Q: Can you provide documentation on the benefits of using the PCS eMAR vs. the ED eMAR?
A: There are strengths to each routine. The PCS eMAR allows for the use of barcode verification of medications and reassessments, while the ED eMAR offers a streamlined look and feel that fits well with the pace of the ED. Please see the following link for information regarding set up and functionality of these routines:
https://customer.meditech.com/en/d/prwedm/otherfiles/edmccbpemarvspcseemaruse.pdf
Q: Does the problem list integration with clinical impressions use IMO?
A: Yes. It will available in the 5.66 release for both platforms. C/S will have this in 5.66 PP 1 and MG 5.66 with the Priority Pack still to be determined, as it is currently in the final stages of testing.
The problem list searching logic will be parameterized to allow a search of either local hospital maintained Problem list dictionary entries, or launch a seeded search into the IMO search engine (from a third party vendor which will be parameter driven) to identify a Problem to associate to a patient.
Q: If a facility is not up with e-prescribing and abnormal results come back, how do hospitals get the new prescription entered? Does the provider write it and leave it at the desk or is there a more streamlined message?
A: Within the Call Back Reminders Process Routine, there is a link to RXM. If you have the patient selected, and the user has access to write prescriptions, the user can launch into RXM to write the Rx for that patient. Ideally, this would be e-prescribed, however, there are other actions that can be set up such as faxing to the pharmacy. In addition, there are always the options of printing the prescription (in which the patient would need to pick it up) or calling it in. Faxing or calling the prescription in would be the most streamlined.
Q: Can you provide more information regarding the call back reminder enhancement included in the 5.65 release?
A: With the 5.65 release, the Call Back Reminders Routine had some major enhancements:
For a more detailed version of these enhancements, you may following up with your EDM Specialist. Please reference Enhanced Call Back Reminders Functionality.
Q: Are there any troubleshooting methods when seeing slowness on the tracker when using call back reminders?
A: Whenever I see slowness on the tracker, whether it is scrolling or a lag of time with indicators or patients populating, the first thing I take a look at is a true all patients tracker. This means a patient tracker with no selection profile attached to it. See if there are patients that may have not been departed appropriately. If there are an excess number of patients on the tracker, this can ultimately cause slowness. We see this a lot in systems with multiple facilities. To remove these patients, place them in a final status event.
If your physicians are utilizing the “My List” Tracker, then these patients must be manually removed by the provider.
Also, ensure that you have the EDM Toolbox Parameter set to automatically remove these patients from the trackers after a certain number of days. If this is not set, and providers let patients build up, the volume of patients will eventually cause system slowness.
Q: If you have a referral in PDoc, does that flow to the Departure routine? Does a referral in Departure flow to PDoc?
A: The referral in Physician Documentation will flow to the Departure Routine. However, a referral entered in the EDM Departure Routine will not update the PDoc Report.
Q: Is there the ability to free text referrals into the system? If so, is it a dynamic system in that entering the free text referral updates the MIS Dictionary?
A: You can free text in referrals. This does not, however, update any dictionary or save it for a future use. If you find that your providers are constantly free texting in a particular referral, your application support should be contacted to see if the referral can be added to the MIS Provider Dictionary or MIS Outside Location Dictionary. Based on the feedback from the Optimization Event, we are looking to submit a proposal to development on the enhancement of the PDoc and EDM Referrals Routine.
Q: When will MEDITECH allow for the ability to e-prescribe narcotics?
A: Currently, we are unable to transmit controlled substances. Our joint project with DrFirst for electronic prescribing of controlled substances (EPCS) is not yet complete or certified. Since Meaningful Use Stage 2 is only looking for percentages of "permissible" prescriptions being transmitted, this has been interpreted by many to exclude controlled substances. Therefore, since we are not required to do EPCS (yet), the focus has been on the required ERX 10.6 changes that must be in place by October 2013. We will be moving forward with EPCS as soon as the 10.6 changes are complete - and the project is a priority for both DrFirst and MEDITECH.
Q: Is there the ability to suggest instructions?
A: Yes, there is. Depending on your EDM Toolbox settings, patient discharge instructions can be suggested based on Clinical Impressions or the Chief Complaint. Also, see KB Article # 40470: Clinical Impression Setup/ Overview/ Frequently Asked Questions for information regarding this functionality.
Q: Is the Ready for Depart button access driven? Could a nurse use this function?
A: The Ready for Depart is access driven. A nurse could definitely use this functionality if they are provided access.
Q: For referrals, when the packet prints the patient report says “Has been referred to:”. This can be confusing to the patient and makes them think an appointment has been made. Are there any plans to change the wording in the future?
A: There are no plans to change the wording at this time. This request has been added to a proposal for Patient Discharge Instructions to add additional information to Packet.
Q: Does the drag and drop functionality apply to MAGIC, as well as C/S?
A: For MAGIC, this will function a little differently. Within the Clinical Impressions in Departure, the sub components will still exist. However, there will be + and - columns to identify adding or ruling out the impression. Drag and drop functionality will not work here.
Q: Are there any changes coming in the future to allow a provider to document that a problem is in the process of being ruled out, instead of strictly documenting when something is ruled out (implying that problem was already fully ruled out)?
A: Coding for the Problem List is complete. Once this is rolled out to customers, we can look to future enhancements of this functionality.
Q: Can you audit what has been edited in the depart routine after the patient has left? Is there a report to determine if/when edits were made?
A: This information will be captured in the standard EDM Patient Audit Trail. For the specifications of the project:
Departure Packet:
Once the patient has been departed, no additional edits will be reflected on the Depart Packet. The Packet needs to be a snapshot of what the patient received at time of Departure.
The Patient Audit Trail will continue to record edits made to Depart after patient is departed.
Q: Can call back reminders go to the patient portal? Specific to results, allowing them to flow to the portal would reduce the number of call back reminders needed.
A: At this time, Call Back Reminders are not sent to the Patient Portal. However, this would be something to consider for future software design.
Q: Will the upcoming universal eMAR apply to OR as well?
A: Yes, it will. The design will integrate ORM, EDM, ONC, and PCS into the Universal eMAR. A set of parameters will be created to allow for any application specific settings needed.
Q: Do the Problems from Clinical Impression connect back to ICD-10?
A: Yes, the Problems from the Clinical Impression can connect back to the ICD-10. If your organization is contracted with IMO, this mapping will be done for you. If you are not contracted with IMO, this would be a manual process to map the ICD-10 in the Medical Problems Dictionary.
Q: Will all of the departure edits update the note?
A: Any edits made in departure will not update the physician’s note or the departure packet, however will be reflected in the EDM patient audit trail.
Q: Will departed patients stay on the tracker if allowing edits to departure information?
A: This depends on your setup. If you have patients auto-filing with departure to a final status event to remove the patients from the tracker, they will no longer appear on the tracker. However, these patients can be accessed from the Patient Routines menu. If you are using a My List tracker, the departed patients will remain on those trackers until manually removed by the user.
Q: Can you reprint the packet after edits to departure information?
A: Once the patient has been departed, no additional edits will be reflected on the Depart Packet. The Packet needs to be a snapshot of what the patient received at time of Departure. The Patient Audit Trail will continue to record edits made to the departure information after patient is departed.
Q: Are the the only edits allowed just to forms or does this apply to all departure information?
A: With the 5.66 enhancement CS EDM 2657, MG EDM 2413, users can have the ability to edit all departure information, not just departure forms.
Q: What is the advantage of using integrated patient discharge instructions?
A: Patient Discharge Instructions save nurses and physicians valuable time. The system's inherent integration automatically pulls patient information directly from the HCIS into discharge instructions. This integration reduces time spent on data entry and allows nurses and physicians to quickly and conveniently access the patient instructions as part of their normal workflow without having to leave the system. Furthermore, organizations benefit from having a cost effective solution that eliminates the need to maintain stored, printed materials.
Q: Are integrated discharge instructions editable?
A: Patient discharge instructions provided by MEDITECH or our other vendors, such as Truven Health, Ebsco, Krames, or Exit Care, are not available for edits. However, you do have the ability to use the MIS Patient Instructions routine to pull the standard content in and make edits/additions as needed.
Q: Is there a way for a nurse to know when a new treatment or intervention has been ordered?
A: Currently, we have the ability to use a Treatment/Assessment Indicator which gives you the ability to display an indicator on the tracker if the patient has outstanding interventions that need to be completed, or if all required documentation is completed.
In the 5.65 release for Client Server, and 5.64 release for Magic, the treatment/assessment indicators were enhanced to allow the ability to define frequencies on assessments. With this enhancement, a visual indicator on the tracker can display to promote timely reassessments and make the documentation process more streamlined for the ED Clinicians. The frequencies are based off patient priority. Please see CS EDM 1316, MG DTS 1540 for more information.
In the 5.66 release, we will also be introducing a New Order Indicator. This new tracker indicator provides users with a visual alert that new orders have been placed on the patient. Clicking on the keyword brings the user into the Order List routine, where they can review the new orders for the patient. Once the user has exited the routine, theindicator resets and will not display again until a new order has been entered. Please see CS EDM 2646, MG DTS 2412.
Q: What do facilities do for tracking IV stop times for reimbursement?
A: Currently, the EDM eMAR does not have the ability to track IV documentation. In order to document IV stop time information, you could either use the IV Spreadsheet which is available from the PCS eMAR, or you could create a Departure Assessment and attach it at either the Chief Complaint or Customer Defined Parameter level. When building your assessment, you can associate date and time queries to capture the stop time information. You have the ability to make the departure assessment required, which will help guarantee that you collect this data prior to the patient being departed, which will help with reimbursement rates.
Q: Can EDM be used in Urgent Care facilities?
A: Yes, EDM can be used in an Urgent Care facility. Many of our customers have either urgent care or quick triage locations set up as different EDM locations to distinguish.
Q: What is the best way and recommendation on how to best up IV Start and Stop time assessments for MAGIC?
A: The best way in MAGIC to document this would be through a Departure CDS that has a required Yes/No type query asking if the patient had IV fluids administered. Additional queries relating to the patient’s discharge may also be included on the CDS. The full overview and setup can be found on our Best Practices Homepage: Documenting IV Start/Stop Times for ED Patients
Q: Can the ED Discharge packet be sent to the patient portal? What currently goes to the portal now?
A: The entire Discharge Packet currently does not get sent to the Patient Portal, however there are components of EDM Departure that do go over at this time: Visit Summary, Forms, Patient Discharge Instructions, and Continuity of Care Document (CCD). More information on the Patient Portal can be found on our Products and Resources Homepage: Patient and Consumer Health
Q: In regards to Call Back Reminders, when a patient leaves and then additional results, such as Lab or Radiology, come back with the need to contact the patient, what is the best way manage, set up, and the ideal workflow for MAGIC?
A: As far as setup, the IT staff should ensure that Call Back Reminders are defined to generate for both partial results and for Resulted/Completed results for both LAB and ITS.
Additionally, Reflex Orders have the ability to trigger reminders now. Within the EDM Module, IT staff should confirm that the appropriate Reflex Orders are also set up for the generation of Call Back Reminders. This would ensure that if orders are triggered off of other procedures, these will generate a reminder. However, any other type of order placed after the patient has been departed will need to be manually entered within the Call Back Reminders Routine. The end user can do this based off of Date or Result. This routine can be added to a user’s main desktop, so the staff placing the order would most likely be the one entering this.
The reminder would process like any other Call Back on the list. A dedicated end user within the ED would then process these reminders.
Q: Currently, in MAGIC, office staff for a provider can not access patients in the system who are not associated with the provider in admissions. For example, if a patient is referred to an orthopedist, but the orthopedist did not see the patient in the hospital and is not associated to the account in ADM, the office staff for the orthopedist is not able to access the patient. What is the best way to handle this workflow and process?
A: Have your IT staff check the Provider/Provider Group restrictions on pg 4 of the MIS User dictionary. This will restrict the user's access so that they can only access patients whom have a link with the Provider/Provider Group that they are restricted to. If these fields are blank on pg 4 of the MIS User Dictionary, it means that the user has open access. These fields are optional and should only be filled out if you want to restrict a user's access.
Q: In Client/Server, users can’t easily edit the depart date and time stamp for a departed patient. What is the best way to do this?
A: Within the 5.65 and previous releases, the only way to edit the Departure Date and Time would be through backing out the defaults within the EDM Departure Routine prior to the patient being in a DEP ER status. If this has already been done, an end user with access to the Registration Management Desktop in ADM would need to go to Undo and ensure that Departure has been undone for that patient. They would then go to the Discharge routine from the Registration Management Desktop and edit the timesappropriately here. They may also access the patient back in EDM via Patient Routines > Depart.
Q: What is the best way to capture the decision to admit time?
A: The best way to capture the decision to admit time is through an Admission Request. This process and setup can be found on our Best Practices Homepage:
MAGIC: Best Practice Series: EDM to Inpatient Admissions with CPOE
C/S: EDM to Inpatient Admission with CPOE
Q: Within the PDoc Departure section there is one small field for dictation/comments. Most facilities have created an additional text component to accommodate the additional documentation, however none of the text pulls into the departure routine. Are there any additional enhancements coming for further integration?
A: There is a proposal out there currently to address this which would increase the space of the Comment fields within Physician Documentation. The feedback from the Optimization Event has been added to the proposal to note the additional interest.
Q: Since taking the 5.66 update the initial visit is prompting users to reconcile the problems, but users are skipping over this. Is there a way to hard stop providers and force them to reconcile the list within EMR?
A: The message that users are currently receiving is “Problem list updated from previous version. Please confirm accuracy." According to the Design Project, the user is not required to perform any actions on the problems to clear the message. Development is looking into further enhancements to the routine to help with reconciling previous entries into the new Problem List routine.
Please be sure to visit our IMO Best Practices Homepage.
Q: Call Back reminder currently do not flow to the EChart in MAGIC. Are there any changes coming to allow for this?
A: In MAGIC, Call Back Reminders do go to the EChart. This needs to be part of the Report Format (Patient Summary Report) that is defined within the EDM Customer Defined Parameters. If Call Back Reminders are not appearing on the EChart, please follow up with your EDM Applications Specialist to review the setup.
Q: Joint Commission requires for the content of the patient instructions to file to the ECHART, is there a way to set this up?
A: At this time, the title of the Patient Instructions will flow to the EChart. This is part of the Report Format (Patient Summary Report) similar to question about Call Back Reminders above. The actual content, however, does not flow to the EChart at this time due to code discrepancies. Our recommendation at this time is to print multiple copies and scan in the Patient Instructions manually. There is a proposal that has been submitted to eliminate this manual process in the future which would send the entire ED Departure Packet to the EChart.
Q: Is there a way to trigger a call back reminder based on the order placed on a patient rather than triggering off a result?
A: With the 5.65 release, Call Back Reminders were enhanced to generate for partially resulted LAB Orders. This would require the order to hit a status of IPRr in order to trigger the reminder. For a reminder to generate solely off of the Procedure Ordered, this would need to be considered for a future software design. The feedback from the Optimization Events has been added to the existing proposal.
Q: Within the referrals component, instead of sorting by name or by group, can there be an option for a combined sort? This would help reduce clicks.
A: This request will need to be addressed in future software design considerations. The feedback from the Optimization Events has been added to the existing proposal to note the interest in this functionality.
Q: Physicians are setting the Ready to Depart flag prior to the patient actually being ready to leave. Would it be possible to have a warning so the physician is able to see if there are any outstanding tests still pending on the patient when they set this status?
A: This can be done with a little bit of setup involved. You are able to have a warning message appear based on required fields when the Provider clicks the Depart button. You are able to have this message appear for required Assessments and Treatments. If a Procedure is tied to a required Treatment, this will need to be processed in order for patient to be marked as “Ready for Departure.” Please follow up with your EDM Applications Specialists to assist in setting this up in your system.
Q: In North and South Carolina there is a regulation which requires the Attending ER physician’s name be printed on any prescriptions written by a PA or NP. Is there a way to set this up in the system?
A: As long as the Attending Physician is documented within the patient’s visit prior to the patient’s prescription being entered, a standard datafield or query can be pulled into a customized prescription. This will need to be built in NPR and added to the RXM Print Forms and RXM Customer Parameters Dictionary. Please follow up with your RXM Applications Specialist for assistance.
Q: Can you use both an Assessment and a Customer Defined Screen within the EDM Departure Routine?
A: Yes, you can. Within the EDM Access Dictionary and Customer Defined Parameters, you are able to define the headers that will appear in this routine. You would want to ensure that you have the following defined under the Departure Plan Functions (Access) and/or Departure Display (CDP):
MG: CUS DEF SCREEN and ASSESSMENT
CS: Include Assessment: Y
Include CDS: Y
Q: Within the 5.66 release, the end user still cannot edit the Date/Time of Departure from EDM (they still need to access ADM in order to complete this.) Will there be a future enhancement to this?
A: This has been discussed with Development and this request would need to be considered as a future software design omission. Discussions are ongoing with Development about the best way to approach this request.
Q: It was asked if Callback Reminders could display in the EMR somewheres else besides the EDM Summary Report. Is there an easier way to find these?
A: There is a way to place these Callback Reminders in a central location within the EMR. Within the “Other Reports” panel, a Report Format can be set up that will display only Call Back Reminder information. A Report Format will need to be created that only includes the Departure Section > Reminders. Once this is completed, a task will need to be opened with you EDM Specialist to supply the mnemonic of the Report Format that you created for the Call Back Reminders. Your specialist will then attach it in the EDM Toolbox parameters. Once this is done, all Call Back Reminder information will display under the “Other Reports” Panel within the EMR. There will be a separate report labeled “Reminders” in which your care providers will be able to access all the Callback Reminders for that patient. This way, they will not need to scroll through pages and pages of the Patient’s Summary Report to find this information.
Q: Can Call back reminders be generated based off of a patient’s disposition - for example - AMA?
A: There are no settings that this time that would allow Callback Reminders to generate based off of a patient’s disposition. This has been considered for a future software design.
Q: When adding a physician as a referral, will this add them to the physician’s list of patients, similar to how a consult works?
A: This will be added to the list of future software considerations to enhance EDM Referrals and with the proposal that EDM referrals information should integrate with the Desktop.
Q: During our discussion session, it was expressed that the specialty doesn’t display on the printed packet. Is this possible, and if not, will this be considered in a future enhancement or design consideration?
A: This will be considered in a future enhancement to add additional information to Packet.
Q: Chief Complaint edits, is there any way to do mass edit similar to ONC?
A: There is a Proposal entered for a future software design consideration. Feedback from the Pittsburgh Optimization Event has been added to this proposal as well, to note the additional interest.
Q: Care Plan does not demo recall, so how do we handle frequent flyers? For example now we have to put a query on MRI - do you have ER Care plan? (CCI screen)
A: The patient’s Care Plan for past visits is available through the EMR. At this time, the EDM module offers indicators on the tracker will display the date of a patient’s past ED Visit or indicate that they may be a ‘frequent flyer.’ The request has been made to incorporate this into any visit the patient may have made to the hospital regardless if it was through the ED or not. Currently, a proposal exists for this functionality. This wouldallow for inpatient visits to be incorporated into the existing repeat visit indicators. When the end user clicks on the indicator from the tracker, they will be launched into the EMR to review past visits and those Care Plans associated to them.
Q: For the Dashboard, has there been any enhancements for a way to print the output besides print screen? Can this be downloaded?
A: This will be considered for a future software design to add Email, Download, Print, View to GPA, and Reports. This proposal has been updated to note the additional interest in this functionality.
Q: On Depart screen, can you Order?
A: There is no direct link in MAGIC to the Orders Routine. However, many sites do give their Physicians access to the Prescriptions header or the Reconcile Medications routine, in which Orders can be launched. Within this routine, they will have access to the Orders button.