Q: Does the problem list integrate with the conditions list in Pharmacy?
A: At this time there is no integration between Pharmacy Conditions and the Problem List. However, there is a proposal tracking a development request for the ability to flag in CPOE and PHA medication order entry for Condition/Disease Contraindications using information recorded for the patient's Problem List without having to manually enter in patient conditions in the Pharmacy application.

Q: If a problem is added when entering an order, where does this show?
A: The order history in the EMR will show the problems added via the order. The problem will also file to the EMR Problem List, where an audit can be run to show the user along with the date and time the problem was entered in on the patient.

Q: If a chronic problem is on this list, how will that show when the patient comes back to the hospital?
A: The Chronic problem from the previous visit will remain on the patient’s Active List upon readmission. 
 
Q: Is the ranking of problems, as well as other features shown today, also available in MAGIC?
A: Yes, MAGIC has the same functionality as Client Server with respect to our improvements to the problem list.

Q: Can the problem list show the ICD codes next to the problem when viewing? Physicians will find this easier when they are reviewing data for billing purposes.
A: The ICD codes display along with the problem in the Add Problems lookups, as well as within the EMR once the problem has been filed on a patient.
 
Q: When showing ICD codes, will you show both ICD9 and ICD10? This is especially important when organizations are migrating from version 9 to 10. 
A: Within the system, there is a program call that determines what the latest ICD version code set is. If it is ICD9, then it displays ICD9 and if it is ICD10, then it displays ICD10. The system will display only one ICD version.

Q: How does one handle cases of acute on chronic such as with chronic renal disease, COPD, pulmonary disease, etc.?
A: At this time, providers are able to document this information on the problem within Physician Documentation as part of their assessment and plan.  In May, a Problem List Focus Group is kicking off to vet additional enhancements to Phase I of the Problem List Re-Design. This question has been brought to the attention of the team coordinating the focus group and will be discussed and vetted through the Focus Group Process on how to best address it.

Q: Does family history show in the history panel?
A: The new Family History routine will continue to update the History Panel in the EMR, in the same manner the PCS assessments used to.

Q: How does this differ from past medical history entered by the nurse?
A: Nursing will use the new Family History routine to capture that portion of the patient’s past medical history. Nurses will no longer use a query based assessment to document the Family History, and will be launched into the new routine to do their documentation. MEDITECH is currently developing the tool to also include the ability to update the Social and Surgical history, as well.
 
Q: Can the problem list still be launched from Physician Documentation?
A: Yes. The enhancement in 5.66 introduced a new Problem component which allows for a problem based and integrated Assessment and Plan. However, the legacy Problem component can still be used within templates as well with the 5.66 release.

Q: If a past problem is moved to active what happens to it when the patient is discharged?
A: Problems will remain on the same tab they were on when the patient was discharged. If a problem was an active problem at discharge, whenthe patient returns to the facility the problem will still be an active problem. The Focus Group starting in May for Phase II of the Problem List will be discussing the possibility of parameterizing an auto resolve and moving them to the past tab of problems after discharge for patients.

Q: When documentation is set to be shared, when a midlevel enters documentation and a physician changes, what happens?
A: With a shared document, any changes the physician makes will be merged with what was originally entered by the mid-level and will have both signatures.  Additional information regarding setup and output for shared documentation can be found in our Shared Editing Enhancement Document.
 
Q: Does the mid-level need to sign again after the co-signing provider makes additional edits?
A: No.

Q: Do the new Meditor changes now allow for word selection by double-clicking?
A: Not currently, but we have made this request to Development for a future Meditor release.

Q: Can you import a .jpg into physician documentation?
A: There is currently an active Development Project working on this enhancement.  It is currently slated to be completed in the latter half of 2013.

Q: Will the uploading of wound photos, ultrasounds, etc. be available for PCS assessments? 
A: We presently do not support the uploading of photographs via PCS. In order to upload an image, a nurse would have to use the ITS module and attach it to a report. There is a Development Proposal which suggests expanding this capability to nursing Text type queries.

Q: How are patients assigned to a service?
A: In Physician Desktop, while on an Inpatient Rounding list, the list of services will be presented  in a popup when the new "Modify Service" footer button is pressed. This button will be available when an inpatient visit is selected. A user can select a service or services to put that visit in, or deselect a service that the visit is currently in. Under Coverage selections, the list of services exists as a new body button option under "Service". Selecting a service or services for coverage will allow those visits under each covered service to appear in the new "Service" list in Inpatient Rounding. Audit data is stored for any visit added or removed from a service, including a user and timestamp. DTS PWM 2024 introduces these changes.

Q: Have patient rounding reports been improved?
A: The PWM Print List footer button in the Inpatient Rounding list launches an NPR report, whose output is in the same format as the Inpatient Rounding list.  The report has some formatting options, which are defined in new fields in the PWM Rounding dictionary. DTS PWM 2024 introduces these changes.

Q: Is the sticky note functionality available for PCS?
A: At this time, the sticky note functionality is limited to the PWM Desktop.  However, Inter Provider Messaging can be used for providers to communicate back and forth, similar to e-mail, on a specific patient. Additional information on this functionality can be found within the Provider Messaging Best Practice.

Q: Any development changes for natural language processing?
A: At this time, Development’s research on incorporating Natural Language Processing into Physician Documentation is underway. Development is working to  determine the scope and effort which will be required for this project, in order to determine when and how this may be addressed.

Q: Can you use Nuance’s Dragon speech recognition on an iPad for dictation?
A: Asof right now, Dragon does not have an Apple version for Medical speech recognition that they are promoting or developing. The iPad does have some great out-of-the-box speech recognition, but it does not handle the Medical terminology well and is not as user-friendly for documentation purposes. At this time, it is not a viable option for clinical documentation.

Q: In the Order Set dictionary, are there suggested problems?
A: The lookup within the OE Order Set Dictionary Suggested Problems prompt is a direct link to the IMO database directory. Problems can be pulled in as suggested Problems to be presented to the user in the Add Problems screen for any orders which have the Problem List component associated to them and are part of that specific order set.

Q: Will the system look to IMO for Family History conditions?
A: All lookups for problems will point to IMO.

Q: Will Nursing documentation have access to the Family History?
A: Yes. In order to meet the Meaningful Use Stage 2 criteria, the new, structured Family History routine will need to be utilized to capture the data.  This routine will be accessible through the EMR Problem List, Nursing, Emergency Department Management, and Physician Documentation. DTS PCM 4938 provides additional information on the Integration with Physician Documentation and DTS PCS 4807 integration with Nursing.

Q: Likewise, if Nursing documented the Family History, will it be available to the physician?
A: Yes, the new Family History routine is a shared routine, so any documentation done by either physicians or nurses will be available for all users to see.

Q: How long is the audit trail maintained?
A: The problem list data is stored on the HUB server. The audit trail is compiled real-time from the HUB server based upon the transactions sent to the HUB server. Since nothing gets purged from the HUB server, the problem audit trail will never be purged.

Q: If we have queries built, will they need to be rebuilt?
A: The new Family History component will replace any queries which have been built for nursing or physician documentation.

Q: Is this available in 5.66 pp0?
A: The EMR and Nursing portion of the Family History routine is available in 5.66 PP0.  The integration with Physician Documentation is available in 5.66 PP1.

Q: Are Sticky Notes auditable?
A: There is no audit trail for the Sticky Notes and these are not considered part of nor saved to the patient’s medical record.

Q: What is the timeframe for loading images on the fly?
A: Development is currently working on the technical aspects of the design for this project. This feature is targeted to be available the latter half of 2013.

Q: Will the Family History documented by nursing integrate with the problem list and Physician Documentation?
A: Yes, a new Family History component has been created and will be shared between nursing and physician documentation. This will replace the current query based collection of family history.

Q: Does IMO mapping need to be done prior to the problem list being there in 5.66 (ie., what would I see in the lookup if the mapping isn't completed)?
A: If the IMO setup has not been completed, the lookup would function as it does prior to 5.66, showing problems in the PCM Problem Dictionary. Mapping and set up for IMO should be completed before going live with the problem list to take advantage of the significant benefits provided by the IMO integration. Additional information on IMO can be found on MEDITECH’s IMO Resources page.

Q: We are a facility that used problem lists in 5.64 and did the build. Using IMO in 5.66, will we need to expunge our non-IMO problems in the dictionary prior to the new load?
A: Once setup has been completed, the non-IMO problems will no longer be the lookup for the problem list. The problem list lookup will be directly to IMO content, and will not reference the current problem dictionary.

Q: Can non-physician users edit the problem list? (ie., nurses, stroke coordinators, CHF coordinators)
A: Yes, via the MIS User Dictionary you can grant view or edit Problem List access to non-physicians.

Q: Is there a way to see clearly who documented each response, or if responses were changed and by whom, within a shared document?
A: If Shared Editing is used, there is no indicator in the final output of the document itself denoting which provider wrote what information. If this information is needed, the Physician Care Manager (PCM) Audit Trail can be referenced as it shows any edits made to the report after the report was initially filed.

Q: Will physicians be able to edit the document text directly from their sign queue?
A: In the sign queue, clicking the “Edit Document” button will launch the provider directly to PDOC where the physician can make the appropriate edits. Editing the output of the document as free text is not something that has been done, since much of the output is discrete data, and would need to be edited within the document itself.

Q: Can you provide information on the build involved with adding a problem to an order set through POM?
A: The ability to add access the Problem List requires set up in the Order Entry Parameters, OE Order Set Dictionary and the OE Access Dictionary. For detailed instructions on setting this up, please reference KB 47054 for the necessary setup for updating the Problem List through POM.

Q: When adding problems via Physician Documentation, you then have to check off the problem once added to pull it into the template. Is there a way to have it be pre-checked if added specifically through PD?
A: At this point, we do not currently have the ability to automatically check the problem off. The reason being, we are launching into the EMR Manage Problems routine when we select the Add Problems button. However, this is a valid question and we will be bringing this to Development’s attention for review.

Q: Does the alias or full name of the problem display on the report? Is there a way to control which is used? 
A: The full name will display on the output of the report, rather than the alias.
 
Q: When you are adding new problems onto the patient, is there an easy way to see the existing problems in case you forget what has already been entered once you get to the Add Problem screen?
A: At this point, unfortunately we are unable to view the existing problems when using the add problems routine. This is a valid question and we will be bringing this to Development’s attention for review.

Q: In the Family History routine, can the system be changed so the top row is frozen? Also, is it possible to make the columns more narrow in the event there are many family members displayed? Lastly, when adding the family member and selecting Mother, Father, etc., it would be nice to be able to define their name right there on that screen.
A: Unfortunately, these requests are not currently available and are not yet being tracked as development enhancements. We will bring this request to Development for review to see if this can be accommodated in future releases.
 
Q: Does Dragon work with the IMO search when adding a problem to the problem list?
A: Yes, a provider would be able to use Dragon to do a type ahead lookup when adding a problem.

Q: In the second Shared Editing scenario, the resident had documented joint pain but the attending removed that response and change it to back pain. In reviewing the report, both still show. Is that correct?
A: With the Allow View of Previous Responses functionality enabled, the correction made by the attending will not overwrite the residents documentation and will show both provider’s documentation on the report. If you do not want the previously documented information to display on the output, you would want to use the Shared Editing enhancement instead. This enhancement will allow the attending to overwrite the residents documentation and will not display the previous response on the report.

Q: Is there a way to disable sticky note functionality?
A: At this point, the sticky note functionality cannot be disabled. However, we do think that the need for facilities, who do not want their providers using this functionality, merits a review by development. We will bring this to Development’s attention to see removing the sticky functionality will be possible.

Q: Is there a DTS to address the ICD9 code showing instead of the problem name?
A: There have been several similar issues reported, but this specific issue has not yet been reported. Please open a task with your Physician Documentation specialist to ensure that this issue is addressed.

Q: How does recall function with the Problems component functionality?
A: Problems can be recalled according to My, All, Group or None. If you notice any issues with this functionality, please report them to your Physician Documentation specialist at MEDITECH.

Also, please note that currently the A&P text associated to the problems are not tied to this setting and will be recalled regardless of the recall method. This is something that has just recently been addressed by Development in a later enhancement. Please request that your Physician Documentation specialist evaluate adding these changes if you are interested in this functionality. Also, the Recall A&P setting does allow you to determine if you would like the recall text to automatically or manually be pulled in.

Q: Dr. Short from Community Hospital of Anderson noted some concerns with using the IMO Problem Search when adding new Clinical Impressions into the Clinical Impression component of his ED Document. Dr. Short noted that entering free-text problems was requiring additional clicks after the upgrade, and that adding Primary, Secondary, and Ruled Out problems take too many clicks in and out of the Problem Search.
A: There was an enhancement to the Clinical Impression edit screen in 5.66, priority pack 4. Everything can be completed on the one edit screen, including adding Primary, Secondary, and Ruled out impressions, with minimal clicks.

Q: Can you clarify problem statuses and how to understand labeling problems as acute versus chronic, particularly when adding problems to the Problem List?
A: The Status options have been streamlined by removing “Active” as an option. With 5.66, the options are “Acute”, “Chronic”, and “Resolved.” In the PCM Medical Problems Dictionary, if a problem has a “Default Status” set, then this will default in when you add this problem to the Problem List. Otherwise, it will default as “Acute.” The Default Status for problems coming from IMO can only be set by IMO.

Q: Can POM Order Rules can be used with Problems?
A: An enhancement available in 5.66, priority pack 2 made it possible to use problems within order rules. The argument uses the IMO problem ID number as part of the rule, as seen below:

IF{[f pt prob current]("IMO-PROB-1004101")=1

For more information on using problems as part of POM Order rules, please check the Knowledge Base or contact your MEDITECH POM Application Specialist. 

Q: It was noted that when using Shared Editing, a mid-level will begin the document and then both the physician and the mid-level will edit as they go. It was found that the mid-level can edit the physician’s notes, though this is not desired. Can physicians be set up to edit each others document or set up to not overwrite each other?
A: A signing enhancement available in 5.65, priority pack 12 allowed for templates to be defined to “Share Document Editing.” If set to Yes, all providers editing a document will see the previous responses set by others and can modify them as if they were their own entries. If this is not desired, “Share Document Editing” should be set to No and “View Previous Responses” should be set to Yes. This will allow users to see, in Bold, the answers set by other providers, but will not be allowed to edit those entries. All edits will display in the output and it will be clear which providers entered which entries.

One feature that may mitigate these concerns is the Queue Co-Signer Second enhancement, available in 5.65, priority pack 13 and 5.66. If set to Yes for a resident in the MIS Provider Dictionary, the report will not queue to the co-signer until the dictating provider signs the report. This will mitigate the chance of residents overwriting the information entered by an attending, as they will have already signed-off.

Q: Can a consulting provider be displayed on the PWM Rounding List?
A: While there is not a keyword that will populate the Consulting provider, there is an option to get this information onto the Rounding List. On your Consult Orders, place a “Consulting Provider” Pointer-Type query that points to the Provider Dictionary. Then, attach this query to your Custom Rounding List in the PWM Rounding List dictionary. The selected consulting provider will then display on your rounding list alongside all other keywords and queries.

Q: From the PWM Rounding List, is it possible to modify the attending provider without having to go to the patient file in Admissions, as the attending switches numerous times over the course of the stay.
A: With the sign-up functionality, providers with appropriate access can replace the attending provider, as well as all other provider types such as Family, Primary Care, etc., with other providers. Setup includes deciding which options for replacing or adding providers will be available globally via the FS Parameters, and then deciding which providers will have which sign-up access via the MIS User Dictionary.