Q: Can each individual provider have their own list of problems and rank accordingly? Example: Surgeon doesn’t care about diabetes...
A: As long as “Shared Editing” is not enabled for the template in use by the providers, each provider will still receive his or her own version of the report upon editing. This means that each provider can manage their own version of the problem list within the document itself. Provider A can choose one set of problems to document on, while Provider B can document on another set of problems for the same patient. Each provider will be able to select which problems they want to include in their own version of the document, and can rank them separately.

Q: Are the MEDITECH and LSS problem lists combined or separate?
A: At this time the LSS and MEDITECH problem lists are not integrated. There are a few proposals with Development to address this functionality for a future release. Any interested organizations can contact their MEDITECH Physician Documentation specialist to be added to the proposal.

Q: When using the shared edit feature, if an attending edits a resident’s document, will it queue back to the resident?
A: If a Resident has already signed a report set up for Shared Editing and the Attending co-signer makes changes to the report, the edits will not queue back to the Resident again for signature. The Attending will always be the last provider responsible for any edits to the report.
 
Q: Can other vendors send problem lists from their system to be filed in MEDITECH?
A: With the new problem list, there is a header tab for External problems, which will populate any problems that have been included as part of the Continuity of Care Document. Any Active Family, Surgical, Social and Medical problems will display under the appropriate section headers to be included as part of the patient’s complete problem list.

Q: Is there a way to disable free text problems?
A: In the MIS toolbox under the Clinical 2 page, there will be a new Yes or No prompt, “Enable Free Text Problems”. This will provide your organization with the option to either allow or restrict users with access to edit the Clinical Review Problem List to enter free text problems.
 
Q: Can users search problems on aliases and/or partial alias mnemonics/names?
A: Any organizations who choose to contract with IMO will have the enhanced search capabilities provided through IMO, which will allow for searching problems by aliases, partial words and misspelled words. Should your facility choose not to contract with IMO, the MEDITECH Medical Problems dictionary can be managed by IS/IT staff to include customer keywords that will allow providers to search problems by aliases.

Q: When a problem is removed from a patient, is it permanently removed or filed under past problems?
A: When a problem is removed from a patient’s record, it will be moved to the “Removed” section under the “Past” header in the EPS Manage Problems routine. These will not be permanently removed. Any removed problems can be re-activated by selecting the problem from the Removed tab (by putting a check mark in the far left column), and clicking the ‘Move’ button. This will then prompt the user with a message, “This will move the problems to their previous sections. Continue?” Users may also click into the detail of any removed problems and select the radio button next to ‘Active” or “Past” to move the problem to any of the other headers (Social, Family, Surgical, or Medical).

Q: Does the problem list pull up in Nursing documentation and would Nursing documentation use the same IMO information?
A: Nursing staff would have access to the new Problem List button within Clinical Review, which will launch them into thesame Manage Problems routine that Physicians can also access. This is one consistent integrated problem list routine that will be shared by all provider types, and will integrate with IMO should your facility be contracted with IMO.

Q: Can physician documentation indicate which edits are the attending’s and which the resident’s?
A: With Shared Editing, the output of the report will not display which provider documented into each component or who made the most recent edits. Only the signature information in the trailer (as well as the audit trail) will indicate which providers documented on the report.

If Shared Editing is not being used however, each provider, upon editing the template, will receive their own version of the report to edit. Each edit made by a provider will display clearly under the Section header on the output, followed by the name of the provider who entered in the documentation. The output can be sorted either by Section or by User (depending on PCM parameter setup), to clearly display who made edits to specific parts of the report.

Q: Is there a setting to allow the attending to make edits to documentation before the resident or PA?
A: There is a new prompt with 5.66 that is available to set on the Provider level, called “Queue Co-Signer Second”. This prompt, if set to ‘Yes’, will mean that any report initialized by that provider will not queue to the To-Be-Signed list of any co-signers, until that initializing provider has signed first. In order to meet CMS and Joint Commission requirements that state that "For Medical review purposes, Medicare requires that services provided/ordered be authenticated by the author," this should be set to ‘Yes’ for any providers set up to require a co-signer.

If this is not set to ‘Yes’ and an Attending signs a report before the dictating provider (Resident, PA, Med Student or any other providers who may require a co-signer), the report will advance directly to its final status. This will ensure that all providers who document on a patient will be able to authenticate their own documentation. This will also prevent Attendings from accidentally signing off on reports before the Resident has had a chance to complete their edits.

Q: With the new discharge enhancements, is it still recommended to use an OV partnership for some of the documentation?
A: Yes, it is still recommended that you pull in the patient instructions from one of our certified partners. MEDITECH currently partners with Micromedex, Ebsco, Krames, and Exit Care.

Q: What is the best way to limit the size of an order set if a physician only wants to see one page?
A: The order sets provided by Zynx and ProVation are very long and it is important to work with your physician team to ensure that you are only including orders that pertain the workflow of your end users.

Q: Is there a way to link to/from another vendor such to load/share order set?
A: The associated or linked sets can be created within Zynx or ProVation, but we cannot attach them to the parent order set within the other vendor.  Order sets created within the other vendor can be linked or associated within the MEDITECH order set dictionary.

Q: How long does the Mapping Process take with IMO?
A: This process will depend on your specific facility. We have seen the process take anywhere from 3-8 months time.

Q: Can problems be rank ordered in PDoc?
A: Yes, you can rank your problems in PDoc within your template. To do this select the problem on the “Details” tab within the Problem List component and use the arrows at the top to adjust the problem’s rank.
 
Q: Is there any documentation on how to set up the Family History Routine?
A: There is best practice information regarding the Family History routine on Meditech.com. The specific link for that best practice for the MG platform is: https://customer.meditech.com/en/d/bestpractices/otherfiles/bp14mgrecordfamilyhistory.pdf

Q: Are the Problem List headers in Clinical Review customer defined?  How do you get problems to display under each of them?
A: The Problem List Headers, which include Medical, Surgical, Family History, and Social History, are hard coded headers. You can define which header each problem falls under by using the “Move” function to place problems under the correct header. If searching for and selecting a problem, such as “Appendectomy” from the IMO search, IMO will file that problem under the appropriate header. In this example, Appendectomy would display under the Surgical header.
 
Q: Can shared editing be used on ED templates?
A: Yes, Shared Document editing is available on all template types.

Q: If using a shared template, does the document go to both providers’ sign queues?
A: Yes, if using Shared Document Editing, the template will queue for signature to any Provider that has made edits to the report.

Q: What is the recommended process for handling a scenario where a resident starts a document and adds a cosigner, but does not sign it prior to leaving the facility permanently. How would this document get queued to the cosigner with the new queue cosigner second enhancement?
A: This process would partly depend on your facility’s policy regarding outstanding reports. In the past, we have seen hospitals create an “Alternate Signer”, for example, a provider who supervises the residents, for the residents. Doing so would allow the Alternate signer to sign off on any outstanding documentation that the resident may not have signed off on before leaving permanently. Once the Alternate signer has signed off on the outstanding documentation, the appropriate Attending would be queued for signature.

Q: Where do you suggest and attach problems to be triggered from the chief complaint?
A: In the EDM Chief Complaint Dictionary, the specific problems can be associated to a Chief Complaint. For specific instructions on how to set this up, please reference our Problem List Best Practice document. The specifics of the build begin on page 59 of the document.

Q: What problems will the new family history component pull into PDoc?
A: The new Family History component within PDoc will pull in any conditions that have been added via the Manage Family History routine. Any ruled out family history conditions will also display.

Q: Why does the formatted data built to pull in only chronic problems no longer function in 5.66?
A: Formatted data for the Problem List should be fully functional in 5.66 and this issue would need to be reviewed by your current Physician Documentation specialist at MEDITECH.

Q: Can formatted data or canned text be used within the Assessment and Plan of the new Problem List component?
A: Currently, canned text and formatted data are not able to be pulled in to the Assessment and Plan of the new Problem List component. There are currently no proposals entered to address this functionality for the MAGIC platform.

Q: When will the Problem List integrate with Medical Necessity Functionality?
A: Phase II of our Problem List focus group just wrapped up and this issue was of some discussion. There are no exact timelines regarding when this functionality will be available, but this is something that has been brought to the attention of Development.

Q: Is there an attribute that can be written to trigger and open the family history component within an ED triage assessment?
A: Depending on your specific setup within NUR or EDM, this may be able to be accommodated. Please contact your EDM or NUR Specialist for help setting this up in your system.

Q: Can you use Canned text in the Problem List component in PDoc?
A: With the current edition of the Problem List, users will not be able to access Canned Text within the new Problem List component. However, they will have the ability to recall the last documented Assessment and Plan text for each individual problem. Users who dictate through Dragon or any other voice recognition device can also utilize macros to pull text into the A&P subcomponent of the report. This may be functionality that Development will consider for a future enhancement to the integrated Problem List.