June 2012 - Quillen Physicians EHR

Volume 2, Number 6
June 2012
Quillen Quick Notes
Johnson City Internal Medicine
Page 1
 JCIM Go-Live
 Which Quillen Sites
Are Live Now?
Page 2
 Pediatrics Preparing
 Directions to Downtown Center
Page 3
The Developer
Page 4
The latest Quillen ETSU site to implement Electronic Medical Records was Johnson City Internal Medicine (JCIM).
On May 7th, providers and staff of JCIM made
the switch from paper to computer, and the
EHR Green Team was present to help out.
Everyone had received training during the prior
two weeks and hoped for the best!
Jane Sparger, RN, (pictured below) set an
excellent example for what other users should
and could be doing to prepare for the switch to
electronic charting.
Our Website
 JCIM Go-Live Pics
Page 5
 EHR Challenge
 Help Desk Support
Page 6
 Are you a Meaningful User?
Sparger visited Kingsport Internal Medicine (KIM), a Quillen ETSU site that has been
live on the EHR for months. She was able to see
the EHR being utilized—a valuable experience
for someone about to take the same journey.
Great job, Jane.
Quillen Sites
Johnson City Family Medicine
Kingsport Family Medicine
Bristol Family Medicine
Kingsport Internal Medicine
Quillen ETSU Surgery
Johnson City Internal Medicine
note of the workflows in place at the site. These
efforts are to be applauded.
Everyone at JCIM was not this pro-active.
More could have been done in preparation of this
go-live. Over the past year, the EHR Support
Team has noted that with each go-live, the transition is made easier with planning and preparation. Even before the training classes, users can
access up-to-date training manuals on the EHR
website, and short, convenient YouTube videos
are also available, which demonstrate every aspect of end-user navigation. And ALL users need
to know their workflows.
Despite the fact that this site was less prepared
than some previous sites, the actual go-live went
somewhat smoothly. Some providers and nurses
did feel unprepared and acknowledged that the
two training sessions were inadequate without
more work done in advance. We can say, however, that JCIM has made the transition, and
paper charts will soon be a thing of the past.
(Pictured above) Dr. Rakesh Patel and resident looking
forward to the day the paper charts are no longer present in
the clinic!
Dr. Bhuvana Guha (pictured above) did the
same thing. She visited KIM and observed the
EHR system in use. She was also able to take
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Q uillen Q uick Notes
And they’re OFF! Training has began for Quillen
ETSU Pediatrics. Many of you recall how this felt.
Wish them luck, as the scheduled Go-Live date is
June 4, 2012.
Directions to the Downtown Center
The Downtown Center is accessed from the Downtown Square
— just off of West State of Franklin between South Roan Street
and Spring Street. The entrance to our building is accessed from
the Downtown Square parking lot, not from Main Street.
From I-26, take the
E. Market St. exit
(0.2 mi), then turn left onto S. Roan Street. Go 0.1 mile, and
turn right onto W. State of Franklin Rd. Turn right into Downtown Square.
If using your GPS,
get directions to:
22 Downtown Square
Johnson City, TN
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Q uillen Q uick Notes
From the Developer Zone
Add Clinical Item (ACI)
The ACI is your workplace for recording and ordering items that are added to the patient’s health
record, including medical history, past and present problems, new orders and prescriptions, and
orders with clinical content that are created based on specific problems.
The ACI has three main tabs:
1. History Builder—add/edit active problems and histories
2. RxOrders—create/record orders
3. Problem-based Orders—create orders based on the patient’s problems
Users sometimes fail to realize they can navigate from tab to tab without exiting the ACI. For example, you can add active problems and histories under History Builder and then move on over
to the RxOrders tab and order prescriptions and labs. You do not have to close the ACI, and then
re-open it in the next section.
We encourage users to explore and ask questions. Review use of the ACI in your user manual.
Efficiency can be improved, making both the patient and the clinician happier.
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Q uillen Q uick Notes
Visit the QETSU EHR Website
The Quillen Physicians EHR website is a tremendous resource at your fingertips.
You can easily access the Training Manuals, How-To Documents, Training Videos, and more.
This link takes you to the website:
JCIM Go-Live Activity
Jackie Collins assists Joann
Leipfert at check out, with
Travis Walker observing.
Carol Fields,
Nursing Supervisor,
during Go-Live.
Green Team members—
Mindy Fleishour, Michelle
Fisher, and Dina Schleicker
Michelle Fisher (Green Shirt)
assists nurses Cheryl Bennett
and Sue Nelms.
EHR Cookie Treat
Tracy Jones and Monaco Briggs iron out an
EHR concern (left) while Travis Walker
works with Rachel Adams at check in.
Dr. Bhuvana Guha working with
Dr. John Snyder during Go-Live.
Nurses Carol (Polly)
Stephens and Tasha
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Q uillen Q uick Notes
May EHR Challenge Winner
We had great response to our May EHR
Challenge question, and the winner is
Joann Leipfert, who works the check-out
desk at Johnson City Internal Medicine.
Joann will receive a gift pack, with Allscripts swag and a gift card. Way to go,
June Challenge
Question: A new tab has been added to the Clinical Desktop. What is it?
TASK your answer to the Allscripts Help Team.
The winner will be chosen by drawing from all accurate answers submitted correctly.
Help Desk Support. . .
When contacting the Help Desk, consider the nature of the support you
If your need is URGENT, call 423-282-6122.
If you have a question or message that does not need to be answered immediately, choose
one of the following:
1. Click on the QITS Help Icon on the desktop and open a ticket
2. Send an e-mail to EHRhelp@qetsu.org
3. Send us a task from your task list; choose “Allscripts Help.”
Remember, the Help Desk is open from 8 to 5, M-F.
After-Hours Support: After-hours support is not available—due to the size of the EHR team. However, if you
have an urgent need, you may send an e-mail with a return phone number to EHRhelp@qetsu.org. If a member of
the team is available, we will get back in touch with you as soon as possible. Please note that messages left on voicemail after hours will not reach us until the next work day.
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Q uillen Q uick Notes
Are you a Meaningful User? — Part V
Working through Workflow Changes
As eligible providers and practices start looking at reporting
for Meaningful Use, often, workflows have to be adjusted to
ensure that all the requirements are being met for the core
and menu set objectives. One of the enhancements to the
new version of Allscripts that Quillen implemented in
March is the Meaningful Use (MU) Alerts that appear in the
encounter summary (assessable by clicking on the red triangle). At the end of each patient encounter, if these alerts do
not disappear completely, it’s a good indication that workflows need to be addressed and adjusted BEFORE the reporting period. Below are some guidelines/
suggestions for altering workflows to
fulfill the MU objectives.
Recording Demographics:
Hopefully, this is not an alert
that is popping up after the patient is checked in.
Demographics are recorded in Experior (the practice
management system), and they are required fields. If
you see an alert about demographics, double check that
you are on the correct patient, and make sure you access him/her from the Daily Schedule tab.
Recording Vital Signs: We recommend that the clinical
staff (nurses, medical assistants) enter the vital signs
before the patient sees the provider. Most offices already have this workflow in place.
Maintaining the medication and allergy lists: This is one
responsibility that is still up in the air for many offices.
It should be made absolutely clear who will be reconciling the allergy and medication lists. Nurses or providers can do it, but making sure it gets done is essential.
We recommend that whoever updates the medical
history also reconciles the medications and allergies.
Some providers feel more comfortable going over the
list themselves, but he/she needs to communicate this
to the staff.
Maintain an up-to-date problem list of current and
active diagnoses: The key word here is DIAGNOSES,
which means this requirement is a provider responsibility. That also means that providers can’t simply “free
text” the diagnoses in the note. They have to be added
to the clinical desktop. Keep in mind, active problems
can be added to the desktop and to the note from within
the note, so there is no need to close the note to add
them. If the office elects to do so, to save the provider
time on new patients (i.e. either those who are new to
the practice or new to the EHR system), clinical staff
can preload the medical history, and then providers can
update histories into active problems. Remember,
however, that this only saves searching time. The provider still needs to click on the history item and update
5. Permissible prescriptions written by the provider are
generated and transmitted electronically. Simply put,
current med list to be accurate, scripts have to be entered into the system, either as history or to send to
the pharmacy, so there is no good reason to write it
on paper. The only time a script should be written
out is when the system is down. Eventually, using the
system to prescribe will speed up everyone’s workflow because the clinical staff can send per protocol
refills by simply renewing the medication from the
medication list.
Record smoking status: This status should be recorded
on all patients 13 years and older. Who should be recording it? Examine the office workflow. It may be
easier for the nurse taking vitals to record the information. But if he/she is getting backed up recording all of
the other information, then the provider can and
should do it —either from within the note or from the
encounter summary. Remember, the keyword for
searching for smoking status is “Smoke.” Select a status
that has “MU” in front of it so that it meets CMS reporting criteria.
Provide clinical summaries for patients for each office
visit within 3 business days. In last month’s newsletter
(as well as on our blog), I provided some suggestions
for dealing with this requirement. Until a patient portal
is put into place, we highly recommend asking the patient at check out if he/she wants a copy of the summary. Postage costs would be too much to mail these
out. Familiarize yourself with the output of the document so that you are clear on what the patient receives,
and if finishing the note is impossible before the patient
leaves, at least get through the plan: Diagnose and Order.
Implement one clinical decision support rule. Before
the reporting period, the organization will determine
what rule will be put in to place and tracked. We recommend getting familiar with the Health Management
Profile (HMP tab) and using it to set up reminders for
your patients’ health maintenance items.