Creating Clinical Content for Centricity
Physician Office - EMR 2005
July 2006
2027167-002 Rev B
GE Healthcare
Centricity and Logician are registered trademarks of General Electric Company.
C
ONTENTS
About this guide ...xiii
Getting the latest information ...xiii
Documentation conventions...xiv
Other resources ...xiv
EMR online help (F1) ...xiv
Documentation area on the ...xiv
Centricity Physician Office Services Web site ...xiv
Training databases ...xv
If you encounter a problem ...xv
Report a defect or an enhancement idea...xvi
Contact us ...xvi
1
Getting started...3
About form components ... 3
About Encounter Form Editor... 5
New features in Encounter Form Editor... 5
Encounter Form Editor compatibility... 6
Microsoft® Access compatibility ... 6
Operating system compatibility ... 6
About the KnowledgeBank ... 6
Install Encounter Form Editor ... 7
Install observation term files (if necessary) ... 7
Install Acrobat Reader and online manuals ... 8
Encounter form tips and limitations ... 8
Encounter form examples ... 10
Form design process ... 11
Design steps ... 11
Create a simple form ... 13
2
Design the form component ...21
About the sample form ... 22
Gather preliminary information ... 22
Example ... 25
Choose connections ... 26
About observations... 26
Storage connections... 27
Data display connections... 29
Flowsheet ... 31
Action connections... 31
Connections example ... 34
Choose form items... 35
Use library items... 35
Use custom form items ... 36
Determine item properties ... 39
Design for text translation... 40
Heading suppression ... 40
Example ... 41
Create preliminary form design... 44
Visual design characteristics ... 44
Formatting items ... 46
Plan for visibility regions ... 47
Visual design tips... 48
Style guidelines ... 49
3
Use Encounter Form Editor ...51
Start Encounter Form Editor ... 51
Supply registration information ... 51
View Encounter Form Editor’s main window ... 52
Exit Encounter Form Editor... 52
Work with forms... 53
Create a new form ... 53
Open an existing form ... 54
Edit a form ... 55
Understand the item list... 56
Select a form item... 56
Find a form item ... 57
Add form items ... 58
Use Centricity Physician Office Term Finder ... 64
Edit an existing form item ... 66
Rearrange items ... 66
Delete an item ... 66
Chart Update and Printed Form translations... 67
Text alignment ... 68
Font ... 68
Text color ... 69
Horizontal percentage ... 71
Pixel height per line... 72
Save a form as a clinical kit ... 72
View and correct errors ... 74
Understand encounter form files... 75
Save a form in an existing clinical kit... 76
Rename a form and form description files... 77
View the form.TXT file ... 78
Preview a form ... 79
Print an item report... 80
Work with item and item group libraries... 81
Add and delete items from an item library ... 82
Add and delete groups from an item group library ... 84
Import and export libraries... 87
Create a new library ... 88
Compact the database ... 89
4
Use advanced features ...91
About advanced features ... 91
About MEL and data symbols ... 92
About data symbols ... 92
About MEL syntax... 94
MEL operators... 96
Write conditional MEL expressions ... 97
Understand rich text formatting (fmt and cfmt) ... 100
MEL functions... 104
Evaluating MEL expressions in forms... 108
About watchers and triggers... 109
Use global variables ... 110
Use the MEL Expression Builder ... 110
Insert a symbol ... 111
Insert an observation term... 111
Create Data Display items ... 112
Write visibility conditions ... 118
Use Set Values Action Buttons ... 121
Add a Set Values Action Button ... 123
About superbuttons ... 124
Use MEL Function/Expression items... 125
Write calculations ... 126
Use the Action Button calculation connection ... 126
Use MEL Expression/Function items for calculations ... 128
Customize text translations ... 131
Change text translation ... 132
Ways to customize text translations ... 133
About default translations ... 134
Customized text translation examples ... 135
Retain customized translations... 137
Customize printed form translations ... 137
Printed form contents ... 138
About default printed form translations ... 138
Ways to customize printed form translations... 140
Change a printed form translation expression ... 140
Retain printed form customizations ... 142
Execute MEL scripts at close/traversal of forms... 142
5
Create E&M Advisor forms... 145
About E&M Advisor... 145
How E&M Advisor works... 145
About HCFA guidelines ... 147
About CPT coding levels... 147
Understand buckets and bullets ... 147
E&M Advisor requirements ... 150
View existing E&M form components ... 153
About E&M Advisor observation terms... 154
Locate E&M Advisor observation terms ... 154
Design E&M form components ... 155
Document history ... 155
Document physical exams... 157
Document medical decision-making ... 160
Document counseling and coordination ... 162
6
Import and test forms ... 165
Review form design ... 167
Test the form... 168
Review text and printed form translations ... 169
Use MEL tracing ... 170
7
Use data symbols
... 173
What is MEL?... 173
About data symbols ... 174
About functions ... 174
About MEL ... 175
Where to use MEL and data symbols ... 177
Use the Insert Symbol dialog box ... 177
Insert a symbol ... 178
Finding symbols and functions... 178
When to evaluate data symbols ... 179
Types of data symbols... 181
Text symbols... 182
Number symbols ... 182
Boolean symbols ... 182
Date symbols... 183
Using data symbol functions with arguments... 183
Syntax for arguments ... 184
Use observation terms as arguments ... 185
Look up observation terms... 188
Look up observation terms in EMR... 188
Tips on searching for observation terms ... 190
Print a report of observation terms ... 191
8
Write MEL expressions... 193
About MEL syntax... 193
Write if-then-else expressions ... 196
Rules for long form if-then-else expressions ... 197
Long form vs. short form MEL syntax ... 199
Using short form syntax ... 199
Rules for short form if-then-else expressions ... 200
Test for returned values ... 200
Use MEL operators ... 202
About value types ... 206
Use MEL rich text formatting functions ... 207
fmt vs. cfmt... 207
fmt syntax ... 207
fmt examples ... 208
cfmt syntax ... 209
cfmt examples ... 211
Use cfmt and fmt in EMR form editors ... 211
9
Use data symbols with MEL in EMR ... 213
Use the rich text format (RTF) editor ... 213
RTF editor options ... 214
RTF editor tips ... 215
Create patient banners... 216
Headers for letters, handouts, and chart documents... 218
About location of care symbols ... 219
Header examples... 220
Text components and templates for letters and handouts ... 220
View sample templates ... 221
Create a new letter template ... 223
Selecting data symbols for letter and handout templates ... 227
Template and component examples... 228
Quick text ... 229
Chart notes ... 231
Form components... 231
10
Test and deploy clinical content ... 233
Guidelines for testing clinical content... 233
Create patient data to test conditions ... 233
Test text components in a chart update ... 235
Deploy your created content ... 236
Export item from the training database... 236
Import item into your clinic database... 237
Build a library of MEL functions... 238
Troubleshoot MEL and data symbols... 239
11
MEL syntax basics... 241
Keywords... 241
Comments ... 244
Operators ... 244
Multiple statements ... 246
12
Values and variables ... 247
Dynamic typing in MEL ... 247
MEL values ... 247 Simple values ... 248 String ... 248 Complex values ... 249 Array ... 249 Variables ... 250 Data symbols... 250 Assignment behavior ... 251 UNDEFINED ... 252 Special operators ... 253 Errors... 253 Compile errors... 254 Runtime errors ... 254
13
Flow control... 255
Conditional statements ... 255 If statement ... 255Short form if statement... 256
Case statement ... 257 Loop statements... 258 While statement ... 258 For statement ... 258 Break statement ... 259 Continue statement... 260
14
MEL functions... 261
Define MEL functions ... 261
Call functions ... 262
Define arguments ... 262
Arguments with simple values ... 262
Arguments with complex values ... 263
Return statement... 263
Community scoping ... 266
Document-scoped variables ... 266
Database-scoped variables ... 268
Variable summary... 269
16
Advanced topics ... 271
Evaluating data symbols during chart updates... 271
Rules for evaluating data symbol functions ... 271
Evaluating symbols during multiple updates ... 272
Evaluating data symbols and expressions in forms ... 273
Data symbol dependency analysis ... 274
Visibility ... 274
Watcher expressions... 275
Watcher expression triggers ... 275
Watcher function and buttons... 276
17
Troubleshooting MEL... 279
MEL error messages ... 279
Use MEL tracing ... 281
A
Form item and connection reference... 283
Formatting items ... 283
Begin Section ... 283
Begin Multi-Item Row... 284
Column Break ... 284
End Suppression Block... 285
Function/MEL Expression ... 285
Begin Visibility Region... 285
End Visibility Region... 286
Form items... 286 Action Button ... 286 Check box ... 287 Data display ... 288 Drop-down list ... 289 Edit field ... 291 Flowsheet View ... 293 Heading ... 293 List box... 294
Multiline edit field ... 296
Radio buttons ... 297
Library items... 299
Assess or update problems... 299
Chief Complaint ... 299
Clinical list subset... 299
Disposition ... 300
Family History ... 300
History of Present Illness... 300
Past medical history ... 301
Preventive care reminders... 301
Library groups ... 301
Active Problems/Meds Boxes ... 302
Add Allergy/Directive/Medication/Problem... 302
Calculations ... 304
Family/Social History ... 305
Multiple items stored in one observation ... 305
Narrative style ... 305
Visibility controlled by an observation ... 306
Visibility controlled by radio button... 306
Vital Signs... 307 Connection reference ... 307 Observation terms ... 307 Clinical functions ... 308 Patient attributes ... 310 Actions ... 312 Flowsheet views ... 313 Flowsheet labels ... 313
B
Update the EMR forms ... 317
Update flowsheet views... 317
Update text and printed form translations ... 318
Update MEL functions and Set Values action buttons... 319
Use EMR E&M Advisor forms ... 319
Edit EMR 2005 E&M Advisor forms... 320
C
E&M Advisor observations and exam
requirements321
Observations recognized by E&M Advisor ... 321D
Technical information ... 347
Uninstall Encounter Form Editor ... 347
Reinstall Encounter Form Editor ... 347
Microsoft Access considerations ... 347
Run-time version ... 347
E
Style guide... 349
Font, style, and capitalization guidelines ... 349
About this guide
Creating Clinical Content for Centricity Physician Office - EMR 2005 is for CentricityTM Physician Office – Electronic Medical Record 2005 users who want to customize the EMR application for use in a clinic. This guide comprises two parts.
The first part, ‘Part A - Creating Encounter Forms’, describes the steps to design customized encounter form components using Encounter Form Editor. It includes information that helps in making decisions about forms, directions for using Encounter Form Editor, and reference material that will help in the design of effective forms.
The second part, ‘Part B- Using MEL’, explains the MEL programming language. MEL can be used to customize the EMR application and create tailor-made encounter forms. Customizations in the EMR application include patient banners, letter and handout templates, chart note templates, and quick text. This manual is also useful for EMR users in creating their own encounter form components using Encounter Form Editor.
Getting the latest information
To get the latest version of this guide that includes any new or updated information added after product release, go to the Centricity Physician Office Services Web site at http://support.medicalogic.com. The publication date of the guide is listed on the document page to make it easy for you to know if you need to download a version that is more recent than the one you currently are using.
Getting the latest information xiii Documentation conventions xiv Other resources xiv
If you encounter a problem xv Contact us xvi
Documentation conventions
The Creating Clinical Content for Centricity Physician Office - EMR 2005 documentation uses the following conventions to represent different types of information:
Other resources
GE offers a variety of other resources to help you get up and running with the EMR application on a daily basis.
EMR online help (F1)
When you need a quick answer about using a particular feature in the EMR application, online help is your fastest route. Wherever you are in the EMR application, simply press F1 for relevant help about the task at hand. You can read about screen items, follow procedures, and browse notes and tips.
Documentation area on the
Centricity Physician Office Services Web site
The Centricity Physician Office Services Web site at
http://support.medicalogic.com, contains the latest, downloadable versions
This convention... Means this...
monospaced type Type this text exactly as it appears. Ctrl + U Hold down the Ctrl key while you
press U, then release both keys. Chart > Clinical Lists Open the Chart folder and select the
Clinical Lists item.
italic type A term that is being defined.
Indicates a note: the information is important and should not be overlooked.3
Indicates a tip: the information points out a shortcut or other convenient, but optional, information!!!
Indicates a caution: the information presented can prevent loss of data.✖
Indicates a warning: the informationIf you encounter a problem of all documentation for the EMR application, LinkLogic, the Formulary Editor, the Encounter Form Editor, and the Messaging applications (with the exception of the online help systems.)
You need a login ID and password to access the documentation area. Contact your EMR Manager if you are unsure of which sign-on information to use.
While at the site you can also: Review known issues.
Search for clinical content in the KnowledgeBank
(http://knowledge.medicalogic.com/) — a repository of encounter forms and other clinical content ready-made by other EMR users.
Join the mailing list and receive email newsletters on topics related to clinical content and the Encounter Form Editor, service packs, and technical alerts.
Training databases
The EMR Single-User Training Database helps you get up to speed with the EMR application and LinkLogic. The database contains a set of patient records that you can practice on without affecting your production records. The EMR Network Training Database is installed when you install the EMR application. You can use this database to simulate multi-user workflows and test setup options without affecting patient records in the production
database.
If you encounter a problem
If you run into a problem while using the EMR application, first try the following:
If you’re inthe EMR application, press F1 and read the online help for your current location in the program and the task you’re trying to perform.
Read any related information in the printed manuals.
Ask your clinic’s EMR Manager or LinkLogic Manager for help. If you’re still having trouble, please contact Centricity Physician Office Services at:
Inside the United States, dial 800.957.6837
E-mail centricityemrsupport@ge.com
Ask questions and receive detailed answers from Centricity Physician Office Services. If you have an urgent question and need immediate help, don’t send e-mail. Instead, call the appropriate phone number above.
Report a defect or an enhancement idea
To report a defect or drop us a line about an enhancement idea, use the
Product Feedback FormonCentricity Physician Office Services Web site at
http://support.medicalogic.com.
Contact us
The Centricity Physician Office Services can be reached by phone in the Portland, Oregon area at 503.531.7000 and elsewhere in the U.S. at 800.322.5538.
Part I—Creating Encounter
Forms
‘Creating Encounter Forms’ describes how to design and create encounter form components for use with the EMR application. This part of the guide is intended to help providers and those who work in clinics design custom forms.
Chapter 1 gives an overview of the EMR application's encounter form com-ponents and Encounter Form Editor (a program that creates form compo-nents).
Chapters 2 and 3 explain the process of designing encounter form compo-nents and describe the basic features of Encounter Form Editor.
Chapter 4 explains MEL, a built-in programming language that is used to fur-ther customize encounter forms in Encounter Form Editor.
Chapter 5 explains the steps involved in creating Evaluation and Manage-ment (E&M) Advisor forms. E&M Advisor helps providers meet Health Care Financing Administration coding guidelines, which specify what, must be documented to bill for a given level of service.
Chapter 6 explains the process of importing the customised encounter forms into the EMR application.
CHAPTER
1
Getting started
Encounter form component: A form used by providers to enter patient information into the EMR applicationThe EMR application includes a variety of standard encounter form
components that make it convenient for doctors, nurses, and other clinicians to enter information into patient charts. If the standard encounter form components don’t support the way you work at your clinic, or don’t collect the right data, you can customize them or design new form components.
About form components
Form components are data entry tools available within the EMR application that make it easy to enter information into patient charts. Form components include “point and click” features such as lists and check boxes to make recording information quick and easy.
Providers insert form components directly into c`hart notes. The form appears onscreen. As the provider enters information in the form, the information appears in the chart note.
A form component consists of three parts, all of which you create with Encounter Form Editor:
Onscreen form component. This is the point-and-click screen that you use to capture data while updating a chart in the EMR application. About form components 3
About Encounter Form Editor 5 About the KnowledgeBank 6
Encounter form tips and limitations 8 Encounter form examples 10
Form design process 11 Create a simple form 13
The onscreen form can’t be printed on paper; it can be used only in the EMR application.
Text translation. As a provider enters data into a form component, the EMR application translates the data entered in the form to narrative text in the chart note. Items not filled out do not appear in the text
translation. When the chart note is signed, the translation becomes a permanent part of the patient chart, and the filled-out onscreen forms for the encounter are no longer available. Providers can review the
translation at any time by opening the patient’s chart and clicking the Documents tab.
Printed form. Sometimes it is useful to print out a text-only version of the onscreen form. The printed form provides spaces for recording data. If the form has been partially filled out onscreen, the data appears in the printed form.
Instead of using the EMR application during the encounter—for
example, if there are no workstations in the exam room—providers can take notes on the printed form. Later, someone else can use the filled-out form to enter data into the EMR application.
About Encounter Form Editor
About Encounter Form Editor
Encounter Form Editor is a program for creating form components. You specify the form items that you want on your form and how you want the data to appear in the chart note. Encounter Form Editor then creates a form file that you can import into the EMR application.
Encounter Form Editor handles many design settings for you, such as item placement, font, and color. Of course, you can customize your forms if the default settings don’t suit your needs.
It’s easy to create simple, effective forms using the defaults supplied by Encounter Form Editor. You can also create complex, sophisticated forms using Encounter Form Editor’s advanced features.
New features in Encounter Form Editor
Encounter Form Editor adds several new features to help you create more useful forms. Here is a list of features added since version 2.1:
Form navigation. New form navigation action buttons add a form component to an update without opening it, open another form component from within a form, or move to a specified page within a form. See Appendix A, “Action Button,”on page 286.
Neworder. Like Newmed and Newproblem, Neworder opens the New Order window with a custom list of orders. (Added with Encounter Form Editor 2.4) See “Action connections” on page 31.
Handout printing. Now you can open the print education handout window and specify a handout to print from a custom list of handouts you create for the form. See “Action connections” on page 31.
Enhanced usability. New larger windows reduce scrolling. Clear buttons on the Customize window automatically clear the Chart Update and Printed Form translation windows.
Open recent form. Click and hold the Open button on the main screen to select from the last six form documents you’ve worked on.
New group library items. New form items in the group library include Add Allergy and Add Directive and Add Medication and Add Problem. See “Add Allergy/Directive/Medication/Problem” on page 302.
Online access to reference manuals. Clicking the View Manual button on any help screen opens the Creating Clinical Content reference manual in a searchable Adobe Acrobat PDF format. Clicking the
Reference button in the MEL Expression Builder window opens the Data Symbols online help.
Encounter Form Editor compatibility
New forms that you create must be edited with with same version of Encounter Form Editor you use to create them. If you open them in an older version, it may break the form, particularly if the form uses new features.
You can easily update older forms by opening them in the current version of Encounter Form Editor. When you save the form, Encounter Form Editor automatically converts it to the current version. See
Appendix B, “Update the EMR forms.”
Microsoft® Access compatibility
If you have installed other tools that are based on Microsoft Access or if you have a full copy of MS Access installed on your workstation, please read
“Microsoft Access considerations” on page 347.
Operating system compatibility
You can run Encounter Form Editor on workstations equipped with Windows 2000 Professional and Windows XP Professional. You cannot run Encounter Form Editor 2.1 on Windows Terminal Server/MetaFrame.
About the KnowledgeBank
Clinical kit: A set ofEMR clinical content files that can be imported into the EMR application
GE encourages providers to develop form components and share them with others. The forms are available as clinical kits on the World Wide Web at the
KnowledgeBank® (http://knowledge.medicalogic.com/). The kits contain editable form description files as well as custom components used by forms, such as flowsheet views and custom problem and medication lists.
Check the KnowledgeBank®before you start designing forms. You may find one there that you can use or modify to meet your needs. Also, consider submitting any forms that you design to the KnowledgeBank®
(http://knowledge.medicalogic.com/).
The KnowledgeBank® (http://knowledge.medicalogic.com/) Web site contains complete instructions for downloading forms and submitting your own forms.
About the KnowledgeBank
Install Encounter Form Editor
GE supplies Encounter Form Editor on CD-ROM. You’ll use the Setup program to install Encounter Form Editor on a workstation running Windows 2000 Professional and Windows XP Professional operating systems.
If you have installed a previous version of Encounter Form Editor, you must remove it before installing Encounter Form Editor. For information, see Appendix D, “Technical information.”To install Encounter Form Editor
1 Exit all applications.
2 Insert the CD-ROM into your CD-ROM drive.
3 Do one of the following:
Click Start, select Run, and type: F:\SETUP.EXE
>
For F, substitute the letter for your CD-ROM drive. Open My Computer, open your CD-ROM drive, scroll until you see the icon for SETUP.EXE, and double-click it.
4 On the Welcome window, click Next to begin installing Encounter Form Editor.
5 On Choose Destination Location , verify the default destination folder or click Browse to select a different folder.
6 Click Next.
7 On Select Components, do the following:
Make certain that Encounter Form Editor is checked.
Verify that the selected location has sufficient space for Encounter Form Editor.
8 Click Next.
9 On Ready to Install Program, click Install.
10 When the installation is complete, click Finish to close Setup.
Local term files. Your site may have requested that GE provide you with special observation terms if the terms supplied with the EMR application don’t meet your needs. Check with the EMR Manager to find out if your site has received local observation term files.
The observation term files are named site.LOT and site.LGR, where site is replaced by your EMR site number—for example 1057.LOT and 1057.LGR.
You may also receive a new KEYWORDS.TXT file.
Updated term files. GE periodically updates the list of observation terms based on customer requests. You can always download the latest observation terms from the KnowledgeBank® (http://knowledge.medicalogic.com/). Always use the latest terms when creating form components or your form may not work properly on other EMR systems.
When you download observation terms from the KnowledgeBank®
(http://knowledge.medicalogic.com/), you receive a Zip archive with several files. Encounter Form Editor uses the files TERMS.FOT, TERMS.FGR, and
KEYWORDS.TXT.
To install local or updated observation term files, copy the unzipped files into the Encounter Form Editor installation directory, usually C:\CLINICAL TOOLS.
Use Windows Explorer to copy the files. If you use a DOS window, the files may not copy correctly.Make sure you’re using the same set of observation terms present in the EMR application. Ask your EMR Manager if you’re not sure.
Avoid using local observation terms in your forms if you intend to share them with providers outside your organization.
Install Acrobat Reader and online manuals
The Encounter Form Editor CD-ROM includes the Creating Cliniccal Content for EMR 2005 guide in Adobe Acrobat® format (PDF). When you install Encounter Form Editor, this document is saved to your computer.
The CD-ROM also includes Acrobat Reader 5. You do not need to install Acrobat Reader from the CD-ROM if you already have Acrobat 5on your computer.
Encounter form tips and limitations
Here are some tips to keep in mind while designing forms:
Check the KnowledgeBank® (http://knowledge.medicalogic.com/) to see if there’s a form you can use as is or modify. Modifying forms is usually
Encounter form tips and limitations Become familiar with the EMR application. Get to know the EMR
application’s capabilities before you start designing forms. In the training database, open several of the supplied form components to become familiar with how they work.
Practice with Encounter Form Editor first. Become familiar with its items and libraries before you start designing actual forms.
Document template: A chart note template that includes form and text components
Work with small form components. Small forms are easier to work with than large ones. You can combine several form components in a
document template for a specific type of encounter. If your components are modular, you can use them in several document templates.
Consider the order of your form items. The flow of the form should follow the flow of the clinical encounter in which the information is collected.
Group related items. Consider how the form component will fit in with other components in a document template.
Design form components with the user in mind. Create separate form components to be used by providers with different roles. For example, a nurse may fill in the vital signs on one form component, while a
physician might record the results of a review of systems with another component. Two smaller forms are much easier to use than one large form.
Enhance form flexibility. Take advantage of action buttons and form navigation features that permit the user to add a form component to an update without opening it, open a new form component from within a form, or jump to another page within a form.
Use E&M Advisor to evaluate encounters. There are special
considerations for designing E&M-compliant forms. See Chapter 5, “Create E&M Advisor forms.”
Involve users of a form in its design. For example, if a form will be used by physicians, those users should get a chance to review its design. The physician on the Implementation Team is an ideal form
designer—especially if that person has taken the Building Forms and Templates class.
For more information about classes:
Go to the Centricity Physician Office Services Web site at
http://support.medicalogic.com and click EMR 2005, then Training Information.
Inquire by email at centricityemrsupport@ge.com.
Test your forms. Test forms thoroughly using the training database. Never import untested content into a live patient database.
Don’t copy your existing paper form. Encounter forms are more efficient and easier to use than paper. For example, it may be possible to
condense several questions into a list or turn a yes/no question into a set of radio buttons.
Don’t worry about formatting. Plan the flow and content of your form first, without thinking too much about appearance and layout of item location, text color, or font. Most of Encounter Form Editor’s defaults are probably fine.
Don’t include patient information on your forms. The EMR application displays this information onscreen during the chart update.
Design your forms to fit the EMR application’s capabilities. If you can’t do something with the EMR application, chances are you can’t do it with a form component. For example, the EMR application doesn’t support interactive graphics, so you can’t “draw” with the mouse on a form component.
Encounter form examples
Encounter Form Editor comes with two sample forms: History of Present Illness-Heart Failure and Review of Systems. This book relies heavily on these two forms to demonstrate concepts and techniques for form building. Other sample forms are those included with the EMR application. You can find them in your EMR staging area in:
<FOLDERWHERETHEEMRAPPLICATIONISINSTALLED
>
\CLIN-KITS\BASICPR\ITEMS\FORMCOMP
<FOLDERWHERETHEEMRAPPLICATIONIS
INSTALLED>\CLINKITS\SPECLTY\ITEMS\FORMCOMP
For SPECLTY, substitute one of the specialties in this list:
!!!
If you want to modify or practice with forms from the EMR application’s standard clinical kits, make a copy first.Encounter Form Editor’s libraries also include many samples. The item and item group libraries contain preformatted items or groups of items that you can use on your forms. For example, the item library contains a form item for Chief Complaint and the item group library includes a set of form items that
Cardio Derm Ent Gastro HemeOnc IntMed Neuro Obgyn Ophthal Ortho Peds Psych Pulm Uro
Form design process collect vital signs. You can use these items and groups as examples or you can put them in your forms, modifying them if necessary. For more
information, see “Use library items” on page 35, and “Work with item and item group libraries” on page 81.
Form design process
Involve users in the design. Designing and creating a form component is usually a collaborative process involving providers, other medical personnel, the EMR Manager, and the person who creates the form. You may want to form a committee to work on form design.
Think carefully about types of components you’ll need. Remember that forms are often used as components within a document template. Be sure to consider the other items addressed in the document template. Because you can easily mix text and form components, think about what type of
component is best for each part of a patient encounter. Remember that text components cannot store observations.
Expect to revise several times before you are done. You may create several revisions of the form component. Collecting information electronically is quite different from using a paper chart and paper forms. As you work with the form, you will often discover ways to make it easier to use, more useful, or more complete.
Structured data: Data that is highly quantifiable or that limits the number of possible responses
Structure your data. As you design your form, think about the possible ways you might use the data you collect. Keep in mind that forms have two purposes: to document an encounter and to collect data for future analysis. You may want to be able to graph a patient’s weight changes over time, or you may be collecting data for outcomes research. In both cases, the more structured your data, the easier it will be to review, graph, report on, and analyze.
For example, your clinic might want to evaluate treatment modalities for low back pain. If you design your forms to collect very specific data on patient pain levels and treatment options, you can create reports that show how effective each type of treatment was for your patient population. You might do this by using a form item that rates pain numerically rather than just noting that the patient has pain.
Design steps
Here is a brief list of steps used in designing a form. For each step, it shows where you can get more information. Use these steps as a guideline. You may find it more convenient to perform them in a different order. For example, some people start right out by drawing the form on paper (step 6).
To create an onscreen form component
1 Gather preliminary information about the form.
See “Gather preliminary information” on page 22.
2 Start a list of the information items the form will collect and display.
See “List your form items” on page 25.
3 Choose item connections.
For each piece of information, decide how data will be stored, what data will be displayed, or what action will be performed.
See “Choose connections” on page 26. Form item: A screen
object such as an edit field or check box
4 Choose an appropriate form item for each piece of data.
Look at the list of items available in Encounter Form Editor, or use “Form item and connection reference” on page 283. Add the form items to your list. Remember, you can also use form items or item groups from the libraries described in Appendix A.
See “Choose form items” on page 35. Properties:
Characteristics of a form or formatting item
5 Determine each item’s properties.
Each type of item has different properties. For example, you can specify the choices in a list or the number of lines in a multiline edit field.
See “Determine item properties” on page 39. Formatting item: A
form item that controls appearance
6 Plan the flow of your form items.
Consider the most natural workflow for prospective users of your form and plan the order of your form items. Map out how you will make your form easy for users to navigate and complete.
See “Create preliminary form design” on page 44.
7 Decide which formatting items you need to make your form look good. Design the form’s visual appearance using paper, a whiteboard, or other techniques. Designing on paper or a whiteboard helps you visualize how the form will look.
See “Formatting items” on page 46.
8 Use Encounter Form Editor to create the form.
See “Work with forms” on page 53.
9 Customize the appearance of form items.
See “Customize form appearance” on page 66.
10 Import the form into the EMR application.
See “Import the form into the EMR application” on page 165.
Create a simple form Enter information in your form onscreen and review the printed version and the text translation. Change the form as necessary.
See “Test the onscreen form in the EMR application” on page 166.
The process of designing and refining a form is iterative, which means that you’ll repeat many of the steps several times. You may also want to perform the steps in a different order. Use the process presented here as a guide to develop your own methods for creating and testing forms.
Create a simple form
This brief tutorial leads you through creating a very simple form component with Encounter Form Editor. You will create a form that collects a patient’s temperature (typed into a box) and temperature site (selected from a drop-down list).
Step 1: Start Encounter Form Editor
Click the Start button on your Windows taskbar. Select the Programs menu, then the Encounter Form Editor program group, and click Encounter Form Editor.
If this is the first time you’ve used Encounter Form Editor, you’ll need to enter registration information. See “Supply registration information” on page 51. If you don’t have the information, call Centricity Physician Office Services at 800.957.6837.You see Encounter Form Editor’s main screen.
Step 2: Name and describe your form
Before you start creating your form, you need to name and describe the form. Do the following:
Type a name for your form in the Form Name field. For this example, use the name “Temperature.”
Provide a short description of the form. It’s also useful to include a version number and the author’s name.
Type the path for the folder in the EMR application where you want users to find your form. Type:
ENTERPRISE\BASIC\EXAM\TEMPERATURE
This is not a Windows file system path. This is the folder hierarchy in the EMR application. The actual hierarchy depends on how the EMREncounter Form Editor looks like this:
Step 3: Set font and style for text translations
You can set the default font and text style for your form’s chart note text translation on the main screen. You can also customize the appearance of individual form items as you add them.
1 To set a default font for the text translation click in the Chart Note Font
list.
The default font setting is Arial 10 point.
2 To set a default style, click a radio button under Chart Note Style. You can choose bold labels only, bold values only, or neither bold.
Step 4: Edit the form and add a Begin Section item
Now you’re ready to start adding items to your form. Click the Edit button to begin.
Because you’re starting a new form, the Edit Form window appears ready to insert a Begin Section item. Since every form must start with a Begin Section, we’ll add one.
1 Provide a name in the Section Name field.
This name is also the page name for our form, so let’s make it descriptive. Type:
Temperature
2 Check Group Box for First Column so the form will have a group box around it.
Enter the form name here Describe the form here
Set default font and style here
Create a simple form The Edit Item window should look like this:
3 Click Close.
Step 5: Add items to the form
After you’ve added the Begin Section item, you see the Edit Form window. This is where you add items to your form.
1 Click New Item to bring up the Item Finder. Click here to add
2 Select Edit Field, which is the type of item you’ll use to collect temperature. Click OK.
3 In the Label field, type: Temperature:
Create a simple form
4 To connect the temperature field to an observation, click Connect To and select New Observation in the Connect Item Finder. Click OK.
5 Type temp in the Search For field and click Search.
6 Select the observation term Temperature. Then click OK. You see the Edit Item window again.
1 Click the Next Item button to add a temperature site item.
2 Click Item Type and select Drop-Down List from the Item Finder. Click
OK.
3 In the Label field, type: Temperature site:
4 Type the following in the choice list. Separate the words with commas. oral, rectal, axillary, tympanic
3
You can add spaces between the items to improve readability, but they’re not necessary.5 Check the Limit Entry to Choice List check box. The Edit Item window looks like this:
6 Click Close in the Edit Item window.
You see the Edit Form window again with your two form items.
Click here to add another item Click here when you’ve finished adding items
Create a simple form
7 Click Close on the Edit Form window.
You see the main window for Encounter Form Editor.
Step 6: Save your form
Once you’ve added the items to your form, you need to save it. Encounter Form Editor saves your form in multiple file formats, two of which are especially important:
A copy of the form description (.fd) file that you can edit using Encounter Form Editor.
A clinical kit (.ckt) file which you can import into the EMR application.
1 Click Save As on Encounter Form Editor’s main window.
The name you gave the form appears as the file name in the Save File window.
2 Click Save.
Click here to save your form
Encounter Form Editor shows its progress as it saves your form and creates a clinical kit for import into the EMR application.
3 Click Close in the Save window.
Saving in Encounter Form Editor is different from saving in mostapplications. Because your work in Encounter Form Editor takes place in a database, it saves every change you make as you make it. That means that if your computer crashes, the power goes out, or you inadvertently close Encounter Form Editor, you won’t lose any information. When you open it again, Encounter Form Editor will ask you if you want to recover the form you were working on.
When you save a form in Encounter Form Editor, it creates a set of files that can be imported in the EMR application or read back into Encounter Form Editor.
Step 7: Exit Encounter Form Editor
Click the Exit button to exit Encounter Form Editor.
That’s it! You’ve created a form component. You’ll need to import the form into the EMR application to view or use the form. For instructions, see
CHAPTER
2
Design the form component
This chapter details the steps you take to design a form. Using the History of Present Illness - Heart Failure form as an example, you’ll walk through gathering up-front information gathering and specifying form items for a preliminary form design.
Depending on how you like to work, you can do these steps in advance or start building the form in Encounter Form Editor as soon as you jot down some basics ideas. If you want to work with Encounter Form Editor directly, read Chapter 3, “Use Encounter Form Editor,” before you start.
About the sample form 22
Gather preliminary information 22 List your form items 25
Choose connections 26 Choose form items 35
Determine item properties 39 Design for text translation 40 Create preliminary form design 44
About the sample form
The sample form, History of Present Illness - Heart Failure, is supplied with Encounter Form Editor. It looks like this:
Gather preliminary information
The first thing to do is to gather basic information about the form. For a guide to organizing form requirements, see “Form Information Sheet” on page 24. Collect this information:
Organization. The name of the organization for which you are designing the form.
Contact name. The person you can contact with questions about the form. This is usually a provider.
Phone. Your contact’s phone number.
Name of form. The title of your form as it will appear in the EMR application’s list of form components.
The form’s title should accurately describe its purpose, whether the form is used for diagnostic purposes or for post-exam documentation.
Titles can be up to 30 characters. If you use abbreviations or acronyms, be sure they’re easily understood.
EMR location. The folder path of the form.
Purpose. Briefly state the purpose of the form. What information is being collected and why? What happens to it after it is collected? Will the information being collected be used to document a patient encounter or for later analysis?
Gather preliminary information Users. List the form’s users: physicians, nurses, lab staff. Keep your users in mind as you design the form. Use appropriate terminology and level of detail for your audience.
When. How often is the form used? For more frequently used forms, it may be appropriate to use more abbreviations. If a form is used infrequently, you need to make sure it is very easy to understand and use.
Disposition. If the form is based on a paper form, note what usually happens to the paper form after it is filled out.
If the form you’re designing is based on a paper form, try to get at least three different examples of the filled-out form. Reviewing the information typically recorded on the form helps you understand how to convert it to an onscreen form. For confidentiality, hide any sensitive information on the paper copies.
Sample form information worksheet
Imagine that you have been asked to create a form component for collecting History of Present Illness information for patients with congestive heart failure. We’ll use this form component as an example throughout this manual.
As your first step, you gather general information about the form. Use the following worksheet as a guide for the type of information to collect.
Form Information Sheet
Additional information:
Organization: Westside Clinic
Contact name: Dr. Alice P. Merriwether
Phone: 503-555-1234
Name of form:
(limit 30 characters)
HPI - Heart Failure
Purpose:
Why collect this information?
Part of standard exam for congestive heart failure patients.
Used by:
Who will use the form?
Physicians, nurses
When:
When and how often is this form used?
1 to 2 times per day
Disposition:
If based on a paper form, what happens to the paper form after it is filled out?
Used for data entry
Faxed to
Filed in paper chart
Other
Mailed to_____________________
List your form items
List your form items
Next, start listing the items to be included on your form. Think of your list as an evolving document. As you work with the form, you will probably revise the list.
Make a list of form items
1 Consider which items of information you want to collect and which you want to display.
Information to collect. First, list the information you want to collect. For example, your list for a History of Present Illness component might include Chief Complaint, Referral Source, and Symptoms.
Information to display. Next, think about other information that would be useful to display on the form. You can display patient attributes, data collected from previous encounters, or lists of problems, medications, allergies, directives, orders, and preventive protocols. If any of this information would help the person filling out the form, include it in your list.
3
Use the paper form that you want to convert as a guide as you list the form requirements.2 Decide the order that items should follow.
Examine your list of items and decide what order they should appear in. The form should follow standard clinical workflow. Revise your list as appropriate. For a suggested clinical workflow, see “Clinical workflow” on page 350.
3 Revise the list and label each item.
Make a final list using a word processor or spreadsheet. Add a descriptive label for each item or group of items.
Example
Your clinic wants to convert a paper form for collecting history of present illness information for congestive heart failure patients. You use the paper form to determine the items for the electronic version of the form. You may even start drawing sketches of what you want the form to look like so you can group related items.
Later, you’ll expand this list with connections, form items, and properties for each item. Here’s what you came up with:
Chief complaint Current symptoms Current treatment items
Diet
Home oxygen (flowrate if yes) Compliance with treatment regime Comments
E&M evaluation
Choose connections
Many form items have connections, item properties that store data, display data that’s already in the database, or perform an action. Encounter Form Editor supports three basic types of connections.
Storageconnections store data from the form in the EMR database. Display connections display data that can’t be changed on the form. Action connections cause changes on your form, help you navigate
through form pages, interact with other parts of the EMR application, or run another program on your computer.
Not all types of connections are available for each form item. Appendix A, “Form item and connection reference,” contains information about the connection types, which form items can use them, and the connection options for each type.
About observations
Observation: Qualitative, quantitative, or semi-quantitative clinical facts about the patient
One of the most powerful features of forms is their ability to display and store clinical observations. You can do things with observations that you can’t do with text in the chart note:
View observations in the flowsheet to track them over time. You can view all observation values under 255 characters in the Flowsheet.
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Some larger observations—for example, Chief Complaint—may be cumbersome be viewed in the flowsheet. You can still display them in encounter form data display items or reports, however. Graph numeric observations to see trends. Include observations in reports.
Use observations in inquiries to find certain patient records. For example, you can select all patients with cholesterol values over 200.
Choose connections Protocol: A set of rules that determine whether a patient is due for a test
or other procedure
Use observations to trigger protocols, informing the provider that specific interventions are due.
Many, but not all, EMR observations can be evaluated by the EMR application’s E&M Advisor, a form-based tool that helps providers meet coding requirements. If you plan to use E&M Advisor with your forms, you should choose observations that E&M Advisor knows about. For more information about E&M Advisor forms, see Chapter 5, “Create E&M Advisor forms.”
How to find observations
There are two ways to locate the observation terms you need: Print a report
Search and browse the list of observation terms
Report. You can print a report of all the observation terms in the EMR application that you can keep handy while designing forms. See
“Observation terms” on page 307 for instructions.
Search or browse. Encounter Form Editor provides the Centricity Physician Office Term Finder, which enables you to search for observations using key words. You can also browse a categorized list of observation terms. See “Use Centricity Physician Office Term Finder” on page 64.
Local observation terms, if you have them, appear in the report and in the Centricity Physician Office Term Finder.If you can’t find an observation term you need, you can ask GE to create one for you. A request form is available on the KnowledgeBank®
(http://knowledge.medicalogic.com/) or you can contact your GE account representative.
Storage connections
You’ll need to decide how to store each piece of information that providers enter on your form. Storage connections dictate how the data can be used later.
Information from forms can be saved as text or it can be stored as
observations in the EMR database. The chart note provides a good summary of everything that happened in an encounter for the patient record.
Encounter Form Editor supports three types of storage connections. See the following headings for details on each type.
Temporary Variable connections store data temporarily in the database and permanently in the chart note as text.
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The temporary variable connection is selected by default in the Connect Item Finder for items that support this connection. New Observation connections store data as observations in the EMRdatabase as well as in the chart note.
New Obs (Default Prev) connections display the most recent observation value and allow you to enter and store new data. The previous value is displayed for reference purposes.
New data is stored as an observation in the database and the chart note only if it is entered on the form. If the clinician doesn’t enter any new data, the previous value for the item is recorded in the chart by default, but not as a new observation.
Temporary Variable connections
Use a Temporary Variable connection to store data in a chart note.
The chart note displays information as it is entered in the form and holds it until the chart update is signed and the information is permanently stored in a chart document.
Temporary variable: A temporary storage place for form data until the update is signed
In Encounter Form Editor, this method of storage is known as a temporary variable, because the information is held temporarily until the update is signed.
New Observation connections
Usethe New Observation connection to record new data as an observation. Observations are stored in the EMR database, where they can be easily searched. The EMR application supplies hundreds of observation terms, which are categories of observations, such as weight.
Some observations can be evaluated by E&M Advisor. For a list of E&M observations, see Appendix C, “E&M Advisor observations and exam requirements.”
New Obs (Default Prev)
Use the New Obs (Default Prev) connection to display observation data already in the database and collect new data if anything has changed.
Choose connections For example, family histories don’t change very often. If you use New Obs (Default Prev), the current family history from the database is displayed on the form, and you can change it if the patient reports anything new. If the provider does not enter any new information for the item, the text translation displays the previous value by default. A new observation is not recorded in the database.
Data display connections
You can display patient registration or clinical information already stored in the EMR application on your form. This information cannot be edited directly on the form, although you can include an action button to take the user to the part of the EMR application where they can change clinical data, such as the Update Problems dialog box.
Encounter Form Editor supports the following connections that display previously collected data. See the following sections for details on each connection.
Previous Observation connections display the most recent signed observation value.
Prev Obs with Date connections display the most recent signed observation value and its date.
Clinical Function connections display stored clinical information about the patient, such as problems, medications, allergies, and directives. Patient Attribute connections display demographic information about
the patient, such as phone number or employer.
Flowsheet connections display observations collected over time. MEL expressions allow you to customize the data display.
Previous Observation
You can display observations recorded during previous encounters. Only the most recent signed observation can be displayed with a Previous
Observation connection. For example, you could use a Previous
Observation to display an adult patient’s height. (Because a child’s height changes, you’d want to use an Edit Field instead of a Data Display item.)
Prev Obs with Date
You can display the most recent signed observation along with the date it was entered. Use this for a single observation. To display several
Clinical Functions
Clinical function: Adata display connection that displays a clinical list
The EMR application also supports inclusion of clinical functions, which display a patient’s clinical lists of coded items with descriptions. Clinical lists include:
Problem list. Medical problems. Medication list. Medications. Allergy list. Patient allergies.
Directive list. Patient directives, such as living will information. Order list. Medical orders.
See “Clinical functions” on page 308 for a complete list of clinical functions. You can display the contents of the clinical lists in several ways:
You can also use clinical functions to show observations made during the encounter, to display a list of assessments made during the encounter, to list observations and interventions due according to patient protocols, and to list medication refills made during the update.
For medications, none of these clinical functions will show expired medications entered during the update. For example, if the data isn’t entered until three weeks after the encounter and the prescription was for only a week, the medication won’t be displayed.Patient Attribute
You can display patient registration information. For example, you may want to display the name of a pediatric patient’s parent or guardian.
This type of display... Shows this data...
After Items on the list before the current update and items added during the current update
New Items added during the current update Prior Items on the list before the current update Removed Items removed from the list during the current
update
Changes Changes made to the list during the current update
Choose connections
Flowsheet
Flowsheet: A tabular view of clinical observations over time
Flowsheet connections enable you to display one or more flowsheet views on your form. Flowsheet views are set up in the EMR application to display a set of related observations together, such as vital signs or immunizations. To connect a flowsheet view to your form, you must know the pathname for the folder that contains the view in the EMR application. You can determine the pathname in the EMR application by using the Large List Lookup
function on the chart Flowsheet tab.
Determine flowsheet pathnames
1 Start the EMR application.
2 Open a patient chart.
3 Click on the Flowsheet tab.
4 Click the Large List Lookup icon.
5 Click on the Enterprise folder, then on the folder that contains the view you want.
6 Record the folder hierarchy as shown at the top of the Find Flowsheet View window.
For example, you want to display a flowsheet view with the results of a lab test for lipids. You use the Large List Lookup function to examine several flowsheet views and note the path for the one you want to use:
ENTERPRISE\LAB PANELS\LIPIDS
When using flowsheet path names, be sure to note them exactly as they appear in the EMR application, including capitalization.MEL expression
A MEL expression connection allows you to create a custom data display using EMR data symbols and observations. For more information about writing MEL expressions, see Chapter 4, “Use advanced features.”
Action connections
With action connections, you can make buttons on your form that take you to other screens in the EMR application or run other programs on your
Add Directives opens the Update Directives dialog box so you can view, add, change, or remove patient directives.
Add Flowsheet opens the Update Flowsheet dialog box so you can view, add, change, or remove observations or change the flowsheet view. Add Form Component adds a form component to an update without
opening it.
Add Medication opens the Update Medications dialog box so you can view, add, change, or remove medications.
Add Orders opens the Update Orders dialog box so you can view, add, change, or remove orders.
Add Problems opens the Update Problems dialog box so you can view, add, change, or remove problems.
Jump to Tab opens a specified page within a form.
Calculation performs a calculation and displays the results in one of the other form items. You write calculations using MEL. For more
information, see “Write calculations” on page 126. Custom list: A
user-defined list of problems or medications
New Handout opens the Print Education Handout dialog box to a specific custom list of handouts.
New Med opens the New Medication dialog box with a specified custom list of medications.
Choose connections New Order opens the New Order dialog box with a specified custom
order list.
New Problem opens the New Problem dialog box with a specified custom problem list.
Open Form Component closes the current form and opens another form component.
Run Process lets you run a program that isn’t part of the EMR
application. It could be an executable file (program.EXE), a batch process
(job.BAT), or any other program that you can run from a DOS command line.
For example, you can run a process that reads data from a home monitoring device and places it into the patient’s chart. You could also open the Windows Calculator, if that is useful in your form.
Set Values buttons fill in values in other form items. For example, you can have a Set Values button that fills in normal findings for items in a physical exam.
Use custom lists with action connections
The EMR application custom lists display a group of related items such as problems or medications. Custom lists are the easiest way to quickly add a new problem, medication, or order. Newmed, Newproblem, and Neworder action connections require custom lists, which greatly reduces the number of items from which a provider must choose. A form user can merely type the first few characters of the desired item, and the list automatically scrolls to that item.
For example, on a form for an asthma visit, you might use custom lists of asthma medications and asthma problems. Then the provider won’t have to scroll through the entire list of medications or problems to find appropriate choices for the asthma visit.
Find the names of medication and problem custom lists
1 Open the EMR application.
2 From the Go menu, select Setup, then Settings.
3 Select Chart > Medication (or Problem) Custom Lists.
4 Note the name of the list you want to use.
You’ll find orders custom lists from the Setup menu. Click Settings, then Orders.need to create a a custom list containing selected patient education or other custom handouts. From Setup, click Settings, then Handouts.
Connections example
You’ve created a list of items you want to collect information for on your form. Next, you add connection information for each item. Note which items connect to temporary variables, and which are stored as observations. Also notice the varieties of observation connections. You can use the Centricity Physician Office Term Finder to determine which observations to connect to.
Your list now includes a new item, “Flow Rate for Home O2 Treatment.” You don’t want this item to show unless the patient is receiving home oxygen.
Form items Connections
Referral source Temporary variable
History from Temporary variable
Reason for visit Temporary variable
Chief complaint New observation [Chief Cmplnt]
Current symptoms Temporary variable
Current treatment None
Notes: This is a heading
Diet New Obs (Default Prev) [Diet Plan]
Notes: This will display the diet plan if one has already been assigned to the patient. A new one can be entered.
Home oxygen New Obs (Default Prev) [O2 Treatment] Notes: Make this a yes/no and display/collect flow rate if yes.
Flow rate New Obs (Default Prev) [Oxygen Flow]
Compliance with treatment regime
Connection: New Observation [Meds Review]
Notes: Use good, fair, poor radio buttons.
Comments Temporary variable
E & M evaluation New Observation [HPI level]
Notes: Use radio buttons for brief (1–3 items) and extended (4+ items). Might need to add some explanatory text.
