1. NEXTGEN PROTOCOL SETUP DEMONSTRATION This demonstration reviews the setup of Protocols for patients in KBM 7.9. Details of the workflow will vary somewhat depending on specialty and practice policy, but this should give you a good idea of NextGen functionality. A separate exercise will demonstrate the usage of these protocols within the context of an office visit. This has been prepared with EHR 5.6.4.15 and KBM 7.9. Subsequent updates may display cosmetic and functional changes. Use the keyboard or mouse to pause, review, and resume as necessary. There is no audio with this exercise.

2. Introduction The Protocols template centralizes two major components of comprehensive medical care: – Health Maintenance Adult preventive care and screening Well child care – Chronic Disease Management Protocols are set up and activated once for the patient, and modified as indicated by changes in medical history After that, the recommended measures are incorporated into the regular visit workflow

3. NextGen provides the following disease- management protocols: – Amiodarone monitoring – Atrial Fibrillation – Coronary Artery Disease – Congestive Heart Failure – Chronic Kidney Disease – Diabetes – Hyperlipidemia – Hypertension – Statin monitoring – Thyroid replacement NextGen provides the following health maintenance protocols: – Health Maintenance (adult) – Pediatrics Practices can modify these as preferred, save specialty-specific variants, as well as create new protocols. You can also choose which aspects to apply to each individual patient.

4. For specialties that use the Advanced template set, such as Family Medicine, Internal Medicine, and Pediatrics, Protocols are accessed via the tab on the far right.

5. Specialties that have not yet incorporated the Advanced template set, such as OBGYN, access Protocols via the Navigation Bar.

6. Disease-Management Protocol Setup and Activation

7. In this exercise, our patient has type 2 diabetes and hypertension. Well activate protocols to comprehensively monitor and manage these conditions. Go to the Protocols tab. Time constraints may make it difficult to do the initial protocol setup during the visit. It may be preferable to do this either before or after the visit, so that the protocols can be used on subsequent visits.

8. To begin, click in the Protocol box.

9. Double-click on Diabetes.

10. Next, click in the Diagnosis box to associate a diagnosis with this protocol. A popup with a list of the patients current diagnoses appears. Double-click on Diabetes 250.00.

11. Click Add to finish activating the diabetes protocol.

12. The individual tests from the diabetes protocol display on the grid.

13. In a similar fashion, add the hypertension protocol, then click Add.

14. A popup will notify you of duplications between the 2 protocols. We need to drop one of these; since theyre identical, it doesnt matter which. Select one. Click Drop, then Update. Next select Diabetes, then click Keep, then Update. When done, click Save and Close.

15. The stock protocols are very inclusive, and contain some entries that individual practices and providers may not wish to follow. Consequently, we need to review the tests listed and see if we want to drop, modify, or consolidate any of them. Use the scroll bar to scroll up and down to review all the tests listed. Lets say we dont want the ECG. Double-click ECG.

16. When done, click Save, then Close. Do not Delete the test; this would make it impossible to add back later if you change your mind. To remove ECG from the protocol for this patient, click in the Discontinue box, and select todays date.

17. ECG has been removed from the test list for this patient. If you review the whole list, youll find some redundancies, such as electrolytes, creatinine, estimated GFR, and BMP, which could be consolidated to just the BMP. There are also some alternatives to choose from, such as doing foot exams vs referral to a podiatrist. Pick and choose among these options as desired.

18. You can modify some other details on these tests. Here well double-click Dental exam.

19. Lets specify an interval for dental exams. Click in the Interval box and select 6 months. Specify a reason as preferred/indicated.

20. If known, you can specify the most recent date for this measure. Click in the Last completed box and select date. When done, click Save then Close.

21. The list of tests is now as you want it to be. If desired, use the scroll bar to scroll down to review the tests youve removed from the protocol for this patient.

22. The removed (stopped) tests are displayed. To reinstate one of these tests, click the Details button. In this example, well resume the Urinalysis.

23. Click the Display superseded/dropped protocols checkbox, then highlight the Urinalysis line. Click Keep, then Update, then Save and Close.

24. New protocols and protocol variants, e.g., a Family Medicine Department Diabetes Protocol, can be established with the assistance of the EHR team or the clinic superusers. (That functionality is not reviewed in this exercise.) Use of these protocol items in the context of a visit is reviewed in another exercise.

25. Health Maintenance Protocol Setup and Activation

26. To add the Health Maintenance protocol, click in the Protocol box, and double-click Health Maintenance in the ensuing popup.

27. The Risk Indicator popup appears. If the patient has no particular risk factors, just click the No risk indicators box.

28. But this patient has diabetes and hypertension. Click the Diabetes box, then select Diabetes Mellitus Type 2 in the popup. Similarly, add Hypertension.

29. When done click Save and Close.

30. The Duplicate Protocols popup appears. We see that flu and pneumococcal vaccines and lipid panel appear twice.

31. Select the first Influenza vaccine line, then the Drop bullet. Then click Update.

32. Select the remaining Influenza vaccine line. Lets say we want this done yearly regardless of age. Click in the Start age box, and enter 1 Year. Click keep, then update.

33. Select your preferences between the duplicate Lipid Panel and Pneumococcal vaccine entries. When done, click Save and Close.

34. Entries from the Health Maintenance protocol have been added to the list.

35. If the Risk Indicator popup does not appear, you will need to click the Add button to add the Health Maintenance protocol. (This step occurs automatically if youve completed the Risk Indicator popup.) In some instances, when you add the Health Maintenance protocol, the Risk Indicator popup does not appear. (One reason for this appears to be that the patient is too young for any of the risk factors to be applicable.)

36. Several Health Maintenance items are optional, contextual, or at the discretion of the patient or physician. Use the scroll bar to review them. In this example, our patient has no particular risks or occupational reasons for a PPD. Double-click PPD.

37. Click in the Discontinue box, and select todays date. When done, click Save then Close.

38. She had a Tdap about a year ago. To enter that, double-click Tdap.

39. Click the Last completed box. Click in the Date box. In the calendar popup, reduce the year by one year. She isnt sure about the exact date, so click the Completed date is approximate box.

40. Click in the Next due box, and advance the year to 2019. When done, click Save then Close.

41. Shes had 3 consecutive normal pap smears, so well change the interval to 3 years. Double-click PAP.

42. Click in the Interval box, and increase it to 3 Years. Choose or type a reason.

43. Her last pap was July 2010, so click in the Next due box, and change it to July 2013. When done, click Save then Close.

44. Use of these protocol items in the context of a visit is reviewed in another exercise. Modify other items as desired.

45. Pediatrics Protocol Setup and Activation

46. To add the Pediatrics protocol, click in the Protocol box, and double-click Peds in the ensuing popup. Then click Add.

47. A list of routine care for the rest of childhood is posted to the grid. Most of these are the familiar Well Child Check visits and screens recommended by the American Academy of Pediatrics and required for Medicaid patients. These generally require little modification, though the practice or provider can make changes as desired, using the methods illustrated for the adult Health Maintenance protocols above. Also, if good office practices are already in place that assure the Well Child Checks are getting done, there may be little added value in using this protocol.

48. This concludes the NextGen protocol setup demonstration. Before they invented drawing boards, what did they go back to?

49. This concludes the NextGen protocol setup demonstration. Before they invented drawing boards, what did they go back to?