1. Provider Cerner Education Session #6
Blue Hill Hospital
Provider Cerner Education Session #6
Dr. Michael Ross / Edited Dr Charles Zelnick June 2019

2. Blue Hill Training Web Page: http://ci.emhs.org/MIO_BlueHill
Provider Cerner Education Session 2

3. Curriculum Outline Week Topics
Navigation, Personalization, Note Creation Overview
Problems (Intro); Revenge of the Message Center, Centricity CCD
Orders and Favorites
Medications, Basic Mmodal
Autotext, Smart Templates, Patient Letters
Recommendations, Patient Care Advisor, Worklists
Family & Soc History, Advanced Mmodal, Q&A
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4. Overview: Todays class Autotext: Advanced Smart Templates
Provider and Patient Letters:
Recommendations M-page component
Patient Care Advisor
Dynamic Worklist
Provider Cerner Education Session 3

5. Test Patients for use: Go to Ambulatory organizer/Home
Be sure to use MAY 1st
Go to Ambulatory organizer/Home
Search for me in calendar; you will see my calendar filled with test patients.
Pick a test patient from the schedule for use today.
We will use this as a source of Test patient’s with Ambulatory encounters for future sessions as well.
Dr Z’s ->
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6. Advanced Autotext uses:
Autotext has no limit: Can add multiple pages of content
Letters
Community resources
Patient Instructions
Locations of care
Dropdowns/configuration/defaults
Smart Templates
Provider-facing content
Patient facing content
Use the Centricity Autotext as a base
(Included in )
Provider Cerner Education Session 3

7. Using Autotext Dropdowns:
Provider Cerner Education Session 3

8. Autotext example:
Provider Cerner Education Session 3

9. Best Method for Sharing Autotext:
Utilize Message Center:
Least amount of clicks
Doesn’t require the user to go into the Autotext tool each time:
Video link:
Provider Cerner Education Session 3

10. Autotext Building Session: (Copy/paste from Centricity Autotexts to supplement)
Provider Cerner Education Session 3

11. Mmodal and Autotext pairing:
Provider Cerner Education Session 3

12. Patient Letter
Provider Cerner Education Session 3

13. Patient Letter: Used to produce letter for patient
Letter templates exist within the system using /let autotext.
Create your own templates as you see fit to supplement.
Provider Cerner Education Session 3

14. Patient Letter Can add orders (including prescriptions) and labs
Change type of letter
Multiselect labs to include
Print, or send to office staff
on your behalf.
Provider Cerner Education Session 3

15. Provider Letter/Provider-to-provider communication
Provider Cerner Education Session 3

16. Provider Letter
Preferred method of sharing clinical content with colleagues
Suggest using this instead of just forwarding notes
Allows delegation to office staff
Draws attention to the most pertinent clinical area
Provider Cerner Education Session 3

17. Example of Provider-to-provider communication:
Provider Cerner Education Session 3

18. Provider Letter: External Providers- Fax your letters
Provider Cerner Education Session 3

19. Recommendations and PCA:
Recommendations helps manage patient preventive and condition care. It allows for real-time notification of health screening, prevention, and management of diseases for patients based on various elements such as age, risk factors, gender, documented conditions, and documented procedures.
Preventive Care Advisor allows clinicians to see a Medicare patient's eligible Preventive Services according to CMS records. The view displays both eligible and future eligible Preventive Services. All services are checked again within Millennium to ensure no current orders or charges could affect eligibility.
Both of these Items work together within the Recommendations component to provide guidance on preventative care.
The Vision:

20. About Recommendations:
Preferred workflow for addressing patient care recommendations
Fully loaded visits
preventative services
Supporting highest level of quality care delivery
Localized and Owned by us (Northern Light Build)
Have specific actions that can/cannot be taken (and associated limitations)
Current build is an amalgamation of metrics from Centricity, Allscripts, Old Cerner newer Cerner build.
Continued cleanup by System recommendations workgroup; new metrics from the System Primary Care Improvement Group.
Provider Cerner Education Session 3

21. Workflow: Active Recommendations
Laboratory Request Changes

22. Workflow: Recommendations Review:
Laboratory Request Changes

23. Wellness visit Recommendations:
Provides both follow-up and this visit options:
Full satisfier for visit billing; partial satisfier for next scheduled appointment.
Laboratory Request Changes

24. Colon Cancer Screening…
Yes.
We Know.
Right now, our incoming colonoscopies do not satisfy the screening automatically.
Right now, you cannot order a colonoscopy from the recommendation.
Provider Cerner Education Session 3

25. Everyone is working on it. We promise.
Provider Cerner Education Session 3

26. BUT: Help is on the Way… Updates this week:
Lipid Screening (IDEA ) routine
Currently state: males >35 and females >45. Needs to be changes to all adults years of age to reflect current guidelines.
HPV Screening (IDEA )
Currently this is only HPV and PAP; needs to be HPV or PAP. We need to update our recommendation to reflect the current guidelines.
Shutting down the Medicare wellness appointment made reminders (INC )
We wanted to change this to 14 days pending. This is included in the next group of changes to be made. 
Smoking Cessation Education reminder (INC )
Name to be changed to Tobacco Cessation Counseling. 
Need to add the following 2 orders as satisfiers with a duration of 365 days: Tobacco Use Cessation Intensive >10 Minutes and Tobacco Use Cessation Intermediate 3-10 Minutes 99406
Breast Cancer Screening and Family Hx Breast Cancer Screening Recommendations (INC )
Corrected to satisfy based on the 'mammography' note type. 
This note type was originally approved but 'mammogram' was accidentally added instead.  This error has made it so the Recommendations are not working as intended.
“Done Elsewhere” to “Done” (DMND ) (New)
Passed by Clinical Stakeholder group 5/14
Provider Cerner Education Session 3

27. BUT: Help is on the Way… Updates this week:
Diabetes Maintenance - Eye Exam (RITM ) (New)
Change satisfier duration from 730 days to 365 days.
Diabetes Maintenance – Microalbumin (RITM ) (New)
Add Urine Microalbumin/Creatinine POC order with a temporary satisfier of 14 days and Urine Microalbumin/Creatinine - POC result with a satisfier of 365 days.
Diabetes Screening (RITM ) (New)
Change population to individuals ages with BMI greater than or equal to 25.
Todd will verify the Diabetes reports sent to Beacon are in line with this.
Recommendation to remove Family History of Breast Cancer and Colon Cancer (INC )
Remove the Family History of Breast Cancer recommendation for ages
Remove the Family History of Colorectal Cancer recommendation for ages
Provider Cerner Education Session 3

28. BUT: Help is on the Way… Updates this week:
Add “Done Elsewhere” to Influenza Recommendation (DMND )
Influenza recommendation only: add an Action for “Done Elsewhere.”  When “Done Elsewhere” is chosen end user will be able to record the date and add comments.  
For all other recommendations change the Action from “Done Elsewhere” to “Done.”  When the “Done” option is chosen, it allows the end user to then choose the Reason – done elsewhere, done in system, or done in office.
Asthma Management (INC )
Component is not satisfying the recommendation.   Aaron to address.
Change colonoscopy default to one year (INC )
Primary Care group voted to change all colonoscopy screening recommendations to yearly as a safety mechanism. Proposed workflow: results to be reviewed and determine clinically what the follow up should be. The provider would then modify the recommendation (push out the date) as appropriate.
Provider Cerner Education Session 3

29. Modifying a time interval between recommendations:
Can be done at anytime (not just during a visit)
Best to do during results review
Indicate within the recommendation:
Next screening due
Reason
Comment (finding)
Provider Cerner Education Session 3

30. Recommendations: Adult
Reminder
Population Included
Frequency
AAA (Abdominal Aortic Aneurysm) Screening
Male tobacco users between 65 and 75 years of age
ONCE
Adult Wellness
Individuals at least 18 years of age
Annually
AMB Joint Practice Protocol
All patients
Blood Pressure Management
Individuals at least 18 years of age with condition of high BP (last result for SBP 140 or greater)
BMI Management
Individuals at least 18 years of age with last BMI result greater than/equal to 25 OR less than 18.5
Annually*
Healthy Adult - Bone Density Screening
Females at least 65 years of age
Every 2 years*
Breast Cancer Family Hx Screening
Females age with family hx of breast cancer
Healthy Adult - Breast Cancer Screening
Females age without family hx of breast cancer
Every 2 years
CAD Maintenance - Lipid Lowering Therapy Evaluation
Individuals with a condition of CAD
CAD Maintenance - ACE Inhibitor Prescribed
n/a
CAD Maintenance - Antiplatelet Agent Prescribed
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31. Recommendations: Adult
Reminder
Population Included
Frequency
Healthy Adult - Cervical Cancer Screening Age 21-29
Females age 21-29
Every 3 Years
Healthy Adult - Cervical Cancer Screening Age 30-65
Females age 30-65
PAP Every 3 Years HPV +/- PAP Every 5 Years
Colon Cancer Family Hx Screening
Individuals age with family hx of colon cancer
Fecal Occult Blood Every Year Flexible Sigmoidoscopy Every 5 Years Colonoscopy Every 5 Years
Healthy Adult - Colorectal Screening
Individuals age without family hx of colon cancer
Fecal Occult Blood Every Year Flexible Sigmoidoscopy Every 5 Years Colonoscopy Every 10 Years
Condition Specific Immunizations - Meningococcal
Individuals at least 18 years of age with hx of splenectomy or cochlear implant
ONCE
Condition Specific Immunizations - Pneumococcal
Individuals at least 18 years of age with hx of any of the following: asthma DM splenectomy chronic lung disease chronic liver disease chronic kidney disease HF cochlear implant
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32. Recommendations: Adult
Reminder
Population Included
Frequency
Condition Specific Immunizations - Hepatitis B
Individuals at least 18 years of age with hx of any of the following: DM chronic liver disease chronic kidney disease substance use/opioid dependence
ONCE
Depression Management
Individuals with a condition of depression
Annually
Depression Screening
Individuals at least 18 years of age
Diabetes Maintenance - HgbA1c
Individuals with condition of diabetes
Every 6 Months
Diabetes Maintenance - Eye Exam
Diabetes Maintenance - Foot Exam
Diabetes Maintenance - Microalbumin
Diabetes Maintenance - Statin Medication Prescribed
Individuals with condition of diabetes without statin medication on chart
Diabetes Screening
Individuals at least 45 years of age
Every 3 Years
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33. Recommendations: Adult
Reminder
Population Included
Frequency
Fall Risk Screening
Individuals at least 65 years of age
Annually
Fluoride Screening
Individuals age 6-60 months
Hepatitis C Screening
Individuals born 1945 through 1965
ONCE
Hypothyroidism Management
Individuals with a condition of hypothyroidism
Healthy Adult - Lipid Screening
Males at least 35 years of age Females at least 45 years of age
Every 5 Years
Lung Cancer Screening
Individuals age years who are tobacco users or have a hx of tobacco use
PPD Skin Test
Individuals who were Acadia inpatients within the past 6 months, without PPD skin test ordered or completed in the past 6 months and without a positive result on the PPD Reading Form
Every 6 Months
Smoking Cessation Education
Individuals with condition of tobacco user
Spirometry
Individuals with condition of asthma
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34. Recommendations: Pediatrics
Reminder
Population Included
Frequency
Autism Screening 18+ months
Individuals age months
ONCE
Autism Screening 24+ months
Individuals age months
Chlamydia Screening
Females age 15-24
Annually
Depression Management (ACO)
Individuals at least 12 years of age with initial depression screen score or detailed depression screen score greater than 9
Depression Screening Adolescent- MUST BE FULL Tool; the “2-items” does NOT satisfy this one.
Individuals age 12-17
Developmental Screening 9+ months
Individuals age 9-14 months
Developmental Screening 15+ months
Individuals age months
Developmental Screening 30+ months
Individuals age months
Fluoride Screening
Individuals age 6-60 months
Influenza Vaccine
Individuals at least 6 months of age
Lead Screening
Individuals age 8-72 months
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35. Recommendations: Pediatrics
Reminder
Population Included
Frequency
Well Child Visit
Individuals age 2-17 months of age
Between 2 and 11 months of age - every 2 months Between 12 and 17 months of age - every 3 months
Well Child Visit.
Individuals age 18 months-18 years of age
Between 18 and 35 months of age - every 6 months Between 3 and 18 years of age - annually
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36. About the Preventative Care Advisor:
Real-time query to CMS database validates Medicare eligibility for preventive services; displays eligible and future services for a charge within the last 6 months.
Services are checked again within Millennium to ensure no current orders or charges could affect eligibility. Typical lag time: 5 days
Clinician can order directly from workflow view
Summary of screenings due are included on all patient visit Summary.
Consistent workflow with Recommendations allow other recommendations to be incorporated into the same workflow.
BUG: refresh issue
Provider Cerner Education Session 3

37. Provider Cerner Education Session 3

38. PCA-Specific Recommendations:
Always indicated by
Same actions as standard recommendations
Expandable to yield prior history of screenings
Provider Cerner Education Session 3

39. Preventative-Care-Advisor Specific Recommendations
Preventive Care Service
Annual Wellness Visit (AWV)
Bone Mass Measurements
Colorectal Cancer Screening
Depression Screening
Diabetes Screening
Glaucoma Screening
Pneumococcal Vaccine and Administration
Screening Mammography
Screening Pap Test
AAA screening
Preventative-Care-Advisor Specific Recommendations
Provider Cerner Education Session 3

40. Think of Dynamic worklists like a “Mini-Registry”
Dynamic Worklist is a user-level query tool designed to query patients with multiple different criteria:
Conditions
Results
Orders
Appointment types
Age
Sex
Clinicians use the Dynamic Worklist to identify subsets of patients in PowerChart, gather relevant information about them, and act upon those findings.
Think of Dynamic worklists like a “Mini-Registry”

42. Limited, specific problems/conditions:

43. Queries return:

44. Links to the Chart:

45. Dynamic Worklist: Creating Patient Communication