Dragon Dictation Pilot

We have begun our Dragon dictation pilot this week.  11 physicians went through an in-depth training session last week and are into their first few days of use.  I've created these primer-level CIS videos for supplementary training. I'd love to know if you find them helpful.

Click on the links below to be brought to screencast.com where you should be able to view them on any BH computer.  If you have any trouble viewing from here, I created these videos on QuickTime and have the MPEG-4 files on my desktop if you want a copy.  Keep in mind that you'll need this Apple freeware that is bundled with iTunes. 


Don't forget to click on the FULL SCREEN button


Move Your Dragon Templates to the Favorites Tab

Beginning PowerNote with Autopopulation

Disable Autopopulation

Problem List Management

Entering Current Medications

Updating Medication List

Setting the Default Folder for PowerNotes

Prescription Writing Woes

Sorry for another long absence. Last week, we spent three days with folks in from Cerner headquarters in Kansas City to hear out and evaluate our disappointment with the Prescription Writer, Medication List and Medication Reconciliation tools. For the most part, we were pleased with the team's receptivity, though less than excited about what can be fixed quickly. The long and the short of it is that we will not see any major changes in the layout and appearance of the Prescription Writer for the time being. However, we will be putting together some documentation to help you optimize the function of what currently exists.

One crucial discovery I have made over the last week is that, in spite of being promised a seamless transition from EasyScript to Prescription Writer, many of the refill/renew and favorites woes are derived from an obvious lack of seamlessness. In fact, I am beginning to untangle myself from the older scripts and will also be building new Favorites folders. This is a major drag since I have about 350 favorites that came over from Easy Script. The problem is that all those extra terms in the sigs and all those problems with renewing and changing doses are a direct result of using old commands to create new prescriptions.

My advice is this: when renewing a med that was originally written in EasyScript, DO NOT use Renew. USE Cancel/Reorder. This will rid of the old version of the Rx, allow you to make changes to the dose and the sig , and should present the mandatory fields in a somewhat more logical fashion. It is definitely worth it. Then, save the new Rx as a Favorite if desired. This new favorite, whether written in the office or on discharge from the hospital, will end up in the Ambulatory Meds favorite folder where you can then organize a brand new folder set based on disease states, medication classes, organ systems, whatever you like. The favorites that fall outside of the Ambulatory Meds folder are all imports from EasyScript. Feel free to delete them as you build new ones.

Keep your eyes peeled for emails and updates on the CIS Info site. We will be getting out details for change in the coming days.

Prescription Writer and the Medication List

My two favorite topics... well, not really. So far, we have had a couple of teleconferences with senior Cerner analysts to share some of the major issues reported thus far. For one, "real estate", the amount of space given to view relevant information, is inadequate. While the old Med Profile seemed less than optimal to many, the new Med List is difficult to read and doesn't take good advantage of potential space.

I remember a time when many of us felt that EasyScript was difficult. With Prescription Writer, the cumbersome task of writing a prescription requires lots of practice and a little luck to boot. It pains me to hear that folks are reverting to paper prescriptions and so the repair of these tools is priority number one.

I am confident that we have been heard by Cerner. Though I can't pin a timetable to the improvements, I believe the practice and process of monitoring and prescribing medications will get better over time.

Below is a slide that Sandy Gagnon of the IS training team put together today. It is a great way to see the Medication List in single-spaced layout. Thanks Sandy!

Uploaded on authorSTREAM by nrk99



And, if anyone is interested, I led a webinar on the Medication List and Prescription Writer last week that can be reviewed via this link: Medication List Webinar

Medication List - writing a prescription

Transparent Informatics: writing prescriptions quickly and efficiently on Prescription Writer will take time and practice. Oddly enough, there are a couple of crucial tricks to getting them done without losing your mind. For instance, make sure that you select Dose as well as Duration in the Details section lest you risk your sanity. I can't say for sure why we are not prompted to select these two elements. Dose refers to the "1 tablet" part of the sig and, if you add Duration, e.g. 30 days, you will not be forced to go back and enter the unit, e.g. tablet, from the bottom of a scroll down list. I know that doesn't make much sense, but do it any other way and you will know what I mean.

I am being as honest as I can be here. I really do think the Enhanced View is a major step forward for CIS, particularly for the ambulatory setting. However, I also agree with all those who have raised concerns about the Prescription Writer. It is Change with a capital C. I've been working for a few hours on the following video and hope it clarifies the prescription writing process. Let me know what you think of the video and whether it needs more help.

Medication List 5 - Prescription Writing

More on the Medication List - Using Start & Stop Columns

So I think I'm onto something for the tracking of meds in the Medication List. In fact, and in spite of first impressions, I think tracking meds for refill will be easier and more accurate in the Enhanced View. Take a look at the video and tell me what you think. I tried to keep down the time and still provide a meaningful description.

Medication List 4 - Start & Stop Columns

Medication List on Enhanced View

Of all the new features of the Enhanced View, the Medication List presents the greatest challenge. I've heard from far and near that this is an obstacle to care. EasyScript has become the tried and true CIS tool that most docs prefer. While I can recall a time when I found EasyScript a nuisance, I tend to agree that EasyScript, in conjunction with the Medication Profile, is more intuitive, easier to read and easier to track prescriptions.

The hitch, however, is that in order for us to be eligible for the CMS incentive reimbursement for ePrescribing (CMS ePrescribing Incentive Program), we need a unified orders entry strategy and the Medication List is the prescribing mechanism of that strategy. The development of ambulatory CPOE is the bigger picture to keep in mind and this is just around the corner. We are in the midst of ACPOE design with the goal of customization for ambulatory practice, be it primary or specialty care.

So whether we keep EasyScript for now or not, we will ultimately need to move towards the Medication List and its Prescription Writer to enable ePrescribing. The Informatics and IS teams are reviewing the feasibility of maintaining some or all of the current-state prescription tools while introducing these new features. In the meantime, I will do my best to provide commentary and counsel on optimal use of CIS Enhanced View.

On that note, I have found another cool Web 2.0 site, jingproject.com, that allows me to create quick video links for your viewing pleasure. The following provide relatively brief introductory instructions on the use of the Medication List. Let me know what you think.

Medication List 1 - Real Estate
Medication List 2 - Drop-Down Menu
Medication List 3 - Customize View