GE Healthcare

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GE Healthcare Centricity Physician Office EMR
2005 Functionality Training Manual
Thats Powerful Medicine
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Table of Contents

• Chapter 1 Getting Started with Centricity
  Physician Office EMR
• Chapter 2 Working with Flags
• Chapter 3 Creating Quick Text
• Chapter 4 Use of Phone Notes
• Chapter 5 Rx Refills
• Chapter 6 Protocols, Letters, Handouts, Graphs
• Chapter 7Clinical Lists Updates
• Chapter 8 Desktop and Document Maintenance
• Chapter 9 Charting a Visit
• Chapter 10 File Attachments
• Chapter 11 Orders Module
• Chapter 12 Save and Restore

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Chapter 1 Getting Started with Centricity
Physician Office EMR

• Learning Objectives
• Log On Off
• Orientation to EMR features
• Orientation to the Desktop features
• Orientation to the Chart features
• Online Help

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Login Screen
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Desktop Orientation
Menu Buttons
Title Bar
Action Buttons Note Desktop is Depressed
Exit Button Allows the user to logout
Tabs to manage information
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Menu Bar-Go Button
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Preferences allow you to customize your desktop
views of a variety of documents. The above
example is of the appointment screen view.
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Menu Bar-Actions Button
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Menu Bar-Options Button
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Desktop Out of Office Assistant
Options- Out of office assistant
You can set up an Out of Office assistant that
alerts senders of flags or documents that the
recipient is out of the office.
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Desktop Summary Tab
Flags Flag Action buttons
Documents Document Action buttons
Appointments and Action Buttons

• The Summary tab of the desktop allows a user a
  snap-shot view of appointments, flags, and
  documents.
• Appointments are seen on the left side of the
  screen. (this information crosses over via
  interface from IDX)
• Flags are displayed in the upper-right corner and
  documents in the lower-right corner.

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Desktop Icons
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Desktop Flags Tab
Flags are electronic post-it notes that are
sent to one or more users. You can even send
flags to yourself and post-date them for future
reminders. Flags can be attached to a
recipient's desktop, patient chart, registration,
and appointments. The Flags tab of the desktop is
the best place to review and manage flags. From
the flags tab, you can hover on a selected field
to expand the text within that field for
previewing a flag. Flags in bold are unread
flags. Flags in italics are saved flags that have
not been completed sent to a recipient.
Documents and Flags are displayed by the
priority given by the sender. Red exclamation
(!) is for urgent priority---shown at the
top Yellow exclamation (!) is for important
priority----displayed after urgent flags and
documents No marking is for normal
priority---displayed last DO NOT PUT CONFIDENTIAL
INFORMATION IN FLAGS!!!!!
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Desktop Documents Tab
Information from the highlighted document above
Document management for reviewing and signing is
best accomplished using the documents tab on your
desktop. Once the document is signed, the
document will no longer appear on the desktop.
The View Documents to allows the user to
change providers and view documents on another
providers desktop (with proper privileges). The
drop-down allows the user to view users in their
current location of care. The binoculars allows
you to select from outside your location of care.
The folder structure in the upper left-hand
side can be organized by the user to sort
documents on their desktop by document type in
the order desired. The All folder displays all
document types on the desktop. The number in
parenthesis ( ) beside the All documents folder
shows the user how many documents are on the
desktop. The subfolders sort the documents based
on type. When you click on one particular
folder, only those documents are
displayed. Documents with the pencil icon mean
the document is unsigned. Comments are throw
away information, they do not become a part of
the permanent medical record.
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Patients Chart-Searching

• There are 4 ways to do a chart look up
• CTRL F button
• Actions-Find Patient
• Go Chart Summary
• Chart Button
• Patients can be searched for by name, Date of
  Birth, SSN, Patient ID, etc.
• Please use first 3 letters of last name, first 3
  letters of first name as in IDX search.

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Chart Summary
Patient banner Blue Active patient chart
(will have DOB) Red Inactive or deceased
patient (deceased will have DOB and DOD) View
Only with tabs Summary-overview of all areas of
chart Problems-list of patient diagnosis or
surgery Medications-list of medications that the
patient is on Alerts-allergies/directives Flowshee
t-vital signs/lab values/immunizations (These are
called OBS TERMS) Orders-services
requested Documents-patient phone notes/rx
refills/visit notes/consents BUTTONS DO, TABS
VIEW Update, Phone Notes, Refill buttons float
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Chart Problems
The problems tab of the patients chart allows
the user to view active and inactive problems
(ICD-9 diagnosis codes) for the patient. This
information is read-only thus we cannot add a
problem to the patients chart through this tab.
The Active Only radio button allows the user
to toggle on only the current problems whereas
the All radio button allows the user to view
all problems ever associated to the patient.
Resolved problems will appear highlighted in
gray. Highlighted problem- information regarding
the problem displays on the grid and
assessment's) that are associated with the
problem display at bottom. View problem details
button displays the same details above, only in a
separate window. Double click on the problem to
view document's) associated with that problem.
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Chart Meds
The medications tab of the patients chart allows
the user to view active and inactive medications
for the patient. This information is read-only
thus we cannot add a medication to the patients
chart through this tab. The Active Only radio
button allows the user to toggle on only the
current medications whereas the All radio
button allows the user to view all medications
ever associated to the patient. Historical meds
will appear highlighted in gray. Highlighted
medication - information regarding the medication
displays on the right side. Instruction and
Refill information appears on the lower right
side. Double click on the medication to view
document's) associated with that medication.
BMN Brand Medically Necessary Updates are
done quarterly on drug list.there is a mechanism
that allows addition of study drugs/new meds.
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Chart Alerts
The alerts tab of the patients chart allows the
user to view active and inactive allergies and
directives for the patient. This information is
read-only thus we cannot add either of these to
the patients chart through this tab. The
Active Only radio buttons allow the user to
toggle on only the current allergies and
directives whereas the All radio button allows
the user to view all alerts ever associated to
the patient. Historical alerts will appear
highlighted in gray. Highlighted alerts-
information regarding the alert displays on the
right side. Double click on the alert to view
document's) associated with that alert. Three
types of allergy alerts are available and can be
classified as critical or non-critical
reactions. Drugs Foods Environmental Variety of
Advanced Directives are available
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These are the symbols that you will see
associated with allergies.
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Chart Flowsheet
Values
Observation Terms
Flowsheet contains discrete clinical data
elements that originate from several possible
areas Interfaces (i.e. lab interface) Chart
updates containing form components that are
programmed to record to specific observation
terms (obs terms). Manual updates to the
flowsheet during a clinical list change. The
observation terms are the labels going vertically
down the page. The observation values lie within
the grid and correspond to an observation term,
and the date the value was observed Blue values
have been imported via an interface and black
values were manually entered. When highlighting a
value in the flowsheet, the details regarding
that value display below. When you double click
on a value, it takes you to the chart
documentation in which the value is associated.
Various icons (tags) are displayed next to the
values. Observation terms that come with the
system are updated every couple of months. Date
resolution can be toggled from days, months,
years, minutes, and you can also look at last
observation. The observation term name column can
be resized to accommodate the long label
names. 15,000 observation terms are
available flowsheets are very customizable to
each patient or clinic practice
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These are the Icons found on the flowsheet along
with definitions. When working in EMR use the
HELP button to find this information.
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Chart Orders
ORDERS CPT CODES Order Types Services
visit types, billing information Tests
labs, radiology Referrals referral to
specialist, require authorization or insurance
approval Order Statuses Admin Hold, In Process,
Complete, Canceled Highlighted Orders will
display detail information in the lower half of
the window. Double click on the order to view
document's) associated with that order. Orders
Module will not be implemented with initial
go-live
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Chart Documents
Documents tab contains all documents for the
patient, unsigned or signed. To view information
in the Documents tab in a variety of ways, you
can Sort the columns by clicking on the column
header. On the left hand side, you can filter to
look at certain documents ltALLgt click on
sign---The documents tab shows every available
type of document Other system setups allow you to
have folders with different document types.
Users can create their own views from the
Organize button. You can open up more than one
document at a time and resize the windows with
the full document viewer. Group by date Several
documents for the same date are all grouped
together click the full document viewer and get
a composite view for that date with page breaks.
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Appointments
VIEW ONLY!!!!! Appointments can be viewed via a
daily, split or weekly view ALL APPOINTMENTS MUST
BE SCHEDULED IN IDX, info then flows from IDX via
an interface to EMR SCHEDULES ARE TO BE PRINTED
FROM IDX PATIENTS ARE ALWAYS ARRIVED/CANCELLED/NO
SHOWED IN IDX, an indicator is then populated on
the EMR schedule Cancelled appt box with an X
Arrived black dot by pt name System
automatically defaults to current date. Use
up/down arrows to scroll to different date, use
ellipsis to change month Provider appointment
screen can be changed via select view button
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Patient Registration

• VIEW ONLY!!!!!
• Only 4 items may be changed in EMR are (with
  privileges)
• Marking the chart sensitive
• Adding/Changing a registration note
• Taking a patient photograph
• Adding a pharmacy
• There are 3 levels of access for sensitive
  charts
• No Access-cannot view the chart and a pop-up will
  display
• Access on Demand-sensitive chart message will
  appear stating a log is being made on all charts
• View Sensitive charts (all access)-no prompt at
  all

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Flags Action Buttons-New
Select Flag Recipient
Message to Recipient
See next slide
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To Create a New Flag 1) Select the New Button
from the Action Button toolbar (The New Flag
Window appears) 2) To Section-- Select the
drop-down box to see users within your location
of care OR click the binoculars button to see all
users in the system. Highlight the user's)
who are to receive the flag. HINT To
remove a user from the recipient list Highlight
the user, then click the red X icon. 3)
Properties Section a) Priority---Mark the
flag as normal, important, or urgent. b) Due
Date---Defaults with todays date, however flags
can be post-dated. c) Attach to---Flags can
be attached in 4 places Recipients Desktop,
Patients Chart, Patients Registration, and
Appointments. Flags attached
properly allow the user to view the pts
chart/registration /appointment with fewer steps
d) Subject It is also recommended to
include a subject for the flag. 5) Messages
Section Type the message. remember that
this content can be converted to a document in
the pt chart 6) Clicking the send button will now
send the flag to the recipients. 7) The save
button will allow your flag to remain on your
desktop to finish send later and will display
in italics.
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Flags Action Buttons-View
Allows to view flags due anytime
It is important where the flag is attached
because when attached properly, it will
automatically allow the recipient to view the
chart, registration, or appointment. Use
Recipients Desktop for generic flags - for
example, meetings reminders. TIP If
your flag references a patient, open the
patients chart, registration, or appointment,
prior to starting the flag, otherwise you must
select the patient by clicking on the button.
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F1 Online Help
Help can accessed by right clicking or clicking
on the Help Buttons NOTE Use of help is not
privilege driven because it is a Windows
function, not CPO EMR. Help is content
specific Help in desktop
accesses desktop related information
Help in chart accesses chart related
information
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Chapter 2 Working with Flags

• Learning Objectives
• Identify potential use of flags
• Forward, reply to and convert flags
• Use the organize flags feature
• Identify 4 places to attach flags

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Desktop Flags Tab
Flags are electronic post-it notes that are
sent to one or more users. You can even send
flags to yourself and post-date them for future
reminders. Flags can be attached to a
recipient's desktop, patient chart, registration,
and appointments. The Flags tab of the desktop is
the best place to review and manage flags. From
the flags tab, you can hover on a selected field
to expand the text within that field for
previewing a flag. Flags in bold are unread
flags. Flags in italics are saved flags that have
not been completed sent to a recipient.
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Flags View, Open, Reply, Forward, Remove
View another users flags
Highlighting a flag will allow the user to open
the highlighted flag, reply to the sender,
forward to a new recipent, or remove the
highlighted flag
Displays details --including time sent and where
this flag is attached for flag highlighted above
Complete message for flag highlighted above
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Flags Convert Feature
Converting a Flag Flags can be converted to
Documents within the patients chart. There are
4 Document types that can be converted into
documents Phone Note, Rx Refill, External
Correspondence or Internal Other.
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The Organize button will allow users to arrange
flag views. It will also allow the user to
bring up deleted flags
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• Flags may be organized according to
• Who they are from
• Who they are to
• Date that a flag is due
• Content of summary line
• Content of message

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Chapter 3 Creating Quick Text

• Learning Objectives
• Distinguish the global list from the personal
  list
• Create quick text using data symbols
• Create quick text using text only
• Identify areas where quick text can and cannot be
  used

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Quick Text
Next Slide
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Quick text is a shortcut tool that lets you
insert common phrases, form components, text
components, and data symbols into a chart note
just by typing a few characters. For example,
when you type .wnl during a chart update, the
EMR application inserts the phrase within normal
limits and when you type .med the patients
current list of medications is inserted.
Similarly, you can insert a form component by
typing the quick text .fc. Quick text can be
global (shared by all users) or user specific
(personal). Users at a clinic can share a common
core of quick text and, also, can define their
own personal list of quick text shortcuts. If the
same quick text abbreviation is used on both the
personal list and the global list, the quick text
on the personal list will override the global
list. Quick text can be accessed via the Options
menugtQuick Text. The Define Quick Text box
displays, which will allow the user to set up a
personal quick text. Only designated staff
with privileges can set up global use quick text.
Instructions for building Personal Quick
text Quick text can be built from your desktop or
while working in a patients chart Select
Options Select Quick Text Choose Personal
Use Type in QT abbreviation preceded by . (ex
.wnl) Tab to with section type in definition
(ex within normal limits) Click Add
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Next Slide
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The Quick Text help lists information about a
particular symbol and how it can be manipulated.
It gives examples of what kind of data can be
pulled into text using that particular symbol.
QUICK TEXT TIPS AND EXAMPLES Quick text
abbreviations are case-sensitive. Build both
upper and lower case if you are not consistent in
upper/lower case letter use. Quick text may be
added will in a patient chart and then used
immediately. Review the list of Global Quick Text
available so as not to reinvent the wheel. Quick
text may be used in the following areas Within a
comment section of an encounter form (CCC) Phone
note Flags Instructions on Rx refill Example
.wnl withxEin normal limits
.sign users signature date and time
.lp After the patient was adequately
sedated, prepped and draped in sterile manner,
Lumbar Puncture was performed.
Opening pressure was noted and approximately
6ml of cerebrospinal fluid removed and sent to
lab. Patient tolerated
procedure well, vital signs remained stable.
Patient to recovery area via carrier with
RN. Quick Text is not required, but in
highly recommended.
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Chapter 4 Use of Phone Notes

• Learning Objectives
• Creating Phone Notes
• Routing Phone Notes
• Signing Phone Notes

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Creating Phone Notes
From the patients chart, you can create a Phone
Note. This automatically launches an
update. Creating a phone note Open patients
chart Click the Phone Note Button
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This is the phone note you will see in the Live
EMR application. The first tab allows for
multiple types of calls in or out of the clinic.
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A chart update with the standard phone note form
will open up Fill in data (i.e., caller,
responsible provider, etc.) as necessary per
phone call. The person who receives the call (or
generates the call) will start the note, document
appropriate information, then close and route to
appropriate staff member.
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The recipient may then use either tab of the
phone note to document actions. If the first tab
is used recipient must remember to .sign their
contribution to the note. If second tab is used
then just click on the teal colored Follow up by
button to sign, date and time the entry. The
phone note is then closed and update ended. If
user is allowed by privileges to sign the note
they may do so, or route to Physician for
signature.
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Routing Phone Notes
Click End Update, New Button. Select recipient
where you see To box. Click OK, check sign
clinical list changes, then Hold Document
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Chapter 5 Rx Refills

• Learning Objectives
• Creating Rx Refills
• Routing Rx Refills
• Signing Rx Refills
• Faxing/Printing Prescriptions

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Rx Refill
Next Slide
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• From the patients chart, you can create a Rx
  Refill this will automatically launch an update.
• Creating a document for a prescription refill
• Open patients chart
• Click the Rx Refill button
• A chart update with the Rx Refill form will open
  up
• Fill in data (i.e., refill info, pharmacy,
  authorization, etc.) as necessary per refill
• Click the Sign Rx button (if authorized to create
  an Rx Refill), or click Close button (if another
  staff member will be ending the update and
  signing the Rx Refill)
• NOTE If you have already refilled the medication
  within the same update, the text on the Refill
  form will appear in blue.

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Next Slide
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• Once the refill box is checked the following
  populate the form
• Quantity
• of Refills
• BMN Brand Medically Necessary
• Pt Info
• Fill in as desired
• Areas of Interest on Rx Refill form
• Current Allergies shows a list of pt allergies
• Pharmacy by clicking on select, allows user to
  chose Pharmacy from a dictionary for faxing
• Authorized By Doctor authorizing Rx
• Prescribing Method, choices are as listed
• 1. Handwritten
• 2. Historical
• 3. Print then fax to pharmacy
• 4. Print then give to patient
• 5. Print then mail to patient
• 6. Print then mail to pharmacy
• 7. Samples given
• 8. Telephoned

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Once Rx refill is completed, if Rx is to be
printed or faxed do the following Click on Print
Options to display Print Box Click on Printers to
pull up Select Printers box Check the
Prescriptions box Use dropdown to choose either
RX printer or Biscom fax server Click OK Close
Print Box Click Print Rx
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Once printing or faxing is completed a box will
pop up that verifies completion of task.
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User will then end the Update and sign document
or route to provider to sign.
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Chapter 6 Protocols, Letters, Handouts, Graphs

• Learning Objectives
• Understanding Protocol functionality
• Customize and Print Patient Letters
• Printing Handouts
• Utilize the graphing features
• Understand growth chart

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Protocols
Protocols allow preventative care to be managed
for patients. If using the Patient Banner with
protocols, the text Check Protocols will be
displayed to alert the user when the patient is
due for a service.
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Letters
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Letters can be printed from the Print button
and drilling down into the letters folder. To
print a Letter do the following Click on
Print Under Print Topics click on sign expand
the Letters folder Highlight correct department
folder OUP_FMC Highlight desired letter Click
Customize if needed Check box to print additional
copy or send a copy to the patient chart Select
Printers
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Check Letters box Use drop down list to choose
correct printer Click Print (letters may also be
preview prior to printing)
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Handouts are accessed through the Handout button
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Handouts can be printed any time for patients.
Custom handout lists will be available in the
drop down box. The binoculars icon allows full
search on the handouts within the system. To
print a Handout do the following Click Handout
button Use drop down to choose appropriate custom
list Highlight handout wanted Click Print (click
preview to view handout prior to printing) Check
report handout printing in chart box if desired
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Sample of Handout document
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Graphing
Observation terms can be graphed by selecting the
graph button from the patient chart. NOTE The
observation terms available to graphs are driven
by the flowsheet view. If you do not find the
observation terms you wish to view, change the
flowsheet view from the flowsheet tab of the
patient chart. Graphs can be printed by clicking
the print button. Values of observation terms can
be viewed by double-clicking on points in the
graph.
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Viewing growth charts
The predefined radial button allows you to access
growth charts for pediatric patients.
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Growth Charts
Display options
Next Slide
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You can view and print the following growth chart
reference graphs Infants (0-36
months) Children (2 years-20 years) Length for
age Stature for age Weight for age Weight for
length Weight for length BMI vs. age Head
circumference for age From this screen you
can Zoom in on details Plot observation values
on chart Toggle between English or metric
units Display age-based observations Print the
graph Display Down Syndrome Growth Charts Display
Shifted Reference Curves Based on Gestational
Ages NOTE These display items above are
available by right clicking on the graph. For
very young infants, you can compare recent growth
data with the data obtained at the time of birth.
Growth charts support the ability to plot growth
data from multiple observation terms. Some of the
terms can be specifically flagged so that their
values are plotted on the birth date rather than
the clinical date of the observation term.
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Growth Charts Percentiles
Percentiles button brings up table form of
values.
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Chapter 7Clinical Lists Updates

• Learning Objectives
• Define Clinical Lists
• Identify Encounter type of Clinical List Update
  vs. Preload
• Add Problems, Medications, Allergies,
  Directives
• Add Pertinent Historical Data to Flowsheet
• Understand signing Clinical List Changes to Chart

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Clinical Lists Update
Next Slide
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Clinical lists are structured sets of data with
clinical significance, such as the problem list,
medication list, allergy list, directive list,
and flowsheet. By structuring important clinical
information, Centricity Physician Office EMR
makes it easy to view, search, and analyze it.
Use the clinical lists along with text in a chart
update to enter changes. A clinical list update
is useful during chart preload and/or adding and
removing items from the medication, problem,
flowsheet, and alerts lists. When starting a
clinical list update, it is recommended to choose
the Encounter Type called Clinical List Update
or Preload. Therefore, there will be a
corresponding text translation (aka chart
document). To start a clinical list update 1)
Open the patients chart 2) Select the Update
action button 3) Choose the encounter type
Clinical Lists Update 4) Type in the Summary
for this update click OK.
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Clinical Lists Update Problem Dialog
The red ltno valuegt area is a placeholder for your
chart note that will be created.
Next Slide
73
To add Problems(ICD-9 driven) do the
following Click on the Problem button Select
New Choose Type of Problem Use Custom List or
Reference List to choose diagnosis
code Description area may be used to further
define problem Comments area may be used to
further define problem Fill in Onset Date if
known, End Date if known Click Save Continue if
adding additional problems If not click OK
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Problem List Management
Organize and Group problems
Before problems have been organized
Dim Problems
After problems have been organized, grouped, and
dimmed
Next Slide
75
Problem list views enable clinicians to organize
patient problems and to share that organization
with other clinicians. Problem list views can be
assigned as a preference so that like-minded
clinicians can share the same view. The
preference is merely a name indicating the view,
such as cardiology view or dermatology view. A
clinician with that preferred view can organize a
patients problem list by ordering, grouping, and
dimming the problems in a meaningful way. Then,
when any other clinician with the same preferred
view sees that same patient problem list, it
appears the way the first clinician organized it.
Any changes made to that view affect all
clinicians with the same preferred view. On the
charts Update Problems screen, users can
reactivate problems track reoccurrence of
problems or organize and group the patients
problems. Those changes are unique to this
patient and problem view.
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Viewing Problem Lists
Summary tab
Problems tab
Chart Summary report
The preferred problem list view appears in the
following places in the patients chart Summary
tab Problems tab Chart Summary report
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Viewing Problem Lists-Update
Update problem screen
Update orders screen
New Diagnosis screen
The preferred problem list view appears in the
following places during an update Update
Problems Update Orders screen New Diagnosis
screen
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Reactivating Problems
Reactivated problem is added to top of problem
list and no end date attached
Problems that have been inactivated in the past
can be reactivated. The EMR application adds a
row in the problem history with the end date
removed. The application also removes the problem
from the Inactive list and places it at the top
of the active list ready for modification and
organization. To Reactivate problems Open the
Update Problems screen. Select the Inactive radio
button to select the problem to be
reactivated. Select the appropriate problem and
click Reactivate.
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Problem Tab Reactivated problem
Once the clinical list change is signed, the
reactivated problem is reflected on the Problems
Tab of the chart
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New Occurrence of a Problem
Use the expired problem as a template for the new
occurrence
Next Slide
81
Expired problems can be used as templates for new
occurrences of the same problem. The new
occurrence will have a different and separate
history than the template problem it was created
from. Create a new occurrence of a problem Open
the Update Problems screen. Select the Inactive
radio button Select the appropriate problem and
click New Occurrence. The EMR application does
not reactivate the expired problem, but displays
the New Occurrence Problem screen populated with
information from the expired problem. You can
then update that problem and save it to the
patients problem list. The Find Problem options
are disabled since you already know the problem.
When you save this problem, it displays at the
top of the Active problem list.
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Problem Tab New Occurrence of Problem
Once the clinical list change is signed, the new
occurrence is listed individually and has a
separate history from the template problem it was
created from
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Problem End Date/ Duration
Adds the duration and problem to the custom list
The diagnosis will become inactive on this
patients problem list in 10 days
For a routine diagnosis, you may wish for that
minor diagnosis to become inactive in the
patients problem list after a certain time
period. When you select the problem type of
Diagnosis of, the EMR application uses the
default duration from the custom list entry in
order to determine the end date. Also, if you
enter a duration and check the Add to Custom List
box, the duration is preserved in the new custom
list entry.
84
Duplicate Problems

• When you add a problem to the patients chart,
  the EMR application checks the patients current
  and historical problems and displays any matches.
  Both active and inactive problems will be checked
  for duplicates. Inactive problems appear with a
  gray background. The EMR considers the problem a
  duplicate when the ICD-9 code is an exact match.
• Based on what you see, you can do the following
• Find out more details about the problem by
  clicking Details.
• If the problem is truly a new problem, click
  Continue Adding Problem.
• If the problem is an existing one but you want to
  add a new assessment, click New Assessment.
• If the problem is the same as an expired problem
  in the chart, select the expired problem and
  click Reactivate.
• If the problem is truly a duplicate, click
  Cancel.

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Clinical Lists Update Medication Dialog
86
Entering a Medication
Typically, medications are entered with a
prescribing method of Historical

• To enter a medication
• Select the Meds button
• Choose New
• Select medication from Custom List or Reference
  List
• Type in Instructions, Start Date, Stop Date,
  Quantity, Refills
• Use drop down to choose authorized by Physician
• Use drop down to choose Prescribing Method
• Oklahoma should default in State
• Chose Save Continue to for adding additional
  medications
• When completed click OK

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Medication Monographs
Monograph
Next Slide
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Medication reference information (monographs) can
be reviewed to find out specifics about a
medication before prescribing it. The medication
monographs feature replaces the Medication Lookup
feature in versions prior to CPOEMR
2005. Clicking the monograph button opens a
preferred website, which enables you to review
information on the medications dosing,
contra-indications, adverse effects, and
precautions when using the medication. Lexi-Drugs
Online is the default reference site and
provides adult comprehensive information. For
pediatric users, you must manually change the
preferred site to Pediatric Lexi-Drugs Online.
(SetupgtPreferencesgtWeb ServicesgtInternet
Sites) You can select one of the following
medication information vendors in
setup Lexicomp Medscape RxList.com Drugstore.com

89
Dosing Calculator
DosingCalculator
When prescribing medications (using the Meds
Button on the update toolbar), clinicians can
calculate how much of the medication to prescribe
using the dosing calculator. The simple layout
of the calculator enables the clinician to verify
the formula and all values used in the
calculation before adding the desired dosage to
the medications instructions. Nearly all
medications can be used with the dosing
calculator. The only ones that cannot are those
that do not have strength or unit data (mg, MCG,
MEQ, or grams) associated with them. In those
cases, the calculator notifies you that it cannot
perform calculations on that medication.
90
Using the Dosing Calculator
Research medication reference info
Select target dose
Verify patients weight
Select dosing frequency
Select the dosing measurement
2nd choice most closely matches the target dose
Choose the dosage for the medication instructions
(SIG line)
Next Slide
91

• Using the Dosing Calculator
• Select the medication from the reference list or
  custom list
• Select the Dosing Calculator button
• Verify the patients weight (The patients
  weight is populated in the formulas in the
  dosing calculator.)
• The clinician can hand-select the dosing interval
  (the frequency of the dose----once a day or three
  times per day)
• The clinician can hand-select dose to the nearest
  (the measurement of the dose----milliliters or
  teaspoons)
• Choose the dosage which closely matches the
  target dose.

92
SIG line
Once the dosage that most closely matches the
target dose is selected, the medication
instructions (SIG line) will be populated.
93
Medication Dosing Profiles
Next Slide
94
The dosing calculator also supports
medication-specific dosing profiles for commonly
prescribed pediatric drugs. The following
common medications are supported Albuterol
Sulfate, Amoxicillin, Amoxicillin-Pot
Clavulanate, Azithromycin, Carbinoxamine/Pseudoeph
edrine, Cefdinir, Cefprozil, Cephalexin,
Cetirizine, Clarithromycin, Erythromycin and
Sulfisoxazole, Ibuprofen, Loratadine, Penicillin
V Potassium, Fluoride, and Trimethoprim-Sulfametho
xazole. The dosing profiles also Predefine the
most common target doses for the drug (based on
industry standard target dose information
provided by Lexi-Comp Online) Associate a target
dose with a patients indication or medical
condition Define age or weight-based rules that
control when certain target doses show Predefine
the most commonly used dosing increments and
dosing frequencies Provide warnings when users
choose an inappropriate amount or form
95
Clinical List Update Allergy Dialog
If patient does not have any allergies click box
to annotate. If user would like to note that
allergies were reviewed during a visit, click
allergies and adverse reactions reviewed.
96
Entering an Allergy
Classifications
Identify as critical reaction
Description field
Next Slide
97

• To enter a patient allergy
• Click the Allergies button
• Select New
• Select the allergy using the custom list or
  reference list
• Use radio button to classify Drug/Food/Environment
  al
• Identify as critical or non-critical
• Type in description of reaction
• Populate Onset date if known or check approximate
• Click OK
• You can use Quick Text in the description field
  box.

98
Allergy Observation NKA
Once an allergy is added to a patients chart for
the first time, the observation NKA will be F or
False
Patients with allergies will have an observation
NKA (no known allergies) F (False). Patients
without allergies will have an observation NKA
(no known allergies) T (True). Check the
statement on the allergy dialog The patient has
no known allergies to document this in the
patients chart.
99
Clinical Lists Update Directives
To note a patient care directive Click the
Directives button Click New Use drop down or type
in directive desired Populate date field Click
OK
100
Clinical Lists Update Flowsheet
To manually add a flowsheet value, choose a
flowsheet view with the appropriate observation
term, then click New to record the value.
101
Adding an Observation
Select the date/time of the observation Enter
the value for the observation utilizing the data
standards of the practice

• To manually add data to flowsheet
• Click on Flowsheet button
• Select New
• Select the date/time of observation
• Enter the value
• Click OK

102
Chart Flowsheet
Values
Observation Terms
Next Slide
103
Flowsheets contains discrete clinical data
elements that originate from several possible
areas Interfaces (i.e. lab interface) Chart
updates containing form components that are
programmed to record to specific observation
terms (obs terms). Manual updates to the
flowsheet during a clinical list change. The
observation terms are the labels going vertically
down the page. The observation values lie within
the grid and correspond to an observation term,
and the date the value was observed When
highlighting a value in the flowsheet, the
details regarding that value display below. When
you double click on a value, it takes you to the
chart documentation in which the value is
associated. Observation terms that come with the
system are updated every couple of months and can
be downloaded from the support website. From
this web site, you can download an information
packet to request custom observation terms if you
cant find an observation term that fits (i.e.,
medical research-related obs terms). (see Lesson
16) Date resolution can be toggled from days,
months, years, minutes, and you can also look at
last observation. The observation term name
column can be resized to accommodate the long
label names.
104
Flowsheet symbols
Next Slide
105

• Various icons are displayed next to the values.
  Online help provides a listing of these icons.
  The help file contains a key for all the icons
  that appear on the flowsheet. The document from
  the help file is called Flowsheet Symbols and
  Indicators.
• Blue values have been imported via interface and
  black values were entered directly into the
  Centricity Physician Office EMR.
• To print a flowsheet
• Open the patients chart
• Go to Print Button
• Select Clinical Lists Folder
• Flowsheet Report
• Click Print or Preview

106
Flowsheet symbols and colors
The new panic low and panic high flowsheet icons
are now more distinguishable from the existing
low and high icons.
107
Flowsheet Views
The Set Attached View button will link the view
currently displayed to the patient.
Flowsheets can be arranged to display different
observation terms in a specific order. This is
called a flowsheet view. There are several
different types of flowsheet views ltALLgt---displa
ys ALL observation terms and values for the
patients history. Everything. The observation
terms will be listed in alphabetical order within
the ltALLgt view. Preferred---the users default
flowsheet view this is linked to the user in
set-up and preferences NOTE If a user
does not have a preferred flowsheet view attached
to their username, by default the ltALLgt flowsheet
view will display for patients.
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Clinical List Updates Ending the Update
To end a Clinical list update or any
update Click End Update button Sign if document
completed If not completed place On Hold or Route
to appropriate user for completion
109
Chapter 8 Desktop andDocument
MaintenanceProviders/Nurses

• Learning Objectives
• Flags/Document Management
• Sign Documents on Desktop and/or in Chart
• Append Documents Text only and Full-Feature
  Appends
• Understand the difference between Unsigned vs.
  On Hold Documents
• Understand how to Remove Unsigned Documents
• Review policies related to Desktop Maintenance

110
Desktop Documents Tab
Information from the highlighted document above
Next Slide
111
Document management for reviewing and signing is
best accomplished using the documents tab on your
desktop. Once the document is signed, the
document will no longer appear on the desktop.
The View Documents to allows the user to
change providers and view documents on another
providers desktop (with proper privileges). The
drop-down allows the user to view users in their
current location of care. The binoculars allows
you to select from outside your location of care.
The folder structure in the upper left-hand
side can be organized by the user to sort
documents on their desktop by document type in
the order desired. The All folder displays all
document types on the desktop. The number in
parenthesis ( ) beside the All documents folder
shows the user how many documents are on the
desktop. The subfolders sort the documents based
on type. When you click on one particular
folder, only those documents are displayed.
112
Document Icons
113
Creating Desktop Document Views
Personal Document views
You can create both global and personal desktop
document views that display documents
by Document type Document status Priority
Location of care Confidentiality type The
document views you create appear as an option on
both the desktop summary and desktop documents
tabs. Additional privileges are required to
create global views.
114
Creating Desktop Document Views
Create new document views
The Organize button on the Documents tab allows
users to create various document views
115
Viewing Multiple Users Desktops
Create new groups and add users
Next Slide
116

• You can view multiple desktops at the same time
  by creating Desktop Groups.
• You can view the created groups on both the
  desktop flags and desktop documents tabs.
• To create Desktop Groups
• Select either Desktop flags or Desktop documents
• Click on the binoculars
• Click MORE
• Click NEW GROUP and create a name for the group
  (exNurses, Admin, South Nurses, etc.)
• Highlight the user you want to add to the group
  and click ADD ITEM and OK
• Repeat for each user you want in that particular
  group.

117
Document Maintenance Unsigned vs. On Hold
Documents status is a description of the document
state in the process between creation and
signing. A document may have the following
status Unsigned --Come from outside the CPO EMR
with the exception of letters and handouts. On
Hold --Are created within the CPO EMR. In
Progressa user is actively updating this
document, only 1 person can be updating at a
time, will only appear on an Internal document
created via an Update Signedhas been signed and
is a permanent part of the patient chart, changes
can only be made via an Append
118
Reviewing and Signing Documents

• The following are ways to sign a document
• Click Sign button
• Ctrl S
• Right click and scroll to sign document

119
Document Maintenance Append

• After a document is signed, the content CAN NOT
  be changed. However, an append allows users to
  make additions to a document.
• There are two types of Appends
• 1) A simple Append-text additions
  only
• 2) A full featured Append-forms
  component additions
• To do a simple append
• Open the chart by double clicking on the
  appropriate document.
• Click on the Append button.
• The Append to Document window will appear.
• Type in any additions to the note

120
Document MaintenanceFull Append
Next Slide
121
Full feature append allows the user to access the
encounter type, thus activating the ability for
clinical list updates which are added to that
document. Example The office visit document is
already signed and the patient is headed to
check-out. At that time, the patient then
requests a prescription refill. Instead of
starting a brand-new document in the chart, the
full feature append can be used. To do a Full
Featured Append Click Click here to do a full
Append Choose form you wish to use Type in
Summary Line Continue with documentation End
Update as usual Sign document
122
Document MaintenanceFiled in Error
Next Slide
123
Filed in Error is utilized when a signed
document was created and signed by mistake,
since discarding the document is not an option.
A filed in error document is forever part of the
patients record, however is ONLY seen when
filtering for Filed In Error documents. Note
Specific privileges are required in order to file
documents in error. Select the document you wish
to file in error. From the menu bar, go to
Actions, Documents, File in Error. The Clinical
List Changes window will appear. Review the
information to confirm filing the document in
error. Click on the Yes button to continue.
The document has been removed from the patients
chart.
124
Routing multiple documents
Selected documents to be routed
You can route multiple documents from the desktop
as well as from the chart documents tab. To Route
Multiple Documents Highlight all of the
documents you wish to route by holding down the
control key and choosing the documents Click
Route
125
Routing multiple documents from Summary tab
Selected documents to be routed
Routing recipients
126
Desktop File Attachments
Only key staff will have the ability to Attach
documents to the patients record.
Next Slide
127
Users may have a fourth tab associated to their
desktop called File Attachments. The File
attachments tab will not be present if the user
doesnt have privileges to attach images. The
file attachments tab allows scanned external
documents to be created into a document, thus
attaching the items to the electronic chart.
IMPORTANT ----the file being attached must be
in a shared location. To attach a document to
a patients chart 1) Click the Yellow button and
search for the patient 2) Click Add 3) Select
Type drop-down and enter a Description for
the document 4) Select the Browse button to
browse out to the document path click
OK NOTE Everyone must have access to
this file path. You also dont want to move the
files, because the link will be lost to the
attached item. 5) Choose Doc type, Responsible
provider, Location of Care, and enter a
Summary 6) You must also associate a clinical
date time to the document 7) If desired, the
document can go in signed, by clicking the signed
box 8) Check route and the document will go to
providers desktop 9) Add text in the body of the
note, then click Create Document 10) Click OK
128
Chapter 9 Charting a Visit

• Learning Objectives
• Use an encounter type
• Open a blank update
• Insert forms based on the needs of the visit
• Document Office Visits/Chart Updates
• Start a New Chart Update vs. Join and Update
  in Progress
• View different form components
• Compare Form component vs. Text component and
  
• Document template and encounter type

129
Select an Encounter Type
130
Update Tab and Document Template
Forms associated with Encounter Type
Action buttons updating Problems, Medications,
Refills, Allergies, Directives, Flowsheet items,
and Orders
Attachments and Favorites Panes
When the CCC forms are closed users may see what
text is going into the document. Note the buttons
that facilitate addition of problems, meds,
alerts (allergies/directives),etc. Note area to
the left of the document which shows templates,
attachments and favorites pane. Also note the End
Update button.
131
Use drop down to Select Specialty Click Refresh
132
This is the entry point or first page of the CCC
forms used for documenting a patient visit. Note
to the right is a box of templates that may be
used in the note. The button (HPI, ACV, PMH, etc)
across the bottom of the form allow users to
navigate to various parts of the forms. The
Previous/Next forms at the bottom also allow
navigation through the form.
133
This is the General HPI form (history of present
illness) On this page users may select PCP, Ref.
Provider, Visit Type, CC(chief complaint-specialty
driven) Users may type in information or use
Quick Text in the History fieldUsers may also
access and select templates from the templates
list There are also buttons below the template
box that launch directly into Problems,
Medications and Allergies Note the radio buttons
below the History box, these may be used if
desired along with an EM advisor.
134
PMH allows users to quickly add patients past
medical history into the chart. If PMH is
unchanged there is a box to check that PMH was
reviewed-no changes required. this page is
customizable
135
PSH allows users to quickly add patients past
surgical history to the chart. this page is
customizable
136
FH/SH allows quick annotation of family history
and social history.
137
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138
ROS is a specialty specific driven. Use of radio
buttons allow user to pick and choose areas for
documentation. If desired user may check See HPI
at top left hand corner of form instead of using
the radio buttons and check boxes.
139
The Vital Signs form allows for a variety of
information, such as follows Standard or Metric
measurements as well as a conversions button VS
Entered By quickly signs, dates and times the
entry Allows for more than just basic VS
assessment Contains a pain assessment Contains a
chief complaint area Contains quick launch
buttons to view/update Problems, Meds, Allergies
and Directives Or to view Protocols Due
140
The Physical Exam (PE) form allows users to
document by systems or regions appropriate
information. The PE contains age and specialty
specific content. Users may document a variety of
ways on this forms, such as Use quick buttons
(normal, prior, clear) Use check boxes Use
Quick text At any time the forms may be closed
to see the text translation in the note
141
The Problems button is basically an avenue to
quickly add problems to Problem list. This list
is specific to the clinic/specialty. Note the
quick launch buttons to the mid-right of the form
that allows access to the Probs, Meds, Allergies
and Orders
142

• CPOE AP (Centricity Physician Office Electronic
  Medical Record)
• AP is specialty specific is used as follows
• Use drop down to choose diagnosis for patient
  (which pulls from current problem list)
• Type in assessment and plan
• Insert a template if needed
• Add/change Meds
• Print patient handouts
• Add all meds to the note
• Launch Orders (when available for use)

143
Patient Instructions allow user annotate a
variety of instructions for the patient ranging
from diet to handouts. Once chosen Click To
Enter Pt instructions may then be printed and
given to pt along with specified pt handouts.
(Notice Print Patient Instructions) This form
is specialty driven and is customizable.
144
Dictation Options
Dictation Placeholder
NotesLink Macro
An available option is using the NotesLink Macro.
In your Centricity Physician Office directory,
there is an Information File which describes the
setup for the NotesLink Macro. Usually, it is
located in this path C\Program
Files\Centricity Physician Office\llogic\macros\HL
7 The numbering system of the dictation
placeholder is specific to each placeholder used
in a given document. The first number represents
the document number in the patients chart. The
second number represents the order of the
dictation placeholder respective to the other
placeholders within the same document. For
example, placeholder 46-1 means the dictation
placeholder is in document 46 of the patients
chart and is the first dictation inserted within
document 46.
145
EM Advisor
146
Ending the Update
When Holding the document, ALWAYS check box in
front of Sign clinical list changes. This
allows the clinical list changes to be signed
into the patients chart, without signing the
document itself. Doing this will allow users to
begin another update and consider the clinical
data you previously entered.
147
Chapter 10 File Attachments

• Lesson Objectives
• Identify methods for attaching chart images
• Learn to crop, rotate and print attachments
• Learn to annote an attachment
• Utilization of favorites pane
• Adding a favorite image component

148
Image Attachment Functionality
149
Image Attachment Functionality
Inserted Pane List of inserted encounter forms
and images
Inserted image in the chart document
Attachments Pane attached images to the chart
document
Favorites Pane List of commonly used images,
form components and text components

• During a chart update, you can attach images to
  a patients chart to document visits and problems.
  
• You can now
• Attach Images to the chart note
• Store internal images to the EMR database
• Annotate chart images
• Search all images attached to a patients chart
• Print chart images

150
Methods for attaching chart images
Option 3 Attach Button
Option 1 Attachments Pane
Option 2 Favorites Pane
During a chart update, an image can be attached
in several different ways. Option 1 From the
middle Attachments Pane, right click and select
Add attachment Option 2 Click the Attach
Button and select Add attachment Option 3 From
the Favorites Pane, click and drag an attachment
into the document template.
151
Document Attachments Window
Document Attachments Window
Once you click Add attachment, a Document
Attachments window will pop up. There are 3
tabs that make up the Document Attachments
window Attach Tab Allows users to attach images
to the current chart update (document) Selected
Document Tab Allows users to manipulate the
images attached to the current chart update
(document) All Documents Tab Allows users to
view all images attached to the chart
152
Attach Tab
From the Attach Tab, you can add attachments from
several resources File Allows navigation to
image on file system from local computer or
network location Camera device WEB-CAM Scanner Cli
pboard Allows you to bring images in from another
application External Reference Allows continued
file attachments functionality where file is
linked to the patient chart, the image is not
saved within the CPOEMR database.
153
Attaching a file
Next Slide
154
To attach an image from a file location Select
Attach a new image from File by pressing the File
button Navigate to the location in the file
system where the image has been saved After
locating the image to attach, the Attachment Name
window allows for renaming of the image
label. Tip Basic black and white images can be
found in the Centricity Physician Office
Evaluation directory inside of the bmps
folder. For Centricity Physician Office
Evaluation, the path is C\Program
Files\Centricity Physician Office Evaluation\bmps
155
Selected Document Tab
Annotate and Zoom
Change Keywords
Rotate, Crop, and Print
From the selected document tab, you will see all
images attached during the current chart update.
Single click on an image and the image will
appear in the Selected Document pane on the
right hand side. Once you have the image
selected, you can crop, rotate, print, zoom,
annotate, and change keywords associated with
that image.
156
Cropping an attachment
Before Crop
After Crop
To crop a selected document Click and drag mouse
over the area you wish to be included in the
cropped image Select the Crop button To undo
cropping Right click on the image Select Undo
Crop Or Right click on thumbnail Select Crop
undo
157
Rotating an attachment
To rotate a selected document Select the rotate
button to rotate the image 90 degrees To undo
rotation Simply click rotate 4 times and the
image will be oriented back to the original
state
158
Printing an attachment
Printing from the selected document tab Click
the Print