1. CERNER MILLENNIUM Introduction to PowerChart
In this lesson we’ll orient you to the components of the PowerChart workspace.
Hello and welcome to this introduction to the Cerner electronic health record. In this lesson we will orient you to the basic appearance of the PowerChart desktop.
This has been prepared using Millennium base code level & mPage 6.0; various package updates & aspects of mPage 6.3 have also been installed. Subsequent updates may display cosmetic & functional changes. All patient names displayed are fictitious.
Slides will advance automatically with narration. Use the left arrow to pause or go back to review; use the right arrow to resume play.

2. Some names to know: Our EHR is Cerner Millennium.
Unity is the name USA has given its deployment of Cerner Millennium.
PowerChart is the program in Cerner Millennium used by most medical/surgical providers in the inpatient & outpatient setting.
FirstNet is the program in Cerner Millennium used by the Emergency Department.
Some other specialties use other Cerner Millennium programs. Examples include Anesthesia, Pathology, & Radiology.
First, a few terms. Cerner is the name of the company, and Millennium is the name of their EHR product. Each client gives their version of Millennium a site-specific name, and USA has named ours Unity. There are several different programs within the EHR. PowerChart is the program that most medical and surgical personnel will interact with. FirstNet is the program used in the emergency department. Other departments like anesthesia, pathology, radiology, & the front office, have their own programs to use within Unity as well.

3. You’ll be shown how to access the Unity EHR & PowerChart, & be given a username & password.
To open PowerChart you click on this icon after you log in to the Unity domain. Enter your username and password, then click OK. Some users may employ a single sign-on process that bypasses some of these steps. Also note that if you're using the Dragon 360 voice transcription program you will see a slightly different variation of this PowerChart icon.

4. When you first log on, you’ll land on a Home screen
When you first log on, you’ll land on a Home screen. You can always return to this screen by clicking the Home button.
When you first open PowerChart you will land on the Home screen.

5. You can choose what to use for your Home screen
You can choose what to use for your Home screen. You might pick your appointment list.
The home screen can be customized somewhat, so it may be different for different users. Common appearances are an outpatient appointment list…

6. In an inpatient setting, you can view a patient list and/or the Physician Handoff tool. Double-clicking also opens the patient’s chart here.
…or a hospital patient list & Handoff tool.

7. Message Center is another common choice for a Home screen.
You might also choose to use Message Center as your Home screen, since you will go to this frequently throughout the day to read messages, sign notes, & review test results.
Message Center is another common choice for a Home screen.

8. On most screens you’ll see a refresh button in the upper right corner
On most screens you’ll see a refresh button in the upper right corner. You can always use this to update the displayed screen to the most current data.
On many screens you will see a refresh button. While sometimes the program refreshes itself, you can always click on this button to update to the latest version of the information displayed, especially if the display shows it has been several minutes since the last refresh.

9. The upper right corner also gives you a way to search for & open a patient’s chart. The Recent dropdown list will show you the last few patient encounters you’ve opened.
Also notice this recent button. This will give you a quick way to return to the last few patient encounters you’ve opened. Recognize that this is the last encounter you’ve opened for the patient, & that this may not be the latest encounter for the patient.

10. You can also type a name in the Search Box, then hit Enter or click the magnifying glass button.
You also have a way to do a quick search for a patient here. While you can type just the last name, typing LastName comma FirstName will improve your results.

11. You can also use the dropdown arrow, to search by Medical Record Number (MRN, specific to the patient), or the Financial Identification Number (FIN, specific to the encounter).
Also note that the dropdown arrow gives you a chance to search for the MRN, which is specific to the patient, or the FIN, which indentifies a specific encounter for the patient. If you know the FIN or MRN, those will be the easiest searches. Whichever you use, click the magnifying glass or hit the Enter key to search.

12. A window opens with your search results
A window opens with your search results. The more information you enter, the more the list will narrow down.
If you use FIN, that encounter will open directly. Otherwise a more full-featured patient search window will open. You can further refine your search here if necessary. Type as much information as you know; the more you enter, the fewer results you will have to sift through. Also note that sometimes the way the search engine ranks its results is not the way a human would rank them, so just remember that the patient you’re looking for might not necessarily be at the top of the list. But it will usually be near the top of the list, and the more data you enter, the higher it will be.
Maiden names, middle names, hyphenated names, & misspellings may also baffle the search engine. If you’re having trouble finding a patient you know is there, try searching on the FIN or MRN, or including the date of birth or phone number.

13. When you click on one of the patients at the top, it will display a list of encounters at the bottom. You’ll usually want to pick the most recent encounter at your venue.
You'll see a list of patients at the top. Once you select one of those a list of the patient’s encounters displays at the bottom. They are usually ordered by date, with the most recent date at the top, but you can click on any of the column headings to re-order them. Often you want the latest encounter at your venue, unless you’re specifically looking for an older encounter. Double-click the desired encounter to open the chart.

14. As you open an encounter on the patient’s chart for the first time, you’ll be asked to state your relationship to the patient. Think of this as an explanation for why you’re viewing this patient’s record. If you already have an established relationship with the patient (e.g., you’re the PCP) you won’t see this.
When you first open a patient's chart, you may be asked to assign a relationship. Just think of this as an explanation for why you're opening the chart. If you already have an established relationship with the patient, for example if you’re the PCP, you may not see this window. The list you see may differ from this example; just pick the best fit that you see.

15. Here is a full view of the chart workspace.
With the patient's chart open the work space looks like this. I've got this open on a desktop computer so that you can see the full the work space with everything expanded. When you're working on a smaller device you may not see all of this at once, but I want you to get the big picture to start with.

16. Windows Menu Toolbars Banner Bar Table of Contents Menu
There are several areas of the chart here to notice. At the top is a Windows menu, & below that are some toolbars. Below that you see information specific to the patient in the Banner Bar. On the far left you see something labeled “Menu,” but that's an unfortunate choice of terms, since we already have a Windows menu up at the top. While it doesn’t say so on the screen, this left-side “menu” is actually called the Table of Contents. The bulk of the space is taken up with an assortment of screens that help you perform your work, such as doing documentation, reviewing information, & placing orders. Let's take a look at each of these.
Table of Contents Menu
Main work space.

17. Like most Windows programs, you’ll see a Menu Bar across the top
Like most Windows programs, you’ll see a Menu Bar across the top. This can be used to change views & perform several functions, but for the most part it just duplicates functionality you’ll access in other ways throughout the program.
As with most Windows programs, at the top you'll see a Menu Bar. There some things here that are useful, but I'm not going go into all that right now. Often this just duplicates things you can do elsewhere in the program, or gives you access to some one-time settings. We’ll point out the important things as we come to them in other lessons.

18. Below that you’ll find something else common to many Windows programs—a toolbar. You’ll use some of these buttons periodically throughout your work session.
Below that is the toolbar, or actually several toolbars. The appearance of these varies from user to user, & you have some ability to customize these. You'll use some of these buttons fairly frequently, & some of them you may never touch. We’ll explain how to use the common ones as they appear in other demonstrations. But let's look at a couple things while we're here. First, understand that the toolbars will expand & contract to adapt to the amount of screen space available on your device.

19. Toolbars adapt to the available screen space
Toolbars adapt to the available screen space. If button isn’t displaying, you can see it by clicking the dropdown arrow at the end of the toolbar.
If you’re ever told to look for an item that you don't see on the toolbar, click this little dropdown arrow & you’ll see other items that are not currently being displayed. You can select them from here.

20. Notice this Exit button. Use this to close PowerChart.
Also notice this Exit button. This is the best way to close PowerChart. If you click the Red X in the upper right-hand corner as you would in many Windows programs, PowerChart may not shut down properly, & it may not preserve any customizations you've performed.
Since that exit button is so important, you might want it at a more prominent place on your toolbar, & ask yourself if there's a way to rearrange these things

21. To rearrange buttons on the toolbar, click the dropdown arrow, hover over Add or Remove Buttons, then click Customize.
Well there is. Click the toolbar dropdown arrow, hover over Add or Remove Buttons & then click Customize.

22. Click on the Exit button & drag it where you want it, e. g
Click on the Exit button & drag it where you want it, e.g. all way to the left.
We don't want to add or remove anything. All we want to do is make that Exit button easier to find. Just click on the Exit button & drag it all away to the left or to the right, whichever you prefer. When you're done click Close & you'll have the Exit button at the location of your choosing.
When done click Close.

23. When the patient’s chart is open, you’ll see a splash of useful information at the top in the Banner Bar.
When you hover over an item on the Banner Bar, it will often display more information. For example, here it shows the encounter date you chose when opening the chart. You can click on this to change encounters.
The Banner Bar provides a splash of face-up information about the patient, like demographics, location, insurance, & allergies. Also in the center you see the Encounter Date you've opened. This is important to note, so that you don't inadvertently wind up on the wrong encounter. For some of these items when you hover over them you’ll see more information. Also for some you can click on them & it will open up an opportunity to make selections or perform documentation. Allergies & Encounters in particular are examples of that.

24. Now let’s look at the actual chart.
Now let's look at the meat of the chart. The exact appearance will vary depending on specialty, but the general theme is similar. At the far left you'll see something that is labeled the Menu, though it's full name is the Table of Contents. This is an older component of the Cerner EHR that some people jokingly refer to as The Dark Side. To the right is the primary work area.
These two parts of the desktop interact & feed each other. The Table of Contents on the far left is the backbone of the chart. It's the file cabinet where all of the structured data is stored. The work area to the right is intended to give you rapid access to the things you need most, & to facilitate smooth encounter documentation. The information in both areas is much the same; it’s just presented differently.
The design premise is that you can do most all of your work quickly & efficiently on the right, only going to the left for a few specialized things, or when you need a little extra detail. Sometimes you’ll probably feel like the designers hit the mark. Other times you may feel like the presentation of information on the Table of Contents is clearer. Over time you’ll probably develop a combination of using some of both that you’re most comfortable with.
Let's review these two parts of the chart individually.
Table of Contents Menu
Main work space.

25. The Table of Contents is part navigation bar & part file cabinet.
The top few tabs provide workflow “viewpoints” for various venues or patient types. Many providers have at least an Ambulatory & an Inpatient viewpoint. Some have additional viewpoints, as illustrated here. Others have only one viewpoint that combines both ambulatory & inpatient workflow tools.
While it’s an older part of the program, the Table of Contents is still very useful. The top few entries, or tabs, provide Viewpoints. You may just see 1-2 of these, or maybe They vary by specialty & by inpatient versus outpatient needs. When you click on one of them it serves the content that you see in the main area of the screen to the right.

26. Other entries on the Table of Contents bring you recognizable aspects of the patient’s chart, like problem list, allergies, histories (medical/surgical/social/family), medication list, etc. It also gives you a way to place orders.
While there are other ways to enter & review much of this information, sometimes you’ll still come to the Table of Contents for these things, since it provides the way to enter the greatest degree of detail, or you just may favor the presentation here.
Below that are tabs that give you access to the actual structured data on the patient chart—things like the problem list, medication & allergy lists, family history, social history, etc. You can also place orders & view documentation here. Sometimes you can enter greater detail here than you can on the right-side work area, & sometimes you just may favor the way the data is laid out here.

27. Items toward the bottom of the Table of Contents include some optional functionalities, niche tools, & demographics.
Near the bottom of the Table of Contents there are usually several items that provide access to niche tools, demographics, or other things that are outside of your typical encounter workflow.

28. Items toward the bottom of the Table of Contents fill some other niches or optional functionalities, like health maintenance, research, or special workflow tools.
In particular here you may want to notice LearningLIVE, which functions as a help file with quick tips & how-tos.
In particular, notice that LearningLIVE presents a help file with tips related to the area of the chart you’re on or recent activities you’ve performed.

29. Moving back to the viewpoints at the top, we see that these serve several workflow tabs, also referred to as mPages. These tabs are designed to be a rapid & efficient way to perform the majority of your work.
When you select one of the viewpoints at the top of the Table of Contents, it delivers a collection of workflow tabs, summary tabs, & Quick Order tabs to facilitate your encounter documentation.
As we start to focus on this workflow area, notice this thumbtack at the top of the Table of Contents. If you click on this to turn it sideways, the Table of Contents will slide in & out depending on whether you're hovering over it.
Once you’re working on the workflow tabs, you may wish to click the thumbtack, which collapses Table of Contents to the left.

30. With the Table of Contents collapsed, you have more horizontal screen space, which comes in handy on small devices. If you need the Table of Contents again, hovering the mouse over it will slide it back out.
This gives you more screen space for the workflow area, which is particularly helpful on a small device. If you want the Table of Contents to stay permanently in place, click the thumbtack to make it vertical.
Many of the workflow tabs, or mPages, also have a navigation bar to the left of them. Often on smaller devices, the program will recognize that display area is at a premium, & it will automatically display one or the other, but not both of these. You can still see them, however, by hovering over them.

31. We’ll look at some examples of these workflow tabs
We’ll look at some examples of these workflow tabs. Here you see the Clinic Workflow tab, where you’ll recognize many familiar aspects of the patient chart. The left-side navigation bar helps you move up & down. You can drag these lines up & down as desired to match your workflow.
Let's look at some examples of these work area tabs. We’ll start on an ambulatory viewpoint. Here is a workflow tab. This is intended to be a tool to work through your encounter, reviewing information & recording documentation as you go. All of these items on the left side navigation can be rearranged as you prefer, just by dragging them up & down.

32. This button on the upper right allows you to choose which components display on an mPage.
You can also click this little button that sometimes people refer to as the pancake stack or hamburger. When you click Components you’ll notice that you can see a list of all of the items that are available for use on this tab. The selected ones appear as headings on the left-side navigation. Except for a few that are locked, you can check & uncheck items, so that you only see the things that you really need.

33. On an inpatient encounter, you also have workflow tabs
On an inpatient encounter, you also have workflow tabs. The Admit tab is used for admissions. The Manage tab is similar, geared for day-to-day rounding, while the Discharge tab provides tools for discharge workflow.
On inpatient encounters you will see some more workflow tabs, often labeled admit, for the day of admission, manage, for day-to-day rounding, & discharge for the day of departure.

34. You also have Summary mPages.
Both inpatient & outpatient viewpoints will usually offer a summary mPage, meant to give you an overview at a glance of the patient's chart. You can rearrange all of these components & change a lot of the other display options like color, number of columns, etc., through that pancake stack button.
Some people may like this, & some may find it to be a bit overwhelming & busy. Just remember that you always have the Table of Contents on the left if you wish to zone in on specific aspects of the chart in a less cluttered fashion.

35. On both ambulatory & inpatient encounters, you’ll also have a Quick Orders tab, which gives you a way to quickly place most orders or PowerPlans (order sets) used in that venue. You’ll sometimes see variations on Quick Orders, e.g., different ones for adult & pediatric orders, or inpatient vs clinic work. You can expand, collapse, & rearrange these components to suit your needs.
Both inpatient & outpatient encounters will also offer one or more Quick Orders tabs. These give you rapid access to most common orders without having to go through the formal order search. Sometimes there are more than one Quick Orders tab; they can vary among adult & pediatric patients, or by specialty.

36. The Demographics tab gives you phone numbers, emergency contacts, insurance information, etc.
You will also find a demographics tab that gives you access to identification & insurance information, as well as emergency contacts.

37. If there is a tab you rarely use, click the X to quit displaying it.
There may also be mPage tabs you’re not seeing. To add additional tabs, click this + sign.
You can choose which mPage tabs you wish to display. If there is one you don’t need, click the X on the tab to remove it. (You can add it back later if you change your mind.) You can also add additional mPages by clicking the + sign to the right of the tabs.

38. Select any additional mPages you wish to use.
Select any additional tabs you wish to display & use. The list may be pretty long, especially for residents. Since they rotate through many different services, they need a variety of tools appropriate for those settings. Sometimes you’ll probably select an mPage for that month, then quit displaying it when you move to another rotation.

39. We’ll review each of these parts of the PowerChart desktop in more detail in other lessons.
Now that you know your way around a little, in other lessons we’ll show you how to use all of these things to document your encounters.