Denali v3.1b1/onc 2015 Edition Webinar EMR General Features Bizmatics, Inc. 4010 Moorpark Avenue, Suite 222 San Jose, CA 95117 www.prognocis.com training@bizmaticsinc.com Copyright 2017 Bizmatics, Inc.
In this session Denali v3.1b1 General Features Patient Register related changes Implantable Device Manager Medication/Prescription related changes Social History & Family History changes Vaccination related changes Patient Education Patient Portal related changes Appendix A MIPS Weightage & Scoring *Many features are required for ONC certification but are not mandatory for QPP/MU.
Patient Register
Patient Suffix 1. Free-text field, up to 10 characters long with first letter forced upper case by default. 2. Existing property patient.name.format now accepts value S to be appended with a comma in order to display it where applicable (ref: Display Name) 3. New output print tag PT_NAME_SUFFIX allows suffix to be included in printed output where applicable
Patient Sexual Orientation/Gender Identity* 1 2 1. Value Unknown now available in Sex dropdown list. 2. invokes new Patient Sexual Orientation/Gender Identity Details popup, which pre-defined values and respective SNOMED codes. The text fields are enabled when choosing value Other (OTH).
Patient Sexual Orientation/Gender Identity (cont d) A check mark will display on the button ( ) when it is populated Output tags applicable for Unknown gender value: New tags available for gender: PT_SEX male / female / unknown PT_SEXCAPS Male / Female / Unknown PT_SEXCHAR M / F/ U For tags PT_GENDER & PT_GENDERCAPS, the value he/he will apply for now For tags PT_HISHER & PT_HISHERCAPS, the value his/his will apply for now Output tags applicable for Transgender values are in the table below: Tag PT_SEXUAL ORIENTATION_CODE Description Displays the code for the patient s Sexual Orientation. PT_SEXUAL ORIENTATION_NAME PT_GENDER IDENTITY_CODE Displays the description of the patient s Sexual Orientation. Displays the code of Patient s Gender Identity. PT_GENDER IDENTITY_NAME Displays the Patient s Gender Identity.
Patient Preferred Language hyperlink replaces the former Preferred Language search icon The Patient Communication Languages popup allows multiple languages along with the patient s ability to express or receive in the language, his/her skill level, and which one is preferred by the patient. 1 2 3 4 1. Click to search/add multiple languages, up to 10 with no dupes. Note: Declined to Specify may only be saved if no other language is present for the patient. An alert will prompt to remove all others and save Declined as preferred.
Patient Preferred Language (cont d) 2. Select a radio button (only one) to indicate which one the patient prefers. Note: By default, the first one selected will be indicated as Preferred until changed. 3. Indicate the patient s ability to receive/express the language Signed patient is able to sign in the language (non-hearing) Spoken patient can speak or understands the language audibly (hearing) Written patient can write or read the language 4. Indicate the patient s proficiency with the language Notes: Output tag PT_COMMUNICATION LANGUAGES$ with extensions N, C, A, or P will print the details accordingly on output. When using the Copy feature to create a new patient record or in Sibling Management, all languages for the patient are also copied to the new one/overwrites the sibling info. Languages are stored under Settings Configuration Group Types System Patient Language. For inactive languages already selected, the Pref button is disabled.
Patient Ethnic Group invokes the Ethnic Group search User may select multiple values, up to 5 with no dupes Note: Formerly, this search screen only allowed a single selection. Modified output tag PT_ETHNICGRP to print all selected values
Patient Register Validation If Language, Race, Ethnic Group, Sexual Orientation, and/or Gender Identity are not entered on the screen, upon clicking to save Patient Register, user will be prompted with a warning This warning may be overridden but will continue to display until the values are entered Note: Though not a direct requirement of MACRA/MIPS or Meaningful Use, these values are required for certification.
Cell Phone Text Reminder Patient s Text Message on Cell reminders can be customized per Encounter Type via Settings Configuration Clinic Enc Types. For each Enc Type, the text may be system Default, Custom, or none at all.
Implantable Device Manager
Implantable Device* Manager Accessed from Encounter TOC or Face Sheet Implanted Device(s) Accessed from Patient Register (unpopulated) or (populated) TOC Menu Options tag ID Facesheet Layout tag DEVICES *Pacemakers, artificial hips, spine screws, rods, breast implants, coronary stents, prosthetic limbs, etc.
Implantable Device Manager (cont d) 1. Click, which invokes the Please enter UDI pop-up. 2. Enter the UDI & click the get details button*, which will populate the Device Details. 1 Device Details 2 * PrognoCIS connects via a 3 rd party web interface to fetch the device details. o Global Unique Device Identification Database (GUDID) - a federal DB that stores the device details as a reference catalog for all such devices. o Unified Medical Language System (UMLS) fetches the SNOMED for the device
Implantable Device Manager (cont d) UDIs (Unique Device Identifiers) are numeric or alpha-numeric and contain a delimiter to identify the different parts of the number. o Device Identifier identifies the product and labeler Note: If only the DI part of the UDI is entered, only partial details will be fetched. o Production Identifier identifies the lot, batch, serial number, and date Three agencies accredited by the FDA currently issue UDIs; each one assigns a different delimiter by which the details are parsed upon import. (See example below*.) o GS1 o Delimiter used is (01) o HIBCC (Health Industry Business Communications Council) o Delimiter used is + o ICCBBA (International Council for Commonality in Blood Banking Automation) o Delimiter used is =/ or =) *(01)08717648200274(11)141231(17)150707(10)A213B1(21)1234 (01)08717648200274 = Device Identifier (11)141231 = Date of Manufacture (Dec. 31, 2014) (17)150707 = Date of Expiration (July 7, 2015) (10)A213B1 = Lot Number (21)1234 = Serial Number
Implantable Device Manager (cont d) The top portion of the Implanted Device screen is data entry and enables you to track a device during an encounter as applicable Mandatory fields are: Device Name description of the device that is implanted Date of Implant date the device was implanted into the patient Note: Date must be between range of Manufacture Date and Expiration Date. Target Site indicate the anatomical location where the device was implanted Status indicates status of the device (Active, Inactive, Erroneous, Duplicative) Additional fields (which are not mandatory) include: More details of Site, Facility, Reason for Status Change text fields Associated Procedure-SNOMED a lookup to select applicable SNOMED Code Date of/reason for Status Change applicable when updating the device during an encounter (perhaps it has expired or otherwise needs replaced).
Implantable Device Manager (cont d) 1. Click to add a new device 2. Select from existing ones in the drop-down. Inactive devices will display at bottom. 2 1 Date shown is Expiration
Implantable Device Manager (cont d) New tags available to display Device Details on output templates PT_IMPLANTDEVICE_TBL$ PT_IMPLANTDEVICE_LINE$ PT_IMPLANTDEVICE_PARA$ The following extensions apply to LINE$ and PARA$ tags: A Status of Device N Device Name B Brand Name P More Details of Site C Company Name R MRI Safety Information D Implant Date S Serial Number E Expiration Date T Target Site F Procedure Facility U Complete UDI Value H HCT/P Code V Version I Device Identifier only W Latex Warning L Lot Number 1 Procedure SNOMED Code M Manufacture Date 2 Procedure Name
Medication/Prescription Related Changes
Electronic Prescription erx Change/Cancel/Fill Encounter-level e-prescriptions may now be cancelled or modified electronically Three new types of SS_ messages the provider will receive in his/her Inbox* All activity is recorded at encounter level and in Current Medications History SS_CHANGEREQUEST 3 types of changes the pharmacy may request of the provider Generic Substitution pharmacy requests approval of the provider to substitute a generic equivalent than what was originally prescribed due to various reasons. Therapeutic Interchange pharmacy requests approval of the provider to fill an alternate drug other than what was originally prescribed due to various reasons. Prior Authorization pharmacy requests the provider to obtain preauthorization which is required per the patient s health plan for various reasons. SS_CANCELRESPONSE 2 types of responses the pharmacy may return to the provider when the provider has requested to cancel an erx (new feature) Delete Drug cancel the entire prescription as submitted Discontinue cancel only remaining refills (e.g.: if original Rx is partially filled) SS_RXFILL 3 types of notifications the pharmacy can send to the provider that indicates the disposition of the erx Fully Dispensed Partially Dispensed Not Dispensed *Applicable setup is required by Bizmatics Technical Admin Staff
erx Change Request Provider receives a SS_CHANGEREQUEST message from the pharmacy* Click to zoom into the message The provider will approve or deny it in conjunction with the reason for the change Generic Substitution Therapeutic Interchange Prior Authorization Required *Supported Events 239, 240, 241 must be enabled for the Alerts to generate
Change Request Generic Substitution Approve 1. Pharmacy suggests 1 or more alternate drugs in the Medication Requested field. a. The selected drug will highlight in green background with its details expanded. b. Click the Edit button to modify dispense details if applicable. 1a 1b
Change Request Generic Substitution Approve (cont d) 2. When the selected drug details are modified under the Edit button, the changes are reflected by a yellow highlight and the original details display with a strikeout font. 3. Click the Accept button; a Confirmation message will display upon acceptance. 2 3
Change Request Generic Substitution Approve (cont d) *Encounter workflow for Approved Change Request: Generic Substitution The original erx is removed from the original encounter Prescription Note: This is true whether the original encounter is open or closed status. A new, closed CR; Surescripts ChangeRequest encounter is auto-generated. Document List A Progress Note for the SureScripts ChangeRequest encounter is auto-generated Indicates the replacement prescription (i.e.: Generic Drug substitution that the provider approved on the pharmacy request) *Note: This workflow is similar to that of SS_REFILLREQUEST messages.
Change Request Generic Substitution Deny 1. Provider selects Denied Reason Code & may enter a Denial Reason Note if applicable 2. Click deny button Note: This button displays disabled until a Reason Code is selected. Reason Code is required 1 2
Change Request Generic Substitution Deny (cont d) Encounter workflow for Denied Change Request: Generic Substitution The original prescription is retained on the original encounter The Type refreshes to CHGRES_D (i.e.: Change Request Response Denied) Document List A new document type Denied Change Request is added for the Encounter Date This is the actual Denied Response sent back to the pharmacy by the provider There is no new Encounter generated in this scenario.
Change Request Generic Substitution Deny (cont d)
Change Request Therapeutic Interchange Approve 1. Pharmacy provides reasons for the change request under Drug Use Evaluation (e.g.: alternate drug has less/no side effects, 90-day benefit for equivalent at lower price, the patient prefers 50mg QD for Rx written as 25mg BID, etc.) 2. Suggested alternate drugs will display in the Medication Requested column 2 1 *Multiple drugs will display collapsed until selected
Change Request Therapeutic Interchange Approve (cont d) 3. Provider can approve as-is or alter the Medication Requested a. The selected drug will highlight in green background with its details expanded. b. Click the Edit button to modify the dispense details if applicable. 3a 3b 4. Click the accept button; a Confirmation message will display upon acceptance 4
Change Request Therapeutic Interchange Approve (cont d) *Encounter workflow for Approved Change Request: Therapeutic Interchange The original erx is removed from the original encounter Prescription Note: This is true whether the original encounter is open or closed status. A new, closed CR; Surescripts ChangeRequest encounter is auto-generated. Document List A Progress Note for the SureScripts ChangeRequest encounter is auto-generated Indicates the replacement prescription (i.e.: alternate drug substitution that the provider approved on the pharmacy request) *Note: This workflow is similar to that of SS_REFILLREQUEST messages.
Change Request Therapeutic Interchange Deny 1. Provider selects Denied Reason Code & may enter a Denial Reason Note if applicable 2. Click deny button Note: This button displays disabled until a Reason Code is selected. Reason Code is required 1 2
Change Request Therapeutic Interchange - Deny (cont d) Encounter workflow for Denied Change Request: Therapeutic Intervention The original prescription is retained on the original encounter The Type refreshes to CHGRES_D (i.e.: Change Request Response Denied) Document List A new document type Denied Change Request is added for the Encounter Date This is the actual Denied Response sent back to the pharmacy by the provider There is no new Encounter generated in this scenario.
Change Request Therapeutic Interchange Deny (cont d)
Change Request Prior Authorization Response 1. The Change Request message will include Benefits Coordination details 2. The provider can enter the Prior Auth. No. if known & indicate status as Approved Note: Provider may also indicate status as Requested, Deferred, or Denied. 3. Click accept button to inform the pharmacy 2 1 3
Change Request Prior Authorization Response (cont d) Encounter workflow for an approved Change Request: Prior Authorization The original prescription is retained on the original encounter The Type refreshes to CHGRES_A (i.e.: Change Request Response Approved) Note: There is no additional entry made to the Document List because nothing about the prescription changed. There is no new Encounter generated in this scenario.
*Encounter must be Open erx Cancel Request 1. On Prescription screen*, select the previously transmitted erx (Type = erx) 2. Click the Cancel erx icon ( ) 2 1 3. Click to Cancel erx (see next slide). 3
erx Cancel Request (cont d) Note: The provider may know up front whether the original erx was processed yet or not; and if so, he/she can indicate to what extent to cancel the prescription. If this is unknown, the pharmacy will ask the provider to clarify by its Response message. Cancel indicates the entire prescription needs to be cancelled. Applicable when the pharmacy has not yet dispensed the original Rx. Discontinue indicates remaining refills only need to be cancelled. Applicable when the pharmacy has already dispensed the original Rx. Encounter workflow for an approved Change Request: Prior Authorization The original prescription is retained on the original encounter The Type refreshes to CANREQ (i.e.: Cancel erx Request Sent) until the pharmacy responds, and then this will update again.
erx Cancel Request Response Approved The pharmacy will respond with a SS_CANCELRESPONSE message. When Approved, additional clarification* may be requested from the provider. 1. Click the delete drug button to cancel the entire prescription, or 2. Enter number of Discontinued Refills then click the delete refills button *Depends whether the Rx has been filled yet or not. 1 2
erx Cancel Request Response Denied The pharmacy will respond with a SS_CANCELRESPONSE message. When Denied, no further action is required from the provider. The pharmacy will give a Denied Reason(s) why the Cancel Request was not filled. No action required
Cancel Request on Document List 1. An entry will be saved to the Document List for the Cancel Request Response whether it is denied or approved by the pharmacy 1 2. The Type column of the original Prescription on the original Encounter will also refresh to indicate how the pharmacy responded; e.g. CANRES_D Cancel Request Response Denied CANRES_A Cancel Request Response Approved 2 There is no new Encounter generated in this scenario.
erx Fill Status Dispensed The pharmacy will send a SS_RXFILL: Dispensed message when the prescription is completed either partially or fully as ordered
erx Fill Status Not Dispensed The pharmacy will send a SS_RXFILL: Not Dispensed message when the prescription is not completed as ordered
erx Fill Status Dispensed/Not Dispensed (cont d) The Type column of the original Prescription on the original Encounter will be refreshed to indicate how the pharmacy responded; e.g.: a. RXFILL_F = Fully Dispensed b. RXFILL_PF = Partially Dispensed c. RXFILL_NF = Not Dispensed
erx Changes Configuration Bizmatics Administrative Staff Contact Bizmatics to have these features added to your Surescripts-enabled providers New clients still implementing, contact your Implementation Manager Live clients already transitioned, contact Technical Support or create a ticket on the Resource Center The features will be enabled within the Provider Master erx button Supported Events 239, 240, and 241 will be enabled Note: The Supported Event triggers the delivery of the message, but the user still requires permissions at the Role level to view its contents. Clinic Administrative Staff Read permissions must be assigned to any user who needs to view these messages. Settings Configuration Admin Role Note: Appropriate system administrator permissions are required.
Prescription Screen Changes Ability to associate primary and secondary diagnosis to a drug on a prescription The selection sequence determines primary/secondary. The tooltip will display both diagnoses as will Current Medication Indication column. For liquid oral drugs, user will be prompted if milliliter is not selected as Dosage and Dispense Unit
Medication History Changes New property rx.medhist.offset.1year can be set On to pull 1 year instead of 2 years New format for displaying demographic details when eligibility is found; reworded message when eligibility not verified (Patient not currently a member of health plan.) Patient details in XML received from Surescripts Patient details as entered in PrognoCIS
Current Medication 1. New Surescripts Status column & invokes the applicable SS_ message from the Document List 2. The tooltip of the icon will indicate the status for the erx based Note: The content of this will vary based upon the message type and whether or not it has been approved or denied or is only informational. 3. All transactions are also audited in the history button. 1 2 3
Current Medication (History) New Surescripts Status column added to Current Medication History table All transactions that occur via SS_CHANGEREQUEST or SS_CANCELREQUEST and whether they are approved or denied is saved
Other Changes/Features
Social, Psychosocial, and Behavioral Data New Social History template and elements (w/applicable LOINC Codes) Note: Though not mandatory for QPP/MU reporting, this is required for certification. New Systems/Elements/Results w/loinc: Financial resource strain Education Stress Depression Physical activity Alcohol use Social connection/isolation Exposure to violence
Social History Results LOINC Code 1. Length of Element Name expanded to 150 characters maximum 2. Provision to associate LOINC codes for Answer at the Element level or for a specific Result if applicable for Boolean or Multiple Select options. 2 1
Family History by SNOMED Ability to search/select by Problem SNOMED Property facesheet.familyhistory.byrelation set to On Property facesheet.familyhistory.byrelation set to Off
Family History by SNOMED (cont d) 1. ICD search defaults pre-filtered to Family history of diagnoses 2. User may clear the filter & search for any standard ICD code instead 2 1
Family History by SNOMED (cont d) Labels changed to correctly identify the SNOMED for Problem and Relationship under the history button Tooltips now reflect the SNOMED for Problem when saved to Face Sheet
Allergies Adverse Type Event 1. The Reaction is now a master search with SNOMED associated to populate the CCD 1 2. New Adverse Event Type is populated from CCD upon import per pre-defined values 2
Past Medical History A new column called Problem Control populated from a CCD upon import for transitions of care or otherwise User may manually use this column manually The values in the pick list are pre-populated per CCD values
Vaccinations (Patient Register) New/additional fields added for required data, including Multiple Birth Indicator, Birth Order No (if the patient is a multiple-birth), Birth Name, and Residence Type New tags to display these details: PT_BIRTH INDICATOR, PT_BIRTH ORDERNO.
Vaccinations (Face Sheet Administer) The Administer Vaccine screen now includes a Funding Source pick-list field Applicable only with the Vaccination on this visit option Funding values are pre-populated
Vaccinations (Face Sheet) 1. A new Registry button will display alongside the Response Log button when applicable. 2. A new Response Log button will display to access Import/Export Logs* 1 2 3 3. A validation will alert user when CVX Code is not present in Vaccine Master. The Administer button will be disabled until a valid CVX code is assigned to the vaccine. *These features require property export.vacc.createhl7message be set On.
Vaccinations (Vaccine Master) 1. The CVX Code is now mandatory field, up to 3 digits as assigned by CDC. Note: See https://www2a.cdc.gov/vaccines/iis/iisstandards/vaccines.asp?rpt=cpt. 2. New VIS Name field allows user to select from all applicable VIS linked to the CVX Code 2 1
Vaccinations Vaccine Master (cont d) 1. NDC Code field lets you define applicable NDC Code (up to 11 digits) for the vaccine 2. Brand Name field lets you define the Brand Name for the vaccine manufactured 1 2 Lot Number Manufacturer 1 2
Medline Plus Patient Education ( ) The MedlinePlus Education can now be displayed in the patient s preferred language* (print, email, or send to portal) as saved under Patient Register Other Info tab. Face Sheet Past Medical History By ICD-10 or SNOMED for each diagnosis Face Sheet Current Medication By RXNORM or NDC for applicable medications Face Sheet Allergy By SNOMED Code for applicable allergies Encounter TOC Assessment ICD By ICD-10 or SNOMED for each diagnosis CPOE Lab Results By LOINC code for applicable lab results present *Note: If the patient s preferred language is not indicated, or it is one that is not supported by MedlinePlus, the education will display in English.
Expressions Provision to enter Bibliography via the Param button, which displays as a hyperlink Note: The values will auto-populate as Unknown but can be overwritten if needed. Adding Special Tag type with an applicable value (e.g.: SNOMED, ICD, CPT, RxNorm, NDC, or LOINC) will add these fields as well under the Param button.
Audit Report Export/Download Transactions User export/download activity is audited, regardless if user confirms or cancels the confirmation alert. Specific report/file name is not recorded only the action. Document List Letters Out Order Sheet CPOE Consult Enc Close MU Summary Draw Tool Tabular Reports Meaningful Use Reports Audit Trail Review TOC Summary of Care Employer Master CPT/HCPC Master Template Test Exec Download Files Data Portability Message In Lab/Rad Vendor Patient Portal Ambulatory Summary
Audit Report Format of Comments Audit comments have been reformatted when activating/inactivating a user, e.g.: DR Provider RS Resource MA Medical Assistant RN Clinical Staff ST Office Staff RD Referring Provider BL Billing Staff ZE Organization Provider ZR Referring Organization The single column Id Chart No# Name DOB is now displayed in 4 separate columns: Pat Name, ID, Chart No#, and DOB.
Patient Portal Related Changes/Features
Patient Gender Value Unknown has been added to patient s Sex field under Personal Details section (Patient Sexual Orientation/Gender Identity Details) is not applicable for Patient Portal (only EMR Patient Register). Label changed to Preferred Language will display only the preferred language if there are multiple ones present in Patient Register The Ethnic Group and Race fields will display only the first value if there are multiple ones present in Patient Register
Attach Reference Link* Patient can now attach a Reference Link/URL from the portal, which will be sent to his/her Primary Provider who can then click the hyperlink & view the details. 1. Select Category (mandatory) 2. Enter Subject (optional) 3. Select Reference Link radio button 4. Click the Attach button 1 2 3 4 *Property scan.onetouch.serverpath must be defined
Attach Link to Health Information (cont d) 1. Specify a Reference Link (URL) which will enable as a hyperlink for the provider 2. Enter Notes, which the provider can view when zooming from the system Alert 1 2 3 3. Click Attach button. 4. The Status will show as Pending on the Portal until the provider accepts or rejects it. 4
Patient Portal Attachment System Alert 1. The patient s primary provider (as indicated on Patient Register) will receive a system alert: PA: Approve Portal Attachment in EMR Inbox. Note: User Role portalattachments must be assigned to users who need to receive the alert in conjunction with the Supported Event*. 2. The Zoom icon ( ) allows it to be viewed, approved, rejected, and/or reviewed Note: The Status on the patient s Documents screen on Patient Portal will be refreshed to indicate the provider s action. 1 2 *Supported Event 215 must be enabled for the Alert to generate
Patient Portal Attachment System Alert (cont d) Viewing the PA: Reference Link 1. Provider may click the Reference Link, which will navigate to the corresponding path Note: Although the URL may not appear as a hyperlink, it will execute as one. 2. Any Notes the patient entered while attaching the link may also be viewed 3 1 2 4 3. Provider may enter remarks under the Review button (not visible on the Portal) 4. Provider may accept or deny the link, which will refresh the Status on the Portal
Patient Portal Attachment System Alert (cont d) PA: Provider Action - Deny If provider wants to reject the link, a Rejection Reason is required. The patient will receive an email indicating it was denied, and the status will be reflected on the Patient Portal Document List.
Patient Portal Attachment System Alert (cont d) PA: Provider Action - Accept If accepted, the document is saved to the Document List in EMR in conjunction with the property review.doclist.types having value PA assigned.
Health Summary History Former Ambulatory Summary label renamed as Health Summary New Past Health Summary sub-menu option* allows the patient or authorized users to access clinical health summaries by Date of Service Up to 10 summaries may be selected at a time to view, download, or transmit Note: This is a requirement for Meaningful Use as well as QPP-MIPS-ACI. *Property Patient Portal Menu Sub Menus pp.tab01.options
Health Summary History (cont d) View Click the View hyperlink to display the Health Summary details on the screen The Health Summary format & contents are modified per new CCD v2.1 specs. Note: Please see ONC-2015 Denali QPP/MU Related Features webinar. UI is not user-interactive with expanding/collapsing TOC and data sections.
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Questions and Answers.