created, there will be viewing issues. They were created under older content and a different structure for the portions of the note (paragraphs, sentences and terms). Therefore, when trying to use the precompleted notes or macros with a new structure, there is a mismatch and some of the terms that were there before are no longer there or have been moved around. In order to resolve the issues, the macros and precompleted notes will need to be created and saved again.
An alternative explanation may be that the precompleted notes are shared and accidentally deleted by another user. Unfortunately, there is no way to back up precompleted notes. Cerner's answer to the difficulties with macros and precompleted notes is to create a compendium of auto-texts that would serve a similar purpose. These are not dependent on content or template format and can be used across all PowerNote Templates or in Clinical Notes were you to work from that screen.
I honestly wish I had better news.
Wednesday, September 16, 2009
Friday, September 11, 2009
Creating Proxy Lists
Granting proxy authorization to another clinician or members of a clinical team enables the proxy to perform any activities for which you have granted them authorization, such as signing, refusing and forwarding messages and results.
To grant proxy authorization to another provider or team member, complete the following steps (see pictorial in slide below):
1. From the Inbox menu, select the Proxy Tab and click the Manage button.
2. Click Add.
3. Search for a user by typing last name, first name. Click the binoculars to search.
From the User list select the user that you want to give proxy to. To grant proxy to more than one user use the arrow to move the current user to the additional user's box and continue searching.
4. Specify a Begin Date/Time and End Date/Time. For example, if you will be out of the office for two weeks, specifying the Start Date/Time and End Date/Time ensures the proxy will be able to access your Inbox messages during that period only.
5. To grant permissions to the selected user, highlight Results or other items you want to proxy.
6. Click Grant
7. Click Accept & Next button.
To remove an existing proxy authorization, complete the following steps:
• From the Inbox menu, select the Proxy Tab and click the Manage button.
• All proxies that you have granted are listed in the Proxies Given By Me pane
• Select a proxy.
• Click Remove. The proxy authorizations are removed.
• Click OK.
To view a list of all individuals to which you have granted proxy authorization, as well as specific permissions of each authorization, complete the following steps:
• From the Inbox menu, select the Proxy Tab and click the Manage button.
• All proxies that you have granted are listed in the Proxies Given By Me pane.
• Select the proxy that you would like to view and click Details. The specific permissions that you have granted are displayed.
To view a list of all providers and document types for which you have been granted proxy authorization, complete the following steps:
• From the Inbox menu, select the Proxy Tab and click the Manage button.
• Click the Received tab.
• The users displayed in the Proxies Received by Me pane are authorizations that have been granted to you.
To view detailed information about the privileges granted by a particular user, select user and click Details.
To grant proxy authorization to another provider or team member, complete the following steps (see pictorial in slide below):
1. From the Inbox menu, select the Proxy Tab and click the Manage button.
2. Click Add.
3. Search for a user by typing last name, first name. Click the binoculars to search.
From the User list select the user that you want to give proxy to. To grant proxy to more than one user use the arrow to move the current user to the additional user's box and continue searching.
4. Specify a Begin Date/Time and End Date/Time. For example, if you will be out of the office for two weeks, specifying the Start Date/Time and End Date/Time ensures the proxy will be able to access your Inbox messages during that period only.
5. To grant permissions to the selected user, highlight Results or other items you want to proxy.
6. Click Grant
7. Click Accept & Next button.
To remove an existing proxy authorization, complete the following steps:
• From the Inbox menu, select the Proxy Tab and click the Manage button.
• All proxies that you have granted are listed in the Proxies Given By Me pane
• Select a proxy.
• Click Remove. The proxy authorizations are removed.
• Click OK.
To view a list of all individuals to which you have granted proxy authorization, as well as specific permissions of each authorization, complete the following steps:
• From the Inbox menu, select the Proxy Tab and click the Manage button.
• All proxies that you have granted are listed in the Proxies Given By Me pane.
• Select the proxy that you would like to view and click Details. The specific permissions that you have granted are displayed.
To view a list of all providers and document types for which you have been granted proxy authorization, complete the following steps:
• From the Inbox menu, select the Proxy Tab and click the Manage button.
• Click the Received tab.
• The users displayed in the Proxies Received by Me pane are authorizations that have been granted to you.
To view detailed information about the privileges granted by a particular user, select user and click Details.
Thursday, September 10, 2009
Results to Endorse successfully rolled out
The number of BMP clinicians now able to manage results through CIS has nearly doubled to about 250 since Tuesday afternoon. This accounts for over 2/3 of all BMP clinicians who practice in the ambulatory setting. Thanks go to all of you who are taking this next step towards a paperless medical record.
One of the major goals in transitioning to electronic resulting is to enable practice sites to develop the means to manage results both on an individual and a group basis. The Proxy tool is designed to facilitate this task. Proxy lists are controlled by the individual clinician and work in conjunction with colleagues and staff. It will be up to the practice to define members of proxy lists and to ensure that those designated to monitor results are included in these lists. Each clinician can proxy anyone on clinical staff to be able to view results and process them as determined by practice protocol.
The following outlines three scenarios for Proxy use:
- Practice A decides that each clinician (physician, NP, PA) reviews, endorses and manages all results sent to their Inbox Results folder. The Proxy tool is employed when said clinician is away from the office, e.g. on vacation, and practice partners and clinical care coordinator are named as proxies to ensure that all results are viewed while the clinician is away. The Proxy tool allows the user to set a finite time period whereby the proxy is in effect.
- Practice B has divided the group into 4 teams. Each team consists of x number of clinicians, medical assistants and/or clinical care coordinators. Each member of the team proxies all other members of their team. Depending on how results are then managed, any of those team members who have been proxied to receive results can view and Skip or choose to take action and Endorse the result. The endorsement action can be performed by any member of the proxy team.
- Practice C has chosen to pair clinician with medical assistant via proxy such that the clinician wants to review only those labs requiring additional clinical input, i.e. abnormal labs. In this case, the medical assistant can go through the results that have been proxied and endorse all normal results. (At the same time, the MA can be tasked to generate a patient correspondence letter informing the patient of their normal results.) In the event of an abnormal result, the MA has two choices: the first is to click on the Skip button and leave the result present for review by the clinician; the second is to endorse the result and then forward the result to the clinician for second review and definitive action.
I am currently working with our vendor to provide a third option which would enable the proxied party to click on a Reviewed button, thus documenting that the result as seen by the proxy (be it MA or covering clinician) and allowing the result to remain for the ordering clinician to endorse.
Turning off the Paper
As you can imagine, part of the end-game is to discontinue the paper delivery of results. From my experience, regardless of all plans and intentions, you are best off living in a “duplicate world” for at least a week or two whereby you have to process results both electronically and on paper. This is done primarily to ensure that you receive all results that were preliminarily processed prior to going live with electronic results. When your practice is confident that electronic resulting is reliable, BRL can stop the delivery of paper results.
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