1. LutheranVista2 EMR Training

2. Module #1: Signing in & Health Insurance Portability And Accountability Act (HIPAA) This session you will learn: -How to sign on -How to set your electronic signature -HIPPA Rules about passwords and EMR -Privacy Tab

3. Signing On to LV2 ***New users: ONLY enter your access code and click ‘OK’. You will be asked to create a verify code. Leave ‘Old Verify Code’ blank. Type and confirm your verify code and click ‘OK’. 1) Find and double-click on the EMR-LV2 icon 2) A new screen will appear, asking for your access code and verify code. 3) Enter your access code and verify code, and click ‘OK’ or press ‘Enter’. ***Note: Your verify code must be alphanumeric with one special character and at least 8 characters in total. Note: Your verify code expires every 90 days, but your access code and signature code will never change.

4. Setting your Signature Code To create your e-signature: 1)Select E-Signature from the menu. 2)A dialogue box will appear – enter your e-signature TWICE and click ‘OK’ *Caps Lock MUST be on to SET your e-signature code, but is NOT necessary after that.

5. HIPAA- I Do not share your access and/or verify codes (login IDs) with anyone Your Login IDs are specific to you It is your responsibility to log off once you have finished with your session To ensure a secure environment, your verify code will reset after 90 days- - you will be prompted to change it.

6. HIPAA- II: Patient Privacy Privacy Tab: If you need to walk away from your computer, make sure to click on the Privacy tab to prevent a patient’s information from being visible (HIPAA).

7. Module #2: Basic Navigation This is a basic navigation session, you will learn: -Notifications -Setting user preferences -Overview of all tabs -Selecting a Patient -Patient Location Verification

8. Notifications I To process a notification: Double click OR highlight one or multiple notifications and click on ‘Selected’ at the bottom right of the screen. *Clicking ‘All’ will process all notifications in succession. LV2 will open to your Notifications Tab *Make sure YOUR NAME appears in the blue bar at the top of the screen. If your name does not appear, SIGN OUT AND SIGN BACK IN AGAIN* An unsigned order or note will then bring you to that patient’s chart where you can sign the outstanding item. *To sign a note, you must right click in the note and choose ‘Sign Note Now’ Note: If a notification was sent to you in error (a request for co-signature or information about someone who’s not your patient), highlight the notification and click on the ‘Forward’ button to send it to the appropriate party. Notifications are actions which are not complete, such as: ~Unsigned medications, orders, notes, and cosigned notes ~Unreviewed labs, consults, or informational updates For information-only notifications, once you have read the information, you can delete the notification.

9. Notifications II – Setting Preferences To set your preferences for which notifications you receive: *There are five mandatory notifications that cannot be turned off: ~ Critical Lab Results ~ Imaging Results Amended ~ Medications- Expiring- Inpt ~ NPO Diet > 72 Hrs ~ Order Requires Elec Signature Click on ‘Tools’ from the Menu Bar Click on ‘Options’ Choose the ‘Notifications’ Tab Check the box to turn notifications ‘On’ Uncheck the box to turn notifications ‘Off’ Check the Notifications you would like to receive.

10. Communications Tab This tab provides you a direct link to your Lutheran email account without leaving Vista

11. Internet Tab Page a Resident offers the names, pager #’s and schedules of the Internal Medicine, Family Medicine, Surgery, Ob/Gyn, and Orthopedic resident staff. *You can also send a text page via this tool. This tab provides access links to sites such as Web MD and Physician’s Portal.

12. Dashboard The Dashboard Tab is where you can access basic information about your patients with links to their charts and create your custom census. There are quick link buttons for: Patient Lookup, Print Census, and Physician’s Portal Patient’s Cover Sheet, Patient’s Labs, Patient’s Orders, and Patient’s Notes Once you have found your patient(s), you can assign yourself to them to create your census. When your census is created, check the box ‘Show my Patients’ to see your customized list. You can then remove patients or share your census with another provider.

13. ED Dashboard The ED Dashboard allows the user to see those patients currently registered in the Emergency Department. *If a patient is admitted from the ER, but the ER chart is still open, to access the patient’s ED notes: 1)Find and select the patient whose chart you wish to review 2) Click the ‘Preview ED Note’ button 3) A pop-up will appear with all documentation written during the patient’s ED visit.

14. Selecting a Patient Click on the Patient Record Tab In both cases, a dialogue box will appear. Once you select a patient, verify it is the correct patient via name and DOB, then click ‘OK’. There are 3 ways to select a patient: 1)Dashboard 2)Patient Inquiry Button 3)Patient Dropdown Menu Click on the Patient Inquiry button in the top left corner OR Click on ‘Patient’ from the choices at the top and then choose ‘Select’ You can search for a patient by typing in part or all of their name or medical record number. ***A patient’s information appearing in RED means that was the last patient you accessed.*** Default the patient list by provider or ward by clicking on the appropriate radio button and then clicking ‘Save Settings’.

15. Patient Cover Sheet Overview I Clinical Reminder Clock: Used by ED and Stroke nurses for their reminders Magnifying glass: Displays Patient Demographic Info Signature Icon: Icon will display when there is something to be signed, ie., order, note, etc., Patient Inquiry: Last Name, First Name, (sex), Length of Stay (LOS), Medical Record #, DOB (age) Height/Weight: Pulled in from Vitals Location/Provider: Nursing Unit w Room and Bed, Account #, Provider Care Team: Primary Care Team, Attending Physician The patient information banner is made up of four panels located at the top of the Patient Record. CWAD: Postings A – Allergies/Adverse Reactions W – MDRO note D – Advanced Directives VHS (Visit History Summary): Provides medication, order and documentation history from prior visits Quick Note: Single click link to frequently used note templates

16. Patient Cover Sheet Overview II Active Problem List: Displays problems as entered via Problem List tab Allergies/Adverse Reactions: Displays allergies. *Right click in the box to add a new allergy Patient Postings: Displays W – warning of MDRO’s D – Advanced Directives A – Allergies/Adverse Reactions *Hover to view details Medication List: Displays Medications. *Click on medication for more details. Clinical Reminders: Displays Clinical Reminders for ED and Stroke Education Documentation Lab Results: Displays last 72 hours of lab results. *Click on lab for more details. Vitals: Displays last documented vital signs *Click on specific reading for more details. Patient Visit(s): Displays patient visit history with admitting diagnosis. Allergies/Adverse Reactions: Displays allergies. *Right click in the box to add a new allergy Active Problem List: Displays problems as entered via Problem List tab Medication List: Displays Medications. *Click on medication for more details. Patient Postings: Displays W – warning of MDRO’s D – Advanced Directives A – Allergies/Adverse Reactions *Hover to view details Clinical Reminders: Displays Clinical Reminders for ED and Stroke Education Documentation Lab Results: Displays last 72 hours of lab results. *Click on lab for more details. Vitals: Displays last documented vital signs *Click on specific reading for more details. Patient Visit(s): Displays patient visit history with admitting diagnosis.

17. Selecting a Patient Click on the Patient Chart Tab Click on the Patient Inquiry button in the top left cornerOR Click on ‘Patient’ and choose “Select” from the menu. In both cases, a dialogue box will appear. You can search for a patient by typing in part or all of their name or medical record number. Default the patient list by provider or ward by clicking on the appropriate radio button and then clicking ‘Save Settings’. ***A patient’s information appearing in RED means that was the last patient you accessed.*** There are 3 ways to select a patient: 1)Dashboard 2)Patient Inquiry Button 3)Patient Dropdown Menu Once you select a patient, verify it is the correct patient via name and DOB, then click ‘OK’.

18. Patient Location Verification Under this tab, the accounts listed are outpatient and / or ambulatory encounters. Under this tab, the accounts listed are inpatient encounters. Before placing any inpatient orders, please make sure there is a current account with the correct provider or attending physician.

19. Discharge Summary: Within 48 hours of a patient’s discharge from the hospital, the discharge summary should be transcribed and uploaded into this tab from Physician’s Portal. Sub Tabs Cover Sheet: Provides summary of patient information Problem List: Entry/display of problems along with any notes that have been added. Medications: Entry/Display of: Discharge Medications Home Medications Inpatient Medications *Medication Reconciliation is completed here Orders: Entry/Display of patient orders in alternating colors *Selection of multiple orders for signing and/or verification – use Shift or Ctrl keys Notes: Entry/Display of Nursing Admission Databases, Provider H&P’s, ED Notes, MDRO Notes, Advanced Directive Notes, and Stroke Education Notes. *Click on any note on the left-hand side to view details. Consults: Displays Ancillary Department Consult status P = Pending C = Completed DC = Discontinued *Select any consult from the left-hand side to view details. Labs: Displays lab results for a patient You can view the information in a table or graph format and you can filter the information by lab subtype, date, or test type *You can also filter your view to include only abnormal results. Reports: Displays multiple types of reports and radiology imaging. * VERIFIED indicates a report is available. Vitals: Entry/Display of vital signs Left click once to view vitals details Use the table on the upper right to view cumulative vital sign entries or view the same results as a graph

20. Module # 3: Problem List This session you will learn: - How to manipulate the Problem List and enter a diagnosis

21. Problem List To add a problem, click on the ‘Add’ button on the upper right and a dialogue box will appear. To search for a diagnosis, type in the whole or part of the term and click search. A list will display where you can search for the diagnosis via text or ICD code. Highlight the diagnosis you need, and click ‘OK’ In the window that appears, you can add more information about the diagnosis, including identifying it as the POV (Purpose of Visit), and any additional notes you wish to write. The primary diagnosis entered in an ‘Admit’ order will automatically cross over into the Problem List for a patient. Any additional diagnoses MUST BE ENTERED manually via the Problem List. *It is the responsibility of the providers to maintain an up-to-date problem list for his/her patients.* *To edit a problem, highlight the problem and click ‘Edit’ on the upper right. *To delete a problem, highlight the problem and click ‘Delete’. A new dialogue box will appear. Choose a reason for deleting the problem and click ‘OK’.

22. Module #4: Medication & Medication Reconciliation & Printing Prescriptions In this session you will learn: -About the Medication Tab -How to do the Reconciliation Process: of Home Medication, Inpatient Medication, and Discharge Medications -How to Sign off on Medication

23. Medications Includes: Outpatient Medications Home Medications Inpatient Medications To take action on a medication, right click on the medication and a dropdown menu will appear: New Medication – add a new medication to the list Change – adjust the dosage, route, or frequency of a medication Discontinue/Cancel – discontinue or cancel a medication Hold – put a medication on hold * You must give a reason Release Hold – release the hold on a medication Transfer to Inpatient – transfer a home medication to an inpatient medication order. Do NOT transfer NF (non-formulary) drugs to inpatient unless there is no formulary alternative or the patient is bring in his/her own med. Transfer to Outpatient – transfer an inpatient medication to a discharge medication or prescription

24. Medication Reconciliation I – Home to Inpatient *Make sure you’re entering medications into the correct section by verifying text in BLUE Medication Reconciliation begins with the RNs. It is their responsibility to D/C all home medications from previous visits and re-enter a new set for the current visit. If the RN has not D/C’ed previous home meds and entered new ones, it is YOUR responsibility to do it in order to complete the reconciliation. *To see if the home meds are up to date, double click on the medication and verify the date it was entered. *The ONLY time you can have a home medication with an active status is if the patient is not currently on any medications and the RN entered: MISC (No home medications) ~ A comprehensive medication list will appear where you can search for medications by their brand and generic names. ~ Choose the dosage, route, and schedule, as appropriate – check PRN when applicable. ~ When you’re ready, click ‘Accept Order.’ ~ When all medications have been entered, click ‘Quit.’ ~ To sign off on your medication orders, click on the hand icon in the upper right corner. *Unsigned orders appear in BLUE AND BOLD To enter a new home medication, right click in the ‘Home Medications’ section and select ‘New Medication’ *When you click to sign your orders, a window will appear listing everything that needs to be signed. Note: Home medications CANNOT be unchecked. Enter your electronic signature code and click.

25. Medication Reconciliation II – Change in Level of Care for NON-ICU Transfers When a patient undergoes a Change in Level of Care, orders MUST BE DISCONTINUED AND REWRITTEN. *Patients transferring to/from the ICU will use Delayed Orders, which will be discussed in a later slide. *Medication orders can ONLY be re-entered from the Orders tab Once you have accepted your order, be sure to SIGN YOUR ORDERS using the hand icon on the upper right To re-enter an existing order, right click on the medication you wish to reorder and choose ‘Renew’ *Note: Renewing a medication RESETS the start/stop time. Be sure to adjust the number of days/dose you wish to order accordingly.

26. Medication Reconciliation III - Discharge When the patient is ready to be discharged home, the final step of medication reconciliation must occur. Once all medications have been transferred to the Discharge Meds section and signed, you can print detailed reports, summary reports, or prescriptions, as necessary. Be sure to SIGN YOUR ORDERS using the hand icon on the upper right In the Home Meds section, any medications that have been put on hold during the visit should be released or discontinued. Right click on the medication to view these options. Medications released from hold should then be transferred to outpatient (O/P) by right clicking and choosing Transfer to O/P – bringing them to the Discharge Meds section. Proceed to the Inpatient Meds section and highlight any inpatient medication(s) you wish to create prescriptions for. Right click on the medication and choose Transfer to O/P – bringing them to the Discharge Meds section.

27. Entering Discharge Medications 1.Select ‘Medication Tab’ and select Discharge Medication pane. 2.Right click and select New Medication 4. Select appropriate medication from Medication Order Dialogue box. 3. Select ‘Click Here to Prescribe Patient Medication for Discharge’

28. Prescription Printing To print prescriptions for a patient: Highlight the medication(s) you wish to print prescriptions for. Click the ‘Print’ button at the top. A dialogue box will appear. Choose ‘Prescription’ and ‘Print.’ Prescriptions will then print to the nearest prescription printer. *Remember to sign your prescriptions.

29. Module #5: Orders In this session you will learn: -How to enter an order -How to use order sets and Why. -How to use “a la carte” menu to place orders -How to sign an order -How to create a delayed order

30. Remember the Patient Location Verification- this is important! The process for inpatient orders is different from outpatient orders EMERGENCY DEPARTMENT is an outpatient location EDH (ED HOLD) is an inpatient location. Make certain the patient is in EDH BEFORE placing inpatient orders.

31. Orders I - Overview Step 1. Click on the “Orders” Tab. To view current patient’s orders: You can sort your orders by the column headers – Service, Order, Start/Stop Date, Provider, Nurse, Clerk, Chart, Status, or Location by clicking on the respective column header. Step 2. Placing medication orders: Order Sets MUST BE USED AS THE FIRST COURSE OF ACTION for placing patient orders. As a matter of fact, some drugs can ONLY be ordered through order set, e.g. anticoagulant, PCAs, and restricted antibiotics. You can find order sets by department on the left hand side of the Orders tab screen. Should you NOT able to find a medication on the Orders Set, it can be ordered from the “A La Carte menus” (Meds. Inpatient).You can find the a la carte order menus on the left hand side of the Orders tab screen below the Order Sets.

32. Orders II – Order Sets For example, choosing the Chest Pain Low Risk Order Set: Order sets, as part of evidence-based medicine, are an important piece of effective patient care. Order sets walk you through a step-by-step process - diminishing the possibility of omitting something when assessing a patient’s care needs. In the Medicine Daily Orders, click on ‘Chest Pain Low Risk Admission’ A series of windows will pop up taking you through the order set starting with the ‘Reason for Request: ADMIT’ Fill in the Admitting Location, Admitting Physician, and Admitting Diagnosis. *If the patient has other pertinent diagnoses, be sure to include them. Click ‘OK’ Accept your Order. The next window to appear is Allergy Entry. Search for allergies typing all or part of the word and clicking ‘Search’. If your patient has no known allergies, be sure to check ‘No Known Allergies’ The next several screens will offer menus for : Nursing Orders Lab Orders VTE Prophylaxis GI Prophylaxis Medication Orders Rad/Diagnostic/Consults Choose whatever orders are appropriate for your patient and click ‘Next’ to proceed to the next screen. You will be brought back to the main Medicine Daily Orders Screen. Click ‘Done’ to return to the main Orders screen and review your orders. Note: Selected orders will appear in blue Unsigned orders appear in blue and bold – REMEMBER TO SIGN YOUR ORDERS USING THE SIGNATURE ICON

33. When a patient has a change in level of care TO OR FROM AND ICU ONLY, existing orders will automatically D/C and new orders need to be written. Orders III – Delayed Orders To ensure that the patient is receiving the proper care in a timely fashion, use the Delayed Orders Order Set to write orders in anticipation of their transfer. Choose the unit where you wish to transfer your patient Confirm where you wish to transfer the patient Accept the order for Transfer A window with your current orders will appear where you can select orders to copy to delayed release. Finally, the receiving department’s Order Sets page will appear, where you can order any other items the patient will need upon transfer. Click on ‘Delayed Orders’ on the left and a window will appear. *Remember to hold down ‘Ctrl’ to individually select orders you wish to copy. OR * Hold down ‘Shift’ and select the first and last item to highlight a block. Remember to sign your orders

34. For non-medication orders such as DME’s, go to the Discharge Order Sets menu. Orders IV Choose Non Medication Discharge Orders (DME/Supplies) Choose whatever supplies or miscellaneous orders you need

35. Module #6: Notes In this session you will learn: -How to view notes -How to create a MD Admission H&P -How to edit note/ append boilerplate text concept -How to sign off on a note -How to create an addendum -How to delete unsigned notes

36. Notes Notes are grouped by whether they are: Signed/Unsigned Inpatient/Outpatient Visit Specific Visit – with most recent note at the top To view a note, simply click on the title on the left hand side, and the right side will preview all the details of a note. The sequence for each note is the same – Date Written, Title of the Note, Unit/Location, Author In the Notes tab, you can view and author notes written for a patient. Signed AND unsigned notes are viewable by anyone accessing the patient’s chart. *Remember that unsigned note is NOT part of the legal chart.

37. Notes II – Authoring a Note When authoring a note, remember the ‘Action’ menu – every action you’ll need to take is there. There are two ways to open a new note: New Progress Note from the dropdown menu OR ‘New Note’ button on the bottom left A dialogue box will appear where you can choose the note you wish to write, for example, MD: Inpatient H&P *Note: You can search for notes by all or part of their title or by Department/Role Prefix, i.e., MD: = Providers ED: = Emergency Department Blood = any notes regarding blood transfusion A template will appear. Highlight the note you wish to write and click ‘OK’ The gray area on top is where you will be filling in patient information. The two white fields on the bottom are auto- populated by what you’re entering above in gray. *Minimize them to maximize template space. Check the section you wish to complete and fill out and complete it accordingly. Fields with a single asterisk are MANDATORY and MUST be addressed or you will NOT be allowed to finish your document. Radio buttons have a ‘one or the other’ functionality. *Be sure to respond to any follow up fields that open when clicking a radio button. Allergies and Medications are automatically pulled in from the patient’s coversheet and CANNOT BE EDITED in the note. *Make sure Allergies and Medications are up-to- date BEFORE you open a note. Check boxes are optional and multiple boxes can be checked off if applicable. *When ticking a checkbox, be sure to fill in any follow up fields *If you finish all sections of the note in one session, click ‘Finish’ when you have completed the last section. At the end of a section, you can: Continue filling out the other sections OR Finish this piece of the note, and come back later to finish the rest. If you have filled in all the appropriate fields, the next screen to appear will ask you to identify the Primary Provider for the patient – which should be YOU. Click ‘Yes’ * If the name shown is NOT the Primary Provider, click ‘Select Primary’ and choose the correct provider. You will be brought back to the main screen with a preview of your note appearing in the right pane. *If you have not completed the note, go to ‘Action’ and choose ‘Save without Signature’

38. Notes III – Appending a Boilerplate When you are ready to finish your note, highlight the note you wish to complete and put it in ‘Edit Mode’ (Go to ‘Action’ and choose ‘Edit Progress Note’) Go to the ‘Action’ Dropdown menu and choose ‘Reload Boilerplate Text’ A new dialogue box will appear: ALWAYS CHOOSE ‘Append the boilerplate text to the text in the note’ Then, click ‘OK’ * DO NOT redo the section(s) you already completed, or your original entries will be overridden. The template will reappear, allowing you to continue where you left off. *Remember, once you finish your note to SIGN YOUR NOTE, using the signature icon

39. Notes IV – Deleting/Editing a Note vs. Making Addenda *BEFORE your note has been signed, you have the option to Edit or Delete it. To Edit or Delete a note, you can: ~Right click anywhere on the note ~Click ‘Action’ from the menu bar Once your note has been signed, you CANNOT edit or delete it. You CAN make an addendum to include additional information and/or clarify a discrepancy, such as entering information into the incorrect patient chart. To make an Addendum, you can: ~Right click anywhere on the note ~ Click ‘Action’ from the menu bar *Be sure to sign your addendum using the signature icon so that others can view the information.

40. Module #7: Consults and Results In this session you will learn: -How to view consults -How to create/order consults -How to complete/ enter results in consults -How to set your preferences to receive consult notifications

41. Consults I – Ordering Consults You can find Consults under two menus in the Orders Tab: Procedures/Department Consults OR Physician Consults A menu of available consults will appear. Choose the one you need, e.g., Internal Medicine A window will pop up, reminding you to call the consulting physician or service. Fill out the consult order accordingly and click ‘Accept Order’ You will return to the home Orders screen. *Remember to SIGN YOUR ORDERS.

42. Consults II – Completing Consults To complete a consult: In the Consults tab, highlight the consult you wish to complete. Click on ‘Action’ > ‘Consult Results’ > ‘Complete/Update Results’ The note dialogue box will appear. Choose the appropriate note and click ‘OK’. Complete the consults results, filling out all information and click ‘OK’ *Remember to sign your note when you’re finished, using *A (p) before the consult type indicates that the consult is pending and has not yet been done. *A (c) before the consult type indicates that the consult has been completed. *A (dc) before the consult type indicates that the consult has been discontinued. *A (pr) before the consult type indicates that the consult has partial results – meaning the note has been started, but not completed.

43. Consults III – Setting Preferences To set your preferences for which consult notifications you will receive: Go to ‘Tools’ Click the ‘Notification’ tab Click ‘Options’ Select all Consult Request options and click ‘OK’

44. Module #8: Labs & Radiology Reports In this session you will learn: -How to view and graph labs -How to view radiology reports and images

45. Labs To view lab results, particularly those older than 72 hours (which are not viewable from the Coversheet) go to the Labs Tab. To view the results for a specific test, click ‘Worksheet’ from the left menu. Choose the test you wish to see Click ‘Add’ Test should appear in the right column. Click ‘OK’ Your lab results will appear. You can change your view with the options above. You can also view lab results in graph form – and can view two items simultaneously, using the Split View function. Click on ‘Graph’ from the left menu. *To view two graphs, be sure ‘Split View’ is checked. Choose the items you wish to see in graph form.

46. Right click on the report of the image you wish to see To view an image: Reports Choose ‘View Image’ from the dropdown menu The results and images from radiology reports are available here once the procedure has been done. To find out if a report is viewable, check the ‘Report Status’ column for a ‘Verified’ status. If the status is verified, select the report and the results will appear in the pane below. A new window will open in Internet Explorer with the corresponding image Click ‘Images (local only)’ to see a list of radiology and imaging reports.

47. You have reached the end of the presentation. Please print out and complete the quiz. You MUST bring this quiz to your validation training. Failure to comply may impact your eligibility for EMR access.