IMPACT Support
During Go-Live their will be roamers to support you and answer questions.
Know who your clinic’s super users are. They will be a valuable resource on going.
Check out the UAB Ambulatory EHR web site. All training materials are posted there.
http://impactehr.hs.uab.edu/
Utilize the IMPACT Help feature. From any screen in IMPACT, choose Help from the menu bar.
Table of Contents
Introductory Material
9Information Security and Confidentiality
9Device Types
9Guidelines for Passwords
10Logging Out
11Schedule Viewer
13Accessing Schedule Viewer
13Overview--Schedule Viewer
13Changing Views
14PowerChart Basics
15Menu Bars, Tool Bars, and Task Bar
15Opening a Patient Chart
18Patient Search
18Select Patient from Recent Charts Opened
19Open a Chart from Schedule View, Patient List, or Task List
19Change Encounters from Visit List within EMR
20Chart Overview
21Demographic Bar
21Menu
22Compared to Inpatient
22Data Retrieval
23Chart Overview
25Immunization Schedule
25Advanced Growth Chart
26Horizon Summary
27Reference Text Browser
27Printing
28Additional Chart Menu Components
29Ambulatory Summary
29Overview
29Other Features
29Collapse All / Expand All
30Customize View
30Adding Orders
31Managing Medications
31Help
31Reports and Documents
33Problems and Diagnoses
34Viewing Problems and Diagnoses
34Add a Problem
35Modify a Problem
36Add a Diagnosis
37Modify a Diagnosis
38Remove a Diagnosis
38Converting a Problem to a Diagnosis
39Converting a Diagnoses to a Problem
40Create a Favorites Folders
41Adding a Problem or Diagnosis to a Folder
42Mark All Problems and Diagnoses as Reviewed
42Medication List
44Documenting Historical / Home Medications
44Right Click Options
46MAR Summary
48Allergies
50Allergy Basics
50Add an Allergy
50Add an Allergy to Your Favorites
53Tips and Tricks
53View Allergy History
53Cancel an Allergy
53Modify an Allergy
53Mark Allergies as Reviewed
54Document No Known Allergies (NKA)
54Perform a Reverse Allergy Check
54Health Maintenance
56Health Maintenance Basics
56View Expectation History
57Default Settings
58Satisfy an Expectation
59Performed Elsewhere
62Postponed
62Refused
63Cancel Permanently
64Adding Pending Expectations
65Unchart an Expectation
66Undo Satisfied Expectation
67Sorting Reviewed Expectations
67View Results in Recently Satisfied Expectations
67Form Browser
69Histories
70Histories Basics
70Adding History
70Modify History
70Mark as Reviewed
70Filters
70Past Medical History
71Reviewing Past Medical History
71Adding Past Medical History
71Modify Past Medical History
71Procedure History
73Reviewing Procedure History
73Adding Procedure History
73Modify Procedure History
74Family History
75Reviewing Family History
75Adding Family History
75Quick List
76Adding family members
77Adding groups
77Modify Family History
77Social History
78Reviewing Social History
78Adding Social History
78Types of Social History
80Alcohol
80Employment/School
81Exercise
81Home/Environment
82Other
83Sexual
84Substance Abuse
84Tobacco
85Modify Social History
85Pregnancy History
86Reviewing Pregnancy History
86Adding Pregnancy History
86Orders
88Orders Basics
88Navigator Overview
88Order Profile Overview
89Order Filters
91Placing an Order
91PowerPlans
96Advance Beneficiary Notification (ABN) Checking
100Order Actions
101Displaying Order Information
102Favorites
102Adding Orders from the Ambulatory Summary
104Acting on Proposed Orders
105Task Lists
106Task List Basics
106Single Patient Task List – Chart Level
106Multi-Patient Task List – Organizer Level
106Task-at-a-Glance Legend
107Using Task Filters
107Charting Tasks
111Chart Done
111Chart Details
111Chart Not Done
112Unchart
112Chart Med
112Chart IV
113Other Task List Actions
114Reschedule a Task
114Create and View an Admin Note
115Multi-Select
115ePrescribe
117Entering a New Prescription
117Proposing Prescriptions
118Routing Prescriptions
119Adding/Selecting a Pharmacy
121Rx Plan Eligibility
122Formulary and Benefits
123External Medication History
123Create a Prescription from Favorites
125Activating a Proposed Prescription
125Reprint a Prescription
127Depart Process
128Follow-Up
128Patient Summary
129Medication Reconciliation
130Message Center
131Message Center Basics
131Basic Navigation
131Searching For Messages in a Specific Date Range
131Creating a New Message
132Additional Options when Creating a Message
133Replying to Messages
133Forwarding Messages
133Deleting Messages
134Signing Documents
134Medication Renewals/Refills
134Requesting a Medication Renewal (Non-Physicians)
134Requesting a New Medication (Non-Physicians)
135Approving a Refill Request
136Refusing a Refill Request
136Modifying a Refill Request
136Approving a New Order Proposal
137Results
137Viewing a Result
137Signing a Result
137Forwarding a Result without Signing or Refusing It (Forward
Only)
138Signing and Forwarding Results
138Generating a Patient Result Letter
138Orders (Cosign and Refuse)
139Approving Orders
139Refusing Cosign Orders
139Proxy Authorization
140Granting Proxy Authorization
140Updating Proxy Authorization
141Viewing Messages as a Proxy
142Viewing Proxy Authorizations Granted to You
142Viewing Proxy Authorizations that you have granted
143To Steal a Proxy
143Pools
144Working with Messages as a Member of a Pool
144Managing Pools
144Notifications and Reminders
145Reminders and Notifications Basics
145Creating a New Reminder
145Reminder Options
146Redirecting a Reminder
146Rescheduling a Reminder
146Generating Quick Reminders from Results
147Setting a New Notification
147Message Journal
147Introductory Material
IMPACT Ambulatory is a component of the electronic medical record. UAB Health System has customized Cerner Corporation’s software to meet our organization’s needs. The programs are housed on a secure computer server that can be accessed only by authorized users. Data storage and transmission along with computer and printer use are as important as personal actions when safeguarding confidential heath records.
Information Security and Confidentiality
Every employee must sign a Confidentiality Agreement Form after reading the standard
Confidentiality of Information. This standard outlines the measures you must take to ensure the security of health information which includes protecting your password, accessing records only when you have a work-related need, and proper use of computers. Every person granted access to the electronic medical record is responsible for following the standards.
You should not access information on patients unless you are directly involved in their care. This includes your own records and those of family members. Accessing information on patients when you are not directly involved in their care is considered a breach of confidentiality and is against Health System policy. This may result in termination. Employees should go through HIM (Health Information Management) department or the medical records person in a physician's office to view their own records.
Device Types
Computers used within the institution include:
Desktops that contain a hard drive to run some programs
Sun Ray machines (thin clients) that do not contain a hard drive but run programs on the Citrix Web. A sun card is required to use a thin client.
Notebooks or tablet style computers
Any identifiable patient data should not be downloaded to unencrypted transportable devices such as thumb drives or handheld computers.
Printers are a part of the IMPACT configuration. Not all printers in the clinics are on the Cerner network. Some printers connected to a PC will not print from Cerner. Cerner network printers are labeled on the front with an identification name that can be found in IMPACT printer lists. Printers may be:
Local printers that are not connected to IMPACT.
Multi-Function Devices (MFD) that have the capacity to print, fax, or print prescriptions on tamper proof prescription paper from a special drawer
Printers set to accommodate printing portions of the record using Medical Record Publishing (MRP). Only select positions can use this functionality.
Scanners are used to import printed material into the electronic record.
Do not move a computer or printer in your work area. Place a request through HSIS to have a technician move the device.
Guidelines for Passwords
When selecting a password, don’t choose anything obvious, such as your birth date, social security number, or spouse and children’s names.
Passwords need to be eight characters long and contain at least one number, three letters and one special character.
Do not tell anyone your password. Your sign-on code to the IMPACT System should be protected the same ways you would protect your legal signature to keep it strictly confidential.
Do not leave the computer while still signed on. If you leave the computer without signing off and someone else uses it to view or enter data, you are responsible. Always sign off the computer when you walk away.
Giving your code to someone to use or signing on the computer and allowing someone to perform functions under your name is considered a breach of confidentiality and by Health System policy is grounds for termination.
If you must write your password down to remember it, do not leave your password in a location that can be accessed by others.
To help you remember, use the same password for Citrix and PowerChart. .
Log In Activities
To access the IMPACT system you must first log in. There are two log in steps for IMPACT; the first log in is for Citrix Web Interface. Access the Citrix Web login screen by double clicking on the IMPACT icon on a desktop computer or inserting your Sun Ray Card in a Sun Ray machine. To use a Sun Ray, place your sunray card into the machine’s slot with the gold label toward the machine. Type in your name and Citrix log in password.
The second log in for IMPACT is for Cerner PowerChart. To log in to IMPACT PowerChart:
1. Verify the correct domain name appears in the Domain window. Actual patient care
documentation will be performed in the PROD domain. Instructions will be provided when another domain is to be used for testing, training, or practice.
2. Type your User Id in the User name field.
3. Press the Tab Key on the keyboard OR click (with the mouse) in the Password field. 4. Type your password.
5. Press the Enter key OR click on OK.
Logging Out
When you have completed your activities, remember to log out of PowerChart for security purposes.
Logging out of PowerChart is best done by clicking on the Exit icon in the Tool Bar.
If you are working on a SunRay and are moving to another location to resume work immediately, you do not need to log out of PowerChart. Remove your sunray card and insert it in the machine in the new work location. Type in your Sunray password and select OK. The screen will appear as it did when you left it on the first machine. Do log out of PowerChart and Citrix by clicking the Exit icon on the PowerChart toolbar and selecting LogOut from the Start Menu when you are not going to be using IMPACT for a while. You must log out of a SunRay if you are moving to a PC to use IMPACT.
Schedule Viewer
Schedule Viewer is a tool to view the IDX schedule for a resource (provider or location) within Ambulatory IMPACT PowerChart. The schedule can be viewed in a daily, weekly, or monthly calendar. Patient charts can be opened from the Schedule Viewer by right-clicking the
appointment line item, selecting Open Chart, and selecting the chart section. Double click a patient’s name on the schedule to open that chart to the Ambulatory Summary.
Accessing Schedule Viewer
The schedule is the Home view. For some positions, the schedule will be the first screen seen at login. You can access the Schedule Viewer any time you are in PowerChart by clicking the Home icon on the toolbar.
Overview--Schedule Viewer
(1) Message Center appears in the left pane.
(2) Today’s date defaults in the date field. Change the date by typing in the field or using the control buttons at the right of the field.
(3) Click the recent button to display recent resources (providers, clinics) that you have viewed. Click on the resource to fill in the Resource Field.
(4) Type in the last name of a provider or a clinic location and click the search icon to see potential matches; click on match to make a Resource selection.
(5) View the patients scheduled for that day for the selected resource. Note times display at the left and when the application is opened, the schedule displays the current time. Use
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the scrollbar at the right to move up and down the page to see earlier and later appointments.
If you leave your Schedule Viewer up, click the Refresh button to get up to the minute information about check-ins.
The appointment line color indicates the appointment status:
IDX Event Color
Scheduled Teal
Checked In Lime Green
Cancelled Red
No Show Peach
If changes to appointment types, such as New or Return are made in IDX, the initial type will continue to display on the schedule in IMPACT.
Changing Views
To change the view of the schedule: 1. Click Schedule on the toolbar. 2. Select View from the dropdown list.
PowerChart Basics
IMPACT PowerChart is designed to operate in two main views: the Organizer and the Patient Chart. The Organizer allows you to access patient charts by a patient list, a schedule, or through the Message Center. The Patient Chart view is similar to a paper chart. It is made up of different pages or views where you can record or view patient specific information such as allergies, medications, immunizations, orders, and problems, among others. Access to views is dependent on your user sign on.
Menu Bars, Tool Bars, and Task Bar
The fist menu row on the screen is shown below. The menu row, like other chart options, may differ from that shown based on your sign-on. Clicking a menu item reveals the options shown in the table. Items that are dithered (grayed out) are not available for your access.
Dropdown arrows separate the toolbars. It might be necessary to click the arrow to see “hidden” icons. You can click on the arrow and drag the toolbars to rearrange them.
Task Change password, Reports, Print, Refresh, Exit Edit Options are dithered and unavailable for all users
View Home, Message Center, Patient List, Toolbars, Women’s Health Tracking List, Case Selection, Hide Patient Demographic Bar
Patient Links to options offered on the Patient Toolbar: Patient Search, Recent Patients; New Medication List, Allergies, Orders, New Sticky Note and PowerNotes
Chart Menu links, Ad Hoc Charting, Clinical Calculator, Depart process and Close Chart
Links FirstNet, Explorer Menu, Paging, LabSource, UAB Formulary, Help Scheduling Scheduling Reports, View, Preferences
Help Links to Cerner Help topics
The Organizer Toolbar is divided into sections shown below:
Click the icon to open the application. o Home view is the patient schedule.
Links Toolbar:
Notifications Toolbar:
Alerts appears on toolbar for physician or mid level provider (MLP) positions when there are critical results to review, orders to cosign, or new messages.
Action and Notification Toolbar:
Click the Exit icon to exit the application.
Click Communicate to enter a message. Click the dropdown arrow to select a message type.
Patient Toolbar:
The Recent button will display up to the last 5 patient records you have opened.
In the Name field, you can type the patient’s last name followed by a comma or Medical Record Number (MRN) and click the binoculars search icon to search for a patient.
Refresh Button: In some views the refresh button appears.
Click the refresh button (minutes ago) after taking action in IMPACT Ambulatory to ensure the system processes the action immediately so you see the most up to date information.
The Task bar is at the bottom of your screen. In addition to Start, icons display for applications you have open. Minimized programs can be maximized by clicking the button on the task bar.
When you leave a PC, you should exit IMPACT Ambulatory. Leaving a program minimized allows another user to enter data using your password. As seen in the example below, you must hover to see the details of two PowerChart applications that have been minimized. It is easy to mistakenly choose someone else’s’ IMPACT session.
The System tray is at the bottom right of the screen. Clicking the arrows <<< expands the bar to show system options. Note the Citrix- Logged On icon.
Opening a Patient Chart
It is critical when entering data that the correct patient and correct episode (visit) be selected. There are multiple ways to select a patient.
Patient Search
You can quickly search for a patient by name or medical record number (MRN). To select a patient by name, type the patient’s last name, comma, first name in the Name box on the Patient toolbar and click the binocular search icon.
To search by MRN, click the drop-down arrow at the end of the name field, select MRN, and type in the MRN before clicking the binocular search icon.
Typing the last three letters of the patient’s last name, first three letters of the first will yield search results but is not recommended due to the number of patient such a search returns compared with typing the full last name and full first name.
The patient search window opens
In this example, only the last name was entered for the search and multiple patients have been returned. The upper pane displays possible matches for the search. The bottom pane lists
episodes for the highlighted patient. You can sort the columns (encounter type, registration date, etc) by clicking the column heading.
Never double-click on the patient name in the upper pane to open a chart.
Always select the correct encounter in the bottom pane and open the chart by double-clicking the encounter or highlighting the episode and clicking OK.
You can search for patient by Name, Medical Record Number (MRN), Financial Number (FIN), and many other criteria. To open the search box without entering a patient name first, click on the binocular search icon. Click the search button after entering your search criteria.
Select Patient from Recent Charts Opened
Click on the drop-down arrow next to Recent in the Patient Toolbar to view up to the 5 last patient records you opened.
The chart will open to the last visit you had open which may not be the correct visit for action you plan on this chart conversation.
Open a Chart from Schedule View, Patient List, or Task List
Right click the patient line and select Open Chart. From the Schedule Viewer, the chart will open to the scheduled visit. This may not be the correct visit on which you need to work.
From the Patient List, the chart will open to the visit associated to the list. This may not be the correct visit on which you need to work.
From the Task List, the chart will open to the visit on which the task was entered. Once again, this may not be the correct visit on which you need to work.
Change Encounters from Visit List within EMR
The Patient Info section of the medical record has several sub-sections. The Patient Demographics Tab tabs allow you to view insurance and contact information. The Patient Provider Relationship (PPR) Summary details who has viewed the record and that person’s relationship to the patient. The Visit List is a record of previous and scheduled encounters.
If you want to view or change encounters while working in a patient’s medical record: 1) Click Patient Info on the chart Menu.
2) Click Visit List tab.
3) Click the column headings to sort data in that column to more easily locate the desired encounter date, visit type, service, or other available visit criteria.
4) Double click the encounter you want to open
5) When prompted, select Yes to confirm you want to change the patient’s chart to the selected encounter.
Chart Overview
The patient chart is divided into several sections shown below: 1. Patient Demographic Bar
2. Chart Menu, sometimes referred to as the Navigator Bar or Table of Contents (TOC) 3. View Window
Demographic Bar
Name Name displayed in registration system
Allergies Displays active allergies in order of severity; click to link to Allergies window Loc Location to which patient is registered for visit being viewed
Fin# Financial Number (Visit Number) for visit being viewed
MRN Medical Record Number
Attending Physician for visit
Patient type Patient type for visit being viewed followed by registration date/time and discharge date if any
Resus Status Resuscitation Status for which there is an active order on the visit
Before taking action, validate that you have opened the correct patient chart and have selected the right visit.
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Up to 3 patient records may be open at one time. When more than one record is open, the banner bars will each have a different color. Colors call attention to the different charts. To close a chart, click the X by the name.
Menu
The Menu provides navigation links for the patient’s chart along the left side of the screen. Click on the icon on the Menu to link directly to the Add workspace for Orders, Medication List, PowerNotes, and Allergies. The Menu contents are dependent on your sign on and privileges.
Compared to Inpatient
Some positions use both IMPACT Inpatient and IMPACT Ambulatory; the menu options for the two components are different. Click on the down arrow at the top of the Menu between the Menu name and the Hide/Unhide push pin to see the options you have for menu views. Change views by clicking one of the options. Options include:
All: a combination of Ambulatory and Inpatient
Inpatient
Option to set the checked view as a Default so each time you open a chart that view will display.
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To begin, make sure you are in the Ambulatory View.
To collapse the Menu and hide it to the left of the screen, click the pushpin icon so that it displays vertically. This allows the work section pane to fill the screen.
To expand the Menu, click the Menu heading at the left of the screen and click the pushpin icon sot.
The pushpin icon is in a vertical position when the Menu is visible. The pushpin is in a horizontal position when the Menu is hidden.
Data Retrieval
Several options on the chart menu allow you to look at results and other patient specific information.
Click on 48 hour View on the Menu to display results. All result windows open with most recent 48 hours defaulted in the Clinical View.
To change the timeframe:
6) Right-click on the blue Clinical Range bar.
7) Select Change Search Criteria.
8) Type in date range or use control buttons to reset From and To dates
To Graph Results:
1) Click to check the results you want to graph. 2) Click the graph icon.
Chart Overview
Chart Overview tabs provide quick access to review patient related data.
This Visit displays results for the encounter you are viewing.
Since Last Time displays information on Encounters, Laboratory Orders, Non Med Orders, Documents, Results (Day View), and Medication Administered that have been posted since your last review.
1) Click to check the box by an item to review details in the right Details pane.
2) Click the Date/Time Stamp button and click the refresh icon to mark information as reviewed and clear the selections.
Patient Summary displays current information including: Immunizations, Procedures, Allergies, Problems, Medications, and Blood Bank Information.
Interdisciplinary Summary allows you to select a time frame for review and what disciplines’ contributions to view.
Immunization Schedule
The Immunization Schedule is used to view and document previous immunizations. UAB chose not to use the Future Immunization Schedule so data will not display in that pane.
To document a previously administered immunization: 1) Click the History button.
3) Click to highlight desired immunization; select Add.
4) Enter data in required fields: Source of Historical Info and Administration Date. 5) Click Chart to finish.
Advanced Growth Chart
The Advanced Growth Chart allows you to enter and view measurements, bone age values, and related data. To access the Advanced Growth Chart, click on the title from the chart Menu. 1) Click on the Change View button to open a box which allows you to change how data is
2) To enter data, click a selection from the Add New menu options.
3) Complete the form and click the green check to sign on completion.
Horizon Summary
Clicking Horizon Summary on the Menu links you to select data on Horizon.
Horizon Documents
Horizon Patient Tracking Lists
Horizon Medications
Horizon Images
In the Horizon Documents pane, click the down arrow by Type to filter the document types to narrow your search for a specific document. Use the scroll bar at the right to navigate through the list or click the arrows beside the Page to move forward and backwards.
Click on the link in Horizon Images to view an image.
Reference Text Browser
Reference Text Browser is an option seen on the menu according to privilege. Click the option on the menu to go to the tool where information on drugs and diagnostic problems, if loaded, can be viewed or printed for patients. Use of this tool will be decided clinic by clinic.
Printing
Only printers designated as Cerner Printers are linked to IMPACT Ambulatory. Many printers associated with a desktop computer cannot be used to print certain documents from PowerChart applications. Cerner printers will be labeled with their name which contains the physical location of the printer followed by additional identifiers.
If a printer needs to be relocated, call CenterNet Support at 934-4888. Moving a printer yourself will make the printer non-functional.
To print from Impact Ambulatory, follow these steps: 1) Click the printer icon on the toolbar. 2) Select the printer from the list provided and click OK.
Prescriptions must be printed on a printer with the rx prefix to insure it is printed on tamper proof prescription paper as required by Centers for Medicare and Medicaid Services (CMS). To prevent accidental selection, prescription printers are not listed with other printers in a clinic location.
When searching for a prescription printer, choose Unknown from the bottom of the location list. Prescription printers with the rx prefix are listed in the right pane.
Additional Chart Menu Components
Ambulatory Summary
Overview
The Ambulatory Summary provides a patient summary view for ambulatory clinicians.
Additional functionality allows clinicians to take action directly from the summary. The actions include adding allergies, documentation (PowerNotes®), and new orders in addition to managing medications and launching the Pediatric Growth Chart. The Ambulatory Summary links to other areas of the electronic record.
Other Features
Toolbar
Click the Search button to search for any text in the Ambulatory Summary. If the
Ambulatory Summary contains the text you typed, the first instance is highlighted. If there are multiple occurrences of the text, the Next button will be active. Click Next to go to the next instance.
If you navigate to another screen within the Ambulatory Summary you can click the home button to return to the main summary screen.
Use the back and forward arrows to return to pages you have already visited.
CollapseAll / Expand All
The collapse all / expand all option is in the upper right hand corner of the screen. Click it to collapse everything on the summary page, and then click expand all to expand everything open again.
Customize View
In the Ambulatory Summary it is possible to rearrange components on the page and define the expand/collapse default for each component.
To do this, click the Customize View link in the upper right-hand corner.
From here click a component and drag it to its new location. It is possible to change the layout from a three column view to a two column view by moving everything over into the first two columns.
Components that have a plus sign will default to being collapsed, and components with a negative sign will default to being expanded. The default can be changed by clicking on the icon. When finished, clicking on Save Preferences will reveal the summary screen with the new layout.
Adding Orders
You can launch the Orders window by clicking the +Add button by My Favorite Orders. To enter an order saved to your favorites folder, click the category header and make a selection from the favorites displayed. The order will display on the Scratch Pad. Click Submit for Signature. The order detail window will display if there are missing details.
If Search Mode is checked, clicking Submit for Signature will launch the order search window to allow entry of orders not saved to Favorites.
Managing Medications
Click the Medications link to launch the medication order window. From that location you can add medication orders, prescriptions, or historical medications. Active medications will display if the Medication section is expanded. From the Ambulatory Summary, you can click on a
medication and take one of the following actions by clicking the appropriate button: Renew (Prescription), Cancel/DC, or Complete.
If Renew is selected, Routing will display the pharmacy or routing selected for the original prescription.
Select Sign to process the medication order action.
Help
Use the Ambulatory Summary Help feature to obtain more information about each of the sections on the page.
Across Encounters
Some of the individual components will pull data across encounters and others only pull data from the current encounter. For example, Problems pull all active from across encounters but diagnoses are only for the current encounter. The table below shows the Look Back or Look Forward date range and status, if appropriate, for each component.
Patient Info – Lifetime and Admission Data
Vitals & Measurements – Last 6 months
Documents – Last 2 years
Allergies – Lifetime, Active and Proposed
Labs – Last 6 months New Order Entry – Not Applicable
Home Medications – Lifetime, Active
Diagnostics – Last 6 months Microbiology – Last 6 months
Diagnoses – Current Encounter, Active
Health Maintenance – Ahead 1 year
Pathology – Last 2 years
Problems – Lifetime, Active Immunizations - Lifetime Outstanding Orders – Last 2 years
Past Medical History –
Lifetime, Active and Resolved
Visits – 5 Previous, 5 Future Notes/Reminders – Lifetime, Active
Procedure History – Lifetime, Active
Social History - Lifetime
Family History – Lifetime, Positive Conditions
Reports and Documents
Reports and Documents can be opened from the Navigator menu in PowerChart.
The reports and documents section allows you search for patient information that has been stored in the folder structure that has been created.
You can search for reports and documents by Type, Status, Date, Performed by, or Encounter. For example: The screen shot below shows reports and documents completed by specific healthcare providers.
You can see operative reports, powerforms that are completed, physicians’ PowerNotes, messages saved to the chart, documents that have been scanned into the system, as well as Horizon Periscope notes that have benn interfaced to the system.
You can change the date range when searching for forms by right clicking in the blue bar and selecting the specified date range.
Problems and Diagnoses
In the Problems and Diagnoses window, you can view problems and diagnoses together on the same window. Depending on your privileges, you can add and update problems and/or
diagnoses, and convert problems to diagnoses or diagnoses to problems. The window allows you to create and view Problems and Diagnoses by status, classification, or management discipline and launch a Medline search to find information on an issue listed.
A problem is an issue or risk that impacts the patient’s health and well-being. Problems can be seen across visits.
A diagnosis is a medical problem used to direct a plan of care; diagnoses are also used for billing to justify orders. Diagnoses are visit specific.
Viewing Problems and Diagnoses
To view Problems and Diagnoses, complete the following steps:
Open a patient chart in PowerChart.
On the chart Menu click Problems and Diagnoses.
To change the Problem List or Diagnoses List view to meet your need, select one of the following options from the Display menu for the list with which you are working:
All
Active and Inactive
The system displays the list you selected.
You can sort the displayed list by clicking any of the column headings.
Add a Problem
To add a problem, complete the following steps: 1) Open a patient record in PowerChart.
2) From the Chart Menu, click Problems and Diagnoses. 3) In the Problem List pane, click Add.
4) In the Problem detail, you can enter a value by selecting an item from the Favorites folders displayed at the bottom of the window or by typing a term and clicking the binocular search icon and selecting a term from the options.
5) Enter values as appropriate in the available fields: Responsible Provider, Display As, At Age, Onset Date, Confirmation, Classification, Status, and Ranking.
The Onset and At Age fields are complementary: If you enter a value in one of these details, the system calculates and populates the other fields with the appropriate value.
o Click on Age in blue and select: Age, About, Before, After, or Unknown then enter data.
o Click on Date in blue and select Date, Week of, Month, or Year then enter data. 6) To file this problem to past medical history, select the File to Past Medical History check
box.
7) To add the problem and close the Add New Problem pane, click OK.
8) To add the problem and a diagnosis simultaneously, click Add to Problems and Diagnoses. The system closes the Add New Problem pane and displays the new diagnosis and new problem on the Problem and Diagnoses window.
9) To add the problem and keep the Add New Problem pane open to add another problem, click OK and Add New.
10) Click Cancel to discard your changes.
Modify a Problem
To modify a problem, complete the following steps:
1) Right-click a problem and select Modify Problem from options.
2) Make your changes. Remember you can also make changes to information revealed by clicking Show Additional Details.
Select any of the other options seen when you right click a problem to take the action described.
Add a Diagnosis
To add a diagnosis, complete the following steps: 1) Open a patient record in PowerChart.
2) From the Chart Menu click Problems and Diagnoses. 3) Click Add in the Diagnosis List pane.
4) You can enter a value by selecting an item from the folders displayed at the bottom of the window or by typing a term into the Diagnosis field and clicking the binocular search icon to search for a diagnosis. You can save any diagnosis to your Favorites folder by right-clicking and selecting the Add to Favorites button at the bottom of the Diagnosis Search window. If you choose to enter a diagnosis from common diagnoses by specialty: a. Click on Folders
b. Click on Cerner ICD9 Common Diagnoses folder c. Click on a specialty folder
d. Click the desired diagnosis e. Click OK to accept the diagnosis
ICD9 codes with more digit s after the decimal are usually more specific than those with less. 5) Enter values for Clinical Service, Date, Type, Confirmation, and Classification. You can
change any data the system auto populates.
6) You may enter information in any of the available fields. Click Show Additional Details to open an optional window that allows entry of data you may find helpful: Qualifier, Severity Class, Severity, Certainty, Probability, and Ranking.
7) To add the diagnosis and close the Add New Diagnosis pane, click OK.
8) To add this diagnosis and a problem simultaneously, click Add to Problems and Diagnoses. 9) To add this diagnosis and keep the Add New Diagnosis pane open to add another problem,
click OK and Add New.
Modify a Diagnosis
To modify a diagnosis, complete the following steps: 1) Right-click the diagnosis from the Diagnosis List. 2) Click Modify Diagnosis from the menu options.
3) Make your changes completing all required details: Clinical Service, Date, Type, Confirmation, and Classification.
4) Make changes to other fields, including those revealed by clicking Additional Details if you choose.
5) When finished, click OK.
Remove a Diagnosis
To remove a diagnosis, right-click the diagnosis you want to remove and select Remove Diagnosis from the menu options.
Any diagnosis you remove goes to Inactive status. You can opt to view these items later by setting the display filter to include Inactive. Inactive items are displayed with a strikethrough mark.
Converting a Problem to a Diagnosis
To convert an existing problem to a diagnosis, complete the following steps: 1) .In PowerChart, from the chart Menu, select Problems and Diagnoses.
2) In the Problem List pane, right-click the problem and choose Convert to Diagnosis from the menu selections. The problem will display as a diagnosis.
3) Click OK to save changes and return to the previous window or click Cancel to discard changes.
Converting a Diagnoses to a Problem
To convert an existing diagnosis to a problem:
Right-click to select a diagnosis and select Convert to Problem from menu options. In the Select an item to map pane, select the item to convert.
Click OK to verify the mapping details.
The system automatically populates the target field, if possible. It also cross-maps the appropriate billing code and places the newly-created problem onto the patient encounter currently selected in the chart. If this is not auto-populated you will need to enter the entire or partial name of the problem you are seeking in the Search field.
Create a Favorites Folders
To create a new folder, complete the following steps when adding a diagnosis or problem:
.
1) At the bottom of the pane, within the Favorites folder, select the dropdown arrow by Favorites to Organize Favorites.
2) Select the location where you want the new folder added, and click Create Folder.
Adding a Problem or Diagnosis to a Folder
To add a problem or diagnosis to your Favorites folder, complete the following steps: 4) Right-click on the problem or diagnosis you want to save in a Favorites Folder. 5) Select .Add to Favorites.
6) Click the folder to which you want to add the entry (or create a folder if necessary). 7) Click OK.
Mark All Problems and Diagnoses as Reviewed
To mark problems and diagnoses as reviewed, complete the following steps: 1) Open a patient chart in PowerChart.
3) Select Mark all as Reviewed button. The system automatically updates the date in the Last Reviewed column for all problems and diagnoses displayed.
Medication List
The Medication List is the recommended place to view all medication therapies for a particular patient. The tab, to the right of the orders tab, provides an easy view of current and past inpatient, outpatient and home medications, allowing for efficient medications management. The
medication list has the same sorting and filtering ability as the orders tab, providing the clinician the ability to customize and manage the view.
Documenting Historical/Home Medications
To document medications that the patient is currently taking at home, use the Document Medication by Hx function.
5) Click .
6) Click to enter the home medication.
Note: This function can also be accessed by clicking in the Home Medications section on the Ambulatory Summary.
7) Type the first few letters of the drug in the Find window and select Search.
8) Select the medication from the list of medications and click Done. Note: The order Type window displays Document Medication by Hx.
9) An Order Sentence dialog box may display
10) Complete the known medication details such as dose, route of administration, frequency, and duration.
11) Click the Compliance tab.
13) Click to save the information.
Right-Click Options
There are five categories of medications on the Medications list: Inpatient, Outpatient,
Prescription, Documented Medications by Hx, and Unspecified. There are different right-click options depending on what category the medication is in.
Outpatient
If a medication has been ordered to be administered during the clinic visit, the right-click options will look like this:
Prescription
If a medication has been ordered as a prescription, the right-click options will look like this:
Documented Medications by Hx
If a medication has been documented as a home medication, the rightt-click options will look like this:
MAR Summary
MAR Summary Overview
To view a patient's Medication Administration Record (MAR) in a summary (grid) view, click on the MAR Summary component in the chart Menu.
The current time interval is highlighted in yellow.
Overdue tasks have a red background and contain an overdue icon.
Scheduled tasks that have yet to be administered have a gray background.
Charted tasks appear as black text on a white background. These tasks also contain the dose and time administered.
Skipped tasks (charted as Not Done or Not Given) appear with an orange border and contain the reason and time documented
Providers who have three chart menu options (Ambulatory, Inpatient, and All) will have two MAR Summary choices on the chart Menu. One is for the current encounter only and one is for across encounters. If you have a patient with multiple encounters and meds on each encounter, you will have to click on each one to see which one pulls across encounters.
Change the Time Intervals
14) Click the navigator button in the upper left hand corner of the screen. 15) Select Change Interval and then choose the desired time interval.
Change Date Range:
16) Right-click anywhere on the light blue date range bar. 17) Select Change Properties.
18) Adjust the From and Through dates to the desired date range.
Allergies
You can view and modify allergies from the hyperlink in the demographic banner bar, from the Allergies component in the chart menu, from the allergies section of certain PowerForms, and the Allergies section of the Ambulatory Summary.
Allergy Basics
The Allergy Profile is used to record, modify, and review all allergies and drug reactions for a patient. By default, the allergies are listed alphabetically by substance. If severity is recorded, allergies sort by severity on the Demographic Banner bar.
The display can be filtered by allergy status:
Active - Displays only current/active allergies for the patient
Inactive - Displays only inactive allergies for the patient
All- Displays all allergies for the patient both active and inactive
Add an Allergy
2) Click .
3) The Add Allergy/Adverse Effect window will display.
4) Type the first few letters of the allergy into the search box and click Search.
5) Highlight the appropriate substance to select it. Double click the selected substance or click Select to add it to the profile.
6) If necessary, change the Category of the allergy. The default is Drug. If you are documenting a food allergy, be sure to change the Category to Food.
7) If desired, change the reaction type of the allergy. This reaction type will be used on the Allergy Profile to allow for easy grouping of allergies.
Note: You do not need to enter a reaction. If you are not entering a reaction, skip the next 3 steps.
9) Search for a codified symptom using the search window. Confirm that the search is for Reaction, rather than Substance.
10) Select the appropriate reaction, highlight it and double-click or click Select to add to the profile.
11) The reaction will now show within the Reaction window. Codified reactions will display with the key icon.
12) Add other additional details as desired.
13) Add additional comments about the allergy in the comments section by clicking on the Add Comments button. Comments display in reverse chorological order.
The allergy will now display on the patient’s Allergy Profile.
Add an Allergy to Your Favorites
By adding allergies to your list of favorites, you can select them quickly. To add an allergy to your favorites, complete the following steps:
1) In the substance search box search for your substance that you would like to add to your favorites.
2) Right-click the substance and select Add to Favorites. 3) To access your list of favorites, click the My Favorites tab.
Tips and Tricks
When searching for allergies, type in the first 3-5 letters of the name.
If no allergies are returned, type an asterisk (*) in the search box.
Allergy checking takes place if any related allergy is documented, for example amoxicillin and penicillin.
View Allergy History
1) Right-click the allergy you want and select View History of [Allergy]. 2) The View History dialog box opens.
3) When you are finished reviewing the history, click Cancel.
Cancel an Allergy
1) In the profile, right-click the allergy you want to cancel. 2) Select Cancel [Allergy].
3) Click OK to cancel the allergy.
The dialog box closes, returning you to the Allergy Profile window. If you have selected All from the Display list, the allergy is displayed with a red line through it. If you do not have All selected form the Display list, canceled allergies are not displayed.
Modify an Allergy
1) Right-click the allergy you want to Modify. 2) Select Modify [Allergy].
3) Confirm that the name of the allergy you are modifying is displayed in the Substance box. 4) Make your changes to the displayed information.
The changes you made take effect immediately and modification date and time are displayed in the history.
Mark Allergies as Reviewed
To mark all allergies as reviewed, click Mark All as Reviewed. The date is displayed in the Reviewed column for those allergies that you have reviewed
.
Document No Known Allergies (NKA)
If a patient has No Known Allergies (NKA) you can indicate this in the chart by clicking No Known Allergies in the Allergy Profile window.
Perform a Reverse Allergy Check
You can check a patient's allergies against current medications (ordered, home meds, and prescriptions) at any time. To perform a reverse allergy check, click Reverse Allergy Check in the Allergy Profile window.
Health Maintenance
Health Maintenance is designed to provide a snapshot of recommended screening procedures and immunizations to maintain health and detect common problems. The recommendations are specific to age and sex of the patient.
Health Maintenance Basics
Health Maintenance can be accessed from the chart menu.
The Health Maintenance window displays two sets of expectations: 1) Pending
2) Recently Satisfied
As pending expectations are satisfied, they are seen on the lower half of the screen as recently satisfied expectations.
Each pending expectation is displayed by: Name, Priority, Status Subtasks, Due Date, Who recently satisfied the expecation.
Note: Pending expectations that are never satisfied will show up as overdue.
View Expectation History
You can select or deselect the icon to show the satisfiers for each expectation or hide them. The example below does not have the satisfiers shown.
Pending expectations can be sorted by using the sort list with the following options: Status (Overdues is listed first by priority, then due date)
Priority (High is listed first by overdue status)
Expectation (All expectations will be listed alphabetically)
Approximate Due Date (All expectations will be listed by due date)
Note: Decision was made that all pending expectations are qualified as high. Recommendation is to sort by Approximate Due Date so that the pending expectations that are up-coming are at the top of the list.
Default Settings
The default settings for Pending and Recently Satisfied Expectations is set at one year but you can go in and set the defaults you want to see when you log in.
To set default settings:
1) Click on the icon on the tool bar. 2) Select from the drop down menu.
You can set a separate default for pending and satisfied. For example, you may only want to see the pending expectations for 6 months and you want to see satisfied expectations for 2 years. 3) You can click on the cursor and drag to time frame you want for both pending and/or
satisfied expectations. Or you can enter the year(s) and month(s) in the boxes next to pending and satisfied to set the time intervals.
The view changes to show the Pending expectations over 6 months.
You can also set the defaults to sort the pending and satified sections by selecting from the options in the drop down box.
Satisfy an Expectation
Expectations are satisfied in Health Maintenance by the following: Orders
Performed Elsewhere Postponed
Refused
Canceled Permanently
Satisfied results or procedures
Order
Pending expectations can be satisfied by placing an order.
1) Select the order under the expectation you are attempting to satisfy. 2) Physicians select .
4) Select .
5) Complete any required details in the order sentences and assign the correct diagnosis for the order.
6) Select Sign.
7) Select Refresh .
By placing an order, the expectation will automatically be moved to the satisfied expectation section but will be classified as pending until a procedure is completed or vaccine administered.
Note: Placing an order will satisfy and expectation for 7 days. Results or procedures will satisfy an expectation the specified length of time for that screening/immunization. Note: A satisfied expectation that is in a pending state can be undone up until the time the
order is resulted. You do this by canceling the order.
Procedure
Documentation of certain procedures can satisfy pending expectations. The list of procedures documented under Procedure History that will satisfy an expectation is lengthy. The correct procedure with coding will satisfy an expectation. Otherwise this will have to be done manually. For example, your patient has a pending expectation for colorectal screening that is due
12/14/2010. The patient states to you when you are performing your assessment that they had a colonoscopy on 12/1/2010. When you document the Colonoscopy under the Procedure History the expectation will be satisfied.
Here are the steps to satisfy an expectation by documenting a procedure.
1) Go to the Histories tab on the Navigator menu. 2) Select the tab for Procedure History.
3) Select + Add.
5) Click on the binoculars to search for the appropriate procedure and code. 6) Select Colonoscopy with the procedure code 45.23
7) Select OK.
8) Enter the date the procedure was performed/completed. 9) Select Refresh
10) Move back to Health Maintenance on the Navigator Menu. 11) Select Refresh
The expectation for colorectal screening moves to the satisfied expectations section.
Note: You may document the procedure before you review Health Maintenance, therefore if an expectation has been satisfied it will be seen under Recently Satisfied
expectations. If it is still listed under Pending Expectations, both the wrong procedure and code were added to the Procedure History or nothing was added to the Procedure History.
Performed Elsewhere
If patients have procedures, tests, or lab work performed at another clinic or hospital, you can manually go in and satisfy those expectations. To do so:
1) Select _________ Performed Elsewhere for the specific expectation. 2) Select the reason from the drop down box.
3) Select OK.
The pending expectation will be moved to the lower section of the screen under satisfied expectations.
Note: Done-Transcribed Paper Chart should be selected if the procedure/test was performed at UAB and you obtained the documentation from the existing paper chart.
Postponed
Health Maintenance satisfiers can be postponed until another date. In order to do this:
1) Select
3) Enter a Postponed Until date 4) Select OK.
The Pending expectation will appear with the postponed date and available satisfiers.
Note: You can undo expectations that have been Postponed.
Refused
Health Maintenance satisfiers can be refused. In order to do this:
1) Select
2) Select the reason for refusal from the drop down box.
3) Select OK.
Note: You can undo expectations that have been Refused.
Cancel Permanently
You can also cancel a pending expectation permanently.
For example, your patient has an upcoming Influenza vaccine, but has a severe allergy to eggs, and can never receive the flu vaccine.
To Cancel the expectation:
1) Select from the list of satisfiers. 2) Select the reason for cancellation from the drop down box.
3) Select OK
The expectation will move to the satisifed expectation as being canceled. Note: You can undo expectations that have been Canceled permanently.
Placing a check mark in the Show all canceled records will move the canceled expectations to the top of the list.
Adding Pending Expectations
Based on the age and sex of the patient the following pending expectations will appear:
Pneumococcal vaccine Tetanus vaccine HPV vaccine
MMR vaccine Varicella vaccine
Zoster vaccine Colorectal screening
Prostate Cancer screening Lipid Screening
Influenza vaccine Breast Cancer screening Cervical Cancer screening Bone Density screening
Other Health Maintenance screening has been built and can be added based on the patient’s history and diagnosis or conditions.
Coumadin Monitoring Diabetes Management Traveler’s vaccines
Note: Any expectation can be added to patient’s screening at any age. To add Health Maintenance screening:
1) Select Add next to Pending expectations.
2) Place a check mark in the screening needed for your patient.
This will place the selected screening on the scratch pad. You can modify the due date and frequency.
3) Double click on the Due date and/or Frequency to make changes. 4) Select OK to close the modify window
5) Select OK to add the selected screening to the pending expectation window.
The Coumadin monitoring will appear with the icon indicating that a health care provider has added this particular screening.
Unchart an Expectation
When you unchart documentation that has previously satisfied and expectation the Health Maintenance section is updated and the expectation is placed back to pending.
For example, earlier we add a procedure, colonoscopy, which satisfied the colorectal screening expectation. When you unchart the procedure, the colorectal screen becomes active again for the patient. To do this:
1) Go to the Procedure History from the Histories tab on the Navigation menu. 2) Highlight the colonoscopy procedure
3) Right click and select 4) Select Refresh
The procedure will then display with a line through it indicating that it has been un-charted. 5) Select Refresh
7) Select Refresh
The Colorectal screening moves to the Pending expectations section with satisfiers and the Satisfied expectations is modified to Undone instead of satisfied.
Undo Satisfied Expectation
You can undo manually satisfied expectations by highlighting the expectation, right click, and choose Undo ________. You need to select the reason for undoing from the drop down box and the expecting will be moved to the pending section to be satisfied.
Sorting Reviewed Expectations
You can sort the satisfied expectations by clicking on the column header you wish to sort by. For example, if you want to see all of the pending orders, you can select the Status section and the expectations will be grouped together.
View Results in Recently Satisfied Expectations
You can review the results of satisfied expectations. To do this:
2) Select View Result of _______________________.
The result details window will open and you can review the test results.
Form Browser
The Form Browser will show you all of the PowerForms that have been documented on each patient.
Note: Physicians to not have Form Browser.
Note: View can be customized by Date, Form, Status Encounter-Form, or Encounter-Date. You can change the date range when searching for forms by right clicking in the blue bar and selecting the specified date range.
Note: PowerForms will display with a red icon if the form has been documented without completing all of the required fields. In the IMPACT Ambulatory design PowerForms will not allow you to sign the document without completing the required fields.
Histories
You can access the Histories tab(s) from the chart Menu. Using the “controls” to document a patient’s history allows all health care provides a single source of truth for documentation. Patients are often asked by multiple healthcare providers about their history. Having a single source of truth allows health care providers to know that in order to view, add or modify information about the patient’s history you go to the Histories section of the electronic medical record.
Histories Basics
Adding History
Adding History is a little different between the types of history and will be reviewed in each section.
Modify History
Modifying History is a little different between the types of history and will be reviewed in each section.
Mark as Reviewed
You can review the history that has been documented by previous health care providers. If after you have reviewed the information and you find it to be correct, you can select the
button to document that you have reviewed the information.
Filters
Each type of history has different ways to filter information. Past Medical History
All Active Resolved
Active and Resolved Inactive
Canceled Procedure History
All Active Inactive Family History
Condition View Family Member (All)
Family Member (Positive Only) Social History
All Active Inactive
Past Medical History
Reviewing Past Medical History
You can review the past medical history that has been documented by previous health care providers. If after reviewing the information and you find it to be correct, you can select the
button to document that you have reviewed the information. Note: The past medical history grid has a column titled Last Reviewed, and the date the
information was reviewed is added there after clicking
Add past medical history by selecting the icon.
The window opens which allows you to search for and add conditions.
Directions:
1) Begin to type in the patient’s condition into the required field. (Use the binoculars to search for conditions)
Note: If you cannot find what you are looking for you can select the check box in front of free text, and type in the name of a condition.
2) After selecting the correct condition, enter the age or date of onset of the condition. 3) Select OK and Add New if you need to add additional conditions for this patient. 4) Select OK if have entered all of the conditions.
Modify Past Medical History
If your patient has past medical history documented, you can modify the past medical history if needed.
To Modify Past Medical History
1) Highlight the history you wish to modify.
2) Select .
The window of information for your patient’s medical condition will appear and you can make changes.
3) Modify any information. 4) Select OK.
Procedure History
Reviewing Procedure History
You can review the procedure history that has been documented by previous health care providers. If after reviewing the information and you find it to be correct, you can select the
button to document that you have reviewed the information. Note: The procedure history grid has a column titled Last Reviewed, and the date the
information was reviewed is added after clicking
Adding Procedure History
Add procedure history by selecting the icon.
Directions:
1) Begin to type in the patient’s procedure into the required field. (Use the binoculars to search for procedures)
Note: If you cannot find what you are looking for you can select the check box in front of free text, and type in the name of a condition.
2) After selecting the correct procedure, enter the provider who performed the procedure and the date the procedure was performed.
3) Select OK and Add New if you need to add additional procedures for this patient. 4) Select OK if have entered all of the procedures.
Modify Procedure History
If your patient has past medical history documented, you can modify the procedure history if needed.
1) Highlight the history you wish to modify.
2) Select .
The window of information for your patient’s procedure will appear and you can make changes. 3) Modify any information.
4) Select OK.
Family History
Reviewing Family History
You can review the family history that has been documented by previous health care providers. If after reviewing the information and you find it to be correct, you can select the
button to document that you have reviewed the information.
Note: There is documentation on the back end indicating that you reviewed the family history after clicking
Adding Family History
Add family history by selecting the icon.
Directions:
1) Click in the shaded cell to place a plus sign in the column for the family member(s) who have a history of the listed conditions
2) Click in the white cell to place a minus sign in the column for the family member(s) who do not have a history of the listed conditions
3) Select OK.
Quick List
To add conditions to the list:
1) Click the binoculars when adding family history to pull up a comprehensive list of conditions you can add.
2) Double-click on the condition(s) you wish to add to the list to move them to the scratch pad. 3) Select OK to add them to the list.
4) After selecting the condition to the list, you can document positive and negative responses for each family member(s).
5) Select OK.
Adding family members
If you need to add a specific family member to the list, do so by clicking on the button and select the appropriate family member,
The family member will be added with a new column so you can chart that family member’s history.
Adding groups
If a group of conditions is not on the list you can select and a set of conditions.
Modify Family History
If your patient has family history documented, you can modify the family history if needed. To Modify Family History
1) Highlight the history you wish to modi
