eCLINICIAN EMR User Guide

Manage your Work Using the In Basket

W

ORK WITH

R

ESULT

-R

ELATED

M

ESSAGES

This section describes the actions to take when processing two of the most common resultrelated In Basket message types: Results and Result Notes.

Turn Off Delivery of In Patient Results

Physicians can request that the delivery of In Patient results to their In

Basket be turned off. When this is done, results still file to the patient chart and are available in Chart Review.

When results are turned off, physicians continue to receive In Patient results from the following:

• Lab and diagnostic imaging results that were copied (CC’d) to the physician

• Provincial Laboratory results

• Private vendor diagnostic imaging results

For more information on results that come into eCLINICIAN

refer to the

sections:

Clinical Data Available in eCLINICIAN

and

Clinical Data NOT

Available in eCLINICIAN

.

To request that the delivery of In Patient results to In Basket be turned off, physicians should contact the e CLINICIAN project team by following the path below:

Epic button > Help > Send a Non-Urgent Help Request to the eCLINICIAN

Team. In the Help Desk window, select Turn Off In Patient Results for In

Basket to auto-populate a request message.

Once the change is made, the physician will receive a notification via an

In Basket message.

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Discontinue the Delivery of Paper Results

Paper laboratory results can be discontinued so that only electronic results are received.

The clinic needs to have been live for a minimum of 90 days and have validated that they are receiving all electronic labs available in

eCLINICIAN

.

To begin the process of discontinuing paper lab results, a clinic representative should call the Help Desk at 780 735 4357. The Help Desk will initiate a ticket and submit it to the LIS team.

The LIS team will assist the clinic with the completion of the appropriate paper work, which will include the following required information:

• Clinic Code

• Discontinue request in writing from each physician in the clinic

• Signature from all physicians or a clinic representative

If a physician works in more than one clinic live on eCLINICIAN, they will continue to receive paper lab results for those clinics that have not completed this process.

To request that “

lab paper reports be discontinued

” for an entire clinic, contact the Help Desk at 780 735 4357 to initiate the process.

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R

EVIEW

R

ESULTS NOT

C

URRENTLY BEING

S

ENT TO YOUR

I

N

B

ASKET

Business practices and workflows outside of the control of Information Systems impact the delivery of results to your In Basket.

The reasons why a result may not appear in your eCLINICIAN In Basket include, but are not limited to, those listed in the following table.

Reason

The result was from a system not interfaced to

e

CLINICIAN

Example

Diagnostic Imaging and Laboratory results performed by an AHS facility outside of the Edmonton zone.

Diagnostic Imaging text reports from Cross Cancer Institute.

TB Clinic

Example: Tuberculin Skin Test results.

Canadian Blood Services

Examples: Pre-natal, ABO & Rh, Antibody screen

Alberta Cancer Board Results from the Tom Baker Centre.

Examples: PSA, Ca 125, CEA.

DI Text reports from any private community DI providers who do not appear on the e

CLINICIAN Data Source listing.

Examples: Breast Centre Radiology Mammography & Ultrasound

(7121 109 St).

APPROACH (Alberta Provincial Project for Outcome Assessment in

Coronary Heart Disease).

Examples: Coronary Angiography and Percutaneous Coronary

Intervention reports.

Service performed and resulted by AHS Edmonton facility but the device is not interfaced to a Laboratory Information System (LIS) or a Radiology Information System (RIS) or to e

CLINICIAN.

Examples:

Pulmonary Function tests.

The laboratory and ultrasound devices at the Fertility clinic at the Royal Alexandra hospital.

The result was “third party” paid and sent from a private community diagnostic imaging provider

Third party (non-insured, private pay) diagnostic imaging results from private community diagnostic imaging providers

Examples: Funds Administrative Service (for refugees or immigrants), Canadian Military, Federal Inmates, WCB, Patient

Paid, and Corporate Paid.

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Reason

You responded “NO” to an applicable eCLINICIAN

Order Entry question

Your name was not added to receive the result

Example

Your response to e

CLINICIAN Order Entry questions drives the delivery of results to the In Basket.

Examples: If you answer “YES” to the question “ECG to be read by DKML Panel?”, DynaLIFE results the ECG and the electronic result returned to you via your In Basket. If you answer “NO” to this question, you need to provide the name of the doctor who will interpret the ECG. In this case, DynaLIFE sends the ECG readings to the physician indicated on the order. The doctor who interprets the ECG sends the paper result directly to you.

Example 1: Workflow determines whether or not you receive the result. For a particular test, the process used by a site or department may be to CC the result to the family physician, if the family physician is mentioned in the dictated result. For the same test done at a different site or department, the process used may not CC the result to the family physician.

Example 2: Registration interfaces and processes impact which results are sent to the In Basket. In the case of Dictaphone

(regional transcription system), if the VAX or Tandem ADT system contains the name of the patient’s family physician, the transcription report is automatically CC’d to the family physician. When transcriptions are performed in other areas that do not use the Dictaphone, no provision of electronic results exists. This would include several specialists who use personal or private systems and staff for their transcription needs.

Your name was incorrectly entered by the sending system

Each clinic must have a formal process in place for the routing of paper results that are not sent electronically to the eCLINICIAN In Basket.

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Manage your Work Using the In Basket

R

EVIEW A

R

ESULT

M

ESSAGE

The In Basket activity instantly provides you with results as they are entered in the system.

1.

Access the In Basket activity.

2.

In the Folder List pane, select the Results folder.

3.

In the Message List (upper) pane, select the message.

High-priority and abnormal results are indicated by a red arrow and a red exclamation point , respectively. All abnormal results are also marked as high priority.

Within the Results message itself, abnormal components are highlighted in yellow and followed by "(A)".

Also, lab results that are flagged as Normal, Abnormal or Critical appear with a green, yellow and red Message Report banner, respectively. Any results that are not flagged appear with the neutral coloured banner associated with the Hyperspace theme in use.

4.

In the Message Display (lower) pane, review the message details.

When the status of the Results message changes from New to Read, eCLINICIAN stamps the result with your name and the date that you reviewed the result. This information is viewable on the corresponding Result report in the Chart Review activity.

5.

From the Bottom In Basket toolbar, click Done. This message is removed from your In

Basket the next time the In Basket refreshes.

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R

ESPOND TO A

R

ESULTS

M

ESSAGE

The results that you receive may require follow-up actions. To detail the actions required and to route the actions to the appropriate recipients, use a Result Notes message.

Result Notes messages are filed in the patient’s chart along with the original result. Having the result as well as the follow-up actions all together in the patient’s chart is an important aspect of patient safety.

1.

With the appropriate Results message selected, from the Bottom In Basket toolbar, click

Rslt Note. The Result Note window displays.

2.

In the Select Orders section, select the appropriate test(s) that relate to your note.

3.

In the Result Note field, type your instructions for the selected test(s).

T

IP

1

: Do not use the

Also file as quick note

checkbox when processing results. This feature creates an additional progress note that has no reference to the original result.

4.

Under the Route Note To checkbox, in the Recipient field, type the name of the person(s) you wish to send the note to (e.g. your support pool or another physician).

T

IP

2

: If you anticipate routinely routing Result Notes to the same recipient(s), select the

Remember recipient(s) checkbox. The system automatically populates the

Recipient

field with this information in the future.

Notice that on the bottom left of the Result Note window, there is a

Save as QuickAction

button. QuickActions allow you to complete workflows in fewer steps, saving you time. To learn about creating and managing QuickActions, refer to the

Personalize eCLINICIAN

section.

5.

Click Accept.

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The In Basket window redisplays. Notice that the status of the message is now Pend.

6.

To mark the message as complete, from the Bottom In Basket toolbar, click Done. When your In Basket refreshes, this message disappears from your Results folder.

Your Result Note is routed to the indicated person(s) in the form of a Result Notes message. The person who receives the Result Note should enter their comments (e.g. “Pt. aware of test results” or “Pt. booked for follow-up”) as another Result Note, which is demonstrated in the next topic.

The repeated use of the Result Note functionality is the best way to quickly view all communication about a result.

R

ESPOND TO A

R

ESULT

N

OTES

M

ESSAGE

1.

Access the In Basket activity.

2.

Select the Result Notes folder. The messages in that folder display in the Message List

(upper) pane.

3.

Select a Result Notes message.

4.

In the Message Report (lower) pane, view the message details and perform any assigned tasks.

The Result Notes message basically serves as a springboard for the creation of additional notes and for any actions you might need to take, such as:

•

Contact the patient to pass along the result

•

Book a follow-up appointment for the patient

•

Place follow-up orders for the patient

The steps for these last two items are documented in the two topics which follow.

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5.

Once you have completed the assigned task(s), on the Bottom In Basket toolbar, click Rslt

Note. The Result Note window displays.

6.

In the Select Orders section, select the appropriate order(s) that apply to the note.

7.

In the Result Note box, type an appropriate note.

8.

Result Note messages can be routed back to the sender as verification that action was taken.

If you do not wish to route your message, deselect the Route Note to checkbox.

9.

Click Accept.

The In Basket activity redisplays, with the Result Notes message highlighted and opened.

T

IP

: This and any subsequent Result Note messages remain attached to the order. Learn how

to view Result Notes in the topic

View Result Notes in the Patient’s Chart

.

10.

If no further action is required, click Done.

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B

OOK A

F

OLLOW

-U

P

A

PPOINTMENT FROM A

R

ESULT

N

OTE

If you have the appropriate security, you can schedule a follow-up appointment for the patient from the Result Note window.

1.

With the Result Note window still displayed, from the Epic button select Scheduling >

Appts. The Patient Lookup window displays showing the patient’s record in the ‘Shortcut to Open patients’ section.

T

IP

: Depending on your security role, an Appts button may also be available to you from the

Hyperspace (main) toolbar.

2.

Select the patient record. The Appointment Desk activity displays.

3.

From the Appointment Desk toolbar, click Make Appt.

4.

Enter the required information in the Appt notes, Visit Type and Providers fields.

5.

To use the Auto Scheduler to find the next available appointment, in the View Options section, select the Auto Search checkbox and click Search. The next available appointment displays in the Recommended Solution window.

6.

To accept the displayed appointment, click Schedule. The Appointment Review window displays.

7.

Click Accept to close the Appointment Review window.

8.

Click Accept to close the Appointment Information activity. The Appointment Desk redisplays.

9.

Close the patient’s workspace. The Result Note window redisplays.

10.

In the Result Note section, type your note including the date of the future appointment.

11.

If no further action is required, click Accept.

12.

Click Yes at the prompt to indicate that you do not wish to route the message. The In

Basket activity redisplays.

13.

With the Result Note message highlighted, click Done.

P

LACE

F

OLLOW

-U

P

O

RDERS FROM A

R

ESULT

N

OTE

1.

With the Result Note message highlighted or with the Result Note window open, from the

Hyperspace (main) toolbar, click Orders Only. The Patient Lookup window displays showing the patient’s record in the Shortcut to open patients section.

2.

Select the patient record. The patient’s workspace opens showing the Orders Only

Encounter navigator.

3.

From the navigator table of contents, access the Meds & Orders section.

4.

Using the Search for new order field or the New Order button, order the required tests or procedures.

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5.

Click Sign. A Providers window displays, prompting you to enter an authorizing provider.

6.

Type the name in the format of lastname,firstname.

7.

Click Accept.

8.

Complete any other details in the encounter.

9.

Close the encounter. The encounter and the patient’s workspace close. The Result Note message redisplays.

10.

Create a Result Note as outlined in the topic Respond to a Result Notes Message in the

Manage Your Work Using the In Basket.

T

IP

: Keep the Result Note window open if you have multiple tasks to perform and document.

11.

When finished, mark your message as Done.

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V

IEW

R

ESULT

N

OTES IN THE

P

ATIENT

’

S

C

HART

If the Result message is still in your In Basket, Result Notes can be viewed in the Message report

(lower) pane.

T

IP

:

Depending on the timing, you may need to manually refresh the system before the result notes display in the Message Report.

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All Result Notes related to a result are attached to the result itself and can be seen in the Chart

Review activity under the appropriate tab (i.e. Lab, Imaging).

1.

Access the Chart Review activity for your patient.

2.

Go to the appropriate tab. A list of result records displays. To the left of some records, there is a blue paper clip icon which denotes an attached note.

3.

To view the Result (order) report, in the bottom pane, click the appropriate record.

Alternately, double-click the record to see the report in an expanded form.

4.

Scroll through the report until you see the Result Notes section. All associated result notes display below this heading.

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