for Allscripts Professional EHR

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for

Allscripts Professional EHR™

Tips and Tricks to get the most out Allscripts Professional EHR™

NoteSwift, Inc. One Boston Place, Suite 2600 Boston, MA, 02108 www.noteswift.com

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Copyright

NoteSwift™ is a trademark of NoteSwift, Inc., in the United States or other countries. All other names and trademarks referenced herein are trademarks of NoteSwift, Inc. or their respective owners.

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Introduction

First Things First

1. Do you have Dragon Medical speech recognition software installed? 2. Do you have Allscripts® Professional EHR™ installed?

3. Do you have NoteSwift™ installed?

If you can answer yes to all three, then proceed to training! If you need to install any of the programs listed above, do so before proceeding.

Assumptions:

This document assumes you are comfortable using speech recognition and that you are able to work with your EHR capably with or without speech recognition. If you are not comfortable with either, seek training before using NoteSwift.

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About This Document: Typographic Weirdness and Helpful Info

There are certain typographic conventions in this document, which, once you learn them will help with you discern what is typed, clicked, or said in each example and exercise.

• NoteSwift commands, words you say to NoteSwift when you want something to happen, are in bold and initial capitals such as History of Present Illness. Additional command alternatives will be listed in parentheses ().

• Where you need to pause your voice for a moment in between commands, we put a comma in the instruction. For example, Exam, neuro, numbness on the right foot. You would pause briefly where the commas appear. This causes NoteSwift to auto-jump™ to the next field in a NoteSwift window.

• If the NoteSwift window has a Next button, it allows entry of more than one listed item (such as in the Allergies, Medications and Social History sections of Allscripts Pro). Say or click Next to add each item into your window. When finished, say or click Done or press the Next hotkey (see below) to enter all information into the form.

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• If you are using a PowerMic hand held microphone, you have the ability to define hotkeys. The PowerMic II uses the defaults below. Find this dialog by clicking on Tools on the Dragon bar, then Options, then click on the PowerMic II tab. You can find more information on how to set your hotkeys in your PowerMic II and Dragon Medical documentation.

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NOTE: In this manual, wherever you are asked to say Next or Done, you may also use predefined hotkeys on a microphone or your keyboard to accomplish the Next and Done functions.

The Good Doctor icon. Whenever you see this icon, it means we have some important and helpful information for you from the Good Doctor himself, Dr. Chris Russell, founder of NoteSwift. These tips and processes will help you learn best practices when working with NoteSwift and your EHR.

Here is your first tip from the Good Doctor! A Next hotkey can be assigned through the NoteSwift Options menu (image below) as well as through the PowerMic options (Image previous page) found in Dragon Medical.These are not mutually exclusive; you may have a Next

hotkey both on your keyboard and your PowerMic. Important: make sure that if you choose a new Hotkey, that it isn’t already assigned to a Dragon function!

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Before using NoteSwift, go the Dragon Toolbar. Select Tools->Options->Miscellaneous, and uncheck the “Voice-enable menus, buttons, and other controls” button:

Make sure this is unchecked.

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Download and Installation

IMPORTANT! If you access your EHR via Windows Remote Desktop (RDP) or Citrix®, The NoteSwift Server component must first be installed and configured on the RDP or Citrix XenApp server where Allscripts Professional resides. For more information, refer to the NoteSwift Remote Desktop Installation Guide.

The following software installation information is strictly for installing the NoteSwift desktop client. It is the same installation whether you are using it as a thin client for Remote Desktop, or a full client supporting a local Allscripts client installation. It will function with both a local Allscripts Professional client, and a Remote Desktop or Citrix session, depending on the profile you select at runtime.

To download NoteSwift on your computer, enter the download URL that was provided to you. A dialog appears asking whether you’d like to run or save the file. Select Run.

If your browser does not give you this option, you will find the file downloaded into your default downloads directory. Double-click on the file to start the installation process.

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You will be asked if you will be running your EHR via Remote Desktop (RDP) or Citrix. Select the correct option and click Next.

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You’ll see a status dialog showing installation progress, and then a final window when the install successfully completes:

Click Finish to end the installation and start NoteSwift for the first time. You’ll see the NoteSwift program, which looks like this:

Once you have created and/or selected a user profile, you can minimize the NoteSwift application during operation. If you chose “Yes” to install the Remote Desktop components, you will be asked to reboot your system before running NoteSwift.

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Creating a NoteSwift User

To create a new user for NoteSwift, you open the NoteSwift program. Click on the Add button

IMPORTANT! If you are running NoteSwift in an RDP or Citrix environment, make sure you select “Allscripts Professional (server)” as the EHR. RDP and Citrix users should first start their remote EHR session (which should be configured to start the NoteSwift Server at the same time) prior to running NoteSwift on the desktop.

• Enter the user name

• Select the EHR

• Select the version of your EHR.

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You will now see the user you added in the listing of users for NoteSwift.

Highlight the appropriate user and then click Open. This opens the specified NoteSwift user. To edit a user’s information single click on the user. Click on Change, and edit the information as needed. When finished click Done.

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NoteSwift desktop application

NoteSwift Server Allscripts Professional EHR Select a patient and initiate an encounter within Allscripts Professional EHR. You are now ready to

dictate a note using NoteSwift. You may start from any window, such as the Face Sheet or Patient Manager.

NoteSwift in a Remote Desktop (RDP) or Citrix Environment

If you are running your EHR via Remote Desktop, your administrator will have previously set up the link with the appropriate startup procedure for you. The correct order for starting NoteSwift in this

environment is to first load your EHR, which will also silently launch the NoteSwift Server. You then start the NoteSwift application from your desktop (making sure that Dragon Medical is also running prior to launching NoteSwift). You should see the following icons on your Windows taskbar:

Notice that there are two NoteSwift icons: one for the NoteSwift Server which is launched when you start the remote session with Allscripts Pro, the other for the NoteSwift desktop application. Both must be running in order for NoteSwift to operate. (RDP users: notice that there is a small circular graphic on the icons that indicate the programs that are running remotely on the remote desktop server.) If you click on the icon representing the NoteSwift Server, the server window will be displayed, which looks like this:

The server is launched minimized, and you would not normally have a need to view it during operation, it can stay minimized, unless you need to view it for troubleshooting purposes.

Status messages are displayed here

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If you should attempt to close the NoteSwift server, you will get a warning:

Unless you are asked to do so, you should choose No. Closing the NoteSwift Server while in operation will prevent NoteSwift from working with your EHR session. If this happens, restart your EHR session and the NoteSwift desktop application in order to continue. If you do encounter an error with

NoteSwift, bring up the NoteSwift Server by clicking on the taskbar icon (where you should see an error message in the dialog window), and click the Restart button. You can then minimize the NoteSwift server window. Exit and restart the NoteSwift desktop application in order to continue working with NoteSwift.

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NoteSwift Windows

NoteSwift allows you to dictate free text narrative and structured data, where NoteSwift does the searching for you from a defined list. In this document we go through the NoteSwift windows and show you how to create the patient note whether you need free text or structured data.

NoteSwift Windows covered in this manual are: • Reason for Visit

• History of Present Illness • Review of Systems

 ROS Template • Past Medical History • Social History • Family History • Allergies • Current Medications • Physical Exam  Exam Template • Assessment • Plan • Prescribe

NoteSwift also has commands for Travel History, Surgical History, Pregnancy History, Diagnostic History, Health Maintenance and Dictation. These commands are similar to documenting the Social and Family History. See the NoteSwift Command Cheat Sheet at the end of the manual for a complete listing of the NoteSwift commands.

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Reason for Visit

Call up the Reason for Visit window. Say Reason for Visit

The Allscripts Professional Reason for Visit details window and the NoteSwift Reason for Visit windows appear, allowing you to dictate complaints, categories, findings, values and descriptive text.

The default EHR target (My Short Lists / Short Lists) is automatically selected. In this example, My Short Lists is the default, and there are three short list folders available. (You can learn more about setting the default tab in Allscripts Professional by referring to the Caregiver Options section in the Allscripts

Professional EHR Clinical Module User Guide). If you want to work with a different tab, you can say the tab name (Previous Complaints, My Short Lists, Short Lists, Master List) and NoteSwift will select that tab. Once you are in the desired tab, the NoteSwift cursor is positioned in the Complaint field. To open a folder (a Short List item called NoteSwift Clinic was created for this tutorial), say

NoteSwift Clinic

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Note that the Complaint field has been cleared, and the cursor placed there again. This allows you to dictate one of the complaints within the folder.

If you have folders inside your Short List item, you can say Open <folder name>, and NoteSwift will open that folder revealing its contents.

If you are working with the Master List, NoteSwift also provides two power commands you can use: Search for, and lookup that allows you to use the Allscripts search function to find the desired complaint. Say Search for (or lookup) bronchitis from the Master List for example, to quickly find and select bronchitis. You can also say Clear Search to clear the search window and initiate another search.

Say Bronchitis

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Say Symptoms

To reveal the findings and values for the Symptoms category. Say Cough

To enter this information, and continue adding additional findings, say Next Finding

The finding for Cough will be entered, and NoteSwift is ready for you to dictate the next finding for Symptoms.

Say Wheezing, Next Finding

Remember that the comma means to pause, allowing NoteSwift to auto-jump™ to the next field. You dictate it as: Wheezing <pause> Next Finding.

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The default for findings is Positive. To change to a Negative finding, say Negative

Now, say Shortness of Breath, Next Finding

You’ll see that the “X” was selected for Shortness of Breath, indicating a negative finding. Say Hemoptysis

Notice that the Negative option is still selected in the NoteSwift window. It will remain set to Negative until you dictate Positive again.

If you wish to enter free text in the note field for any finding, say Note

NoteSwift moves the cursor to the Note field in the NoteSwift window. Say Sputum is clear

Move directly to any NoteSwift field by simply dictating the field name, such as Note. This is also useful when you would like to go back and change your input for a given field, such as

Finding.

To enter a negative finding for Hemoptysis and then move on to enter data in a new category, say Next Category

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NoteSwift has entered the negative finding and free text for Hemoptysis, then positioned the cursor at the Category field, ready for you to dictate findings in another category.

Say Onset… (spoken: “Onset ellipsis”, or “Onset dot”. The reason for this is that only saying “Onset” will match with the first occurrence of the word, which in this case is “Onset Mode”. We want the second occurrence, so we dictate “dot” or “ellipsis, and NoteSwift will now find “Onset…” )

Say Week, 2, Next Category

Noteswift selects the “weeks (ago)” finding, places the value “2” in it, and is ready to enter data into another category.

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NoteSwift does not require you to dictate an entire term exactly as it is written. You can dictate part of a finding, and NoteSwift will look for the first closest match. For example, it would be difficult to accurately dictate “week(s) ago”. But, since “week” is a word that is unique to that finding, NoteSwift locates it correctly simply by dictating Week . With practice, you’ll learn how to quickly get to the desired items, letting NoteSwift do the work for you.

To enter findings for more categories, here are some things you can try: Preceding Event, An upper respiratory infection, Next Category Exacerbating Factors, Exercise, Note (to jump directly to the Note field) Patient states that the symptoms worsen with exertion.

When dictating findings, you can also say All Positive, or All Negative. This will set all the findings to either positive or negative.

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When you are done dictating for this complaint, you can say: Next – to select another complaint

Done – to dismiss the NoteSwift Reason for Visit window

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History of Present Illness (Reason for Visit)

Reason for Visit is the recommended best practice for entering structured data as required for Meaningful Use. However, the HPI exists entering unstructured data into the Reason for Visit Note. Call up the History of Present Illness window.

Say HPI (or History or History of Present Illness)

The History of Present Illness window appears. Dictate the patients’ history. For example:

The patient comes in today with symptoms consistent with bronchitis. She complains of a cough and wheezing. Symptoms do not include shortness of breath or hemoptysis, her sputum is clear. Onset was 2 weeks ago, following an upper respiratory infection. Patient states that her symptoms worsen with exertion.

The words you dictated will appear in the HPI window. If there was existing highlighted text already in the window, the new dictation will replace it.

Say Done or the name of the next window, such as ROS Template.

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Other Commands Available in the HPI Window:

Recover brings back the

text from a prior HPI dictation. This is useful if the text was lost from a previous dictation. To recover lost text or text not transferred:

• Say HPI

• Say Recover

Append moves the cursor to the end of existing text and adds additional dictation to the

end of previous dictated notes.

This is useful if you have already dictated the HPI and need to add additional information. From the HPI window click or say Append and continue with your dictation. Say HPI first to open the HPI window and then you continue as mentioned above. Then say Next or

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Creating an Alias

Aliases allow you to substitute a simpler term for an existing system term or template name. For example, it is easier to say GERD than Gastroesophageal Reflux Disorder. Or COPD over Chronic Obstructive Pulmonary Disorder. Also, things such as template names may have any variety of punctuation according to your naming conventions, which may be difficult to dictate.

You can create Aliases in a number of NoteSwift windows such as: • ROS Template • Exam Template • Social History • Medications • Prescribe • Plan

The way in which Aliases for templates are created for ROS and Exam Templates are slightly different than for other forms. Both methods are described here.

Creating aliases for ROS Template and Exam Template

In this example, we will create an Alias in the ROS Template NoteSwift window. Say ROS Template

The ROS Template window appears. Say Alias

The Alias dialog appears.

In the field titled Spoken Alias type or dictate the term you wish to use. (In this example, the spoken alias “complete female” will be defined for the Template Term “General Multi-System – Adult Female – Complete”)

You then select the desired template from the Templates pull-down list within Allscripts Pro. Say Done

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Creating an alias for Exam Templates works in the same manner.

Creating aliases for other NoteSwift forms

In this example, we will create an alias for the Plan form. Say: Plan - to bring up the plan form

Labs - to set the target to the Labs source Alias – to bring up the Alias dialog.

1. Enter the spoken alias term

2. Select the desired template

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In this example we will create the alias “CMP” which will refer to “METABOLIC PANEL, COMPREHENSIVE (90053)”. In the Spoken Alias field, type CMP. In the Search Term field, type in METABOLIC PANEL, COMPREHENSIVE (90053). In this alias form, you will also select the search source, in this case Labs. Say Done

Now when you use the Plan Form you can dictate CMP, and NoteSwift will select the appropriate lab for you.

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Documenting the Review of Systems

The ROS window allows the provider to modify an existing ROS template. NoteSwift is good at recognizing varying terms for ROS text, but it expects a certain format. Generally templates are used to document negatives, but they can be used for positives as well.

Using a Template in the ROS window:

If you would like to use a pre–existing template in the ROS window, call up your ROS template. Say ROS Template

The ROS Template window opens showing ROS templates available. In the example below, we have a NoteSwift form populated with Template Terms that have corresponding Aliases.

If you have not yet read the section on Aliases, do so now.

Speak the name of the template you wish to apply. In this example we will use the alias that we created in the previous example on pages 31-32.

Say Complete Female

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When finished, say Done or the next area you wish to document, such as ROS.

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Review of Systems

Call up the ROS window. Say ROS (or Review of Systems) The NoteSwift ROS window appears.

Say Cough, for two weeks.

(Remember that the comma means to pause). Cough is entered in the Positive finding field, and the cursor auto-jumps to the Note where the text for 2 weeks is entered.

Say Next

If you wish to dictate a negative finding, say Negative and then dictate the finding into the negative field. You can switch back to documenting positive findings by saying Positive before dictating any additional findings.

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Any note text that is dictated during the Review of Systems is added and appears beside the corresponding symptom. Present symptom notes appear in all caps. Not Present (negative) notes appear in proper case.

Reminder - The ROS form by default starts with the cursor in the Finding field and the default is set to Positive. Speak the name of the finding when the cursor is in the Finding field. NoteSwift highlights that term and jumps to the Note section. You can then optionally dictate narrative text about that finding. Say Next, and the ROS is changed. When finished, dictate your next area of documentation, such as Past Medical History.

Make sure that the toggle Navigation button is set to “on”, and the navigation window is displayed.

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Past Medical History

To dictate the Past Medical History into your encounter say Past Medical

The Past Medical History window appears.

Dictate the medical condition into the Item field. For this example, we will say Hypertension

After you say hypertension and pause your voice, the cursor automatically jumps to the Note field. Dictate a note for the condition.

To dictate additional conditions, say Next and continue adding conditions as mentioned above. When finished say Done, or the next area of documentation such as Social History.

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Social History

Say Social History

The Social History window appears.

Dictate the social history item Say Alcohol

When you pause your voice, the cursor automatically jumps to the Note field. Dictate a note for the item.

She admits to 2 glasses of wine per day with dinner.

Say Next to add additional items. Try adding data such as Living Situation, Current Work Status or Tobacco History using the above method.

Say Done or the next area of documentation such as Family History when finished adding items.

The Source defaults to Social for the search and entry. If you wish, you can also say Free Text

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Family History

Say Family History

The Family History window appears.

Say Father

The cursor will automatically jump to the Note field. Say Coronary artery disease

Say Next if other family history items need to be added. The history item is transferred and you are ready to dictate another item.

When all items are added say Done, or the next area of documentation such as Allergies.

Pregnancy History and Travel History, although not covered in this manual, work in the same

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Allergies

Say Allergies to open the Allergies window Dictate an allergen into the Item field. Say Penicillin

The cursor automatically jumps to the Note section. Dictate the allergy reaction, for example, Anaphylaxis.

Say Next to add another allergy. The information is transferred to the encounter in Allscripts Professional EHR. When finished, say the name of the next section you wish to move to such as Medication History, or say Done.

Allscripts Professional EHR categorizes allergens into different types (Drug, Common, Drug Class). You can choose the allergen type for the particular item. When you select an allergy type for a particular item, NoteSwift remembers it the next time you dictate that item.

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If the Allscripts Professional EHR search results in more than one result, NoteSwift defaults to the first item listed. If the first item in the list is not the one needed, single-click on the item you want in Allscripts Professional EHR and then say Next to transfer the data. Alternatively, you can say Item to position the cursor on the Item field, say Select all to select the previous entry, and then dictate a more exact version of the item you want to select, such as Penicillin G Procaine.

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Medication History

Call up the Medications History window. Say Medications.

Dictate the medications your patient is taking. In these examples, dictate the medications all in one command speaking fluidly. NoteSwift will automatically parse all the data for you and put the drug name strength and dosage all in the right places.

Say Lisinopril 20 mg daily (Pronounce mg as “milligrams”) Next

Low dose aspirin QD Next

NoteSwift searches for the dictated medication and dosage when you pause your voice. If there are multiple medications matching your search, you can either single-click on the medication that you want, or, by dictating a more exact version of your choice. You can accomplish this by saying Clear to erase the NoteSwift field, and dictating your new selection. When you are finished, say Next to continue adding medications. Say Done when finished, or the next section you want to move to, such as Exam.

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Medications are entered as structured data and as such can be used in the Assessment and Plan to prescribe the medications. Unknown Dosages: If you do not know the dosage of a medication, dictate unknown as the dosage.

Medication Extras:

• Number: You can specify a range, such as Lortab 1-2 daily PRN (use the word hyphen for the dash, say “one hyphen two” for 1-2).

• Frequency: NoteSwift understands most standard medical abbreviations such as QD, BID, and TID.

• PRN: NoteSwift supports the term PRN or as needed at the end of the dictation, along with the reason. For example, Lasix 20mg 1-2 daily PRN edema.

• No Meds: If the patient is on no meds, activate the No Current Medications button in the Medications window by saying None.

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Documenting the Physical Exam

Open the Exam Template window. Say Exam Template

Speak the spoken term of the Alias you have created. In this example, we will use general exam.

If you have not yet read the section on Aliases (page 31), do so now.

Say General Exam

Say the next area of documentation such as Exam, or Done to apply the template.

The template window applies the template. You are now ready to dictate the physical exam.

When your Exam Template window opens, you will see the list of Aliases for templates customized for use with NoteSwift. Creating your own Aliases will allow you to use a spoken term to apply either system-delivered templates or the customized NoteSwift templates.

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As with ROS Template, you can say Last Visit to bring in the previous encounter as the exam template.

Physical Exam

The physical exam window uses the search functionality within the Physical Exam to document positive and negative findings. Set-up and customization needs to have been completed by your NoteSwift implementation specialist for this to happen. If you have not had this done, you will need to document the physical exam using the point-and-click method. If customization has been completed follow the directions below:

After completing the above steps to apply the physical exam template Say, Exam to open the Physical Exam window.

To dictate a positive finding, make sure the cursor is in the Positive text box. You can switch between positive and negative finding by saying Positive to document the positive findings or Negative to document negative findings.

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When you pause after dictating a finding, the cursor will jump to the Note box. You can then dictate a comment related to the finding. The note is added to the note section of the finding in the Allscripts Professional EHR Physical Exam.

Say Lung Sounds, Wheezing noted bilaterally.

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Abnormal findings are noted in all caps. Notes are added to the appropriate section.

Say Next to continue adding information. When you are finished, say Done, or the name of the next section you wish to move to such Assessment to document the Assessment and Plan.

Make sure that the Navigation toggle button is set to “on”

The search pane to the left should look like this

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Assessment

The Assessment window provides many options for entering structured data into the note. You can: • Access information from My Short Lists, Short Lists, the Patient Problem List, or search the

Master List

• Easily navigate to, and select one-click protocols

• Navigate protocols with folders, selecting diagnoses and plan items from virtually any folder structure.

• Navigate more complex structures containing nested folders. Say Assessment to open the Assessment window.

The tab selected in the EHR will match whatever your system default is. In this example, we will work from My Short Lists. The Short List item “Sick Visit” has been created for this tutorial. It contains two different styles of protocols, as shown:

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We’ll first look at the one-click protocol for Bronchitis. In the NoteSwift Assessment window, first open the Sick Visit folder.

Say Sick Visit

NoteSwift opens the folder. Whenever a folder also contains a folder named Protocols, NoteSwift will conveniently open that at the same time.

This is a folder-style protocol. The available medications, procedures, education and follow-up options are stored in separate folders.

This is a one-click protocol. The medications, procedures, etc. are located with the diagnosis, and can all be entered in a single operation.

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Say Bronchitis

NoteSwift selects the one-click protocol. To add this protocol to the Current Plans, say Next Item, and continue entering additional items. Say Next or Done if you are finished with this assessment.

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Now, we’ll take a step back and document via a folder-style protocol. First, delete the prior assessment in the EHR to avoid any conflicts.

Say Assessment to bring up the Assessment window, Say Sick Visit to open the Sick Visit Short List item,

NoteSwift opens Sick Visit, and the Protocols: directory as it did in the first example.

Say Cough and NoteSwift selects and highlights the Cough protocol. The cursor auto-jumps to the Note field. Dictate additional information, such as

I will order today a chest x-ray to ensure there is no underlying pneumonia. I'll also give the patient a prescription for prednisone. I will see her back in our office in 1 week.

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You will see that in the process of entering the diagnosis into the Current Plans window, the Cough folder was opened so that additional items can be added by navigating the folders within. Say Open Medications (or Expand Medications) and the folder will open, revealing a list of medications. You can now dictate the desired items into the Item field, adding Note text if desired. For example, say Prednisone, Next Item

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You may want to create this or a similar Short List protocol for practice. To complete this assessment example, you can try the following. Say:

Open Procedures Chest X-Ray Next Item CBC Next Item Open follow In 1 week

Say Next if you want to go back to the top and close all the folders to start a new assessment, or Done if you are finished with the assessment. You can also say the name of another area, such as Plan.

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More about navigation in Assessment

Dictating the name of any of the radio buttons in the NoteSwift Assessment window will select that tab in the EHR.

Selecting Search allows you to search for and select diagnoses in the master list. You can then add procedures and medications to the selected diagnosis following the assessment, via the NoteSwift Plan and Prescribe windows. This may be helpful when you need to add an additional assessment for which you don’t currently have a Short List.

By selecting Free Text, you can enter your assessment as unstructured data. Dictate the assessment in the Item field, and any narrative into the Note field. The information will be entered into the Current Plans as unstructured data.

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You can also select Patient Problem List to bring in an assessment from a previous encounter. Again, you can use the Plan and Prescribe capabilities in NoteSwift to add medications, procedures, and the like to the diagnosis.

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Plan

The NoteSwift Plan window allows you to order individual items such as procedures, labs, referrals, etc. You can enter from various sources or you may specify Short List. To use a Short List, you must first enter the information for your Short List in NoteSwift.

Setting Default Target for the Plan window

From the main NoteSwift window, select Options.

The Options dialog appears. Click on the Plan tab. Choose a default target. If you choose Short List, enter the name of the Short List you will use.

Click Save

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Say Plan (or Orders) to open the Plan window

The target can be changed when you are in the Assessment and Plan by dictating the name of the target (e.g. Labs) you wish to search.

Select the diagnosis for which you will be adding new orders if it is not already selected in the Current Plans window of the EHR. Dictate the order which you want to add. If there are multiple in the list, single-click on the item that you are ordering and say Next.

To add a new order to the Cough diagnosis, first make sure it is highlighted in the Current Plans window. Say CT Sinus

Select the desired choice from the search results by single-clicking, then say Next to add the procedure to the Current Plans for Cough.

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Continue this process until you have added all orders. When you are finished say Done, or the next area of documentation such as Prescribe.

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Prescribe

To order a new medication for a patient, say

Prescribe (or New Prescription) to open the Prescribe window.

Dictate the medication name, strength, dosage, number and refills. To dictate the example above you would say

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NoteSwift searches for the medication and dosage and delivers the search result. If you do not single-click an entry, the first entry in the search result will be applied by default. If the desired drug/dosage dictated does not appear first on the list, click once to select the drug and dosage you need.

Say Next to continue adding medications, or when finished say Done.

Before continuing, you will be required to Click OK to close the EHR prescription window. This is one of the few places where you are required to manually click, to allow you to review the prescription prior to submitting it. At this point if you say Next, The NoteSwift window will still be displayed and will be waiting for you to dismiss the prescription window in order to dictate the next prescription.

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Dictation

As a convenience, NoteSwift offers a dictation box, which allows you to quickly dictate free text to be pasted into whichever area you choose, without having to leave NoteSwift. First, place the cursor where you would like to insert text.

Say Dictation

to open the NoteSwift dictation window.

You are now free to dictate your information. You can also say or press Recover to bring back text from a prior dictation. When you are finished dictating say Done, and the text will be inserted into the selected field.

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If you have finished entering all desired sections of your note, click on the History and Physical icon in Allscripts Professional EHR to see what your complete patient encounter looks like:

Amy NoteSw ift

9/26/rrrrrrr 10:50 AM

Location: Professional Main Location

Patient #: 1234Swift

DOB: 5/20/1978

Married / Language: Undefined / Race: Undefined Female

History of Present Illness (Terry A Manning, MD; 9/26/2014 12:27 PM)

The patient is a 36 year old female who presents with chronic bronchitis. Symptoms include cough (Started 2 weeks ago after a cold.) and wheezing (Worsens with exertion. She is using her MDI as needed.), while symptoms do not include hemoptysis (Sputum is clear area) or shortness of breath. Onset was 2 week(s) ago. Onset followed an upper respiratory infection. Symptoms are exacerbated by exercise (Patient states that the symptoms worsen with exertion.).

Problem List/Past Medical (Terry A Manning, MD; 9/28/2014 9:06 AM)

Hypertension (401.9)

Allergies (Terry A Manning, MD; 9/26/2014 3:15 PM)

Penicillin G Benzathine & Proc *PENICILLINS*. Anaphylaxis

Medication History (Terry A Manning, MD; 9/26/2014 3:44 PM) Lisinopril (20MG Tablet, Oral daily) Active.

Low-Dose Aspirin (81MG Tablet, Oral daily) Active.

Social History (Terry A Manning, MD; 9/26/2014 2:41 PM)

Alcohol use. She admits to 2 glasses of wine per day with dinner. Current work status

Family History (Terry A Manning, MD; 9/26/2014 2:43 PM)

Father. Coronary artery disease

Review of Systems (Terry A Manning, MD; 9/26/2014 2:15 PM)

General: Present- Feeling well. Not Present- Fatigue, Fever, Night Sweats, Weight Gain > 10lbs. and Weight Loss > 10lbs.. Skin: Not Present- Change in Wart/Mole, Itching, New Lesions and Rash.

HEENT: Not Present- Headache, Visual Disturbances, Hearing Loss, Frequent Colds, Bleeding Gums and Hoarseness. Neck: Not Present- Swollen Glands.

Respiratory: Present- Cough (FOR 2 WEEKS.). Not Present- Difficulty Breathing. Breast: Not Present- Breast Mass, Breast Pain, Nipple Discharge and Skin Changes. Cardiovascular: Not Present- Chest Pain, Shortness of Breath and Swelling of Extremities.

Gastrointestinal: Not Present- Abdominal Pain, Constipation, Diarrhea, Difficulty Swallowing and Rectal Bleeding.

Female Genitourinary: Not Present- Frequency, Menstrual Irregularities, Painful Urination, Pelvic Pain, Urgency and Vaginal Discharge. Musculoskeletal: Not Present- Calf Pain, Joint Pain and Muscle Cramps.

Neurological: Not Present- Dizziness, Numbness and Weakness. Psychiatric: Not Present- Anxiety, Change in Sleep Pattern and Mood changes.

Endocrine: Not Present- Cold Intolerance, Excessive Thirst, Excessive Urination and Heat Intolerance. Hematology: Not Present- Easy Bruising, Enlarged Lymph Nodes and Prolonged Bleeding.

Physical Exam (Terry A Manning, MD; 9/26/2014 4:12 PM) The physical exam findings are as follows:

General

Constitutional - Normal appearance. Integumentary

Skin - Normal skin, Normal skin appearance and Incision clean, dry, intact consistent with normal anticipated wound healing. No skin nodules. Head and Neck

Neck - Normal jugular pulses, Normal thyroid size and consistency without masses and Trachea midline. Eye

Eyes - Normal lids and conjunctiva, Normal pupils and irises and Normal fundi. ENMT

ENT - Normal external ears and nose, Normal ear canals and tympanic membranes, Normal hearing, Normal nasal mucosa, Normal mouth and Normal oropharynx. Chest and Lung Exam

Chest - ABNORMAL LUNG SOUNDS (WHEEZING NOTED BILATERALLY.). Normal respiratory effort, Normal chest percussion and Normal chest palpation. Cardiovascular

Cardiovascular - Normal heart sounds, Normal carotids, Normal abdominal aorta, Normal femoral pulses and Normal foot pulses. No leg edema. Neurologic

Neuro - Normal cranial nerves, Normal strength and tone, Normal reflexes and Normal sensation. Neuropsychiatric

Psych - Normal mood and affect and Normal mental status. Musculoskeletal

Musculoskeletal - Normal gait, Normal digits, Normal extremities and Normal spine. Lymphatic

Lymph - No neck lymphadenopathy, axillary lymphadenopathy or inguinal lymphadenopathy.

Assessment & Plan (Terry A Manning, MD; 9/28/2014 9:42 AM)

Cough (786.2)

Current Plans

 _{CHEST X-RAY, PA AND LATERAL (71020)}  _{CBC & PLATELETS (AUTO) (85027)}  _{Follow up in 1 week or as needed}  _{CT SINUS WO/W CON (70488)}

 _{Started PredniSONE 10MG, 1 (one) Tablet daily, #30, 09/28/2014, Ref. x3.}

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NoteSwift Menus and Options

Options... Customization options for each NoteSwift form.

Users Tools for creating, selecting and editing user profiles, as well as importing and exporting information from other profiles

Help Provides links to documentation, as well as version and support information.

Options…

There is a tab for a number of NoteSwift forms, as well as the General and Unity tabs. Each tab contains several options to change the behavior for the corresponding form. With the exception of the Plan and PMH tabs, you should not need to change any options from their default setting.

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General

Next/Done Hotkey Allows you to create a keyboard hotkey which you can use instead of dictating Next.

Auto Jump to Note This causes NoteSwift to automatically move the cursor to the Note area after dictating fields.

Transfer Note Using This should not be changed from the default “Clipboard” unless instructed to do so by support staff.

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Unity

This is where the Allscripts Unity Service URL, and the User Name and Password are entered. This is reserved for future use.

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Transfer Text Using This should not be changed from the default “Clipboard” unless instructed to do so by support staff.

Delete Old HPI When Transferring Text This default will remove any existing Note text in Reason for Visit prior to transferring the current text.

ROS

All Caps Abnormal Findings This default converts Review of Systems abnormal finding text to all caps.

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PMH (Past Medical History)

Target Free Text/Search determines where NoteSwift will enter PMH data.

Exam

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All Caps Abnormal Findings This default converts the note text associated with a positive finding to all caps.

Plan

Default Target This selection defines which data source will be searched by default for plan items Default Short List If Short List is selected, the specified folder in the Default Short List field will be

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History

Social history defaults to Free Text When checked, NoteSwift will enter any social history items dictated as free text, rather than searching for the item within the social history source

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Dictation

Transfer Text Using This should not be changed from the default “Clipboard” unless instructed to do so by support staff

Users

Importing / Exporting Aliases

NoteSwift provides the ability to import and export your aliases. You can import either from another user profile you have created in your NoteSwift environment, or a folder. You can export your aliases to a folder. In the NoteSwift application, select Users->Export->To Folder…

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From here, you will browse to the folder where you’d like to place your alias files, optionally creating a new folder for them.

To import from another user, select Users->Import->From User…

Here you can select another user profile and the Aliases you wish to import from it into your currently active profile.

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Select the alias files you wish to import, browse to the directory where they are located, and click Import.

Help

The following table outlines the help menu items

User Manual Links to the latest online version of this manual

Release Notes Links to the latest online version of the product release notes

About Displays a splash screen with pertinent version and license information regarding NoteSwift

Server Log Saves the current NoteSwift activity to a file for use by support and development. Do this only if instructed to by support staff

Clear Cache NoteSwift caches some information to help improve navigation speed. Support may ask you to select this option if you begin experiencing certain behaviors when using

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Appendix A: Command Cheat Sheet

This is the list of available commands used to call up the NoteSwift windows, and commands available within each window. In addition to what is listed in the table, you can always dictate Done, Next and Cancel. You can also say the name of any field within a NoteSwift window to move the cursor there.

NoteSwift Window What to say to call up the NoteSwift _Window What else you can say

Allergies Allergies Drug, Common, Drug Class, No _Allergies

Assessment Assessment

Open <item/folder>, Expand

<item/folder>, Open Item, Next Item, My Short Lists, Short Lists, Search, Free Text, Patient Problem List

Diagnostic Studies Diagnostic Studies

Dictation Dictation Recover

Exam Template Exam Template Alias, Last Visit

Family History Family History

Health Maintenance Health Maintenance

History of Present Illness HPI, History, History of Present Illness Append, Recover Medications Medications, Meds, Problem List Alias, Clear

N/A No Meds, Meds Review

N/A Dictation

Past Medical History Past Medical, Past Medical History Free Text, Search, Alias Past Surgical History Past Surgical, Past Surgical History

Physical Exam Exam Alias, Positive, Negative

Plan Plan, Orders Alias, Short List, Procedure, Labs, Education, Office, Discharge Plan, Nursing, Forms, Referral

Pregnancy History Pregnancy History

Prescribe Prescribe, New Prescription Alias, Clear

Reason for Visit Reason for Visit

Search For <item>, Lookup <item> Clear Search, Open <item/folder>, Choose <item/folder>, Next Category, Next Finding, Previous Complaints, My Short Lists, Short Lists, Master List, All Positive, All Negative Review of Systems ROS, Review of Systems Positive, Negative, Alias ROS Template ROS Template Alias, Last Visit, Last Office Visit

Social History Social History Free Text, Social

for Allscripts Professional EHR

for

Allscripts Professional EHR™

Tips and Tricks to get the most out Allscripts Professional EHR™

Copyright

Contents

Introduction

First Things First

Assumptions:

About This Document: Typographic Weirdness and Helpful Info

Download and Installation

Creating a NoteSwift User

NoteSwift in a Remote Desktop (RDP) or Citrix Environment

NoteSwift Windows

Reason for Visit

History of Present Illness (Reason for Visit)

Other Commands Available in the HPI Window:

Creating an Alias

Creating aliases for ROS Template and Exam Template

Creating aliases for other NoteSwift forms

Documenting the Review of Systems

Using a Template in the ROS window:

Review of Systems

Past Medical History

Social History

Family History

Allergies

Medication History

Documenting the Physical Exam

Physical Exam

Assessment

More about navigation in Assessment

Plan

Setting Default Target for the Plan window

Prescribe

Dictation

NoteSwift Menus and Options

Options…

General

Unity

ROS

PMH (Past Medical History)

Exam

Plan

History

Dictation

Users

Importing / Exporting Aliases

Help

Appendix A: Command Cheat Sheet