1. CERNER MILLENNIUM Prenatal Visits
This demonstration reviews a typical prenatal visit. It should serve as a good introduction for providers, students, & residents familiar with PowerChart in general, but new to maternal health workflow. Note that workflow expectations may vary among clinics, & that some activities may be performed by nursing/MA staff or providers.
This has been prepared/updated for Millennium code level & mPage Subsequent updates may display cosmetic & functional changes. All patient names displayed are fictitious.
Use the keyboard or mouse to advance.

2. Upon logging in to PowerChart, the provider will see the appointment list on the Home screen. (A student or resident may need to select the provider with whom s/he is working.) Clinic staff has roomed the patient & performed other activities as per the clinic’s routine, such as performing a urinalysis. Click on a patient to open the chart.

3. The chart opens to the Prenatal/Postpartum workflow tab, or mPage
The chart opens to the Prenatal/Postpartum workflow tab, or mPage. In most cases this step will have already been completed, but if you’re the first person to document on a new pregnancy, you’ll need to initiate that pregnancy by clicking the + sign for Add Pregnancy or Add a pregnancy.

4. Begin by documenting Onset Date, either by typing or using the calendar dropdown. This will usually be the LMP; if there is any doubt it’s good to start with the earliest possible date here.

5. Record other details. Here we’ve recorded 8/9/16 Onset Date Use as LMP Date; Confirmation method Urine hCG; menses was of Normal Amount/Duration; this is the Initial EDD dating.
Today’s date (or the date this was recorded, if documenting late).
EDD & EGA calculate. When done, click OK.

6. The pregnancy is created
The pregnancy is created. Similar to other encounters in PowerChart, the Table of Contents is on the far left, & the components of the Prenatal/Postpartum workflow tab are next to that. (You can drag these components to arrange them however you like.)

7. All general medical history details are entered just as they would be for any other patient. For the purpose of this exercise, we’ll assume this is either an established patient with those details already entered, or that your nurse entered them for you earlier. You’ll review as necessary.
We notice there is no information about previous pregnancies recorded yet. Click on the Pregnancy History tab.

8. Notice there is no direct way to record previous pregnancy history here.
To proceed, click the Histories heading on the workflow tab. (You could also go directly to Histories on the Table of Contents.)

9. To record history about her first pregnancy, select the Pregnancy tab then click +Add.

10. The required fields are highlighted in yellow
The required fields are highlighted in yellow. The first pregnancy concluded 9/11/09, so we’ve completed the first required field here.

11. She reports a miscarriage at 9 weeks, so we’ve entered those details.
When done click OK & New.

12. Her second pregnancy was a vaginal delivery 2/2/14, so we’ve recorded those details.
If there were twins, we’d click Add Baby, but we don’t need to do that here.
There are no other pregnancies to record, so click OK.

13. NOTE: Sometimes this screen can be too large to fully display on smaller devices. To see the OK / OK & New / Cancel buttons, you might have to scroll down & right. If you don’t notice this, you won’t be able to complete the entry, causing frustration or incomplete documentation.

14. The prior pregnancies display
The prior pregnancies display. Navigate back to the Prenatal/Postpartum tab. (Ways to do this include the Table of Contents, the Back Arrow, or the “Breadcrumb” List of previous places you’ve been on the chart.)

15. Prior pregnancies also now display on the workflow tab (after refresh).

16. Now we’ll turn our attention to this pregnancy
Now we’ll turn our attention to this pregnancy. A general overview of the pregnancy is presented here.

17. Details of this pregnancy may have already been recorded by the staff
Details of this pregnancy may have already been recorded by the staff. But for this demonstration we’ll enter them now.
Risk Factors haven’t been documented yet, so click the Risk Factors + sign.

18. The only thing notable is her previous D&C after the miscarriage, as illustrated below. When done, click the check button to sign.

19. Risk Factors display. Similarly, we’ll review Genetic Screening by clicking the + sign.

20. Record details, then click the check button to sign.

21. Genetic Screening details display.

22. Now we’ll review current medications
Now we’ll review current medications. While you can see them directly here, for the purposes of this demonstration, click Outpatient to further reconcile & edit.

23. We’re OK with her PRN loratadine for allergies
We’re OK with her PRN loratadine for allergies. She gets that over the counter, so we’ll just click the Continue bullet.
While we’re here, let’s go ahead & prescribe prenatal vitamins. Click +Add.

24. Start to type Prenatal vitamins, then select the resulting match that you prefer. (You can hit Enter to see a longer list of results.)
After making your selection that’s the only med we need, so click Done.

25. Modify details as desired. Here we’ve made it 90 with 3 refills
Modify details as desired. Here we’ve made it 90 with 3 refills. If there were an actual patient, the pharmacy would display here for Erx.
When done click Reconcile and Sign. The multivitamin prescription will be sent to the pharmacy.

26. You return to the med list
You return to the med list. Navigate back to the Prenatal/Postpartum tab using your preferred option.

27. The Home Medications list is updated (after refresh).
Now let’s see the patient & document the provider’s patient discussion & exam. Navigate to Prenatal Visits.

28. This is where the provider documents concise details about each prenatal visit. Today’s entry may have already been started through the staff’s data collection, though if necessary you could begin an entry by clicking the + sign.

29. To add to today’s entry, hover over the date, & the word Chart will appear. Click Chart.

30. Make entries in fields as appropriate
Make entries in fields as appropriate. This is like the new line you would add on the ACOG form at each visit. When done, click the check mark to sign & post the entry.

31. Entries are displayed in a grid fashion.
Also, if an entry is too long to display fully, you can see the full entry when you hover over it.

32. You can use these View Buttons to toggle from the grid view to this “index card” view.
You can Chart from this view as well.

33. If you’ve already entered some comments that visit, but want to add more, right-click, then click Add new value. (This works in both grid or card views.)

34. Make your new entry, then click the check mark.

35. The new entry displays; if necessary, hovering over it will show the full text. (Your previous entries also remain, & will appear in your visit note.)

36. Next let’s order initial prenatal labs
Next let’s order initial prenatal labs. You could manually search for these, but we’ll order them from the Quick Orders page. Click OBGYN AMB Orders.

37. Click Prenatal Profile 1-(LC).

38. While we’re here, let’s go ahead & add the visit charge
While we’re here, let’s go ahead & add the visit charge. Click Initial Prenatal Care Visit.
NOTE: Technically, you should place your visit charge after you complete your note. But if you’re sure you’re going to do your note a moment later, placing the charge now saves you from having to navigate back here to do it.

39. Let’s also place our clinic follow-up visit order
Let’s also place our clinic follow-up visit order. Click Clinic Follow-Up.

40. When all orders are placed click the checkout cart.

41. Associate the Pregnancy diagnosis with the orders (if they’re not already associated), then click Modify.

42. For the clinic follow-up, we’ll use the available fields to add instructions to schedule F/U w/ me in 4 wks.
To complete the other orders, click Missing Required Details.

43. For the Prenatal Profile, select Collection Priority Routine, & there are no more missing details. (The Missing Required Details count drops to 0; sometimes the count just isn’t right.) When done, click Sign.

44. Navigate back to the Prenatal/Postpartum tab.

45. Let’s look at Patient Education
Let’s look at Patient Education. Since we’ve already added the diagnosis of pregnancy, the program suggests pregnancy-related materials. At this time 1st trimester education would be in order, & we see listings for that, including 1st trimester education that we’ve customized previously.
Notice there may be several pages of suggestions; clicking Next would show you additional materials, such as the 3rd trimester education.

46. Clicking on one of the materials will add it to this encounter.
You or your staff can click the Printer icon to print it, or the Pencil icon to review & edit it. We’ll click the Pencil.

47. Review the material; edit, remove, or add text as you deem appropriate.

48. For this illustration, we’ve scrolled to the end, & we’ll add a section about breastfeeding. Place the cursor in the document & type, or paste from materials you already have prepared.

49. After making your edits, you might want to save this as custom patient education. Right-click the title & select Save as Personal Custom Instruction.
You’ll be prompted to give it a name. Assign one; including your name or initials may help you search for yours easily in the future. Then click OK.

50. Click Print if you wish to print it now; otherwise, just click OK.

51. Click your customized version to add it to today’s encounter.
Click the X next to First Trimester of Pregnancy to remove the original version.

52. Notice the faint stars to the right of each item
Notice the faint stars to the right of each item. Clicking these will allow you to add them to your Personal Favorites.

53. The star will turn gold for your Favorites.
You can also view all your collected Favorites by clicking the Favorites button.

54. Now we’ll start the visit note. Click the Documents + sign.

55. Most providers will use the Dynamic Documentation, or DynDoc, method to create notes, & that may well appear initially here. Unfortunately, prenatal visit DynDoc content has not yet been created by Cerner, so the standard approach will be to use the older PowerNote method to create notes. To change to that, click the dropdown arrow next to +Add, & select PowerNote.

56. Select Note Type; here we’ll pick Obstetrics Office Clinic Note
Select Note Type; here we’ll pick Obstetrics Office Clinic Note. (Family Medicine would select the most appropriate note type available, perhaps Family Medicine Office Clinic Note.)

57. There are a few ways to begin
There are a few ways to begin. We could browse the Catalog tab to make a selection. Here we’ll illustrate searching for an appropriate note under Encounter Pathway. Type OB & search; in the results, select OB Antepartum, Initial Visit.

58. PowerNote is a point-&-click approach to document creation, though you also have access to free text, AutoText, & Dragon voice recognition. You can move about with the navigation bar on the left, or using the scrollbar.
For this exercise, we’ll click through making entries. There’s a lot of stuff here. Just pick the things you would usually document. For example, click Gravida/Para (ST).

59. Those details are inserted.
Navigate down adding more entries.

60. After making all your entries, click Sign/Submit.

61. Residents & students would click Request endorsement & search for the supervising attending.
When done, click Sign.

62. The document appears on the Documentation list.
That would finish off this encounter, but in the next section we’ll look at a few other points.

63. Ultrasounds
Here are some notes about ordering ultrasounds, & updating the EDD after reviewing an ultrasound.

64. In-clinic ultrasound orders & charges will be handled differently in the OBGYN & Family Medicine clinics.
In OBGYN, to order an obstetrical ultrasound, go to the OBGYN AMB Orders tab & select MFM/OB Ultrasound (US). Sign the order as usual, & it will go to the MFM ultrasound techs, who will perform the ultrasound, & submit a combination of the technical & professional charges.

65. In Family Medicine, ultrasounds are performed by the providers
In Family Medicine, ultrasounds are performed by the providers. To schedule an ultrasound appointment, select Clinic Follow-Up.

66. Note that you could combine ordering follow-up for the next clinic appointment with the ultrasound appointment. For example, we’ll add instructions to schedule F/U w/ me in 4 wks. Schedule U/S in our office next wk. Then sign orders as usual. The staff will receive the order & schedule both appointments.

67. After you’ve performed & interpreted the ultrasound, return to the OBGYN AMB Orders tab, & select the appropriate charge order. This will usually be WH Ultrasound OB < 14 wk single fetus or WH Ultrasound OB > 14 wk single fetus (You can manually search for other WH Ultrasound charge orders.) Sign this order to drop the technical & professional fees for the ultrasound.

68. To record ultrasound details & update the EDD, go to the Prenatal/Postpartum tab & click EDD Maintenance +.

69. Click the Method dropdown & select Ultrasound.

70. Fill in other details determined by the ultrasound.

71. If you’re at a point in the pregnancy where you’re sure you will not further update the dating, you can click Final. Otherwise, leave this unchecked, since you won’t be able to make further changes after that.
We want to use these dates going forward, so click Use this estimate for EDD calculations. When done, click OK.

72. The updated dating is posted to the EDD Maintenance list.
Printouts from the ultrasound machine will also be scanned into the chart.

73. A follow-up prenatal visit is similar, except that you won’t have all of that first-time information to enter.