NextGen EMR with Oasis Oncology Content Training Manual

Transcription

1 NextGen EMR with Oasis Oncology Content Training Manual (8/10/07) Oasis Provider Manual Page 1 of 164

2 Oasis Provider Manual Page 2 of 164

3 Table of Contents Page LOGGING IN AND OUT OF THE EMR... 5 CONFIGURING USER PREFERENCES... 8 MENU AND TOOLBAR FUNCTIONS WORKFLOW MODULE TASKING AND SCHEDULE MEDICATION MODULE NON CHEMO PRESCRIPTIONS DIAGNOSIS MODULE BASICS ALLERGY MODULE BASICS WILD CARD SEARCH IN MODULES PATIENT DEMOGRAPHIC TEMPLATE PATIENT ASSESSMENT AND ENTERING VITALS PREASSESSMENT NON-CHEMO ADMINISTRATION VITAL SIGNS GROWTH FACTOR DOCUMENTATION FLOWSHEET AND LAB DATA ENTRY ENCOUNTER SNAPSHOTS PROVIDER CHARTING GENERAL HX TEMPLATE TREATMENT HX TEMPLATE SUB/OBJ/DATA TEMPLATE ASSESS / PLAN / ORDER TEMPLATE THERAPY AND GROWTH FACTOR ORDERING CHEMO PROTOCOLS O CP STARTING A NEW OCP SIGNING OFF CHEMO ORDERS DISEASE MANAGEMENT TEMPLATES RN DESKTOP GUIDE NEXTGEN EMR REFERENCE SHEET FOR NURSES CHEMO MEDS INFUSION TEMPLATE GENERATING NEXTGEN DOCUMENTS HOW TO GENERATE A DOCUMENT PRINTING DOCUMENTS FAXING DOCUMENTS IMAGING ORDERS NEXTGEN S EMR PATIENT EDUCATION DOCUMENTATION ICS SCANNING SINGLE DOCUMENT TYPE FOR A SINGLE PATIENT Oasis Provider Manual Page 3 of 164

4 FILING AND POSTING A SCANNED DOCUMENT BATCH DOCUMENT SCANNING FOR MULTIPLE PATIENTS OR DOCUMENT TYPES FILING AND POSTING BATCH SCANNED DOCUMENTS VIEWING SCANNED DOCUMENTS IN EMR PSR (FRONT DESK)DESKTOP GUIDE FRONT DESK - CHECK IN CHECKLIST: USING RIGHTFAX IN NEXTGEN PHONE MEMO TEMPLATE PAQ PROVIDER S APPROVAL QUEUE PATIENT SCENARIOS FOR PRACTICE NURSE DATA ENTRY AND PHYSICIAN OV FREQUENTLY ASKED QUESTIONS OASIS GLOSSARY EMR EMERGENCY CONTACT LIST: NOTES Oasis Provider Manual Page 4 of 164

5 Logging In and Out of the EMR 1. The first step is to launch the Citrix Client or Thin client to the NextGen application menu. Note: Some users will have access to the NextGen application menu via a Fat client. The Fat client is not used to the extent that the Thin client is used throughout the AHN network, so chances are you will be using a thin client. 2. Following are the various icons that might be used to identify the Thin or Fat client for the NextGen application: 3. Double click on any one of the icons above which indicate the desired NextGen environment. AHN has four environments, (Production, Test, Development, and Demo). Each icon must be specifically configured to connect to each of these environments. 4. Once connected to the appropriate environment, the user should see the NextGen menu or Application Launcher. 5. At this point the User may choose the specific NextGen application. For the purpose of this manual, we will choose EMR. The following screen will appear. Oasis Provider Manual Page 5 of 164

6 6. As the user, you can simply press ENTER to accept the disclaimer because this is the default response. 7. You will then see the Log-on screen appear. 8. Field 1 is where the User ID is input. (This is typically the first 5 characters of the user s last name and the first two consonants of the user s first name. (i.e., Joseph Hercules would be HERCUJS) 9. Field 2 is for the User s password. Passwords are always lower case. 10.Field 3 is for the Enterprise that you are located in. (At this point there is only one Enterprise, and that is American Health Network. 11.Field 4 is for the practice that you wish to access. For MOST users, you will be associated with one and only one practice. There is a drop-down arrow on this field for users to scroll down to the desired Practice. For Oncology this is AHN Hematology/Oncology Center. 12.Once you have completed entering the above information, click on Sign on to enter the application. 13.NOTE: The very first time you access the system, you will prompted to change your password. Below is an example of the message you will see. 14.You will then be prompted to enter your NEW password. See below. Oasis Provider Manual Page 6 of 164

7 15.At this point you will be prompted to enter you NEW password, initially and a second time to confirm your entry. Near the bottom of the screen you will see the password requirements, either content or length. 16.At this point the NextGen EMR application will launch and the main screen will display. The application will appear to be blank until you enter your user preferences. 17.Go to the next section Configuring User Preferences. Oasis Provider Manual Page 7 of 164

8 Configuring User Preferences 1. Once you are logged into the system, you will need to configure your preferences for the EMR application. 2. This must be performed once per environment and it is tied to your User Id. 3. To begin the process of configuring your preferences, click on the word Tools from the top toolbar. 4. Then scroll to the bottom option preferences. You will see the following screen: 5. The Preferences screen consists of 6 tabs. a. General b. Main Toolbar c. Medical Records d. Templates e. Medications f. Formulary 6. To Change Preferences: a. Choose a Preference Tab by clicking on the tab. b. Change the desired preference associated with the tab c. Press Apply, and then OK to close the screen. 7. For specifics associated with each tab, go the next section below. Oasis Provider Manual Page 8 of 164

9 Individual Tab Explanation & Configuration 1. The GENERAL Tab a. This tab contains 7 sections that the User can configure. (The values on the following screens are the recommended settings. i. Patient Selection section select your desired patient selection preference. Patient Selection Options: ii. Show Appointment Entire day it will only affect the patient selection Window 1. Select the checkbox if you would like to see all of the appointments scheduled for the date selected. Oasis Provider Manual Page 9 of 164

10 2. Do not select the checkbox if you would like to see ONLY the appointments scheduled from the current hour onward. iii. Top Toolbar - This is for customizing viewing preferences on your top or Main toolbar. 1. There are three settings Top Toolbar Options: Note: It is recommended that you select Images and Text iv. Labs 1. Allow users to choose if they would like to view long or short descriptions of the tests in the Lab Module. 2. The Default value is to view the short description. a. Note: It is recommended that you NOT select either Checkbox, this will give you the best setup to view Lab results. v. Session Setting 1. When NOT selected, it allows EMR and EPM applications to synchronize all patient information. The user has the option to suspend this feature. vi. Logout after 1. NextGen EMR has an additional built-in security feature where the user is logged out after XX minutes. The default value is 10 minutes. You may choose a time frame that best suits your environment. vii. Initial Module 1. This enables users to select a Module within EMR that is automatically populated upon a successful logon, therefore requiring fewer mouse clicks. a. Note: It is recommended that users select the Workflow module as the default module. Oasis Provider Manual Page 10 of 164

11 2. Main Toolbar a. This tab has three different sections. i. Display section 1. Here the user can determine what will display in the main EMR Toolbar or History toolbar area. 2. Note: It is recommended that the user select Encounter Date 3. A checkbox labeled Provider Name is also available. When the User checks this box, the Provider s name will appear next to each encounter, so that the User can instantly see who the provider was for that encounter. If your screen resolution is low, this option may is not recommended. 4. At the drop down at the bottom of this section there are 4 choices that the user can make regarding how they want to view the encounters associated with any given patient. The two most popular are Expand Most Recent and Collapse All. You can choose the option that fits you best; however, it is recommended that you choose Expand most recent. Of course, these options are only defaults and can be changed at any time. ii. Filter 1. Here we have just two options, Billable & Optical Encounters. Currently we do not have the Optical Oasis Provider Manual Page 11 of 164

12 3. Medical Records Tab application, therefore, you should only check the billable option. a. There are just two sections to this tab. i. Location ii. This is where the user can define what the default practice will be when the EMR application is launched. iii. Click the Ellipsis button for a listing of locations. Choose the desired location, and then press OK. b. Provider i. This is where the user can define what the default Provider will be when the EMR application is launched. ii. Again, click the Ellipsis button for a listing of providers. Choose the desired provider, and then press OK. **Note: Choose a provider even if you deal with multiple providers. This selection is purely the default choice. Depending on your position, you will change this value throughout the day. c. Default to Last Selected i. If this box is checked, whether on the Location or Provider setting, the last location or provider will be input into memory and will appear the next time you log onto Oasis Provider Manual Page 12 of 164

13 the NextGen EMR system, irregardless of how your preferences were originally set. 4. Templates Tab a. There are basically three sections associated with this tab. i. Available Templates This window displays all available templates that are associated with each Template Type. ii. Preferred Templates most frequently used template(s) as selected by the user. This list is typically much smaller than the ALL templates list. This list will be much easier to sort thru than the ALL templates list. Oasis Provider Manual Page 13 of 164

14 Recommended settings for Oncology: Note: Default template recommendations: 1. Physicians Enc_Snap1 (General History) 2. Nurses RN_Desktop 3. Front Desk PSR_Desktop iii. Template Type (Blue Box) 1. There are four groups of Template types: Medical records Demographic. System Group Templates 2. The Default template type is Medical Records. In fact the majority of the templates are located under this template type. 3. You can click the dropdown arrow to change the template type, then the templates associated with this type will be displayed. Oasis Provider Manual Page 14 of 164

15 iv. Adding and Removing a Template to the Preferred Template screen: 1. Click on the template name that you wish to add to your preferred list. 2. Click on the Move Right button (Red Box) to add a template to the Preferred Templates Window. 3. Scroll down, when necessary, to pick the desired template in the Available Templates Window. 4. To add all of the available templates, click on the double right arrow below the red box. 5. To remove a template from the Preferred Templates window, click on the single left arrow (Green Box) v. Default Template 1. This field allows the user to select a default template that opens when a new Encounter is created. (Yellow Box) This requires the user to click on the NEW button. 2. Click the dropdown arrow and select your preferred template. It is recommended that the users select the template that corresponds with their roll in the clinic. 5. Medications Tab a. There are three sections to setup within the Medications module. i. Search section 1. This section allows the user to determine how to search for the desired medication. Oasis Provider Manual Page 15 of 164

16 a. All b. Payer or Insurance c. Provider d. Problem or Medical condition 2. The NextGen default is to allow users to search for ALL medications. 3. Users can also choose to search by Brand Name or Generic Name or Both, by clicking both boxes. 4. If Show Brand for Generic is checked, the Brand Names of the medications will display during Generic name Search. 5. Users should always select Auto Search; otherwise the users will have to perform the search manually. 6. The time frame should be set to 800 milliseconds, which is the default value. ii. Printing and Faxing 1. Check for Interactions Enables NextGen EMR to run an auto search in order to determine whether the particular medication chosen by the user is compatible with either another medication or an allergy associated to the patient. 2. Use medication Verification This will prompt the user to re-enter his or her password before the prescription is either faxed or printed. This is usually not checked since it creates more key strokes, especially for the providers. 3. Prescribed Elsewhere indicates the selected medication has been prescribed by another practice or provider for the selected patient. Note: 1.) User Defined Allergies are NOT evaluated for interactions. 2.) All three checkboxes in this section are checked by default. Users will need to uncheck Use Medication Verification and Prescribed Elsewhere. iii. View 1. This setting allows users to choose what type of medication orders should be displayed in the Medication Module. 2. The NextGen default is ALL. 3. There are three available types: All Active Inactive Oasis Provider Manual Page 16 of 164

17 6. Formulary Tab a. There are four sections to this tab, and they are as follows. i. General 1. You are able to search medications by using the formulary, when the checkbox User Formulary as default medication search is checked. ii. View Options 1. Allows the users to choose whether Formulary Status and Notes will display within the Medication module. iii. Drug Information 1. Select specific drug information to display. 2. You can choose to display any combination of available medication information 3. There are four choices a. Display (Chemical Name) b. Display Only Drugs c. Display OTC Meds d. On Formulary Only iv. Formulary Status 1. Select how the Formulary Status displays. You can select Text & Images, Images Only or Text Only. We recommend that you select Text & Images Oasis Provider Manual Page 17 of 164

18 Menu and Toolbar Functions 1. Title Bar The Title Bar is located on the very top of the application window. The Title bar contains the Patient Name, Encounter Date & Time, plus the name of the Template, Document or Module. 2. Menu Bar The NextGen EMR Main Menu is located at the top of the Main Window. It contains the following options: File, Edit, View, Tool, Utilities, Window, and Help. 3. Top Tool Bar The Top Toolbar is located directly under the NextGen EMR Main Menu. It consists of ten buttons and two drop-down lists. Exit Top Toolbar Icon Save Clear Delete Location Provider Patient History Inbox PAQ Function Logs out from, but does not close, the application. Saves the work in the active window. Clear the data you have entered in the active window. Deletes the data you have entered in the active window. Allows selection and displays the location of the provider selected. Allows selection and displays the name of the provider selected. Prompts the Patient Lookup dialog box. Toggles the History Toolbar on/off. Toggles Workflow Module on/off. Prompts the Provider Approval Queue (PAQ). Note: The PAQ must first be enabled. Oasis Provider Manual Page 18 of 164

19 Apps. Close Enables opening other licensed NextGen applications directly from the NextGen EMR bypassing the Sign On screen. Closes the current open window. 4. Main Tool Bar/History Tool Bar The History Toolbar consists of four separate components: a. Encounter Tab b. Demographics Tab c. Categories Tab d. Medical Records Module icons Oasis Provider Manual Page 19 of 164

20 5. Toggling You can toggle between EPM and EMR application. There are two ways: 1. Press and hold on ALT key, then press the TAB key, you can continue press TAB key until you get to the application you would like to open, then release both ALT and TAB key together. 2. You can also go to either application by press the Icon in both applications accordingly. a. In EMR Click on Apps. Icon, then select NextGen EPM Oasis Provider Manual Page 20 of 164

21 b. In EPM Click on EMR Icon in Top Tool Bar OR Click on Task on the Menu Bar, then select EMR from the dropdown list. 6. Minimize/Maximize Screens a. You can minimize or Maximize the Application by clicking the appropriate icon located at the top right hand corner of the Window. Oasis Provider Manual Page 21 of 164

22 7. Help Features 8. Exiting/Logging Out If you want to Log out of the application, but not close the application, press icon from the Top Tool Bar. If you want to Log out and Close the application, you can click on File and select Exit from the dropdown list (A) or click the X from the top right-hand side (B). (B) (A) Oasis Provider Manual Page 22 of 164

23 9. Migrating through EMR Screens and Templates a. It is critical that migration thru the various templates is done in a specific manner. i. Users should always use the left-hand side Navigation pane to move between templates. 1. When using the Navigation pane, previous template data is always saved and closed ii. Users should NOT use the History toolbar to move between templates 1. This is because the template data is NOT saved. Which means that if you have entered a whole section of data, and it does not get saved, you will have to re-enter that information. iii. Users should Never close a window or template by clicking on the X in the upper right-hand corner this will cause you to loose unsaved data. b. Bottom line if you do not save your data by using the left-hand Navigation pane, you are at risk of losing all of the information you ve input into the system. Oasis Provider Manual Page 23 of 164

24 Workflow Module Tasking and Schedule The Workflow module also identified by the Inbox icon from the top toolbar, is a very powerful tool that can be used to manage and track a provider s schedule, as well as handle the various tasks that may be assigned to a user. The Appointments section offers a very unique feature that allows the user to access data within the patient s chart. The Tasking section also offers features that allow your staff to communicate with each other regarding patients, as well as other issues that arise throughout the day. This document will explain further the functionality of the Workflow module. 1. Components of the Workflow Module a. The workflow module has three components: i. Appointments or Provider schedule ii. Tasks List iii. NextGen b. Accessing the Workflow Module i. Select the workflow icon from the top toolbar, it will appear as: 2. Once the icon has been clicked the workflow screen appears: (Below) 3. Appointments a. The appointment section of the workflow module is used to quickly view a provider s appointment schedule as well as the status of each appointment. This section is provider and date specific. i. To change the provider s schedule to another provider within the practice, change the provider by using the drop down list on the Top toolbar. Oasis Provider Manual Page 24 of 164

25 ii. You will need to close and open the Workflow screen for the schedule to update to the newly selected provider. b. The appointments or scheduling section is constantly being updated as changes are made within the EPM module. c. The Date field may be changed to view appointments for other dates. i. To change the date field: 1. Click on the drop down arrow within the date field. 2. The Select Date screen appears 3. Select the desired day/month/year. 4. The appointments for the selected date will now appear in the Appointments section of the Workflow screen. d. Appointment preferences enable the user to configure how they view the appointments or the schedule section. i. To configure appointment preferences, click on the icon located in upper left-hand side of the appointment region. Choose Preferences, and the following screen will appear: Oasis Provider Manual Page 25 of 164

26 ii. We ask that users NOT change the colors for the displayed statuses because these are Global settings and they will change all users. This setting is NOT configured by user or practice. 1. Users should check the check-box next to Refresh Appointments every X minutes. 2. Users should be encouraged to refresh the appointments screen every 1 minute. iii. Other user preferences within the Appointment preferences window. 1. This is the menu that you will find when you access appointment preferences. 2. The user can force an instant refresh by clicking on the <Refresh> phrase. 3. By choosing Show Cancelled Appointments, all cancelled appointments for the chosen providers schedule for the date chosen with be displayed with a line thru the appointment entry. See two screen shots above for an example. A checkmark will appear when the preference is turned on. 4. The Room field is a field that is present on the appointment/schedule section that can be updated if you are interested in tracking the location of the patient. You may choose to use this field to update the status of the patient. (i.e., Patient is in Exam Room 3, in Lab, etc.) a. To enter the room number, select a patient by clicking on the record. b. Then click on the appointment preferences icon c. Choose the selection labeled SCHEDULE. The following screen will appear. Oasis Provider Manual Page 26 of 164

27 d. Select the appropriate encounter at the bottom of the screen. e. Enter the patient s location in the Room field. f. Then press the Update button on the right-hand side. When you return to the appointment section of the Workflow screen, you will see the updated room information. See next page. g. The user also has the option of updating the REASON and the STATUS, if so desired. 4. Tasking iv. Patient information is updated from the EPM module as patients are scheduled or checked-in. Recall the refresh time setting will determine how frequent this occurs. a. The Tasking portion of the Workflow module is used to communicate between other members of the Healthcare team. The Tasking module is a major feature of the NextGen system. It alerts users to key tasks, which must be completed. Users will find information associated with patient charts that need to be signed, medications that need to be refilled, patient lab results that should be reviewed, and other key clinical information. b. This tasking section is located in the upper right-hand side of the Workflow screen. Oasis Provider Manual Page 27 of 164

28 c. There is an icon of a clipboard just above the Tasking window. This is where user preferences can be configured. More to follow on this in an upcoming section. d. There are several types of tasks available to the user. i. Action Tasks These require the recipient to do something. ii. Informational Tasks These are tasks that are intended to notify staff members of a message. iii. Notification Tasks These are tasks that alert users about something that requires their attention. (i.e., Lab testing notifications) iv. Individual or Group Tasks Tasks can be assigned to an individual user or to a group of users as define within the system. For example, if a provider wants to send a task to one of his Nurses, but the provider is not sure which nurse is available, the provider can send the task to a predefined group of nurses that are associated with the provider. This is especially useful since the Task, once accepted by one of the nurses, will fall off of task list of the remaining nurses within the group. e. Configuring the Tasking module This is where the User can specify certain preferences be applied to their Tasking module. i. Click on the Tasking module preferences icon Before After ii. The graphics above show the default settings, illustrated by the checkmarks, are to have the three settings activated. 1. The checkmarks to the left of each phrase are simply toggle checkmarks. Click on the phrase, it turns on; click it again, it turns off. 2. The After graphic demonstrates the recommended configuration for the tasking system. 3. iii. Setup Tabs This feature allows the user to create and/or modify the Tabs associated with the tasking module. Part of the flexibility with tasking is that you can setup tabs that contain tasks that are specific to certain Task categories. For instance, you can have a LAB tab, that contains nothing but Lab related tasks, or you can have a RAD tab that contains all Radiology associated tasks. NOTE: One thing to remember is that all tasks, irregardless of the category, will be contained within the ALL TASKS tab. Oasis Provider Manual Page 28 of 164

29 f. Entering a Task To utilize the Tasking feature, the user should perform the following. i. To create or initiate a task, the user will first launch the Workflow module. ii. The next step is to click on the NEW TASK button just below the tasking window. This will open another window, called NEW TASK where the user may enter specific information regarding the Task. See below for details. iii. The User can enter several pieces of information regarding the task. 1. Date The date is entered here. The date can either be today s date, if that is when the task should be performed. Oasis Provider Manual Page 29 of 164

30 This date can also be a date in the future if that is when the task should be performed. 2. Priority There are three levels of priority a. Low signified by a blue arrow pointing downward b. Normal c. High signified by a red exclamation point. 3. Subject Where the User can give a brief description 4. Description The User can enter more extensive information regarding the task in this section. 5. Assigned This section is where the User can assign the task to an individual recipient or a group of recipients. a. To assign to a recipient, the User will click on the Assign To button to the right of the Assigned field. This will launch the Select Task Recipients dialogue window. b. The User can now migrate to the desired recipient or group c. Once identified, the User should click the Add User(s) or Add Group button. This will move that User or Group to the Task Recipients right-side window. d. In the same manner, if the User wants to delete a recipient, they will highlight the user or group in the Task Recipients window and click the Remove button. e. To clear all choices made in this routine, the User can click the Clear button. 6. Patient This is where the User can select a patient that is associated with the task. If NO patient is associated with this task, then this field may be skipped. The beauty of this feature is that when the task is opened, the attached patient s chart will be automatically opened, eliminating several steps for the User. a. To select a patient, click the SELECT button to the right of the Patient field. This will launch the Patient Lookup routine where you can search for a patient using one of several data fields. 7. Attach Here the User can attach, if available, one of three data types a. Template A list of available templates will pop up for the User to choose from. Select the template, and then click OK. b. Document A list of available documents will pop up for the User to choose from. Select the document, and then click OK. c. Image - A list of associated images will pop up for the User to choose from. Select an image, and then click OK. d. None If no attachment is chosen, the default value will be (None). Oasis Provider Manual Page 30 of 164

31 8. Task Category Here the User can select a predefined category to associate the task with or a Custom category may be used. The beauty of this is that the User can associate a task with a category, then the recipient can use custom Task Type Tabs to pull in specific Task types. 9. Send The User should click the Send button if the task is completed and ready for sending, otherwise the User can click the Cancel button. iv. Other Action Buttons These buttons are used to act upon existing tasks. 1. Delete This button will delete a task 2. Modify This button will allow the User to change various aspects of the task. 3. Send 4. Chart This button will automatically take the User into the associated patient s chart. v. Task Statuses Task statuses allow the user to view a task and instantly determine if it has been acknowledged. 1. Black These tasks are NOT overdue and they have not been opened by the recipient. 2. Gray These tasks have been opened and are not overdue. 3. Light Gray These tasks have been completed, and due to the preferences setting, are being displayed in the task list. 4. Bold Red These tasks are overdue, and they have not been opened. 5. Light Red These tasks are overdue, and they have been opened by the recipient This icon shows that a task has been completed This icon shows that a task has been handed off This icon shows that a task has been accepted by the recipient. Oasis Provider Manual Page 31 of 164

32 Medication Module Non Chemo Prescriptions NextGen s Medication module is the system that allows the provider to manage the patient s medication needs. The Medication module is a very comprehensive system. This system stores historical data as well as current medication data. Medications can be evaluated for drug to drug compatibility and for ingredient allergies. Completed orders can then be printed or even faxed to the pharmacy of choice. 1. To Access the Medication Module a. Once a patient has been selected and the patient s chart opened, the user will click on the Pharmacy module icon. This can be found in the Tic-tac-toe area. b. The following screen will appear. i. The Medication module displays the patient medications, along with all of the supporting information regarding the Rx. ii. To view information on a specific Rx, the user will click on the Rx of choice. iii. Once the Rx has been selected, the supporting information on the Rx will be displayed below the section with Rx listings. 1. This bottom half of the screen is where the provider or the provider s nursing staff can enter the specifics about this Rx. a. Medication itself b. Dose c. Administration form Oasis Provider Manual Page 32 of 164

33 d. Route e. SIG (Special instructions or directions for taking the medication.) f. Practice location g. Provider s identification h. Problem or medical state i. Start and Stop dates j. Quantity k. Refills l. Generic vs. Brand 2. If the patient is new, there are fields present to document Rx s that have been prescribed at another location. 3. If dispensing samples to the patient, this too can be documented. 4. Drug to Drug, and Drug to Allergy checking can also be performed by checking the checkbox labeled Check for Interactions Oasis Provider Manual Page 33 of 164

34 2. Ordering Medications a. The first step in ordering a medication for a patient is to open the Medications module. See previous steps. b. The user should make sure that all other supporting information is correct. There are basically four pieces of data that should always be verified before processing any item. i. Patient ii. Location iii. Provider iv. Encounter c. Once these parameters have been confirmed, the user will click on the NEW button. Oasis Provider Manual Page 34 of 164

35 d. Selecting the NEW button will launch the Medication selection tool seen below. i. The user has the option of searching meds by 1) Provider 2) Dx Code 3) Payer or lastly 4) All or the entire database. ii. Based on the user preferences that have been entered, this screen will have certain default settings. 1. If Brand Name and Generic Name are checked, then you will be able to search by either name. 2. Enter the medication name in the field right below Brand Name. a. As you type, the window will display all matches. b. The user will then select the desired dosage and form. i. You can double-click on the medication or you can select the medication then press the Select button. c. Once the medication has been selected, it will appear in the main window within the Medication module. At this point the user can search and select additional medications until all have been entered. Oasis Provider Manual Page 35 of 164

36 3. Now the user must update each medication selected in the previous step before it can become active. The following fields should be evaluated. a. A SIG code must be added to each medication b. The user can enter specialized instructions that the provider would like to appear on the prescription order. c. The user can enter a start/stop date if desired. d. The user can enter a quantity to be dispensed. e. The user can enter a number of refills. f. The user can enter whether Brand is required. 4. Once all of the above information has been entered, the user has a few options available to them. a. Save the order b. Print the order (must also be saved before it can be printed) c. Fax the order (must also be saved before it can be printed) iii. Users also have the ability to change the status of a medication. The first column may display one of several statuses. 1. A Active 2. T Temporary 3. I Inactive 4. D Deleted iv. Depending on the access level of the user, you may or may not have the ability or rights to inactivate a medication. Deleting Rx s is generally not permitted. 1. In the event that an Rx has been entered in error, the user should inactivate it and add a comment or note to the med describing the reason why it is in the patient s chart. This is extremely helpful when questions arise down the road and the staff member is no longer employed by AHN. 3. Medication Education a. Patient monographs are extremely useful in educating your patient population. With Patients becoming more and more involved in their own healthcare decisions, the medication monograph is an excellent adjunct. b. To print a monograph or patient education document, perform the following. i. Open the Medication module within the patient s chart. ii. Select a medication, within the main medication module window, that has been ordered on the patient. iii. Once selected, the EDUCATION button on the Medication toolbar will light up. Press this button. Oasis Provider Manual Page 36 of 164

37 iv. A window will pop up with the medication information, displayed in layman s terms, that can be viewed by or printed for the patient. 4. Medication Dosing a. Users have the ability to check medication dosing within NextGen s EMR. b. The Dosing feature provides users with quick-check information on the usual range of daily doses on the most frequently prescribed medications. Oasis Provider Manual Page 37 of 164

38 c. ONLY the medications provided by First Data Bank formulary services are available within this Dosing feature. d. Dosing Groups (based on age and weight) i. There are three groups of Dosing information available that target specific age groups. 1. Min/Max Adult Daily Dosing group for the average adult years of age. 2. Min/Max Geriatric Daily Dosing group for the average geriatric adult with the age greater than 65 years old. 3. Pediatric Dosing group for children from 31 days to 18 years of age. ii. Min/Max Dosing definitions 1. Minimum and Maximum dosing is defined as follows: a. The Minimum is the minimum amount of the selected medication that would satisfy recommended dosing requirements on a daily or 24-hour basis. b. The Maximum is a product-specific amount of the selected medication. The defined 24-hour dosing maximum for a selected medication could vary, based on a number of medication specific factors. e. Dosing availability i. Medication available in the Dosing feature includes any drug product that can be measured in quantitative units, (i.e., tablets, capsules, etc.), on a daily basis per recommended dosing guidelines. ii. Any medication that requires a patient s weight as a necessary parameter for dosing is NOT included in the Min/Max Adult Daily dosing group and Min/Max Geriatric Daily Dosing group. iii. Most of the topically applied products, (i.e., creams, lotions and ointments, etc.), as well as medication that cannot be measured quantitatively are also excluded in Dosing. f. Working with the Dosing Feature i. To view available Dosing information: 1. Select a prescribed medication 2. Click the Dosing button. You are prompted with the Dosing Range screen. a. Pediatric Dosing: Oasis Provider Manual Page 38 of 164

39 b. Adult Dosing: 3. Press Display Dosing, the message 6181 days old At Kgs Dose between 5.0 mg/day and 60.0 mg/day is displayed at the bottom of the Dosing Range Window. See below. 4. Reseting the Patient s weight - You can also reset the patient s weight by pressing the Reset Weight button. The Patient s weight field will clear allowing the user to enter a new weight. a. Once when you have entered a new weight, you can press the Display Dosing button again. The dosing message will display at the bottom of the Dosing Range Window with the new weight. b. Click OK to close the Dosing Range routine. 5. Medication Interactions a. NextGen s EMR allows users to check for interactions between the prescribed medications and those already on the patient s medications list, as well as interactions between the prescribed medication and any known Allergies the patient might have. b. If the Medication Interactions feature is turned on in NextGen EMR Preferences, the application checks for all interactions between already prescribed medications and a newly added medication automatically. Oasis Provider Manual Page 39 of 164

40 i. NextGen s EMR will prompt users with a warning dialog in case there is a negative or unwanted interaction. See example below. ii. When prompted with the Drug Interaction screen, highlight the listed medication to view a summary of the existing conflicts. NextGen s EMR lists a summary of effects and levels of risk. iii. To learn more about the conflict between prescribed medications, the user should click the Monograph button to prompt the Drug- Drug Interaction Monograph screen. iv. Medication interactions will be checked across practices, however you will not be able to see the actual medications from the other practices using the Medication Module itself until later versions of NextGen. You will need to work with the other practice to change their medication list if you wish to do that. c. Levels of Interaction i. There are four Levels of Interaction: 1. Level 1 one of the prescribed medications contains an ingredient that matches an ingredient stored in the patient s allergy list. 2. Level 2 one of the prescribed medications contains an ingredient that has an identical Specific Group Allergy Code as the ingredient in the patient s allergy list. In this case, a patient has identified either an ingredient or allergen class that matches the allergen group of an ingredient in one of the prescribed medications. 3. Level 3 one of the prescribed medications contains an ingredient that has an identical Cross Sensitive Allergy Group Code to that of the ingredient in the patient s allergy list. This is similar to Level 2, except that an overlap occurs based on a cross sensitivity link as opposed to the specific allergy group. 4. Level 4 one of the prescribed medications contains an ingredient that creates a drug-drug type interaction Oasis Provider Manual Page 40 of 164

41 associated with an herbal or alternative medicine type drugs. Level 9 Interaction has an undetermined severity; users must assess the risk to the patient and take all necessary actions. 5. Note: Matches that occur in a Level 2 Interaction do not guarantee an allergic reaction will occur, however, they indicate a strong possibility for such. Matches that occur in a Level 3 Interaction present a less frequent reaction than that of Level 2. Oasis Provider Manual Page 41 of 164

42 Diagnosis Module Basics 1. To add new diagnosis a. Click the New button and type in ICD9 code or type in description. b. Remember the module does not recognize decimals (.) and correct spelling is very important. c. The onset date is the encounter date in which the information is being entered into the system. d. You can enter Status and Severity. e. To enter the date the patient was diagnosis, type the information in the note section of module. f. Make sure location and provider are correct. g. Click Save. 2. To resolve a diagnosis a. Click on the diagnosis that has been resolved. b. Then click on the ellipsis button ( ) and click on date the diagnosis was resolved. c. The diagnosis will move to the resolved area of module. d. Click Save. 3. To delete a diagnosis a. Select the problem to be deleted. b. Click Delete button. c. You are prompted with a warning dialog. Click Yes. d. Click Save button. Oasis Provider Manual Page 42 of 164

43 Allergy Module Basics 1. To add new allergy a. Click on the Allergy ellipsis ( ) button b. Type in description. Correct spelling is important. c. Click Add. d. If you would like you can add a comment or reaction. e. Make sure location and provider are correct. 2. To delete allergy Oasis Provider Manual Page 43 of 164

44 a. Click on allergy that you wish to delete. b. Click the delete button. c. You will get a window that asks you are you certain. 3. To resolve an Allergy: a. Select the required Encounter in the Main Toolbar. b. Click the Allergy icon to display Allergy Module screen. c. Highlight the desired Allergy. d. Enter the date for allergy resolution. Use a pop up Calendar by clicking the ellipsis button. e. Click the Update button. Tips 4. To enter Mycin allergies Mycins usually means tetracycline for most patients. (terramycin was an old form of tetracycline). It could also be erythromycin. Ask if it was oral or IV (gentamycin and tobra are IV only) and what it was prescribed for (URI, etc). Which one or ones to include when you get that history needs to be checked with the doctor. Probably need to include both TCN and Emycin if it was oral and patient isn't sure. Usually it is just GI intolerance anyway. To enter Sulfa allergies For all Sulfa allergies: Sulfamethoxasole For PCN allergies: Penicillins Oasis Provider Manual Page 44 of 164

45 Wild Card Search in Modules This feature can be used to search for a diagnosis if you do not know the IC9 code or you can even search for an allergy or medication. Steps First click into the Diagnosis, Allergy or Medication module. Then click on the New button. This will open the screen Select Allergy, Select Diagnosis or the Medication screen. If you know the allergy, ICD9 code or medication name type it in the correct field then click the Search button and add it but if you do not know the code or correct spelling for example all you need to do is click in the field labeled Description. In the Description field type in an asterisk " * " then type in the problem/disease/allergy/medication you are looking for and then type another asterisk " * " and click the Search button. This is the "wild card". For example: I can type in, *Melanoma* and click the Search button The database search will include any ICD9 codes that have the "words between the asterisks" You then double click on the correct listing and this adds it to the patient's module. Note: If you only want to type the first few letters of a problem/diagnosis, for example "melan" instead of the entire word "Melanoma it will search for all entries with the letters between the asterisks. Oasis Provider Manual Page 45 of 164

46 Example: Oasis Provider Manual Page 46 of 164

47 Patient Demographic Template Oasis Provider Manual Page 47 of 164

48 Entering and Editing Patient Demographic Template 1. When entering information it is very important to be accurate and consistent with the data entry. When entering New Patient demographic information or editing Existing Patient demographic information this should be done in EPM/EAS first then completed in OASIS. This means address, phone numbers, DOB and SS#. When Patients demographic information is entered into EPM/EAS it will populate into OASIS. 2. If a patient s name changes, you must make that and other core demographic changes in the NextGen EPM tool. When entering New Patient information into EPM/EAS please remember to check and make sure the patient is not already in they system. You can search by Name, DOB or SS#. 3. Privacy Notice Given to Patient This is to be checked when the patient receives this information. When the box is clicked a date box will appear and show the date the information was given. Oasis Provider Manual Page 48 of 164

49 Patients Basic Demographic Information 4. The patient s name, address, phone numbers, sex will come from EPM. So remember to add this information first to EPM. The account number and ID number will automatically generate so you do not need to add this information. 5. Cell Phone number will need to be added in OASIS. 6. Clinic Location Field- This is the patient s home clinic. To enter this information you click on the box and a pick list will appear. Click on correct location and it will appear in the box. NOTE: This is the patient s home clinic. The clinic in the top toolbar is the clinic they are in for that encounter date. 7. Employer Just click and type in box. 8. Address Just click and type in box. If patient wants to be removed from address check the Remove From List. Alerts The Clinic Alert and Business Alert are shared with all the desktops. AHN Providers 1. To add a provider to these fields click in the box. The Select A Provider window will appear. To select a provider you can type in the first few letters of last name and first few letters of first name, then click search. To choose provider you can double click or you can highlight and click OK. 2. To change a provider click clear button and the follow same process 3. Contact Information 4. To enter contact information double click in the Summary Grid Area. The Contact window will appear. To add the information click on the fields and enter the information. Once you have completed this click Save then Close. The information you added will appear in the Summary Grid. 5. To edit this information double click on the Contact Type you wish to edit. Click on the Clear to Add button. Make necessary changes. Then click Save then Close. 6. To Delete Double click on contact you wish to delete. The Add Contact window will appear. Click on the Delete button. 7. Outside Providers 8. Referring MD - To add or edit click in field and the Referring Physician window will appear. To select a provider you can type Oasis Provider Manual Page 49 of 164

50 in the first few letters of last name and first few letters of first name, then click search. To choose provider you can double click or you can highlight and click OK.UPIN # - Type number into box. 9. Locate UPIN This button will launch you to a site where you can enter the doctor s name, state and specialty and it will locate the provider s number if they are the database. 10. To add other Outside Providers double click in the summary grid area. The Provider window will appear. Type in correct information. Then click Save then Close. The information will appear in the summary grid area 11. To Edit or Delete Provider Double click on the Provider you wish to edit or delete. Then click on the Clear to Add button or the Delete button. Then click on Close Pharmacy Information 1. To add Pharmacy you can double click on the box and the Pharmacy window will appear. To look for a Pharmacy you can type in the name and click on search then highlight the correct pharmacy and click OK or double click on the correct Pharmacy and the information will appear. 2. You can also click in the fields and type the information if the Pharmacy you are searching for does not appear in the Pharmacy window. 3. Obtain Referral Number 4. This is away of tracking if the referral number was obtained and who received it. 5. Yes- When choosing yes the Obtained By and Date fields will appear. Click in each box and your name and date the referral was obtained will automatically appear. 6. If no referral was obtained click NO. 7. If referral does not apply click N/A. Patient Status (Active/Inactive) 1. This is where you can see if a patient is active or inactive. If the patient has been made inactive you can see the reason. Once the patient has been made inactive an alert will appear on all desktops. VERY IMPORTANT: Only the Billing Department will make patients Inactive. Also, they will check if a patient needs to be removed from mailing list. Oasis Provider Manual Page 50 of 164

51 Page Down and Page Up Buttons 1. By clicking on these buttons it will allow you to move up and down the template. Save Button 1. When adding or editing information click the Save button. If you do not information could be lost. If you forget to click the Save button and window will appear to ask you if you would like to save changes. If you have made any changes click YES. If you were viewing only click NO. If you click cancel you will not close the template. Oasis Provider Manual Page 51 of 164

52 Patient Assessment and Entering Vitals Top of Template The encounter date, patient s name and dob will appear. Vital Signs Vital Signs: This is where the patient s initial vital signs will be documented. To enter information click in the boxes and enter information If unable to obtain vital signs click in the Unable to obtain vital signs box and a comment field will appear for documentation on why vital signs could not be obtained. Allergic to Contrast Dye Click the Yes or No fields. If yes is clicked an alert will appear on several desktops, forms and orders. Oasis Provider Manual Page 52 of 164

53 Allergies Reviewed Once patient s allergies have been reviewed check the Allergies Reviewed box. The name of the person reviewing the patient s allergies will appear. If no allergies click the No Known Allergies box. The name of the person checking this box will appear. Medications Reviewed Once patient s medications have been reviewed and updated check the Medications Reviewed box. The name of the person reviewing/updating the patient s medications will appear. If no current medications are added click the No current meds box To add new medications double click in the medication summary gird and the medication module will open. Update necessary medications and save. Repeat Vital Signs If it is necessary to repeat the patient s vital signs do so by clicking in the Summary Grid. The Repeat Vital Signs window will appear. Type in information. Click Save. Information can be viewed from the summary grid on the Patient Assessment. Note: This is shared on several different orders and forms. Orthostatic Blood Pressure To document double click in summary grid the Orthostatic Blood Pressure window will open. Complete information and save. Information can be viewed for the summary grid on the Patient Assessment. Note: When adding new information to the summary grids double click in the correct grid. When the next window opens you will see the last information that was added. To add new information click the Clear for Add button. This does not delete the pervious information it clears the window so new information can be added. Comments This field can be used to make any additional comments. Click in field and type remarks. Oasis Provider Manual Page 53 of 164

54 Desktop Buttons There are buttons on this template that will take you to the Chemo Desktop, RN Desktop and MA Desktop. Oasis Provider Manual Page 54 of 164

55 Preassessment Top of Template The encounter date, patient s name and DOB will appear. Buttons There are several buttons to the right of the patient s DOB that will launch you to different templates. Preassessment Symptom Assessment: Click Yes or No. When clicking Yes a box will appear where additional information can be added. This information is shared with the ROS (Review of Systems) and the doctors will choose whether or not to put the information in the progress note. Coumadin Therapy: Click Yes or No. This will appear on the MD Snapshot and will also appear on the MA desktop. You can also clear the coumadin buttons if it doesn t apply. Oasis Provider Manual Page 55 of 164

56 Advance Directive Information: Click on the appropriate information. If this information is already carried over from the VO conversion it will already appear. This will also appear on the RN Desktop. Venous Access: Click in the Type box and Site box to fill in information. This is shared with several RN forms and Doctor forms. Reason for Catheter Access: Click on the boxes that apply. When choosing Other a box will appear for you to type information. Dressing Change: Mark Yes or No Blood Return: Mark correct response. Catheter Flushed: Mark Yes or No. When marking yes, boxes will appear for the Saline and Heparin doses to be documented. Documents Pump DC and CVC Flush buttons will generate the documents for you. Comments The field will allow you to make any additional comments. Oasis Provider Manual Page 56 of 164

57 Non-Chemo Administration Oasis Provider Manual Page 57 of 164

58 Top of Template The encounter date, patient s name and dob will appear. Vital Signs The vital signs will come from the Patient Preassessment template. Vaccines By double clicking in the Summary Grid the Vaccine Administration Window will appear. Click in boxes and fill in correct information. You will be able to choose from a pick list or type in to the boxes. Launch Vaccine Document button: By clicking on this button you can create the documentation for the vaccines. Note: To add new information clicks the Clear for Add button. Repeat Vital Signs If it is necessary to repeat the patient s vital signs do so by clicking in the Summary Grid. The Repeat Vital Signs window will appear. Oasis Provider Manual Page 58 of 164

59 Type in information. Click Save. Information can be viewed from the Summary Grid. Note: This is shared on several different orders and forms. Growth Factor Documentation This button will launch you to the Growth Factor Administration form. Double click in the Physician Order field to see the Growth Factor Order form. Click in fields and choose the correct information from the pick list that will appear. Administered By will automatically appear for you. Click Save. By clicking the Document button you can generate the Growth Factor Document. Click Close. A blue checkmark will appear to let you know there is information in this form. Miscellaneous Injections This is the Summary Grid that will be used to document all other injections. Double click in Summary Grid. The Injectable Medication Documentation form will appear. Mark the buttons. Click in fields and fill in information. Many of the fields will give you a pick list to choose from or calculators. Click Save. Click Close. Information will appear in the Summary Grid. To create document click Launch Injection Document button. Note: To add new information click the Clear for Add Button. Non-Chemo Infusion Record This is where Non-Chemo Infusions will be documented. Click in fields and fill in information. By clicking in the date filed you will get a calendar to choose date from. Some fields will give you a pick list and in other fields you will type the information. Oasis Provider Manual Page 59 of 164

60 Today s Infusion/Drug Orders This information is ordered on the MD Order form and can be viewed on the Non-Chemo Administration template Antiemetics Administered Click Yes or No. IV Complication Click Yes or No. IV Discontinued Click Yes or No. CVC/Peripheral Flush Click Yes or No. If yes a box will appear to document saline and heparin doses. Note: There is a Comments box to document additional information. Patient given the following educational information Click all that apply. Launch to Pt. Education This button will launch you the patient education materials that are posted on the Intranet. Patient verbalized understanding of teaching Mark Yes or No Launch Document Button Once template information is completed you can create the Non- Chemo Admin document by clicking this button. Save document once created. Page Up/Page Down Buttons These buttons will help you navigate easily up and down template. Oasis Provider Manual Page 60 of 164

61 Flowsheet and Lab Data Entry Flowsheet Flowsheet data is displayed by encounter date Data cannot be modified or entered in this page, go to Flowsheet Entry page for this Scroll left or right or up or down to see more data We have added a button to print the entire flowsheet for auditing purposes, it creates a very large and unreadable document, but a comprehensive list of all drugs given, vitals taken, and other chart data. Oasis Provider Manual Page 61 of 164

62 Lab and Tumor Size Data Entry Enter lab information directly into this page for each encounter If there are labs but no unlocked encounter, create a new encounter Entering labs under Laboratory Results is the main function of this page for sites that do not have a direct interface to the lab module for ordering and resulting labs You can also enter tumor size information for the flow sheet further down the page All other information pulled into the flowsheet is pulled directly from other data entry points. Oasis Provider Manual Page 62 of 164

63 Encounter Snapshots Provider Charting Physician Workflow Templates At the top of each encounter snapshot you will see the following information. Date Attending Physician. This comes from the Patient Demographic template. MLP. When the MLP clicks in this field they will see a picklist to choose their name from. Then they will need to check the appropriate box. MLP with Attending, MLP only or Collaborating Other. Buttons General HX, Treatment HX, SUB/OBJ/Data, ASSESS/PLAN/ORDER, NAVIGATOR, FLOWWSHEET, CHEMO ROUND, Help. When clicking a specific button it will take you to that specific template. Patient Information Patient s Name DX field. This field comes from the currently selected patient diagnosis in the middle of the General History page. It is the selected diagnosis form the pop-up list. The diagnoses that populate the list come from the Cancer and Hematological diagnoses selected in the Diagnosis Module. TX and Current Cycle day come from the current primary OCP template. DOB, MR#, Home Phone, Referring and PCP information come from the Patient Demographic template. Helpful Hint Any header/button that is in all upper case letters will launch you to another template or site. Oasis Provider Manual Page 63 of 164

64 General HX Template Current Medications The drugs listed in this grid come from the Medication Module. They are the active medications. If you double click in the grid it will launch you to the Medication Module. Drug Allergy The allergies listed in this grid come from the Allergy Module. If you double click in this grid it will launch you to the Allergy Module. Major Disease HX When you click in the fields you will get a Major Disease Area picklist to choose form. Oasis Provider Manual Page 64 of 164

65 Then the next picklist will be an appropriate list according to the area you choose. You can also type in these fields by clicking the blank space in the picklist. Major Disease Hx/PMI (Gray bar above white boxes) button. This will launch you to the Major Disease Hx template where you can do your documentation. To have Major Disease History in the progress note you must check the box on the Assess/Plan/Order template. Then generate note. Encounter Date and Type Encounter date area will give a list of the patient s most recent encounter dates. Type will show the name of document that was created for the Encounter Date. DX1, DX2 and DX3 To fill in this information click in the field and choose from the patients diagnosis list. Only cancer (ICD9 Codes ) and hematological diagnoses (ICD9 Codes ) will appear in this list. If there are no choices in the picklist, you will need to go into the diagnosis module in the tic tac toe and determine diagnosis You may see diagnosis in this picklist that are from other practices within AHN that are not in your diagnosis module view, try to pick only diagnosis that you have entered in your practice. To change the HPI and staging information, choose another radio button in front of the diagnosis to see information for that diagnosis Staging To do the staging on DX1, DX2 or DX3 click the appropriate radio button. Then click the Staging button. This will take you to the staging template to complete staging. Once this has been completed it will show in the fields on the General History template. Note: Once this is completed it will also copy forward to the Disease Management template. There are also Prognostics, Met Site 1, Met Site 2 and a Comment field that can be filled in. Oasis Provider Manual Page 65 of 164

66 Prognostics, Met Site 1, Met Site 2 these fields will give you picklist to make choices from. Note: The nurses can complete the diagnosis area and link the staging. Hx Present Illness To do documentation on DX1, DX2 or DX3 click in the appropriate radio button. Then click in the date field. You will get a calendar to choose date of documentation. Event, Intervention, Outcome/Comment. To document in these fields click in the box and type. To have HPI in the progress note you must check the box on the Assess/Plan/Order template. Then generate note. Primary Cancer History Continued Button. When this button is clicked it opens a template that will allow you to type additional information. This does not go into a note. Additional Links Primary Cancer Hx, New Patient Template, Vitals Primary Cancer Hx If you want to expand on the primary cancer Hx, this button will take you to a page that is blank for free text, you can import this language into the New Patient Note New Patient Template For your new patient note, you may want to enter expanded Social Hx, Family Hx, Med list and the like, this is the button you would click on to go to this. Most of the information entered on the new patient template is only for the New Patient document and will not carry forward into the Progress Note document Vitals this is a quick link to enter height, weight, bp and anything else if your front desk staff has not entered it Oasis Provider Manual Page 66 of 164

67 Treatment HX Template The information on this template comes for the OCP s, which the nurses generate and do documentation. You can quickly view Current Protocol and Support Protocol information. Last Cycle/Day, dates and the next cycle/day and projected date. The Initiated On Why comes from the Disease Management template. The Stopped On Why comes from the Change/DC entries for the template. The Date Mod 1, Date Mod 2 and Reason fields come from the most recent Change/DC entries. There are also comment fields that can be used. These comments do not appear in a note. Current Protocol 1 and Current Protocol 2 Buttons. By clicking these buttons physician can see at a glance the treatment dates and CD for a treatment. Oasis Provider Manual Page 67 of 164

68 Staff may also click the buttons labeled "Current Protocol 1"or "Current Protocol 2. This changes the "TX" and "Current Cycle/Day" fields at the top of the screen. Clicking on one of these buttons will also change the verbiage in the progress note for today's encounter. Example: "Current Protocol 1" is HyperCVAD."Current Protocol 2" is 5FU 400 mg/m2 Leuc 400 mg/m2 Infusional. If the end user clicks ""Current Protocol 1" The note will read, "Today is C1D1 of HyperCVAD. If "Current Protocol 2" is clicked the note will read "Today is C1D1 of 5FU 400 mg/m2 Leuc 400 mg/m2 Infusional" Oasis Provider Manual Page 68 of 164

69 SUB/OBJ/DATA Template Lab Summary These labs only will display if the work was done at the Core AHN lab or in house, Outside lab information will show up as a scanned document and in the Flowsheet The lab information that appears in this area comes from the Lab Module. You will see the 4 most current dates. There is a comment box to use to make notes in. This field does not appear in a note. Imaging / Pathology This grid will allow you to see at a quick glance the patients imaging and pathology information. To add results: o Click the appropriate radio button (Imaging or Pathology) and a picklist will appear. Chose the image or pathology type you would like to add results to. Oasis Provider Manual Page 69 of 164

70 Type in the results in the Results box. Click the Add button and the results will upload to the Imaging template and appear in the grid. Comment Box can be used to make notes in. This area does not appear in a note. Review of Systems Section There are office visit button at the top of each section. By clicking the appropriate button the normal responses will appear in the boxes below. If you need to change or clear responses in the Review of Systems section click in the box with the black checkmark. Then if needed type in the appropriate response. Note: When changing a response it will appear in red. Red lets you know a current change has been made. When you see a response in blue this lets you know a change has been made in the past. Below the office visit buttons in the Review of Systems section is Surveillance. By clicking the appropriate radio button this information will appear in the Chief Compliant section of the progress note. ECOG/PS, Pain, Fatigue, Nausea/Vomiting. These boxes will give you picklist to choose from. Comment Boxes: You can type additional information you wish to appear in the Review of System section of the progress note. There is a Clr Comment button to the right of the box if you need to clear a response and a Add l Comment button if you need more space to type. To go to the Physical Exam section click the button labeled: Click here for Physical Exam. Physical Exam Section There are office visit button at the top of each section. By clicking the appropriate button the normal responses will appear in the boxes below. If you need to change or clear responses in the Review of Systems section click in the box with the black checkmark. Then if needed type in the appropriate response. Note: When changing a response it will appear in red. Red lets you know a current change has been made. When you see a response in blue this lets you know a change has been made in the past. Oasis Provider Manual Page 70 of 164

71 Port is Normal Checkbox. Checking this checkbox will add a comment to the progress note. The default wording is "Port site non-tender, Non erythematous." No PE This Visit Checkbox. Checking this checkbox will allow the user to omit the PE from the Progress note without eliminating the PE data from the template. Please note if the check box is unchecked the PE section will go into the progress note. Vital Signs: The patient s vital signs will appear under the Physical Exam section. This information will appear when the MA has completed the Patient Assessment template. At the bottom of the Physical Exam Section there are 4 buttons. The Assess/Plan/Order button, Return New Pt Template button, Return to Review of Systems button and a vitals. By clicking these buttons it will take you to that specific template. Oasis Provider Manual Page 71 of 164

72 Assess / Plan / Order Template Assessment/Status/Plan To enter information into the Assessment and Plan fields you can click in the checkbox to the left of the Assessment field. This will give you a picklist to choose from. Once you have made a choice from the first picklist the plan picklist will automatically pop up for you. This is called a daisy chain. If you wish to type other information. You can do so by clicking in the boxes and choosing the blank space in the picklist. To clear information you can click the corresponding Clear Button to the right of this area. Not Assess Checkboxes. The user may also omit individual assessment/status/plan rows from the progress note by checking the corresponding "Not assess. checkbox to the right of the "CLR" buttons. If these are checked the corresponding line of data will not appear in the progress note. Comment Box. If you need or want to make additional comments this box can be used. Just click in it and type. This Oasis Provider Manual Page 72 of 164

73 information will appear in the progress note under the Assessment/Plan section. Addl Comment Button. If you need additional space you may click this button and it will launch you to a template that can be used. Clear Comm. Button. By clicking this button it will allow you to clear the Comment Box. Follow Up Orders To schedule Appointments: Patient appointments must be scheduled from doctor s appointment to doctor s appointment. This area is where you will schedule follow up appointments and the labs that need to be done for that specific appointment. To schedule follow up appointments click in the boxes above the grid. When you click in a box a picklist will appear. When you have made a choice from the picklist the next picklist will pop up for you to make your next choice. Note: The boxes correspond with the column in the grid below Once the appointment information has been completed click the Add button this will add the information to the grid and the staff will see what needs to be scheduled and what labs need to be drawn for that specific appointment. If the next MD appointment is the same as the last visit you can click the checkbox that is labeled Same as Last MD Visit. The click the Add button and this will add the appointment to the grid to be scheduled. Outside AHN: When labs or injections need to be done outside of the clinic make appropriate choices in the order boxes. Then you will see a checkbox appear to print orders. Outside AHN Orders To order labs or injections to be done outside AHN in the Follow Up Appointment area click in the Provider box and choose Outside AHN. In the Appt Type box select Lab or Injection. Instead of doing Interval it is best to select Apx Date. If ordering labs fill in the labs that need to be drawn in the lab boxes. If ordering injection, type this information in the comment field. Oasis Provider Manual Page 73 of 164

74 To the right side of the Follow Up Orders you will see checkboxes that appear, Print Out-Pt Lab Order or Print Out-Pt Inj Order and a box labeled Enter Location. Before checking box to print order enter the location that the patient will be going. Check box and order will generate. Save and print. Once order has been printed then add to the grid. Note: If the physician signature does not appear on the order it is because a Patient Demographic Template is not saved in the date of service. Additional Orders Click in the box below where you see the Service label. You will see a picklist to make a choice from. Your choices are Imaging, Procedure, Ref/Consult, Therapeutic and you also have a blank space to click to type in what you want. Once you have made the choice from the first picklist the next picklist will pop up for you. To send the order to the Front Desk for this to be scheduled click the Send Button. The Send Buttons are located next to each row. If you need to clear a field there are Clear Buttons located next to each row. Misc Order field: This is a field you can type directly into. The Transfusion template and document buttons will appear to the left side of the Misc order field when transfusion has been selected as a procedure. When this is clicked it launches the Transfusion template. Once this is complete staff will see a button labeled Print Transfusion Order Hospital Admit Orders Hospital Admit Button will launch you to the Hospital Admit Order template. This is where hospital admission orders can be completed and printed for the hospital. Yes/No Buttons. If the Yes Button is clicked an alert will appear on the RN and PSR desktops to let them know the patient is being admitted to the hospital. Reason and Adm Loc fields will let staff know why the patient is being admitted and where to admit. Oasis Provider Manual Page 74 of 164

75 Therapy and Growth Factor Ordering To order new therapy or new growth factors. Click the Order Therapy/Growth Factor Button. This will take you to the area where these orders are to be completed and sent to the nurses. You will see four areas: New Chemo Orders, Current Therapy Modification, New CSF/Support RX Orders and Support RX Modification. Go to the area you wish to complete and click in the boxes. Picklists will appear make your choice then the next picklist will appear. Complete orders Note: Providers may also order protocols that are note listed by choosing the option Not On List- See Comment. Then type their choice in the comment field. To send therapy orders click the VIEW/Send New Chemo Orders Button. When clicking this button it will allow the provider to view the information on the Disease Management template to see if any information is missing and when clicking this button a red alert will appear on the RN Desktop to let them know there is a new chemo order. An alert will appear to confirm that the order has been sent. Oasis Provider Manual Page 75 of 164

76 To send NEW CSF/Support RX Orders (Growth Factors) complete the section and click the button below that says Send Order to MA (click once). If you click the button several times it will duplicate the order. This is primarily for one time orders. If you are trying to schedule out multiple Supportive care orders, either add them to the primary protocol or start a second supportive care protocol instead. An alert will appear to confirm that the order has been sent. To Modify Current Therapy or Growth Factor Orders Click the Order Therapy/Growth Factor Button If modifying therapy go the Current Therapy Modification area. Fill in the correct information and click the View/Send Therapy Mod Orders Button. This will allow the provider to view the Disease Management Template for missing information and a red alert will also appear on the RN Desktop. An alert will appear to confirm that order has been sent. If modifying a growth factor go to the Support RX Modification area. Click in the Drug field and a picklist will appear. Choose the drug you wish to modify and complete the other information. Click the Send Change to MA Button to send updated information to the MA. An alert will appear to confirm that the order has been sent. Treatment Approved Today Checkbox. Checking this checkbox will adjust the Cycle/Day in the progress note. If the patient sees the provider before getting therapy it will change the C/D in the progress note to reflect that therapy was administered today. For example: Top of template displays today as C1D22. The provider checks the box because the patient is heading to the chemo room for treatment. This will change the wording in the document to C2D1 Today s Visit Charge We will not be using this at this point Click in the New Patient box or Established Patient box. Picklist will appear for you to choose the office visit charge. Oasis Provider Manual Page 76 of 164

77 Generate Note To generate the progress note click the Generate Note button. There will be a picklist that appears. Chose the type of note you wish to generate. Another picklist will appear asking you if you want to send the note. You have 3 choices. o Default: This has been set up to send a task to the medical records group to send out new patient notes, C1D1 notes, monthly and annual notes to the referring provider and primary care provider. o No Send: If you do not wish to send the note click this choice. o Send Special: This will take you to the Send Notes Template. Click in the Note Send Grid fill in the information and click the Send Note Button. A task will go to medical records to send out the note. Once medical records has sent the note they will document that it has been completed. Once you have made the choice on how you want the note sent the document will begin to generate and you will be able to view. Your signature will appear on the note automatically if you are signed on to OASIS. Note: If you dictate you will need to go to the Assess/Plan/Order template and generated the note for your signature to appear and for a task to be sent to medical records so the note will be sent out. You cannot just sign off in your PAQ. Major Dx/PMH and HPI Checkboxes. If you wish for this information to be in your note you first must check the appropriate box before clicking the Generate Note Button All Active Meds checkbox can be checked if you would like all active Rx module medications to be brought into your New Patient or Progress note. If this is NOT checked, only the medications you prescribe today will be brought into the note. AHN will not be using the Medicare Demo guide and Disease Management guide. Please contact your project management for more details for more details. Oasis Provider Manual Page 77 of 164

78 Chemo Protocols O CP1 Starting a New OCP 1. General History Vitals button 2. Enter Height and Weight 3. Billing Dx codes must be current 4. General Hx button 5. Click Staging button/save 6. Return to General Hx/SAVE 7. Treatment Hx Summary 8. Sub/Obj Data ROS and PE 9. Assess / Plan do two assessments and then enter new chemo order and click send 10. Disease Management Template 11. Review and Continue 12. This takes you to blank protocol 13. Right to left, top to bottom Oasis Provider Manual Page 78 of 164

79 14. Fill in today s wt. 15. Click on a value for creatinine Select if not applicable 16. Enter CA type 17. Select 2 nd box for specific protocols or select another protocol 18. Select 3 rd box for Master Protocol list. 19. Select today s date 20. Select date to start chemo 21. Fill in Checklist 22. Click on calculate to fill in protocol 23. Change an dosages or dates in the protocol 24. Click Save Signing off chemo orders 1. On the OCP click on the launch button in the upper right 2. Go to Chemo order keys 3. On first visit - Click on MD Approval under Initial Chemo order 4. On every visit - Scroll down to the Today cycle/day sign off 5. Click in the blank to insert your name to sign off on today s treatment do not click Add to grid, the last person to sign off on the protocol will add to the grid 6. Save and close Oasis Provider Manual Page 79 of 164

80 Disease Management Templates Patient Name: Will automatically populate. Form Completed by: Will automatically populate. Refresh Diagnosis List Button: This button will refresh the patient s diagnosis list. Date of Diagnosis: Copies forward from the Diagnosis Module. NOTE: THIS IS VERY IMPORTANT! When entering the patient s diagnosis in the Diagnosis Module you MUST change the Onset Date to the date the patient was diagnosed. If you do not do this it will show the date that you entered the diagnosis not the date the patient was diagnosed. Diagnosis: When you click in this box you will get a pick list of the patient s diagnosis that have been entered in the Diagnosis Module. Chose correct diagnosis. Oasis Provider Manual Page 80 of 164

81 Disease/ Protocol: When this field in clicked in you will get two pick lists to choose from. One pick list you will pick the disease area. From the next pick list you will pick the type of protocol (standard, non-standard, research). Protocol: When you click in this field you will get a pick list to choose the specific protocol. Current Treatment Indication: When you click in this field you will get a pick list. Metastatic Site/Second Metastatic Site: This information comes from the Assess/Plan/Order template. NOTE: The above information (Diagnosis, Disease/Protocol, MD Comment and Current Indication) will all copy forward to the Disease Management template if an Assess/Plan/Order template has been completed. Staging: This will copy forward from the Staging and General History templates. Don t get data from Assessment/Plan template Enter Manually Checkbox: This box will need to be checked if an Assess/Plan/Order template has not been completed. Then you will need to complete the Disease Management template manually. AHN Oncology does not use FOCUS at this point. Has FOCUS Appointment been scheduled?: You will need to choose the correct response. Remember if FOCUS appointment has not been ordered please order it on the MD order template. Make sure your Front Desk staff knows to schedule this appointment for the patient. Back To Assessment/Plan Button: This button will return you to the Assess/Plan/Order template. Continue Button: This button will appear when the Disease Management template does not need to be completed for a protocol. When this button is clicked it will take you to the OCP. Modification Made to this Protocol Grid: This information comes from the Assess/Plan/Order template. Oasis Provider Manual Page 81 of 164

82 All Growth Factor Orders Grid: This information comes from the Assess/Plan/Order template. Pre Chemo RX options New orders are indicated; the nurse will go to the Chemo Desktop and start a new OCP by clicking the appropriate OCP button. Next the Disease Management template will appear for the nurse to view and verify completion. The new section "Pre-Chemo RX Options" will be on the left side of the page and the default antiemetic option will be filled in based on the protocol. The nurse can then click the button "Create and Print Prescriptions". This will update the medication module and print out the antiemetic prescriptions for the patient. If modifications are indicated the staff can make changes to the antiemetic default by selecting another option displayed on the template or staff can check the checkbox to go to the "Pre-Chemo Prescription" template to make changes and print additional prescriptions. No prescriptions will be created from this template unless the Create and Print Prescriptions button is clicked. Once this is complete, click the "Continue" button and it will launch the appropriate OCP. Notes: When medications are chosen on the template and the template is saved, these medications will appear in the Medication Module as Active. If a medication is chosen in error and the template has been saved. Staff will need to go to the Medication Module to delete the incorrect medication. If you need to change a dosage or sig for a medication you will go to the Medication Module to make the change. Then save and print prescription from the module as you normally do. Oasis Provider Manual Page 82 of 164

83 RN Desktop Guide Oasis Provider Manual Page 83 of 164

84 Top of Desktop At the top of the desktop you will see the following fields: Encounter Date, Patient Name, Diagnosis, Treatment, Current Cycle/Day, Date of Birth (DOB), Social Security Number (SS#), Home Phone Number, Cell Phone Number, Attending, Referring and Primary Care Physicians and Pharmacy name and number. The information that appears in this area comes from information that has been completed on other templates such as the Patient Demographic template or the OCP s (chemo flowsheets). The diagnosis that shows comes from what is marked on the General History template, Primary Diagnosis area. Alerts: These alerts will show at the top of the desktop, Patient Inactive, Admit to Hospital, Contrast Allergy Alerts. You will also see boxes for the Business and Clinical Alerts. Please take time to read these alerts. They are important. The clinical staff does have permission to place Clinical Alerts and this can be done by clicking in the box and typing. If you place an alert please remember to put you username and date the alert was entered. This helps with tracking purposes. The alert will remain in the system until it has been deleted. Oasis Provider Manual Page 84 of 164

85 Advance Directives Information: Please mark the appropriate information for the patient. This will copy forward from visit to visit. Changes can be made if necessary by checking the correct information. Make sure to uncheck in information that does not pertain to the patient. Primary Diagnosis Area This area will display the three primary diagnoses. These diagnosis will be the patient s oncology or hematology diagnosis. The information that displays here copies forward for the General History template. It is important that the Diagnosis Module is completed, then the General History template (Primary Diagnosis and Staging) be completed. Imaging Summary Grid You can use this grid to review imaging results. For the information to show in this grid it must first be completed on the SUB/OBJ Data template in the Imaging/ Pathology Grid. Medication and Allergy Grids These grids will show the patient s current medications and allergies. This information comes from what has been entered into the medication and allergy modules. You can double click inside each grid and open the modules to add or update information. Medications Reviewed and Allergies Reviewed checkboxes: The patient s medication and allergies are to be reviewed each visit. Once these have been reviewed with the patient the boxes should be checked so the staff knows that this has been done for the visit. Lab Summary Area The results that appear in this area come from the Lab Module. Once the Lab Tech has entered the results in Orchard, the results will appear in the Lab Module and also copy forward to the RN Desktop and the SUB/OBJ Data template. You will see the latest 3 dates. If you need to view older results you must go to the Lab Module. Note: If current information is not showing you may need to refresh this area. To do this click the LAB SUMMARY/REFRESH bar. Vital Signs This information comes from the Patient Assessment template. Once the MA has completed and saved the Patient Assessment template the information will copy forward to the RN Desktop and the SUB/OBJ DATA template, Physical Exam section. Oasis Provider Manual Page 85 of 164

86 You will see the latest 3 dates. If you need to refresh this area you will need to close the desktop and reopen it. Follow Up Orders Grid This grid allows you to see what appointments need to be schedule for the patient. You can scroll up and down or side to side. Each gray header identifies what information each column holds. FOLLOW UP ORDERS/REFRESH button allows you to refresh the grid so you can view current orders that have been entered from the Assessment/Plan/Order template. Assess/Plan/Order button. This button launches to this template if you need to view information. You do not add any orders. Note: This grid is read only you can t add information to it from the desktop. Additional Orders Grid This grid allows you to see what additional appointments need to be scheduled for the patient. Such as imaging and referrals. Each gray header identifies what information each column holds. ADDITIONAL ORDER/REFRESH button allow you to refresh the grid so you can view current orders that have been entered on the Assessment/Plan/Order template. GO TO IMAGING ORDERS button will launch you to the Imaging Orders template where the order can be completed and printed for the patient. Note: This grid is read only you can t add information to if from the desktop. Helpful Hint When a button or header are all in upper case this means you need to click on them. They will bring up a picklist or will launch you to a template. Navigation Buttons These are a series of buttons that open picklist and help you to navigate to other templates or when clicked will launch you to a specific template. They also will allow you to complete certain task such as print the medication list or print labs. Note: There are Navigation Buttons at the top and bottom of the Desktop. Treatment History Summary This area will allow you to see and complete functions regarding a patient s treatment such as chemotherapy and growth factors flowsheets. You can view the patient s type of treatment and see when it was initiacted and if any changes were made. Oasis Provider Manual Page 86 of 164

87 This is also where you will come and open and complete the OCP s and Chemo Desktop. See Chemo Desktop Guide. Note: The Initiated Date and Why come from the Disease Management template being completed. The Stopped, Why, Date Modified and Reason come from the information being completed in the DC/ Change Documentation grid on the correct OCP. If it is not completed in this grid the information will not copy forward to the RN Desktop or the Treatment History template. Active Therapy Hx This section will allow you to quickly view the patient s current treatments and see when the last cycle/day and date given and the next cycle/day and date. Important Note: For this information to show the Date Given fields must be completed on the appropriate OCP. If the Date Given fields are not completed the information will not copy forward to the RN Desktop, Treatment History template or show up correctly in the Cycle Day fields that appear at the top of all the Encounter Snapshots and at the top of the RN Desktop. Precert Summary Grid The PRECET SUMMARY bar when clicked will launch you to the Precert template where you can complete and send precerts. The grid will allow you to easily view the status of precerts. Growth Factor Grid This grid will allow you to view what growth factors have been ordered for the patient and when they are approximately due to have the injections. Oasis Provider Manual Page 87 of 164

88 NextGen EMR Reference Sheet for Nurses RN Desktop make sure diagnosis is present. If not go to General History, put O in front of appropriate diagnosis, save and return to RN Desktop. If no diagnosis present one needs to be added to the encounter. Growth factors if ordered will have a red message on this screen. Look at Vital Signs box for weight, BP. Can add info here by clicking on box. Go to Flowsheet for labs for the day, if not entered they can be entered by going to Flowsheet Entry, enter data and save. (If you have a lab interface they will come into the chart automatically) Pre-certs and referrals can be found on PSR Desktop or Treatment History page. Go to Treatment History for orders chemo, growth factors at bottom, precert information is also located here. Choose OCP1, which takes you to the actual chemo orders verify date, and dosages, make changes as necessary print order. Be sure to look at Treatment History page carefully, there may be more than one OCP for a particular patient. If there is more than one repeat the steps of 6 to print this second order. This has been used for Zometa when given along with chemotherapy for example. Hit Launch in the upper right of the screen. Click on Chemo Order Keys For initial treatments the Nurse Assessment and Nurse Verification keys should be signed off on. Scroll down the page to the sign off grid for the particular day you are working with. Enter date, nurse signing and nurse verifying information. The doctor should and pharmacy tech signs off here. Once completed, add to grid. Launch to Chemo Desktop (again verify there is only one OCP activated). Go to PreAssessment, and complete. Go to NonChemo Meds, complete. If more than one dose of a drug is given (ex: Calcium and Mag) click on the Repeat Non Chemo Meds add information in. Save screen. Go to Chemo Meds, complete and save. If patient received chemo go to Chemo Post Assessment, complete page, repeat vital signs are added here. Save. If patient did not receive chemo go to O Non Chemo Admin, complete the appropriate section and save. Document on the post assessment section at Oasis Provider Manual Page 88 of 164

89 the bottom of the page if appropriate. Launch your document for what was done. This is used for hydration, vaccines, growth factors, phlebotomies, B12. Once you are sure all times and information has been added to the various screens, launch to Document Chemo. This will generate a visit note. Review the note for accuracy and completeness. This can be adapted and modified. Once you are finished hit save and print. This is to be attached to the fee ticket when it goes to billing. Misc Nurse Templates have templates for injections (growth factors, B12, vaccines), phlebotomies, Phone triage, Pre-cert requests, Coumadin Management, Procedures (Bone marrow and LP) and Miscellaneous Nurse notes. To add an order for chemo or growth factors go to Assess/Plan/Order. Oasis Provider Manual Page 89 of 164

90 Chemo Meds Infusion Template The Chemo Infusion Record is where Non Chemo Meds and Chemo Meds that where given to the patient will be documented. Top of Template You will see the encounter date, patient s name and dob. Date Given: Click in this box and chose the date, then click OK. The date will appear in the box. Chemo given in hospital: If the treatment was given in the hospital click this box. Oasis Provider Manual Page 90 of 164

91 Non Chemo Meds / Chemo Meds Click in the boxes of all the drugs given to the patient. Then click in the following boxes and fill in correct information: Dosage: Type in dose given to patient. Fluids: A pick list will appear for you to choose from. Click on correct amount and it will appear in the box. Route: A pick list will appear for you to choose from. Click on correct route and it will appear in the box. Access: A pick list will appear for you to choose from. Click on correct information and it will appear in the box. Start Time and Stop Time: Type this into the fields. Use Military Time. Admin By: When you click in this box your name will automatically appear for you. Note: When using the Pick List if you do not see your choice you can click in the blank space at the top of the Pick List and this will allow you to type the information directly into the box. Comments The Comment field at the bottom of the template will allow you to type in any additional information. Such as drugs not given or drugs wasted. Document Document is created from the Chemo Post Assessment document. Chemo Meds is actually the nurses note as well. Page Down/ Page Up buttons These buttons have been placed on the template so you can easily move up and down the template. Oasis Provider Manual Page 91 of 164

92 Generating NextGen Documents NextGen documents server a very useful function when considering the patient s EMR. Documents are an excellent way of pulling all of the data that the medical staff enters into the EMR and applying it to a format this is easy to read, or perhaps in a particular format for submission to various agencies, or for giving to the patient for their personal records. 1. NextGen provides many out of the box document formats that generally fit into most environments very nicely, but on occasion it is necessary to create new or specific formats for special requests. 2. How can Documents be used with a typical patient visit? a. Documents can be used to reformat data from templates to concise letters (Excuses, Injuries, etc.) b. Documents can be used to summarize data from a visit for easier review for both the clinical perspective and from a office or billing perspective. c. Documents can be used to store information that can be categorized for quicker retrieval. d. Plus many more uses. e. Examples: i. Jury Duty Excusal letter Oasis Provider Manual Page 92 of 164

93 ii. Doctor s excuse for a school aged child. iii. A patient s lab report if using AHN Core Lab. How to generate a Document a. Documents can be generated from several areas within the EMR. Links have been embedded throughout the various templates that will generate documents. Users can also generate documents directly from the Document Module, (2 nd icon in the first row of the tic-tac-toe area) b. Some documents will generate in the foreground, meaning you will actually see the document as it is creating, while others compile in the background and will only appear in the patient s chart when the document has finished creating. Oasis Provider Manual Page 93 of 164

94 c. Generating a Document To generate a document, complete the following procedure(s). iv. Open the patient s chart in the EMR. v. You can generate documents on by launching them from specific templates 1. Ideally any Documents that you need will be generated from Oasis templates, here are some examples: a. Progress Note launches from Assessment / Plan b. New Patient Note launches from Assessment / Plan c. Referral note launches from Assessment / Plan d. Nurses note called Chemo Meds and launched from Chemo Post assessment (Chemo Doc button) e. Jury letter, work excuse ect generated from Misc Templates button or Letters button from RN desktop or other desktops 2. Generating a document from the Document Module. Do this if you can t find a document from a template. Try to use only the Oasis documents (usually o_******* ) because they will pull in information from the Oasis templates that you have populated. a. Open NextGen s EMR, and select a patient. b. Rather than click on a button or link that will generate a predefined document, this method of generating a document requires that the user be familiar with documents and that they know the name of the document to generate. i. Once in the patient s chart, click on the Documents module icon from the tic-tac-toe area. It will look like this ii. Once you click the icon, the following screen will appear. iii. Let s assume that the desired document is the AHN Lab Report document. (Red Arrow above). Oasis Provider Manual Page 94 of 164

95 iv. The user will need to highlight this document, then click on the GENERATE button. v. The document will then generate in the foreground. An example of such has been attached to the left. Printing Documents a. Obviously all documents generated can be stored within the patient s chart for future reference. However, there are times that it is very beneficial to print these documents out for Employers, Schools, Specialists, Patients, etc. b. There are several methods to print a document. vi. Print a single document following generation. 1. Generate a document 2. The user will click on FILE from the Top toolbar. 3. Scroll down to and select PRINT. 4. The Print dialogue box will pop up. Choose the desired printer, then OK. vii. Printing several documents at one time. 1. Open the patient s chart 2. Click on the FILE verb from the Top toolbar. 3. Scroll down to and click CUSTOM PRINT 4. The CUSTOM PRINT dialogue box will appear. 5. The user will need to choose Documents from the drop down list at the bottom of the screen. 6. Then a list of patient encounters that contain documents will pop up for the user to pick and choose the documents that they want to print. Oasis Provider Manual Page 95 of 164

96 Faxing Documents a. The user has the option of selecting one document at a time by clicking the arrow without the line on it. b. If the user clicks the ALL button which appears as then all documents are selected for printing. c. The inverse is also true for removing documents from the print list. viii. Exporting Documents 1. This is not actually printing, but works in the very same way. 2. Users will open the Export utility by clicking on the verb FILE, then scrolling down to and clicking on Export Patient Documents. 3. The user will then select the desired documents to export, in the very same way that the documents were selected in the previous step. 4. Once selected the user designates the location either on the local computer or network to send and store the documents. a. If the actual location is not known, the user has the ability to browse to the location by clicking on the ellipsis button. 1. This too works very much like printing a document, with the exception that the user can create a cover page or can choose a default cover page to accompany the fax. 2. Also, the faxing routine allows the user to send to Pharmacies, Locations, and Providers, if applicable. 3. Users have the ability to search the tables for those entries that exist for Pharmacies, Locations, and Providers. 4. The user must also enter the Fax#, and other information, including comments. Oasis Provider Manual Page 96 of 164

97 Imaging Orders Oasis Provider Manual Page 97 of 164

98 Imaging Orders For Physicians and most users ordering Imaging and other procedures will be done from the Assessment/Plan template and will be documented in detail by Check out staff from these pages You will be able to view the patient s Active Protocols, Billing Diagnosis, Allergy List and Physician Problem List. To view, add or update information double click in Summary Grid. Buttons Several buttons have been placed on the Imaging Order form for easy access to other templates, orders and desktops. View buttons will allow you to see information by category, document or date. Select Orders Buttons These buttons allow you to print the orders for the patients. You can search for the order two ways by date or category. To print orders by date click the Select Orders by Date button. When the date window appears enter order date, click add, then OK. Oasis Provider Manual Page 98 of 164

99 To print orders by category click the Select Orders by Category button. When the window appears click on the drop down key for the category field and choose correct category, click add, the OK. Once you click OK the report will appear for you and then click the print button, These orders are a Crystal Report. For them to show in the Patient History Toolbar they will need to be scanned. See procedure for scanning. Contrast Allergy Alert The MA or RN checking the button on the Vital Signs/Pt Assessment template sets this alert. Imaging Detail Imaging History button will launch you to the patient s imaging history summary grid. To view a specific date double click and the Imaging Order Detail will open for the date or you can scroll side to side at the bottom of the grid. This is the form that will be used by the Doctor, RN or FRONT DESK to order patients test and for the FRONT DESK to document the scheduling details. By clicking in the Summary Grid it will launch you to the Imaging Order Detail. Top Section of Imaging Order Detail Top of Order Detail tells you the encounter date, patient s name and DOB will appear. Same as Last Order box will be checked by the doctor. The Front Desk will need to go and look a pervious order to schedule test. Fill information by clicking on buttons and entering information into fields. Pick list may appear and be used. Click save then click close. Scheduling Details This is where the Front Desk staff will document the scheduling details of the patient s test by clicking in the fields and entering the information. Once orders are completed click save and close. When you close the Imaging Order Detail there are buttons on the Imaging Order to print the orders and give to patient. See instructions above under the Select Orders Buttons Oasis Provider Manual Page 99 of 164

100 Precert Approved, Results on Chart and Rescheduled Test boxes. Mark these boxes when the Precert has been approved, results are on the chart or the test was rescheduled. When the test has been rescheduled don t forget to change the Date Scheduled field. AHN Location field: This shows the patient s clinic location. If this is not correct click in the box and a picklist will appear. Choose correct location. Save and close. This needs to be correct or the wrong location will show before on the orders. AHN Imaging Tracking field: This may be a required field and must be completed in order to save template. Tips To add new information into Imaging Order Detail template click the Clear for Add button. Make sure all necessary fields are completed. It helps to schedule test if the Front Desk staff has the diagnosis code. This can be entered into the Comment section. Front Desks remember once you have completed the scheduling REMEMBER TO PRECERT, if you would normally do this. Oasis Provider Manual Page 100 of 164

101 NextGen s EMR Patient Education Documentation The NextGen EMR application is a very functional product, especially from the perspective of the Healthcare worker, but it contains features that are equally important to the patient. With patients becoming more involved in the day to day decisions affecting their healthcare delivery, patient education itself is becoming a big part of healthcare. Providers can now educate as well as treat their patients. NextGen can assist in this educational process by providing the healthcare staff with the tools to assist in this education. NextGen has teamed up with McKesson to provide your healthcare staff with the latest clinical information. I. Accessing the Patient Education module a. Open the NextGen EMR module as if you were going to access a patient s chart. b. From the Top toolbar, click on FILE. c. Scroll down to and click the PATIENT EDUCATION entry. i. The following menu will appear ii. Click on the first option, ADULT HEALTH ADVISOR and the following routine will appear. Oasis Provider Manual Page 101 of 164

102 1. This index lists all conditions alphabetically. 2. The first column is typically a category. In the above example, Abscess is the category, and skin or soft tissue & tooth are the specific conditions. 3. When one of the specific conditions is selected, the DISPLAY button will become active; the user then has the ability to display that topic. 4. Click the display button to view the educational material concerning skin or soft tissue abscesses. on. and it continues Oasis Provider Manual Page 102 of 164

103 d. Users have several Education categories available to them. i. Adult Health Advisor ii. Behavioral Health Advisor iii. Eye Advisor iv. Pediatric Health Advisor v. Senior Health Advisor vi. Women s Health Advisor e. Educational Module is available in several languages. i. English ii. Spanish II. Printing Educational material a. Once the Education module is launched, there is a printer icon that populates a special toolbar within the education module. Oasis Provider Manual Page 103 of 164

104 ICS Scanning Set up and preferences before scanning 1. Go to File and choose Select Scanner. 2. Choose from the list the item that includes the word TWAIN as that driver will usually be the easiest to use. After selecting the line with TWAIN, click the select button. We recommend that you select it each time you sign on to ICS as we have found that there are times that if you do not check it, you will get the default driver instead of the TWAIN driver when you start scanning. 3. Now go to Admin, select Preferences and User. Select Preview Images During Acquisition and click OK. Oasis Provider Manual Page 104 of 164

105 Single Document Type for a Single Patient Scanning Documents 1. Prepare your documents for scanning. All staples need to be removed and all papers need to be facing the same way. If you have a scanner with a multi-document feeder tray, you can place all of the documents to be scanned in the tray at the same time (up to the scanner designated limit) and scan them altogether in a batch. Make sure when you place your documents in the scanning tray, you place them according to your scanner s instructions, as to whether they are all face up or down. 2. When you are ready to scan, go and select the Scan & File button on your toolbar. When the batch information window opens, make sure that Acquire Profile is set to scanner and that Auto Save Batch after Acquisition is unchecked. (You will want to save and post manually each document after everything is scanned so that you can assign it a document type and to a specific category.) Normally, the window will open in with these preferences. You will want to change the Batch Description from QuickScan to something to identify the patient, like patient name or number, so that you can easily identify the batch from the batch list should you ever need to go back and scan more for that patient. When ready, click Acquire to start the scanner driver. Oasis Provider Manual Page 105 of 164

106 Oasis Provider Manual Page 106 of 164

107 3. When the scanner driver window opens, there are settings available here that you need to either apply or verify. The settings that are mandatory are that the scanning is in black and white mode and the dpi or resolution settings are at 200. Some scanners will allow for duplex (front and back) simultaneous scanning and if you have documents that have data on both front and back, you will want this on. If your scanner has this capability, also see if it also has the ability to drop/skip blank pages so that it doesn t create/save every document scanned with a blank back. Also, your scanner may have the ability to Deskew or straighten pages that are either scanned crooked or appear that way on the original document as well as clip the image to the original document size. You will want these turned on as well as they will improve the final image. 4. After you have checked all of the necessary adjustments for the scanner settings, you are ready to click the scan button and scan your documents. Filing and Posting A Scanned Document 1. Once your document has completed its scanning, you will have the image on your computer monitor for you to file and post. 2. Click the File Page button on your toolbar to start the Filing/Posting process. You can also right click your document image to bring up a menu that has the same option. Oasis Provider Manual Page 107 of 164

108 3. On the File window, select the Document Type that the document image you are viewing is going to be filed under and selected from EMR. After you have selected a Document Type, you will need to click the Norton button to lookup the patient these documents will be assigned to. After you have selected a patient, the File window will populate with data from the patient s chart. The Test Date field is optional and used only for documents of labs or tests that need the date performed entered. This date will allow the doctor while selecting documents in EMR to see when the test was done and in what order. If you select a document type that makes the Encounter Date field available, use the same rules you would have applied for the Test Date field. Oasis Provider Manual Page 108 of 164

109 Oasis Provider Manual Page 109 of 164

110 4. When you have completed all of the fields you need, click the File button. Do not click the OK button as that will not file or post but will close your document images. If you do accidently click the OK button, click the Batches button on your toolbar and select the last images/batch file you created and open it. You will have your images back so that you can start the process over again with filing and posting. Oasis Provider Manual Page 110 of 164

111 5. When you file this document, you will receive a message indicating that the document is complete and would you like to post it. Select YES as this creates the listing in EMR with the correct links to the scanned document files. 6. When the posting process completes, you will receive another request window asking you if you would like to add it to workflow. This request has to do with the issue of does the doctor need to see this document and sign off on it right away? This decision will need to be made by the practice, per practice, and per doctor if not every doctor is actively using EMR. Oasis Provider Manual Page 111 of 164

112 7. If you select Yes to adding to the workflow, it opens the Create To Do window, which is the tasking process for EMR. In the Send to field you need to select which Doctor or whoever is designated to sign off on new documents. You must select a due date for the signing of the document. You can edit the subject and description fields as you wish. When finished with this window, click send to create the task for the individual you selected in the Send To field. 8. The screen is reset now and ready for you to scan your next document(s). If you are finished with this patient, you are ready to go back to the scanning documents section and start scanning another patient. Oasis Provider Manual Page 112 of 164

113 Batch Document Scanning for Multiple Patients or Document Types Scanning Documents 1. Prepare your documents for scanning. All staples need to be removed and all papers need to be facing the same way. If you have a scanner with a multi-document feeder tray, you can place all of the documents to be scanned in the tray at the same time (up to the scanner designated limit) and scan them altogether in a batch. Make sure when you place your documents in the scanning tray, you place them according to your scanner s instructions, as to whether they are all face up or down. 2. When you are ready to scan, go and select the Batches button on your toolbar. When the Image Batches window opens, click on the Norton button and select New from menu to create a new scanning batch for your group of documents. Oasis Provider Manual Page 113 of 164

114 3. When the Batch Information screen opens, first create a batch name in the Batch Description field. This will give you something to come back to if you wish to add more documents later to the batch. DO NOT select Auto Save Batch after Acquisition as this will save and close your batch before you have a chance to file the scanned documents. You would only use this setting if you were going to do a lot of batch scanning and you weren t going to file the documents right away. This would allow you to come back later and work on batches that were previously scanned. Make sure that the Acquire Profile is set to Scanner and that there is nothing in the Secured to User field. When ready, click Acquire to start the scanner driver. 4. When the scanner driver window opens, there are settings available here that you need to either apply or verify. The settings that are mandatory are that the scanning is in black and white mode and the dpi or resolution settings are at 200. Some scanners will allow for duplex (front and back) simultaneous scanning and if you have documents that have data on both front and back, you will want this on. If your scanner has this capability, also see if it also has the ability to drop/skip blank pages so that it doesn t create/save every document scanned with a blank back. Also, your scanner may have the ability to Deskew or straighten pages that are either scanned crooked or appear that way on the original document as well as clip the image to the original document size. You will want these turned on as well as they will improve the final image. Oasis Provider Manual Page 114 of 164

115 5. After you have checked all of the necessary adjustments for the scanner settings, you are ready to click the scan button and scan your documents. Oasis Provider Manual Page 115 of 164

116 Filing and Posting Batch Scanned Documents 1. Once your documents have completed their scanning, you will have the images on your computer monitor for you to file and post. 2. Click the File Page button on your toolbar to start the Filing/Posting process. You can also right click your document image to bring up a menu that has the same option. Oasis Provider Manual Page 116 of 164

117 3. On the File window, select the Document Type that the document image you are viewing is going to be filed under and selected from EMR. After you have selected a Document Type, you will need to click the Norton button to lookup the patient this document will be assigned to. After you have selected a patient, the File window will populate with data from the patient s chart. The Test Date field is optional and used only for documents of labs or tests that need the date performed entered. This date will allow the doctor while selecting documents in EMR to see when the test was done and in what order. If you select a document type that makes the Encounter Date field available, use the same rules you would have applied for the Test Date field. You may want to write down your person number incase you need it later with any of the other documents. Oasis Provider Manual Page 117 of 164

118 Oasis Provider Manual Page 118 of 164

119 4. When you have completed all of the fields you need, click the File button to move on to the next document image. Do not click the OK button as that will not file or post but will close your document images. If you do accidently click the OK button, click the Batches button on your toolbar and select the last images/batch file you created and open it. You will have your images back so that you can start the process over again with filing and posting. Oasis Provider Manual Page 119 of 164

120 5. Your file window is now ready for the next document. Go through each document repeating steps 3 and 4 for each document. If you are changing document type from the previously used type, click the New Doc button at the bottom of the window to indicate that this is a change in document type and location. If you receive any messages asking you if you want to create a new document, always select YES. When you are changing document types using New Doc, you can also change patient as well, which will allow you to process a list of documents that are not all going to be assigned to the same patient. When you have filed the last document, you will receive a message indicating that the document is complete and would you like to post it. Select YES as this creates the listing in EMR with the correct links to the scanned document files. 6. When the posting process completes, you will receive another request window asking you if you would like to add it to workflow. This request has to do with the issue of does the doctor need to see this document and sign off on it right away? This decision will need to be made by the practice, per practice, and per doctor if not every doctor is actively using EMR. Oasis Provider Manual Page 120 of 164

121 7. If you select Yes to adding to the workflow, it opens the Create To Do window, which is the tasking process for EMR. In the Send to field you need to select which Doctor or whoever is designated to sign off on new documents. You must select a due date for the signing of the document. You can edit the subject and description fields as you wish. When finished with this window, click send to create the task for the individual you selected in the Send To field. 8. The screen is reset now and ready for you to scan your next document(s). If you are finished with this patient, you are ready to go back to the scanning documents section and start scanning another patient. 9. The screen is reset now and ready for you to scan your next document(s). If you are finished with this patient, you are ready to go back to the scanning documents section and start scanning another patient. Oasis Provider Manual Page 121 of 164

122 Deleting a Scanned Page From a Batch Prior to Filing and Posting By using the button with your batch and file open, it will remove the current visible image from your batch and you can move on to the next image for filing. When you post your batch, that image will be hidden from ICS or EMR. This way you can remove pages/documents from the batch that scanned poorly, are white (if you are using duplexing), or you accidentally received the document from an outside entity where the patient is not seen at your practice or even by AHN. Scanning More Documents to a Batch 1. If you have more documents to scan to a patient, click the Batch button on your toolbar, find the batch you are going to scan more documents to, and open it. If there are documents already scanned to that batch, it will open the document images as well. If it does, click the close document button on your toolbar and it will close back to your batch information window. 2. On the Batch Information window, you need to verify that the Batch Description and Batch Information area are correct ensure that you have the correct batch selected. If you did not select the correct batch, do not try to type over the Batch Description field as it is already set and should not be changed. If the Batch Description/Information is correct, click Next Doc to start scanning more documents to this batch. When you do this, ICS will open your scanner driver and is ready for you to scan more documents starting with instructions #3 in the Scanning Documents section. The remainder of the steps will be the same as performed previously. Oasis Provider Manual Page 122 of 164

123 Oasis Provider Manual Page 123 of 164

124 Refiling Documents NextGen ICS enables you to change the filing information you applied when you initially filed the document. To refile a document that has been filed already: 1. Open the document you want to refile in the ICS window/viewer. You may do that either through the Batches button if you know what batch the image/document was scanned in, or you can go to the Search button and find the patient that the document was filed under and reopening the document. 2. With the document open, click the File (or in this case refile) button on your toolbar. 3. When you click the File button, the File dialog window opens displaying the existing filing information for that document. Change the filing information you wish to update. 4. If you want to: a. Save your filing information for the page and file the next page as part of the same document, click the File button. b. Save your filing information for the page and file the next page as part of a new document type, click the File button and then click the New Doc button on the next File dialog window. c. Save your filing information for the page and finish refiling the batch, click OK. Oasis Provider Manual Page 124 of 164

125 Viewing Scanned Documents in EMR 1. Click on the categories tab on the history toolbar 2. Open the category of the document type you are looking for 3. Click on document date icon that you wish to open 4. This opens ICS and you can view the scanned document Once in ICS you can view other scans for this patient by clicking on the window item in the toolbar and choosing search results which will bring up the window at the bottom of this page. Oasis Provider Manual Page 125 of 164

126 PSR (Front Desk)Desktop Guide Oasis Provider Manual Page 126 of 164

127 Top of Desktop At the top of the desktop you will see the following fields: Encounter Date, Patient Name, Diagnosis, Treatment, Current Cycle/Day, Date of Birth (DOB), Social Security Number (SS#), Home Phone Number, Cell Phone Number, Primary Insurance, Attending, Referring and Primary Care Physicians. The information that appears in this area comes from information being completed on other templates such as the Patient demographic template. Alerts: These alerts will show at the top of the desktop, Patient Inactive, Admit to Hospital, Contrast Allergy Alerts. You will also see boxes for the Business and Clinical Alerts. Please take time to read these alerts. They are important. PSR Comments box: This box was designed for the PSR to make any necessary notes. Example: Call Bob at to pick up patient. This field does copy forward. When placing a comment please remember to put your initials behind the comment so there is a record of who did this documentation. Chart Sent Out box: This is to be used when a chart is requested by another clinic or Medical Records Department. To use place a checkmark in the box. A date field and location field will appear. Document the date the chart was sent and the clinic it was sent to. Helpful Hint When a button or header are all in upper case this means you need to click on them. They will bring up a picklist or will launch you to a template. Check In / Check Out / Chart Prep Buttons When a button is clicked the appropriate picklist will appear for each function (Check In, Check Out and Chart Prep). Complete each task. Once the button has been clicked you name will appear in the field below the button. Copay Info This area will allow you to document the patient s copay for the date of service. Drug Allergy You are able to view the patient s allergies. Oasis Provider Manual Page 127 of 164

128 The information that appears here comes from the Allergy Module once the nursing staff has entered it. Follow Up Orders Grid This grid allows you to see what appointments need to be schedule for the patient. You can scroll up and down or side to side. Each gray header identifies what information each column holds. FOLLOW UP ORDERS/REFRESH button allows you to refresh the grid so you can view current orders that have been entered from the Assessment/Plan/Order template. Assess/Plan/Order button. This button launches to this template if you need to view information. You do not add any orders. Note: This grid is read only you can t add information to it from the desktop. Additional Orders Grid This grid allows you to see what additional appointments need to be scheduled for the patient. Such as imaging and referrals. Each gray header identifies what information each column holds. ADDITIONAL ORDER/REFRESH button allow you to refresh the grid so you can view current orders that have been entered on the Assessment/Plan/Order template. GO TO IMAGING ORDERS button will launch you to the Imaging Orders template where the order can be completed and printed for the patient. Note: This grid is read only you can t add information to if from the desktop. Precert Summary Grid The PRECET SUMMARY bar when clicked will launch you to the Precert template where you can complete and send precerts. The grid will allow you to easily view the status of precerts. Navigation Buttons These are a series of buttons that open picklist and help you to navigate to other templates or when clicked will launch you to a specific template. They also will allow you to complete certain task, such as print labs, view the MD order document or view categories. Note: There are Navigation Buttons and the top and bottom of the desktop. Active Therapy History Section Oasis Provider Manual Page 128 of 164

129 This area of the PSR Desktop can be navigated to by clicking the Active Treatment HX button located in the Navigation Buttons section. This area is for viewing only. You can view the patient s current treatments and see when their last treatment (cycle/day) was and when their next treatment (cycle/day) is due. Growth Factor Grid: This grid will allow you to view what growth factors have been ordered for the patient and when they are approximately due to have the injections. There are a series of navigation buttons below this section also. Note: To return to the top of the PSR Desktop click the button labeled PSR Desktop Oasis Provider Manual Page 129 of 164

130 Front Desk - Check IN checklist: Check/Add Attending and Referring Physician and Clinic location from Patient Demographics (O Patient Demo) Add weight and height from Patient Assessment (O Pat Assessment) - Vitals Add current primary disease through the disease module on the history toolbar (chief complaint), use either ICD9 or Cat. Desc. to find you can look up in EPM if existing patient Add current medications through the medication module on the history toolbar excluding chemo drugs (current med list) Check Prescribed Elsewhere if the medication was prescribed by another doctor or you don t want it to go in the current progress note for today s visit Add current allergies through the allergy module on the history toolbar (current allergy list) Check in Pt from PSR Desktop Review Patient demographics, current treatment cycle, any warnings (add any warnings necessary) Add any other physicians that will be receiving progress notes from our physician to the Patient Demographics (O Patient Assessment) Should look like the following the diagram to the right. Add any Copay information to the PSR desktop ($ collected) if time allows Oasis Provider Manual Page 130 of 164

131 Front Desk - Check OUT checklist: Review PSR desktop Follow Up orders and schedule them in NextGen EPM Review PSR Desktop Additional Orders and Schedule them, add any detail necessary to imaging orders if needed Complete any Pre Cert information via the PSR desktop if needed Click Check out on PSR Desktop Review tasks from Workflow (inbox) to see if there are any additional tasks (like send progress note these get sent to Primary and Referring unless otherwise noted in the task or Send Note template) Oasis Provider Manual Page 131 of 164

132 Using RightFax in NextGen Setup 1. Currently, RightFax works only through the thin-client applications of NextGen and will not be accessible from a fat-client. After you have started NextGen, double check that the RightFax icon is located in the system tray by your time/date stamp. If it is not there, close all of NextGen, wait for the Windows 2000 window to appear, and restart NextGen. If the icon is still missing, contact the help desk. Access and Use 1. At this point, Right Fax has been set up on the thin client computer you will be faxing from in NextGen. It will appear as any other printer driver you have installed and/or have access to. 2. When you get the option to print in NextGen, you will want to always select the preview button. If you select the print button, the document may automatically go to your default printer. 3. When the print preview screen comes up, you will select the Print or Print Preview icon from the tool bar. This will open your options window. Oasis Provider Manual Page 132 of 164

133 4. Click the RightFax Fax Printer driver and select Print to start up the faxing process. There may be a time delay in this process so be patient. Oasis Provider Manual Page 133 of 164

134 5. The RightFax window will open. Here you can add information two different ways. A. You can type the Name and Fax Number in manually OR B. You can select the fax location and number from the Practice Phonebook. To use the Phonebook, click the button to open it and double click on the fax recipient so that it is added to the list of current recipients. More than one can be added. Oasis Provider Manual Page 134 of 164

135 Oasis Provider Manual Page 135 of 164

136 6. In addition, you can type in information in the Voice Number and Company fields and it will show on the Cover Sheet if you select the Use Cover Sheet from the Options on the right side of the window. What Cover Sheet looks like: 7. If you go to the Cover Sheet Notes tab, you can type in information that will also show under Notes of the Cover Sheet, if you select it. 8. It is NOT RECOMMENDED that you use the Add Entry button to add fax numbers to the phonebook. There will be a designated phonebook administrator for each practice and they will add fax numbers to the master phonebook. If you use this button to add fax numbers, the information added will only show in the phonebook on the computer in which the information was added. It will not travel around with the user from computer to computer! 9. When your information is ready, click send to start the faxing process. 10. To view the faxing process, click on the RightFax icon in the system tray and select FaxUtil. This will open the Fax Utility window where you can see all of the faxes sent from this computer. If the fax number is busy, RightFax will automatically wait and resend the fax at a predetermined time interval. Oasis Provider Manual Page 136 of 164

137 11. At the end of the day, the computer(s) will need to be checked to verify that all faxes have been sent. 12. To resend a fax or change its number and fax to a different number, select the fax you want to send/resend and click the icon on the toolbar showing the mailbox with the arrow pointing towards a telephone pole and wires. When you click this icon, the main faxing window reappears with the information you put in when you faxed it originally. You can change any information in this window and click the OK button to send the fax on its way. Oasis Provider Manual Page 137 of 164

138 Useful Information 1. All phone numbers should be tried with a 1 + Area Code first to see if the fax number is long distance or not. The fax server is located at One Call in Carmel and that is where all faxes are being sent from, not the local practice office. 2. Within NextGen, you can broadcast your fax job to multiple fax numbers by adding multiple numbers in the faxing window. Unfortunately, you can not simultaneously fax pages from more than one location in NextGen in one fax job. Although, you can attach any saved document on your computer to a RightFax fax job by going to the attachments tab of the faxing information screen and navigating to your saved document(s). RightFax will attach the documents to your fax as additional pages. 3. The FaxUtil screen refreshes its view every 60 seconds automatically. You can refresh it manually by using your F5 key. 4. When you close NextGen, you will have to manually close RightFax since it will not automatically close. To close it, click the RightFax icon and select Exit. 5. If you are having problems getting NextGen to allow you to select a printer before sending the print job, you can change some settings that may allow you to access the printer select window. a. In EPM, select Admin, Preferences, User, and General. Oasis Provider Manual Page 138 of 164

139 b. Go to the Printing Tab and check the option for Prompt for Options Dialog. Click OK. Oasis Provider Manual Page 139 of 164

140 Phone Memo Template Oasis Provider Manual Page 140 of 164

141 To log a phone call: 1. Make the patient who you want the phone memo attached to their chart is the patient in context 2. Double click in the first white data grid to bring up the new record pop up 3. Fill out all required fields and click on Save 4. Close the pop up 5. If you would like to send this call as a task you would click send task, other wise you can close the phone memo template as you have documented the call Other template functions: 1. You can add a clinical or business alert here 2. Phone call Hx will show you historical call from before today and a summary 3. You can review allergies and medications on this page. Double click in the datagrid to open either module to make changes or request renewals Oasis Provider Manual Page 141 of 164

142 4. At the bottom of the page you can log unsuccessful attempts to contact the patient, remember to save the template before closing if you add anything here New phone record pop up: 1. You must pick one of the radio buttons with Incoming call or outgoing or return call 2. You must enter the name of the person calling or being called and relationship to the patient 3. Reason for call and phone number are required and then you can use the comments to keep notes Alternate Phone memo strategy: 1. For sites not using the phone memo for documenting patient communication, providers can document their discussion and action items in the Comments section of the Assess/Plan/Order template 2. These communications will carry forward to the next visit and should be reviewed by each provider 3. After documenting patient communication the provider should create progress note for that date, and just take out non-applicable information like the physical exam if the patient wasn t evaluated that day Oasis Provider Manual Page 142 of 164

143 PAQ Provider s Approval Queue The Provider Approval Queue (PAQ) is the module within NextGen s EMR where the Provider s can review Documents & Reports associated with their patient population. This is a secure system requiring the provider to provide their User ID and Password before any document can be reviewed and signed off on. To Logon to the PAQ: 1. From the NextGen EMR Top Toolbar click the PAQ Icon. (Red circle) 2. You are then prompted with the sign in dialogue box. 3. Enter your Password, then click Sign In. 4. The Provider Approval Queue window will display. Oasis Provider Manual Page 143 of 164

144 Setup PAQ Options: 1. On the PAQ Sign-In Screen. a. Check the Checkbox Keep me signed in on this computer unless I log out. This enables you to stay signed in the PAQ for as long as you are logged in to the NextGen EMR application. 2. To access the remaining PAQ setup options, click on the OPTIONS tab on the PAQ main menu. Oasis Provider Manual Page 144 of 164

145 a. Make sure the first two boxes are checked: i. Keep me signed in on this computer unless I log off ii. Select the first item in the list when initialized. b. Sort Item by i. Item Type ii. Item Description iii. Patient Name iv. Date Time this is the recommended option. 1. After selecting the desired parameter to sort the items, you can select to have the item listed in Ascending or Descending order. c. Display Options: i. Display Pending documents ii. Display Pending Images iii. Display Rejected Documents iv. Display Rejected Images. 1. It is recommended that all of the aforementioned display options be checked for display. d. Lab Results Options i. Currently we are not using Lab results notification from PAQ. Once NextGen makes the necessary changes to these options, we will reconsider this format e. Refresh i. Please check the checkbox to enable auto refresh. Please select a time frame for auto fresh. ii. It is recommended that the user set this value to refresh every minute. To Review an item in PAQ: 1. Open the PAQ and select the item you wish to view. The preview window displays all of the available information. Oasis Provider Manual Page 145 of 164

146 a. Click the OPEN button to go to the selected patient s chart. The PAQ will automatically close once the patient s chart is open. i. Once in the chart, you can review the lab results from the LAB module. ii. You also have the ability to sign-off on the results. To Leave a Comment: iii. Once completed reviewing the patient data, you can go back to the PAQ. To do this, click the PAQ icon on the top toolbar. 1. Open the PAQ and select an item, document or report from the left pane. 2. Select the Comment Tab (red circle) 3. Enter the pertinent comments in the lower window. 4. Once finished, click the ADD button 5. At this time, this comment will only appear within the PAQ, it is not copied to any other field. Tasking from the PAQ I. Creating a NEW task. a. Open the PAQ b. Select an item from the left-hand pane (Document, Report, Lab, etc.) c. Click the To Do button at the bottom of the screen. Oasis Provider Manual Page 146 of 164

147 d. Complete the Task fields and then assign the task to the appropriate user, then press ADD. e. Note: Had you previously added a comment, it would have appeared in the task as TASK DESCRIPTION. Rejecting an Item 1. To Reject an Item: a. Open the PAQ and select an item. b. Once highlighted, click the Reject button. You will be prompted with a warning dialog. Click OK. The Comment tab is automatically selected, where you can add a comment c. Enter the explanation for the rejection and click Add. d. Once you have rejected all items you wish to reject from your PAQ, they will be sent to your rejected list. e. You can review all of your rejected items and/or approve them at a later time by clicking on your rejected item tab. Reviewing Rejected Items 1. To Review a List of Rejected Items: a. Open the PAQ b. Select the Rejected Tab. You are prompted with the list of all rejected items. c. When working with the rejected list, you are able to utilize all of the standard PAQ functionality. Accepting an Item 1. To Approve an Item: a. Open the PAQ and select an item. b. Click the Accept button. For rapid approval of items in your PAQ, simply keep clicking the Accept button. c. By clicking on the Accept button, You ARE signing off of that item. Notes: Since we are not using PAQ Lab Notification, the task box and the PAQ don't interact with each other. You will have to complete your task on Lab Results Notification in the task box even if you had signed off in the PAQ. Oasis Provider Manual Page 147 of 164

148 Patient Scenarios for Practice Nurse data entry and Physician OV Enter this scenario for your pt. (Bold is for nurses) 1. At eagle location, review demographics and attending and referring physician 2. Enter height (if not entered 60 ), weight (200 lbs or other), bp is optional 3. review allergies and meds add if needed 4. Add medication lisinopril 5mg sig PO QD, aspirin 81mg (acknowledge warning if any) 5. Add diagnosis mal neo bronch/lung 6. perform pre assessment on pt 7. SOB on exertion 8. venouos access periphal 9. therapy 10. Add labs 11. wbc anc hgb hct platelets creatinine glucose Add PMH hyptertension 19. link dx HPI 1/11 s/p rtx (or other hpi) 21. Add staging information - date, thorax non small cell lung link diagnosis t4 mx nx (or other) 22. ROS full no resp ps 3 pain 0 fatigue 1 n/v 0 om PE change lungs - notable scar to left upper chest 24. Add Assessment - disease related dyspnea mild disease related fatigue mild symptomatic 26. Add follow up orders phys phy and chem. 1 week - CBC 27. Add additional orders imaging ct scan with contrast chest routine Methodist downtown all cts evaluate response to therapy 28. Add new chemo non small cell lung tx continuation alimta 500 mg / m2 single agent q 21 d 29. Add growth factor aranesp 500 mg 30. send growth and chemo Oasis Provider Manual Page 148 of 164

149 31. creatinine initial date ordered 1/3/ calculate from 1/3 34. cancer type non small cell lung 35. alimta 500 m2 36. check off 37. calculate protocol 38. change dex to 10 for all 39. change alimta to 1000 for all 40. Print Chemo order for C/D 41. Sign off on today s cycle / day 42. Flowsheet review 43. Disease management review 44. O CP review 45. Document chemo given: alimta 1000 ns 100cc inf peripheral (or other from printed order) 46. Docment non chemo 47. Add decadron mg 10 50cc d5w inf peripheral (or other from printed order) 48. Order b12 from additional orders 49. Document injection: 50. vit b mcgm sub cut site sub q right upper arm reason per protocol tolerate procedure education understood 51. Perform post assessment - consent for treatment signed 5/23/ no anitmetics yes chemo fill out form 53. create chemo note nurses note reviewed 54. SOB on exertion 55. add 500 mcg to aranesp 56. n/a post chemo vital signs 57. remove language about advanced directives 58. delete pt assessment info you don t want 59. go to assess/plan and create progress note 60. review progress note Return visit same pt just physician 1. enter weight 2. vitals review meds and allergies 3. general history 4. treatment hx 5. sub ob data 6. ROS and PE OV4 7. surveillance disease N/v 0 Oasis Provider Manual Page 149 of 164

150 8. reclick assessments 9. F/U orders RN chemo 1 week CBC - BMP 10. generate progress note Return visit for chemo 1. vitals 2. weight Add labs 4. wbc anc hgb hct platelets creatinine glucose meds reviewed and allergies reviewed 12. review treatment hx 13. sign off on today s order - keys 14. print today s order from chemo plan 15. perform patient preassessment 16. sob pos. mild with exertion 17. fatigue a little 18. venous access peripheral wrist left 22 guage 19. Fill in date given on chemo plan 20. document chemo meds 21. alimta md 1000 ns 100cc inf periph non chemo meds 10 d5w 50 cc inf peripheral post chemo documentation all normal 24. create nurses note in post assessment 25. review note and correct if SOB missing 26. save note and print for chart 27. mark any pieces of the chart you want scanned Oasis Provider Manual Page 150 of 164

151 Frequently asked questions Why can t I add or update information on a template? Why is the screen gray? Check first to see if the visit is locked. How do I lock/unlock a visit? Make sure you are on the correct encounter date. Right click. Choose Lock or Unlock You will need to type in your PIN or Password The folder on the Patient History Toolbar will open or close. What if I don t have the permissions to do this? You will need to add an addendum to the encounter for that date. Click on the encounter date that you would like to add an addendum to Click on File / New / Addendum to add Then click on the template button in your modules Then select either the Phy_new_enc.NGN or the Phy_prog_enc.NGN as seen below, then click generate to generate a note for that encounter Once an encounter is locked, the only way to add new data to that encounter is by unlocking it What if I can t find an allergy or medication? Type in only a few letters of the medication or allergy. Then click search. Oasis Provider Manual Page 151 of 164

152 Correct spelling is very important. If it still cannot be found contact the OASIS Development Team or the Pharmacy maybe able to help with naming convention. I can t find a diagnosis? Don t use periods when using ICD9 to search. Use the Category Description box. Click on the drop down key and click on AHN 2004 ICD codes. This is the lamented sheet and information is by category. Refer to your fee ticket as a reference point How can I create a Custom Visit? Click on the File icon on the Top toolbar. Click on New. Click on Custom Visit. Choose the date you wish to create and click OK. Double check date and click OK. Your date will appear in the Patient History Toolbar. Why do my reports come up without a date? Check that there is a provider and location assigned to the visit. Right-click on the visit and select Properties. Make sure that a location and a provider are assigned. Why is there no physical exam (PE) in my note? Go to the Physical Exam section on the OBJ/SUB/DATA template. If the No PE This Visit box is checked uncheck it. Go to the Assess/Plan/Order template and regenerate the note by clicking the Generate Note button. Why is there no physician signature on my outside lab or injection orders? Make sure there is a Patient Demographic template save in the date of service. If there is still no signature make sure a AHN Attending Physician has been listed on the Patient Demographic template. What is the navigator template? The navigator template can be used to link to templates that you wouldn t normally link to from your own desktop. Cycle day doesn t seem to update on my templates? Oasis Provider Manual Page 152 of 164

153 The way the system is programmed, you must go to the treatment history page after the cycle day is approved or marked as delivered to update the cycle/day When I create a document for the referring MD, it doesn t allow me to select that doctor to send the document to? Make sure to put in referring doctor in the patient demographic template Oasis Provider Manual Page 153 of 164

154 OASIS Glossary Alert: Windows may appear to let you know certain information needs to be completed before saving or to let you know the status of the patient s account. Allergy Module: This contains specific information regarding the patient s allergies. You will see the patient s allergy grid shard on several templates. If you double click in these grids it will launch you to the Allergy Module where you can add and update the allergies. You can also access the Allergy Module from the Tic Tac Toe board, which is located under the Patient History Toolbar. Button: Is a gray bar that is located on templates or square boxes in the toolbars. Each button is labeled. When a button is clicked it will take you to the specific template or module that needs to be completed, viewed or to look something up Check Box: These are square boxes found on templates. To choose an option click inside the box a checkmark will appear. If you make a wrong choice click on the box and the checkmark will disappear. Desktop: When you first log on to a computer this is the first window you will see. The desktop will have several icons on it. These icons will allow you to open specific programs. Such as EPM, EMR, Word, Outlook, etc. When in OASIS each job category has a desktop with the primary functions they need to perform their job all in one place. Document: A document is note that is generated based on information that has been completed on a template. This could be letters, orders, progress note, nursing notes, etc. When information on a document needs to be changed it is best to do go to the template and make changes then regenerate the document. Drop Down List (Picklist): Is a list of choices that will appear when some fields are clicked in. The drops down lists are very specific to the field you are in at the time. Each drop down list contains a blank field at the top of the list so that you can type in what you need if your choice is not on the list. Oasis Provider Manual Page 154 of 164

155 EMR (Electronic Medical Records): The Electronic Medical Records module is designed to improve quality, reduce risk, cut costs and increase revenues. It creates and maintains complete medical records with minimal effort while it streamlines workflow, controls utilization, and manages critical data related to patient care outcomes. NextGen EMR automatically creates documents and letters, manages prescriptions and clinical images, provides patient education, and exchanges data with other systems within, and external to, the enterprise. Fee Slip/Procedure Module: The Fee Slip/Procedure Module provides users with an easy way to create a detailed summary of services provided with procedures, problems and modifiers linked to each other. Moreover, users could assign summary of services to a particular health plan and subsequently export all of the available information to a billing system. Finally, through the use of a report generating software, Fee Slip/Procedure allows you to create userdefined reports based on the summary of services. The staff will document billing information so specific templates which will be submitted and will cross over to the Fee Slip/Procedure Module. Field: Is an area on a template where certain types of information are entered or displayed. Examples: Date, Category, Phone Number, and Physician. Icon: This is a type of button that has a graphic on it which lets you know the function the button will perform. Lab Module: The Lab Module is where the patient s lab results can be viewed and signed off by the physician. Specific Crystal Reports have been designed so the lab results can be printed. Please see Desktop training guides for more details on how to print lab reports. Locked Visit: When a Key appears in the folder next to an encounter date this means the visit has been locked. The information in the visit can be viewed but cannot be edited. To unlock a visit to edit you must right click on the date click unlock and type in your password or PIN. Logoff: The process of quitting or stopping from the computer. To logoff you shut down all applications then click on the start icon at the bottom left of your screen and click on shut down. Oasis Provider Manual Page 155 of 164

156 Logon: The process of starting to use the computer. You logon by typing in your User ID and password. Main Toolbar: This may also be referred to as the Patient History Toolbar. This toolbar is located to the right of the screen. In this toolbar you can create new visits, view and update patient existing encounter dates. You can also navigate to specific modules by clicking in the Tic Tac Toe board. Medication Module: The Medication Module was designed in order to enable users to write, print, fax, update and renew patients' prescriptions. Moreover, through the Medications Module, users can educate patients on Medications prescribed to them, as well as check whether the prescribed medication has any interactions with other prescribed medication or an existing allergy. Module: Contains information regarding a specific topic. Allergy, Medication, Diagnosis, Fee Slip/Procedure Modules. NextGen: Is the name of the company we purchased the EPM and EMR software from. OASIS (Oncology Application for Streamlining Information System): The Electronic Medical Record (EMR). Password: A secret code that is to serve as a security measure against unauthorized access to data. Each user has a password assigned to them. This is not to be shared with anyone. PIN (Personal Identification Number): See Password. Pop Up: A small window or menu that appears on top of existing window. Once the appropriate choice is made the pop up will disappear. Problem Module (Diagnosis): The Problem module enables users to list specified medical problems related to each particular patient. Such problems are separated into Resolved and Unresolved, allowing users to set specific dates for onset of a given problem, as well as a date it was resolved. All of the problems added to a patient's medical record will be displayed in the Content window of the Main Toolbar. Provider Approval Queue (PAQ): Using the Provider Approval Queue (PAQ) enables you to sign off on all relevant documents, Oasis Provider Manual Page 156 of 164

157 transcribed notes, lab results and images. The PAQ allows you to review all of the items that you receive, if needed, add comments and/or create a New Task and then either Accept or Reject the item. Radio Button: This is a series of buttons that allows only one selection. If a button is currently selected it will deselected when another button is selected. Referral Module: The Referral Module is an optional module of NextGen EMR. It is available for purchase for an additional charge. The module enables NextGen EMR users to gather all of the required information in order to produce a clear and concise referral form. You are required to create a specific report using Crystal Reports in order to be able to print out referral forms. All of the information entered in the Referral Module is available through other modules of NextGen EMR however, utilizing the Referral Module allows an easy way to create and print referrals. Note: This is not a module that will be used at this time. Refresh: To renew. Sometimes you may need to refresh a document or screen so that updated information will show. You do this by clicking certain icons or drop down keys. Regenerate: To update an existing document so that corrected information will show or the appropriate signature will show. Soft Exit: This icon appears on the Top Toolbar. By clicking this icon the Logon window will appear and allow a user to logon to OASIS without having to shut the entire computer down. Template: This is where patient s medical and demographic information are documented and stored by encounter dates. Tic Tac Toe Board: This area is located underneath the Patient Encounter History Toolbar. It is made up of several different buttons that when clicked on will take you to different modules or to look for templates or documents. Toolbar: These are made up of several different buttons that will help you navigate and perform certain task. Such as looking up patients. There are 3 toolbars in OASIS: Menu Toolbar, Top Toolbar and Patient Encounter History Toolbar. Oasis Provider Manual Page 157 of 164

158 User ID: The name you use to identify yourself when logging onto a computer. Workflow Module: The Workflow Module was created in order to assist users with routine tasks that occur through out the practice. While working with the Workflow Module you can assign, view, accept or decline tasks; read, save and send s; view patient appointments. You are able to access patient s charts, as well as specific components such as templates, images or documents. Oasis Provider Manual Page 158 of 164

159 Buttons, Check Boxes, Drop Down List, Fields, Icons and Radio Button Examples Drop Down List Buttons Radio Buttons Field Checkboxes Oasis Provider Manual Page 159 of 164

160 Patient History Toolbar, Module Icons, Template, Document, Image Icons Tic Tac Toe Board Patient History Toolbar Template Selection Document Selection Image Selection Procedure Module Problem Module Allergy Module Medication Module Referral Module Lab Module Oasis Provider Manual Page 160 of 164

161 Desktop Tic Examples: Tac T B d PSR Desktop Oasis Provider Manual Page 161 of 164

162 RN Desktop Oasis Provider Manual Page 162 of 164