1. EHR Patch Updates Office Hours EHRv1.1p9 What’s new, What’s changed IHS-Office of Information Technology EHR Program

2. Office Hour Presenters CDR Susan Pierce-Richards, ARNP, OIT EHR Project Lead CDR Mary Ann Niesen, PharmD, OIT, ARRA Deployment Pharmacist Barbara Hess, DHA, OIT EHR Project analyst

3. Agenda Introduction Presenters – Office Hour Presenters have different specialties within the EHR system who will be responding to your questions Questions/Answers – Please do not put your phone “On Hold” during the conference call – “Raise your hand” through the WebEx features provided – Please state your name/site – Please state your question clearly – Please keep background noise to a minimum to better hear the questions/answers Patch 9 Resources – Patch 9 resources will be placed on FTP site (RPMS patch folder) for your review after session – If you can not access the FTP site please e-mail barbara.hess@ihs.gov for a copybarbara.hess@ihs.gov

4. FIXES

5. Fixes ComponentIssue Allergy/ADR - Properly filters out “Other Reaction” for both reactant and sign/symptom CCD viewer - No longer hangings on VPN session - PDF generation with IE9 fixed - No longer allows query if no patient selected - Print/Save button disabled until processing complete Chart Review - Adding problem from Visit Diagnosis or Historical Diagnosis now stores Reviewed and Updated CSV - ICD9 look up now returns long narrative text Immunizations - No longer populate CPT codes - Education now stores properly when “Patient/Family Counselled by provider” checked.

6. Fixes ComponentIssue Notifications - Flagged OI Expiring notifications work properly now - Now honors BEHOPTCX REQUIRES HRN parameter and if set will not allow user to process a notification for patient not registered in logged in division. Order Checks - Height and Weight limits now honored for CT and MRI order checks Outside Med Details - Documented by now displays logged in user rather than visit context provider Quick Order - Now honors default Clinical Indication set in Quick Order Patient Education - Text now properly wraps when viewing standards

7. Fixes ComponentIssue Reminder dialogs - Measurements “done elsewhere” now store the correct date/time Reminder dialogs - No longer creates second Primary Provider when processing reminder dialogs on inpatients Reports - Requestor no longer displays on Outside Medication entries in the Order Summary Reports Suicide Form - Updated to current Behavioral Health GUI Visit Context - Now excludes ancillary inpatients when selecting visit Windows 7 - Superbill and Patient Education check box behavior resolved

8. NEW FEATURES/CHANGES

9. New Features FunctionalityFeatures Med Order DialogClinical Indication Prompt Med Order Field Restrictions Pharmacy type settings Internal Internal/External External Controlled substance prescribing parameters Pre-placed for future use CII prescribing Examples

10. New Features FunctionalityFeatures Printing prescriptions and medication orders Queue Print Rx Print Format (template) editor Rx Printer Configuration RPMS parameters Rx Printer Preferences editor Configuration SummaryAll sites Internal set up Internal/external set up External set up Screen shotsMed Order Examples Pharmacy Search Examples Printing examples

11. MED ORDER DIALOG

12. Clinical Indication prompt ICD9 coded clinical indication now required for medication orders *** The changes for Med Orders were done to comply with eRx requirements *** You must select an indication for each med order New med order will display a blank clinical indication – Not pre-populated with the last entered – This is a change, please alert your providers Offers Problems, POV’s after filtering out un-coded diagnoses, “Other” – “Other” search returns only coded entries for selection Renew, Copy and Change pre-populates with clinical indication of the original order *** Tip *** Encourage maintenance of clean problem lists Encourage selection of POV prior to ordering medications Once a clinical indication is chosen, the indication “follows” the medication order through its lifecycle (refill, renew, change, copy)

13. Clinical Indication prompt

14. Med order field restrictions Character limit is 140 characters for transmitted prescriptions Character limit for comments is 210 characters for transmitted prescriptions *** Tip *** Recommend setting APSP AUTO RX ADD PRV COMMENT to No at the system level Add “Comments” to the bottom of Prescription template to communicate comments to outside pharmacist

15. Setting Pharmacy type The APSP AUTO RX parameter sets the type of pharmacy you have. You will be required to set this for electronic prescribing. *** Tip *** The APSP AUTO RX setting and associated parameters are designed for use in advance of electronic prescribing and provide enhanced Med Order dialog and Prescription/CII order printing capability.

16. Benefits of setting APSP AUTO RX 1.Enhanced Med Order dialog with pick up locations presented to prescriber based on facility type and other configurable settings. 2.Can enable “Internal/External” and “External” without using ePrescribing – Meds for outside fill are auto-finished and queued for printing – Can help sort out workflow issues prior to eRx 3.Enhanced printing – CII order for signature, CII prescriptions, Non CII prescriptions and receipts for electronically transmitted prescriptions “queued” – Configurable default settings for formats and printers. – Click sends all jobs to appropriate printers. *** Tip *** There is now a “P” (for print) for pick up location in Quick Orders

17. Pharmacy Type Settings APSP AUTO RX Setting InternalPatients only fill Rx written by in house providers at in-house pharmacy 1.In house options for Clinic, Mail, Window retained 2.CII order for signature queued to print Internal/ExternalPatients fill Rx written by in-house providers at in-house and outside pharmacies 1.In house options for Clinic, Mail, Window retained - CII order for signature queued to print 2.Prior to Surescripts ® set up/deployment enables the “Outside Pharmacy – Print” functionality - Auto-finishes meds upon signature and queues prescription for printing 3.After Surescripts ® set up/deployment enables the “Outside Pharmacy – eRx functionality - Auto-finished meds upon signature, transmits and queues receipt for printing ExternalNo in-house pharmacy 1.All med orders auto-finish upon signature 2.Prior to Surescripts ® set up/deployment enables the “Outside Pharmacy – Print” functionality - Auto-finishes meds upon signature and queues prescription for printing 3.After Surescripts ® set up/deployment enables the “Outside Pharmacy – eRx functionality - Auto-finished meds upon signature, transmits and queues receipt for printing

18. Pick up locations Med order dialog has 5 pick up locations exposed to the user depending on APSP AUTO RX parameter settings Pick up locationAPSP AUTO RXSPI*Status on signature ClinicInternal Internal/External External N/APending Active Mail Window Internal Internal/External N/APending Outside Pharmacy – eRx * *Requires Surescripts ® implementation and population of SPI Internal/External External Yes Active Outside Pharmacy – PrintInternal/External External N/A Active

19. Setting Pharmacy Type APSP AUTO RX -set at division or system

20. CII-V electronic prescribing parameters APSP AUTO RX ERX OF CII Pre-placed for eventual allowance of electronic transmission Defaulted to “null” which disallows transmission Not editable at this time APSP AUTO RX SCHEDULE RESTRICT Pre-placed for eventual allowance of electronic transmission Defaulted to schedules 2,3,4 & 5 to disallow transmission Not editable at this time

21. Med Order Dialog examples: Pick up locations Internal – Legend and Controlled drugs

22. Pick up locations Internal/External – non CII, provider has SPI Internal/External – CII or Non CII and provider has no SPI

23. Pick up locations External – non CII, provider has SPI External – CII and/or provider has no SPI

24. CII prescribing APSP AUTO RX CII PRESCRIBING You may now restrict CII ordering at the following levels *** – User – Class – Division – System *** Tip *** When set the “CII ordering disabled” dialog pops up when a user selects a CII drug from the Medication Order dialog *** This works for meds ordered via Medication Order (ie. “other meds”) and not quick order menus. EHRp10 will add this functionality

25. PRINTING FUNCTIONALITY

26. Printing functionality “Smart logic” is used to determine which order requires a print job and if so which type based on – Status (Active or Pending) – Pick up location – Type of drug (Controlled or not) “Queues” the print jobs for printing Formats may be defaulted to specific templates Formats may be defaulted to specific printers at the User, Location, Division and System level

27. Queue Print Facility type Pick up locationStatus after signing CII?Print formatIcon InternalClinic Mail Window Clinic Window Pending No Yes N/A CII Order for Sig ExternalClinic Outside Pharmacy – eRx Outside Pharmacy - Print Active No Yes No Yes N/A Prescription (CII) Receipt (Non CII) Prescription (Non CII) Prescription (CII)

28. Queue Print Facility type Pick up locationStatus after signing CII?Print formatIcon Internal/ External Clinic Mail Window Pending No N/A Clinic Window Pending Yes CII Order for Sig Outside Pharmacy – eRx Outside Pharmacy - Print Active No Yes Receipt (Non CII) Prescription (Non CII) Prescription (CII)

29. Queue Print After signing, the meds that have print jobs are highlighted and the Queue Print button is active

30. Queue Print Click the Queue Print button and the print jobs are displayed, associated with pre-defined templates for each format and default printer (user may change)

31. Reprinting If you need to print a prescription due to failed transmission, re-print due to printer failure, or destruction of prescription you may do so. You may only print the day the prescription was finished and must put in a reason. Reasons for re-printing are logged. Highlight med you wish to reprint Click PRINT button Select Prescription (New Format) Click “Print” Select reason Enter comment (optional) Select printer (or accept default) Click “OK””

33. Order Detail

34. Rx Print Format (Template) editor Set up: 1.Design mode> Desktop Properties> Custom Menus 2.Add Menu item “Rx Template Editor” 3.Add the following in Action (lightening bolt) $(BEHRXGENERATORSERVICE.RXGENERATOR.edittemplates) 4.Click Apply and Ok 5.Make sure you have BEH Rx Generator Service checked under “required services” 6.Only place on EHR GUI templates of those who are responsible for editing Prescription formats (ie. CAC, pharmacy Ad Pac)

35. Rx Print Format (Template) Editor Design ModeRx Template Editor

36. Rx Print Format (Template) Editor Template type (format) – Prescription (Non-CII) – Prescription (CII) – Order for signature (CII) – Order for signature (Non-CII) – Receipt (Non-CII) – Receipt (CII) Template – Default template for each template type delivered with EHRp9

37. Rx Print Format (Template) Editor Importing template: The files are.ptxml files 1.Save the files to a local drive 2.Open Rx template editor 3.Select template type 4.Click Import 5.Change the name if desired, click OK 5.Click “active on” 6.Select Yesterday at 6:00 am, then OK 7.Now you may edit the template 8.Click OK to store

39. Rx Print Format (Template) Editor Active on – set activation date (usually Yesterday at 6:00am) Preview – Display preview of current template Import – import template Export – export template Add Free Text – you may add as many as you like. May include header info for format, alternate signature lines, etc. Mark Inactive – inactivates template so users cannot select *** Tip *** To Copy a template - export, save and import: - Change to a local name on imports. - Set “active on” to Yesterday at 6:00 am. - Make changes then click OK Highly recommend using the copy process and creating local templates rather than editing nationally delivered default templates ***

40. Rx Print Format (Template) Editor Change font Set fields for inclusion, change print labels, and set columns in the Fields section

41. Rx Printer Configuration In RPMS set the BEHORX PRINT FORMATS parameter Associates the Format type with the Format (Template) May set at User, Class, Location, Division and System level Most commonly will be set at System or Division level Select Format Type: ?? Instance values are (Commonly set format types) : PC:RX CII PN:RX NON-CII OC:ORDER CII ON:ORDER NON-CII RC:RECEIPT CII RN:RECEIPT NON-CII LC:LABEL CII LN:LABEL NON-CII

42. Rx Printer Configuration

43. Populate the BEHORX PRINT FORMAT TYPE This associates the Format type: Order for signature (CII) Prescription (CII) Prescription (Non-CII) Receipt (Non-CII) with a default printer. – Set at User, Location, Division or System level – In RPMS or in EHR Printer Preferences tool

44. Rx Printer Preferences Editor Set up: 1.Design mode> Desktop Properties> Custom Menus 2.Add Menu item “Rx Printer Config” 3.Add the following in Action (lightening bolt) $(BEHRXGENERATORSERVICE.RXGENERATOR.EditPrinterPreferences) 4.Click Apply and Ok 5.Make sure you have BEH Rx Generator Service checked under “required services” 6.Users will only be able to set their own defaults 7.Assign the BEHORX PRINT key for CAC/IT staff who will set Location, Division, System settings

45. Rx Printer Preferences Editor Design ModePrinter Preferences

46. Rx Printer Preferences Editor Use dropdown to select level, template type, printer settings. Click APPY to store the parameter. To remove a parameter level, bring up the level and click REMOVE

47. Rx Printer Preferences Editor RPMS display parameter BEHORX PRINT FORMAT TYPE RPMS enter/edit parameter BEHORX PRINT FORMAT TYPE

48. CONFIGURATION SUMMARY

49. Configuration steps – All Sites *** This is in addition to pharmacy package optimization for eRx and Surescripts ® credentialing/set up/deployment *** ParameterSetting APSP AUTO RXAppropriate facility type APSP AUTO RX ERX OF CIIVerify is set to Null at System Level APSP AUTO RX ADD PRV COMMENTS Set to NO at the System Level (recommended) *** Tip *** DO NOT TOUCH ANY OF THE OTHER APSP AUTO RX PARAMETERS. The majority of these are for use in eRx configuration for Surescripts ®. This is a separate set up and deployment!

50. Configuration steps – All Sites *** This is in addition to pharmacy package optimization for eRx and Surescripts ® credentialing/set up/deployment *** - Review Formats (Templates) for Prescriptions, CII order for sigs and Receipts using the Prescription Print service Template Editor tool and copy/edit accordingly - Set BEHORX PRINT FORMATS parameter to set default format (template) for print Format types - Determine printers for system, division and/or locations and set using Prescription Print Service Printer Preferences tool or the BEHORX PRINT FORMAT TYPE parameter. *** Tip *** This is a business process review. Review current processes and optimize with new features.

51. Internal Set Up APSP AUTO RXInternalInternal pharmacy only. Able to print “Order for Signature (CII)” using Queue Print button BEHORX PRINT key Assign to CAC, Site ManagerAllows GUI configuration of Rx printing BEHORX PRINT FORMATS Set default Template for Order for Signature (CII) BEHORX PRINT FORMAT TYPE Set default Printer for Order for Signature (CII) Depends on workflow

52. Internal/External Set Up APSP AUTO RXInternal /ExternalInternal pharmacy that also sends prescriptions out. Auto finishes on signature med orders with “Outside Pharmacy Print” pick up location. Enables printing of “Order for Signature (CII)” BEHORX PRINT key Assign to CAC, Site Manager Allows GUI configuration of Rx printing BEHORX PRINT FORMATS Set default Template for: Order for Signature (CII) Prescription (CII) Prescription (Non CII) BEHORX PRINT FORMAT TYPE Set default Printer for the Order for Signature (CII) Prescription (CII) Prescription (Non CII) Depends on workflow

53. External Set Up APSP AUTO RXExternalExternal pharmacy – sends prescriptions out. Auto finishes on signature med orders with “Outside Pharmacy Print” pick up location. BEHORX PRINT key Assign to CAC, Site Manager Allows GUI configuration of Rx printing BEHORX PRINT FORMATS Set default Template for: Prescription (CII) Prescription (Non CII) BEHORX PRINT FORMAT TYPE Set default Printer for the Prescription (CII) Prescription (Non CII) Depends on workflow

54. SCREEN SHOTS

55. Med order examples

57. Click on Outside Pharmacy – eRx Click on search button to locate pharmacy

58. Pharmacy search

60. Pharmacy Search Highlight chosen pharmacy and click OK

61. Printing

63. Resources links will be active AFTER patches released! EHRv1.1p9 guide ftp://ftp.ihs.gov/rpms/patches/ehr_0110.09o.pdf