CERNER MILLENNIUM FirstNet Introduction to Workflow & Documentation In this demonstration we’ll review basic workflow & documentation for Emergency Department providers in FirstNet. This has been prepared for Millennium code level 2015.01.15 & mPage 6.0. Subsequent updates may display cosmetic & functional changes. Use the keyboard or mouse to advance.

As you arrive for your shift, the first thing you’ll do in FirstNet is make yourself available as a provider. Hover over the check-in area… …and click Check In.

You can assign a default location, initials, default relationship, & color used on the ED LaunchPoint. But most importantly, check Available Provider & Available Reviewer. (When done click OK.)

If you work in both EDs, you can also change your location for the day.

Now let’s pick up a patient Now let’s pick up a patient. Click in the provider assignment column for the desired patient.

Then click Assign.

Your initials appear under MD. To get a picture of what’s going on, click the patient’s name to bring up the Patient Summary.

You see an overview of medical history You see an overview of medical history. Use the other buttons at the top to review further.

You see some lab has already been done; scroll down to review all results, then click Review All.

You also see that a chest X-ray has been done. Click XR Chest 2 Views.

Review the report. When done click the X to close this window.

Note that you can bring up the Add Order window from many of these screens. Since there’s no EKG yet, let’s order one. Click Orders.

In the search box, type EKG In the search box, type EKG. As results display, double-click EKG 12 Lead. You could search for more orders, but for now just click Done.

You’re dropped into the Orders for Signature window You’re dropped into the Orders for Signature window. Required detail fields will be highlighted. There’s one here: Reason. Click Chest Pain, then Sign.

The EKG is added to the order profile The EKG is added to the order profile. Click ED LaunchPoint to return there.

By now you’ve probably at least briefly seen the patient, & you have some other orders you want to enter. Right-click the patient’s name, then click ED Workflow.

There are a couple of Quick Orders pages here, Emergency Orders & Pediatric Orders. Click Emergency Orders.

Here you see an assortment of orders that are commonly used in the ED Here you see an assortment of orders that are commonly used in the ED. You can rearrange sections, expand or close sections, etc., to meet your preferences. Select the orders you want. For this example, we’ll click CMP & Troponin-I.

The number 2 now appears here, often referred to as the checkout cart The number 2 now appears here, often referred to as the checkout cart. Click this to begin signature of these orders.

Click Sign.

Let’s say some time has passed, & the patient needs to be admitted Let’s say some time has passed, & the patient needs to be admitted. Click Request for Admit.

As before, click the checkout cart, then Sign.

Certified Emergency is a required field; click Yes, then Sign.

That being done, return to ED LaunchPoint.

Now let’s create our note. Click the box under Doc.

The New Note window opens The New Note window opens. Notes in the ED are currently done using the PowerNote method (in contrast to DynDoc, which is used in most other venues.) In the Encounter Pathway field, type Chest Pain, then click the Binoculars button.

Double-click Chest Pain *ED.

The Chest Pain template opens The Chest Pain template opens. PowerNotes are created in a point-&-click manner, though you also have the ability to use free text, AutoText, & macros. Work your way through the template to create your note. When done click Sign/Submit.

A resident or student would search for the attending to submit to.

Then click Sign. After the attending has signed the note, it can no longer be edited, though you can add an addendum to it. (If the resident adds addendum, it must be re-submitted to the attending.) After 30 days, no further addenda can be added.

The note appears on the document list.

If instead the patient were being discharged, you would need to complete the discharge process. In ED LaunchPoint, right-click the patient’s name & click Discharge Process.

Required fields that haven’t been completed are highlighted in yellow Required fields that haven’t been completed are highlighted in yellow. We’ll go to the first one, Medication Reconciliation, & click the Pencil Icon.

We see the patient’s home meds We see the patient’s home meds. We don’t want to change any of those, so click Acknowledge Remaining Home Meds. We want to prescribe a new med. Click +Add.

In the search box, start to type Pantoprazole In the search box, start to type Pantoprazole. Double-click your desired result as it appears. That’s all we want, so click Done.

Pantoprazole appears as a prescribed med Pantoprazole appears as a prescribed med. Prescription details can be adjusted at the bottom. (Send To would usually be set to transmit electronically to patient’s pharmacy, though that can’t be shown in this demo.) When done, click Sign to complete the reconciliation & the prescription.

Medication Reconciliation is no longer yellow Medication Reconciliation is no longer yellow. Click the Pencil for the next item, Patient Education.

Double-click one or more of the suggested educational materials.

Text can be modified as desired, then signed. Now click Follow Up.

We don’t want the patient to follow up with the ED physician, so we’ll click the X here to remove him.

Make selections for who to follow up with & time frame. When done, click Sign.

With all discharge elements now satisfied, click the Patient… demonstrates understanding… checkbox, then Sign, completing the discharge. (You or your staff could print it.)

While there are numerous other potential details beyond those illustrated, this exercise has demonstrated the basics of how to place electronic orders, electronically prescribe meds, generate encounter documentation, admit, & discharge a patient.