PARAGON WEBSTATION FOR PHYSICIANS. Adapted from McKesson Paragon Implementation Services, February 2013 Page 1

Transcription

1 PARAGON WEBSTATION FOR PHYSICIANS Page 1

2 Table of Contents Topic Page Logging In.. 3 Navigation Banner. 3 Census 4 Allergies 10 Tab Strip 12 CPOE Tab.. 15 Documentation Tab 24 Problem List Action List. 28 Orders Tab. 29 Results Tab 30 Med Rec View Tab 33 Meds Tab Vitals Tab.. 35 Clinical Assessment Tab Clip Board. 37 Important Take Away Items. 40 PRN Medication Reason Codes 41 Notes Page 43 Page 2

3 Logging In Physicians will use their standard log-in Username (all lower case) and Password (case sensitive) The Navigation Banner When you log into WebStation for Physicians, the browser displays the application in a browser window. Several icons display to the far right above the patient worklist. This area of the window is referred to as the navigation banner. Page 3

4 Suggested Workflow Once Logged In 1. Select the Action List tab to Sign-Off orders 2. Access the Deficiencies tab to Sign-Off on any assigned deficiencies 3. Build your patient worklist using the Census tab Census Page 4

5 Relationships Providers will have relationships and registration groups defined from the current STAR system. Each user will want to move the appropriate relationships to the selected side and Save to ensure that the changes become the default value each time the use logs in. Patient Search My patients patients with whom physician has an association Personal list - customized list of patients. Patients can be added to or removed from this list by clicking in the column labeled P. This is a useful feature for an instance where a patient may fall off of the census, yet a user desires easy access to the patient record (e.g. a patient is discharged with results pending and the user needs to follow-up on the result outcome and contact the patient). All patients - access to this area is controlled through WebStation for security. This allows access to all patients and allows access to all orders, results and vitals for those patients. Open access - rights are controlled through WebStation for Security. Allows access to all patients; however, need to indicate why you are accessing this patient. Group patients - patients that are assigned to a particular physician group. My patients and personal combine My Patients list and Personal list Group patients and personal combine Group Patients and Personal list My patients & covering - includes physician's patients and those patients of any physician that are being covered by another doctor. Page 5

6 Group patients and covering - patients in the physician group plus any of the patients being covered by another doctor. Covering - patients that are being covered by someone other than their normal physician A user can set the filters to desired values and use the save button to make these the default values that will populate each time the screen is accessed. Advanced Patient Search Allows greater refinement of the patient search to include searching specifically by facility, medical record number, visit ID, service code, date of birth, or patient type Page 6

7 Encounters Personal List Results Page 7

8 Vital Signs Abnormal Results Populating Worklist Page 8

9 The physician will enter in the search criteria and complete the search. They will be able to select a single patient or multiple patients with the check marks at the far left. (Notice that the dropdown box at the very top left of the screen is very small during this stage). Once patients (s) are selected the physician will click add to worklist. The tabs to the right can be useful for printing a facesheet or a daily rounding list of the patients you want to see. Also, you can select patients to place on a hand-off report. Notice that the dropdown box at the top left has expanded. This is because there are now items (patients) in the dropdown. This dropdown list is the driving item for all subsequent actions and results. The patient that is selected from this dropdown list will be the patient for whom results, orders, medication reconciliation, etc. are displayed in the tabs below. Page 9

10 Upon selecting the appropriate visit a safety check verifying that the correct patient was selected will appear. The physician can either click Yes or press the enter key on the keyboard. Upon acknowledging this prompt, the patients name will appear in the upper left dropdown list. At this point, the Worklist Banner and Tab Strip will become available (as well as each of the tabs) and all actions made will be for the patient shown in the dropdown. Selected Patient Worklist Banner Tab Strip Page 10

11 Tabs Page 11

12 Allergies Editing Allergies Click on the Allergies icon in the top left of the screen to expand the allergies window. If you wish to edit the allergies, select the blue underlined Edit Allergies text. Page 12

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14 Adding Allergies Page 14

15 Tab Strip The majority of the items within the tab strip are entered by registration staff and clinicians (nursing, pharmacists, physical therapist, respiratory therapist, etc.) within the Patient Profile module. The data that is entered in Patient Profile will carry over from visit to visit for each patient. Problems - Displays the Problem List entered in the Patient Profile. It includes the description, status, date and note (if applicable). If you hover the mouse over the Description of the problem, the SNOMED code and description display in a tool tip. To view the Patient Profile Report, click the View Profile hyperlink. The Reports tab opens and the report automatically runs for the patient. Home Meds - Displays the home medications entered in the Patient Profile. It includes the Home Med name, Dose, Route, Frequency, PRN indicator, Most Recent Dose date, Start Date, Stop Date, and Reason for Taking. Adv Dir - Displays the patient's advanced directive from the visit record including the type of Directive, Doc in Chart indicator, Effective Date/Time, Custodian Name, Address, Phone and Note. Demog - Displays the demographic data for the patient including Medical Record Number, SSN, DOB, Gender, Race, Drivers License number and State, Primary Address, Primary Phone, Age, VIP indicator, Veteran indicator, Religion, Marital Status, Nationality, Primary Language, Language Ability Expr, Language Ability Rec, and Communication Barrier. If an image has been entered in Person Maintenance for the Social Security Card and/or driver's license, a Camera icon displays to the right of the respective field. Click the Camera icon to view the image. To close the image, click in the upper right corner. Implants - Displays the Implants entered in the Patient Profile. It includes the Implant Date, Description of the implant, Quantity, Removed Date (if applicable) and any Comments. To edit the Implants, click the Edit Implants hyperlink. To view the Patient Profile Report, click the View Profile hyperlink. Newborn - Displays the newborn data entered in Medical Records or Clinical CareStation. It includes the mother's name, mother's visit ID, mother's medical record number, birth weight in grams, and APGAR scores 1, 2, and 3 Blood - Displays the blood information entered in Medical Records including the blood product and number of units. Page 15

16 Immun - Displays the immunizations entered in the Patient Profile. It includes the Immunization Name, Date administered, and Time Since Administration. If you hover the mouse over the name of the immunization, the MVX code and name as well as the CVX code and name display in a tool tip. To add or edit immunizations, click the Edit Immunizations hyperlink. Pat Alerts - Displays the patient alerts entered for the patient across clinical and non-clinical applications. The Patient Alerts tab provides important patient-specific information that you may need to know. Examples of patient alerts include the following: "Patient is combative," or "Patient is a board member." Alerts are stored at the person or visit level. Alerts stored at the person level are available for subsequent visits. Access to the Patient Alerts, including confidential and non-confidential alerts, is controlled by Web Security. The Pat Alerts tab displays alerts for the patient currently selected from your patient worklist. Alerts entered at both the person and visit level through the Paragon Alerts function appear on this tab and includes the following information: Pain - Displays the pain assessments entered in Paragon Clinical CareStation within the last 24 hours. The hour displays across the top, the date displays across the bottom and the color coded pain scores display in the center. They display in the order in which they were entered. The color codes are as follows: Score of 10, 9 = Red Score of 8, 7 = Orange Score of 6, 5 = Yellow Score of 4, 3 = Light Green Score of 2, 1, 0 = Light Blue If you hover the mouse over the hour at the top of the grid, the time (hh:mm) the pain assessment was entered displays. If you hover the mouse over the color coded pain score in the grid, the location for the pain assessment displays. A trend arrow that is the color of the previous pain score taken displays. The trend arrow points in the following direction based on the slope of the trend: Points north-east if the slope is positive (trending up) Points south-east if the slope is negative (trending down) Points east if the slope is zero (no change) Visit - Displays the patient's visit information. It includes patient type, admission date, admitting complaint, admitting diagnosis, visit status, code status, facility, patient location, attending Page 16

17 physician, point of origin, admission service, discharge service, organ donor indicator, admission height, current height, admission weight, current weight, BMI, special needs, isolation, gestational age (date and ultrasound), lactating indicator, LMP, and notes. Financial - Displays the financial/insurance data for the patient's visit including the primary guarantor, primary employer, and primary insurance. If an image has been entered in Person Maintenance for the Social Security Card, driver's license, and/or insurance card, a Camera icon displays to the right of the respective field. Click the Camera icon to view the image. To close the image, click in the upper right corner. To view the Facesheet, click the View Facesheet hyperlink. A print preview window opens displaying the facesheet(s). Contacts - Displays the relationships entered in Person Maintenance for the patient. It includes the contact name, type of relationship, next of kin indicator, emergency contact indicator, guardian indicator, agent indicator, phone number, education level, and contact date. To edit the Patient Detail, click the Edit Patient Detail hyperlink. Social Hx - Displays the patient's Age and Smoker indicator/code (for example, 'Former Smoker (3)'). To edit the Patient Detail, click the Edit Patient Detail hyperlink. Vitals - Displays the patient's vital signs entered within the last 72 hours (up to six separate "entry for" dates/times). To edit Vital Signs, click the Edit Vitals hyperlink. This tab allows the provider to enter and/or edit vitals. Alcohol - Displays information about the patient's alcohol use, including variables such as type, amount, frequency, duration, number of drinks and quit date. To edit alcohol usage information, click the Edit Alcohol Usage hyperlink. See Editing Alcohol Use Information - Patient Profile for further information. To view the Patient Profile Report, click the View Profile hyperlink. Tobacco - Displays information about the patient's tobacco use, including variables such as type, amount, frequency, duration, and quit date. To edit tobacco usage information, click the Edit Tobacco Usage hyperlink. Rec Drug - Displays information about the patient's recreational drug use, including variables such as drug classification and name, amount, frequency, duration, and quit date. To edit recreational drug usage information, click the Edit Drug Usage hyperlink. Family Hist - Displays information about the patient's family history, including family member information such as relationship, birth date, race, ethnicity, age, and deceased indicator. To edit family history information, click the Edit Family History hyperlink. Page 17

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19 CPOE Tab The CPOE tab contains several tab windows: Order Queue tab - Provides the ability to view the orders for the current visit for the selected patient and to view orders from previous visits with start dates less than or equal to 90 days from the current date. You may submit orders added from the Search tab, discontinue, resume, or renew orders as well as reorder previous orders for the patient. You may define a relationship for Pharmacy medication orders (for example, medications to be administered simultaneously). You may also view, acknowledge and/or sign Pharmacy alerts for the selected patient from this tab. Remember that orders must be Submitted in order to be executed. Search tab - Provides the ability to search for orders and add them to the Order Queue or submit them directly by opening Order Details. You may also flag an order code to display on the Favorite Orders tab. Favorite Orders tab - Displays the order codes you have flagged as your favorites on the Search tab and provides the ability to select the frequently ordered items for the selected patient. Medication Reconciliation tab - Provides the ability to review a patient s existing medications upon Admission, Transfer, or Discharge and allows the physician at the receiving location to continue, cancel, or edit existing medications. Order Queue You can click on the Bolded / Underlined headers to sort results by the header of the column. Clicking on a header the first time will sort in descending order, clicking the column again will sort in ascending order. Frequently sorted columns include: Order Status this will group orders with the same status together. Examples include active, dates met, discontinued, etc. Processing Status this will group order with the same status together. Examples include unsubmitted, add pending, or blank. Grouping orders in this way makes it easy to see what has or has not been submitted. Area this will group orders together by area. Examples include pharmacy, lab, dietary, nursing, occupational therapy (RX, LB, DI, NS, OT). Start or Stop Time Originally Ordered By this will group orders together based on the ordering physician Page 19

20 Search Order Detail Once you have performed an order search, order results will populate below the search bar. If the order does not appear exactly as you want to order it, you should not select Save. To modify the order, click on the underlined order description. This will launch the Order Detail for the individual order. From this screen you can modify the order Frequency, Duration (start time, stop time, number of days, or total quantity), Priority, as well as provide free text Instructions. If you are only submitting one order, it may be faster to submit your order from this screen rather than saving and having to return to the Order Queue tab to submit the order. Page 20

21 Submit / Save / Cancel Edit / Cancel Order Upon launching into Order Details the user will have multiple choices: Submit User can make necessary modifications to the order and fully submit the order Save User can make necessary modifications to the order and save the order for submission at the Order Queue Cancel Edit User will lose any modifications made to the order and the default order is saved to the Order Queue Cancel Order User cancels any modifications made and the order is not saved to the Order Queue Edit Full Order (medications) Upon searching for a medication, the results will not have Save or Favorite Flag options. The user will need to click on the medication description that matches the desired medication and route. Upon clicking the medication available medication, dose, route, frequency options will populate. These items are available for Save and / or Favorite Flag options. You may need to uncheck the Common Orders Only option if the dosing option is not available for immediate selection. Page 21

22 If the medication option is still not available, a user can click on an order that closest resembles the desired order. This will launch the Order Detail screen in which Start / Stop date, Priority, Instructions, and Instructions to Pharmacist can be modified. The user retains the same four options discussed above (Submit, Save, Cancel Edit, and Cancel) and gains two additional options. Screen perform drug to allergy and drug to drug interaction checking and provide alerts prior to placing the order Edit Full Order allows for further modification of the order, please see below If the user needs to modify the order further, they can select edit full order. This will allow additional modification to the Dose, Frequency, PRN status, and Site. The user will retain the same four options discussed originally Page 22

23 (Submit, Save, Cancel Edit, and Cancel). If an order will be submitted as PRN, the order will require a PRN reason. These are predefined system codes; pg 41 provides a reference of the defined codes. Page 23

24 Required Fields For an order to be eligible for submission, ALL required fields must be completed. Orders with incomplete required fields will appear with a stop sign icon next to them when viewed from the Order Queue. To complete the required fields, click on the underlined order and complete each field with a red asterisk next to it (all medical imaging orders will have additional required fields). The user can choose between the Reason / Indication field (which has prepopulated dropdown options) or the Reason / Indication Text field which allows free text entry. This text entry will become part of the permanent medical record. Order Sets Order Sets provide common order groupings. Order Sets cannot be Saved to the Order Queue from the Search tab, however, they can be added to Favorite Orders. To begin using an Order Set, search for the desired Order Set and click on the underlined description. Page 24

25 If an Admission Order Set is selected, a pop-up box with prompt the user to initiate a medication reconciliation. If the user selects yes it will launch into the medication reconciliation, if the user selects no they are directed to the initially selected Order Set. If completing an Admission Order Set, it is recommended that you select the Yes option. If no is selected and additional medications are added within the Order Set, these medications will require reconciliation. If you are performing a discharge Order Set, it is recommended that you select the No option as you will be completing a separate D/C Medication Reconciliation. Once in an Order Set, orders can be selected from the left column and will move to the right column which shows all orders that have been selected and are available to Cancel, Save (to the Order Queue), Preview, or Submit. Orders may be pre-selected in some Order Sets however, pre-selected orders can be unchecked. Page 25

26 Favorite Orders The Favorite Orders module displays the orders that you have flagged as your favorites on the Search module. It enables you to quickly select an order code or order set that you frequently use. You may also remove an order code or order set from this tab if you no longer want to designate it as a favorite. Page 26

27 Favorite orders can also be organized into groups. Add grouping titles with the Label Maintenance button. To add an order to a group (or multiple groups) click the price tag icon to the left of the order name and move the appropriate group(s) to the right side. Medication Reconciliation To begin medication reconciliation, the user will click the arrow inside the green circle for the appropriate type of reconciliation to be performed. The user will be able to see the home medication and with a transfer or discharge reconciliation the additional medications from during the admission. The user will have the option to continue, defer, modify, or discontinue each medication. The green house icon signifies a patient s home medication. Page 27

28 Notice that the complete button only becomes available once each medication has a selection (compared to above). Upon completion of medication reconciliation a checkered flag icon will appear to indicate a completed document. The document can be viewed by clicking on the book icon to the far left of the row. The document will also be available from the Clinical CareStation and Pharmacy modules. Page 28

29 Order Queue (To Submit Orders) Orders can be populated to the order queue by clicking the save button from the order search or favorite orders areas. This can be a faster way to submit multiple orders rather than submitting them one at a time. The Order Queue tab the orders will appear in an unsubmitted status. To submit the orders click the Submit button. Unsubmitted orders will be available for individual selection (or by clicking the select all check mark). Once desired orders are selected, click Submit. Page 29

30 Documentation Tab The documentation tab has three sub tabs: Documents - drafts and completed documents are available for review, addendum, and completion Search Note Templates allows search / narrowing of available documentation templates Favorite Note Templates allows individual templates to be saved as favorites and allows for grouping of favorites Favorite Note Templates Note templates are added to the favorites by clicking the flag to the far right. Favorite notes templates can be separated into groups in the same way favorite orders can be organized. Page 30

31 To begin documenting on a template click on the book icon to the far left of the row. This will launch the template. Templates will pre-populate with data as available. Fields within templates include check box, diagrams, and free text. Documents require electronic signature to be fully completed. Clicking the hyperlink will attach the physician s electronic signature. Page 31

32 Completed documents are available for review or addendum attachment. Preliminary documents are available for further editing and completion. Page 32

33 Problem List To meet meaningful use requirements, physicians must maintain an active problem list. Page 33

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35 Action List This tab is used for tasks to be signed off by an individual physician. Examples of things that will be found in this tab are: Telephone Orders, Nurse Entered Orders, and Medication Reconciliation for patients that you are the admitting or attending physician, or if pharmacy has had to make changes to a medication ordered. Items are selected individually for sign-off. Page 35

36 Orders Tab Page 36

37 Diet orders appear in a separate section of the section of the Orders tab. Page 37

38 Results Tab The Results tab window includes several sub-tabs (modules): Laboratory, Radiology, Cardiology, Cardio Images, and Other. Results appear in Paragon WebStation for Physicians at the event level. For example, an order may be entered as once a day for three days, which creates three order event records. Each order event is then resulted, which creates three associated result event records. Results Indicators A gray circle represents a Normal Result A yellow "yield" sign with an exclamation point (!) indicates an Abnormal result A red stop sign with the letter "C" indicates a Critical result Results can be selected to view details. A user can click on an underlined result to view the individual result only, or a user can select one or more of the checkboxes to the left of each item. If multiple items were selected and the user is ready to view the next or previous result, the user can use the arrow buttons. Page 38

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40 For an individual result, a user also has the ability to Trend or Reorder. Selecting Reorder will save a new version of the original order to the Order Queue. Selecting Trend will allow a side by side comparison of results. A user can select (by checking the box to the left of each result) an entire result or individual items within a result to trend. The screenshot below demonstrates two full BMP results being trended. Each result will populate a vertical column with the date of the encounter at the top. Page 40

41 For items that have a camera icon as part of the result, the user can click on the camera icon to launch the result image. Page 41

42 Med Rec View Tab When this tab is clicked, it will launch HPF and directly to the patient that the user had selected in WebStation for Physicians. Navigation of HPF will be the same as the current HPF system accessed from Physician Portal. When the HPF window is closed, the user is returned to WebStation for Physicians and the Med Rec View tab. If the window was closed in error, the View Documents button can be used to launch into HPF again. Page 42

43 Meds Tab Medications that are approaching the stop date will have an icon which represents Stop Date Review Requested. These items will also go to the physician Action List for review. Page 43

44 Vitals Tab A physician can save their preference for a search query for each of the fields. Initially the significant check may be selected and the time will be set to 24 hours. At a minimum, physicians at Centegra will want to remove the significant check and save each query parameter. Below are examples of how data will display on the Vitals tab. Page 44

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46 Clinical Assessment Tab Clinical assessment and notes appear through this module. Tab/category notes are labeled 'Note and the 'Note' heading appears in alphabetical order within the list of entries for a specific category (tab). Group notes appear alphabetically according to the group name. To display results, ensure that the Significant check box is not selected. From the Report drop-down list, select the assessment type for which you want to view data (you can save a search query to be your default view which will load automatically). From the Time drop-down field, select the desired value if not the current value. You can select a specific tab (category) for which to view data. For example, for the daily assessment, you could select 'Cardiovascular' to view only data entered on the Cardiovascular tab of the daily assessment. Available dropdown options for Report, Time, and Tab : Additionally, a user can select multiple categories by holding the CTRL button and clicking on the individual categories. The search query definition can be saved as the default for the tab. Page 46

47 Clip Board A physician can add items to their clipboard to be transferred into Physician Documentation. This helps eliminate potential for transposing error between results and documentation tabs. Items that can be added to the clipboard include: Vital Signs, Labs, I/O, Measurements, and CPOE Orders. To add one of these items to the clipboard hover over the item to receive the Click to add to Clipboard message. Clicking on an item will make the item will change the appearance of the box. Multiple items can be selected and saved to the clipboard at the same time from multiple locations (e.g. Vital Signs, Labs and I/O). Copying orders to the clipboard is accomplished from the Order Queue. A user can select the Clipboard option which will bring a list of all orders. Page 47

48 The user can then select the checkmarks to the left of each order they wish to copy to the clipboard and click add to clipboard. Once items have been placed on the clipboard the user can navigate to a documentation template, select a text field that they wish to enter data from the clipboard, and select the clipboard icon. Page 48

49 Items from the clipboard will pop-up for selection. Please note that the clipboard is broken down into 6 sections: All, Vitals, Labs, I&O, Measurements, CPOE orders. The user can select the item(s) that they wish to add the previously selected field and click the plus sign for Add selected Data to document. If the field selected within the documentation template is not compatible with data on the clipboard, the user will be prompted with No field exists on note for selected data. Page 49

50 Important Take Away Items 1. Orders must be submitted for them to be processed and executed. If a user goes to exit WebStation for Physicians with unsubmitted order or unsigned documentation, they will receive a reminder of these items. The user can then utilize the Return to CPOE or Return to Documentation short-cuts to review the items and submit or finalize them. 2. You are encouraged to use Order Sets for increased ease, accuracy, and speed. 3. Order sets must be used when ordering any Cardiology testing this will help ensure that all parts of the desired test are ordered 4. Significant Centegra is not using significant / abnormal functionalities as they relate to vital signs and clinical assessments. 5. Use the Save icon to customize your experience- A user can set a filter to a specific desired value and use the save button to make these the default values which will populate each time the screen is accessed. These saved filters can be modified at any time. 6. There are times that you may appear stuck in a screen. - If you have opened an item on the Tab Strip, to close the tab re-click the same Tab Strip item that you opened originally. - When editing an area such as Med Rec, Allergies, Problem List look for one of these icons that are typically in the bottom left to save or cancel and move on: OR OR If editing a problem on the problem list, to save the change, the user must click the check mark to save the changes made. Page 50

51 PRN Medication Reason Codes A B C Abdominal distention Bad breath Callus or corn Acne Bleeding Cardiac arrhythmia Agitation Blood pressure Chest pain Alcohol withdrawal Bradycardia Cold sores Alkalinization Breakthrough pain Cold symptoms Allergic reaction Bronchodilation Congestion Allergic symptoms Bronchospasm Constipation Allergy symptoms Cough Analgesia Croup Anaphylaxis Anesthesia Angina Angioedema Anxiety Asystole D E F Delirium Ear pain Fatigue Diarrhea Ear wax Fever Dilation Edema Flu symptoms Disinfection Encephalopathy Frequent urination Drowsiness Erectile dysfunction Dry eye(s) Exercise induced bronchospasm Dry eyes Extrapyramidal effects G Dry lips Eye irritation Gastric reflux Dry mouth Dry nasal passages Dry skin Drying and crusting inside the nose Dyspepsia Dyspnea Page 51

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53 H I L Headache Increased blood pressure Labor induction Hemorrhoids Increased intracranial pressure Labor pain Hyperglycemia Indigestion Lactose intolerance Hyperkalemia Infant colic Laxative effect Hypertension Inflammation Loose stool Hypertensive emergency Insomnia Hypocalcemia Itching Hypoglycemia Hypomagnesemia Hypoproteinemia Hypotension M N P Menstrual cramps Nasal congestion Pain Menstrual pain Nausea Parkinsonism Migraine headache Nausea and vomiting Peptic ulcer Morning sickness Neuromuscular blockade Premature ejaculation Motion sickness Nicotine cravings Premature labor Mouth irritation Prevent allergic reaction Mouth sore pain O Psychosis Muscarinic signs and Pulseless ventricular Ocular congestion symptoms fibrillation Muscle pain Odor Muscle spasm Opiate reversal R Muscle spasticity Opioid reversal Rash Mydriasis Runny nose S T V Secretions Tachyarrhythmias Vaginal cleansing Sedation Tension headache Vaginal dryness Seizure activity Tetanus Vaginal irritation Seizures Tetralogy of fallot Vascular headache Shortness of breath Thyrotoxicosis Ventricular arrhythmia Shortness of breath or wheezing Toothache Ventricular fibrillation Sinus symptoms Vertigo Skin cleansing U Vomiting Skin irritation Uterine bleeding Sleep W Page 53

54 Sore throat Spasms Sun exposure Sweating Wheezing Wound healing Notes Page 54