Physician Reference Guide Paragon Clinician Hub Version 13.0
Table of Contents Table of Contents Clinician Hub 13.0 4 5 Clinician Hub 13.0 6 7 Key Features Clinician Hub 13.0 How to Unlock an Applica on Clinician Hub 13.0 Census How to Create a Census Clinician Hub 13.0 Collec ons What is a Collec on? Clinician Hub 13.0 Collec ons How to create a Collec on Clinician Hub 13.0 Collec on How to add a pa ent to a Collec on Clinician Hub 13.0 Collec ons View pa ents in a Collec on Clearing a Selec on Rename a collec on Clinician Hub 13.0 Collec ons Remove a pa ent from a Collec on Clinician Hub 13.0 Collec ons Delete a Collec on 8 9 10 13 14 15 16 17 18 19 20 21 22 23 Clinician Hub 13.0 Manage Consultant 24 25 Rela onships Assign Yourself as a Consultant Remove Yourself as a Consultant Clinician Hub 13.0 Card and List View 26 27 Clinician Hub 13.0 Physician Work Queue 28 29 Clinician Hub 13.0 Overview Window 30 Pa ent Sidebar Clinician Hub 13.0 Overview Window Vitals I & Os Clinician Hub 13.0 Overview Window View Results View Orders View Meds & IVs Clinician Hub 13.0 FlowSheet View Flowsheet 31 32 33 Clinician Hub 13.0 View Previous Date Clinician Hub 13.0 Ordering Real Time Dropdown Search Results Admission & Transfer Med Rec (Defer Remaining Home Meds) Clinician Hub 13.0 Med Rec Discharge Med Rec (Cont, DC & AMEND) Clinician Hub 13.0 Bulk Sign Off Order Pa ent Orders Sign Off Diagnosis Search Clinician Hub 13.0 Prescrip on Writer 34 37 38 39 40 41 42 49 Clinician Mobile 50 55 Order Sets 56 57 PhysDoc: Addendum PhysDoc: Invalidate Deficiencies: Signature Missing Text Dicta on Clinician Hub 13.0 Ordering How to cancel Request Clinician Hub 13.0 Ordering How to Discon nue Request Clinician Hub 13.0 Ordering Label Maintenance 58 59 60 61 62 67 68 69 70 71 72 73 2 3
Clinician Hub 13.0 Paragon Clinician Hub 13.0 Access to Paragon Clinician Hub is via Microso Internet Explorer with appropriate access to the hospital s internal network. An applica on lock can occur for a pa ent visit when certain ac vi es are performed by Paragon and Clinician Hub users. Some examples of ac ons that might cause a lock include: Medica on Reconcilia on dra is locked while home meds are being updated in Pa ent Profile Clinician Hub mes out with a medica on reconcilia on dra s ll open 4 5
Key Features Icon Key Features Descrip on Provider Name Help Lock Paragon Clinician Hub replaces Websta on for Physicians Logging out of applica on Icon Descrip on Census View/Informa on Default physician census The default view of the physicians pa ent list. Physicians can request coverage from another physician. Shows cases for surgeons booked via ORM. Physicians can view/complete deficiencies for One Content deficiencies only Alternate view of the physicians pa ent list. A grouping of pa ents Refreshes the screen Search Appointments schedule or available mes for scheduling Referen al content and pa ent educa on Personal links are useful links (URLs) that can be added by the physician to suit specific needs. Up to 24 personal links can be entered. Reset selected filters Save selected filters Op on to view the physicians rounding report and other ac ons. Filter criteria The physicians current work queue Includes the categories of filters (Group, Loca on and Demographic) Displays selected filters 6 7
Clinician Hub 13.0 How to Unlock an Applica on Note: A user with Super User Authority security can unlock applica ons as necessary. Clinician Hub 13.0 How to Secure a Session Step Ac on Step Ac on 1. On the Naviga on Banner: 1. the pa ent name link on the pa ent card for which you need to unlock an applica on. The pa ent is put in focus 2. the down arrow for your user name select the Super User op on. 2. When you return: Type your Password 3. for the desired applica on you want to unlock. Note: The applica on is no longer displayed on the window to indicate that it is unlocked. If you need to walk away from your session, you can secure it to prevent others from performing ac ons using your login. Note: If you leave a session secure for 30 minutes, the system automa cally signs you out. 4. Repeat step 3 for another applica on, if desired, or click 8 9
Census Census Step Ac on 3. Repeat Step 2 un l all desired filters are selected. 4. To modify your selected filters, click Clinicians can find the pa ent(s) they need using the Census tab in PCH. Via the census, clinicians can: Create a census based on a variety of filters Search for an individual pa ent Create one or more collec ons (personal lists) to track specific subsets of pa ents. Select the ac on they wish to take on a pa ent they select Access their Physician Workqueue, which contains tasks and ac ons they need to take on all of their pa ents How to create a Census Step Ac on 1. In the Group, Loca on or Demographics category, click the filter name 2. Select the check box or radio bu on next to the desired entry for the filter. If there are more entries for a filter than can display in the window, use the scroll bar to display/select the desired filter values. Note: The filter turns blue to show that a selec on has been made; the filter is applied to the search and the search results display 5. To remove a filter, click next to the filter. 6. To clear all filters, click 7. To close the View Filter String, click in the upper right corner of the View Filter String window. 8. Once the filter is set, click 9. Name the filter, then click 10. The filter appears in the Filter dropdown list. To make this filter the default filter that is used when accessing the census screen, select Set as default 10 11
Census Addi onal Tips Notes Refining Census The default My Pa ent census may contain pa ents you do not wish to include on a daily basis, for example outpa ent visits or ED pa ents. Use the filters to restrict pa ent type (inpa ent, observa on, other relevant types) and the pa ent status to restrict to admit. You may also want to filter the rela onships to include admi ng, a ending, and/or consul ng only. Save this modified filter for future use with it s own name (e.g.: My census ) and set this census to show as your default census. 12 13
Collec ons Collec ons How to create a Collec on Step Ac on 1. the Collec ons drop down arrow. The drop down expands to show MyCollec ons. What is a collec on? A collec on is a grouping of pa ents. Collec ons are userspecific and are therefore not visible to other users of the system. (i.e. follow up cultures, labs Ortho pa ents, "Chemotherapy pa ents" or "Dialysis pa ents"). 2. the A field displays. entry. Collec ons are at the pa ent level first and then the visit level. A collec on must be created before pa ents can be added to it. 3. Enter the name for the collec on in the field provided. It must be unique. Up to 50 alphanumeric characters can be entered. 4.. The following message displays the collec on is saved and available in the My Collec ons list. 14 15
Collec ons Adding pa ent to a Collec on Method #1 Collec ons Adding pa ent to a Collec on Method #2 Step Ac on Step Ac on 1. With the census displayed, select the pa ent you want to add to a collec on. Note: You can Mul select pa ents to add to a collec on if desired. 1. With the census displayed, select the pa ent(s) you want to add to a collec on. 2. the Select An Ac on... drop down arrow 2. In the List view, click for the pa ent you want to add to the collec on. 3. Select Add selected pa ents to a collec on 4. Use the drop down to select the Collec on to which you want to add the pa ent 3. 4. Use the drop down to select the Collec on to which you want to add the pa ent 5. 5. 6. to close the Pa ent Added to Collec on dialog box. (The box will close automa cally a er a few seconds) 6. to close the Pa ent Added to Collec on dialog box. (The box will close automa cally a er a few seconds) 16 17
Collec ons Collec ons Viewing pa ents in a Collec on Clearing a selected Collec on Step Ac on 1. On the Census tab, click on Collec ons Select the desired collec on in the drop down list. Note: The pa ents in the collec on display on the window. Step 1. Action With the collection selected on the Census tab, click in the Collections field. The Collections field clears. Rename a Collec on Step Ac on 1. the Collec ons drop down arrow on the Census tab Note: If desired, you can use the Pa ent Filters to filter the collec on. For example: The "Chemotherapy pa ents" collec on is selected in the Collec ons dropdown list. You can click the Sex filter and select the Male check box to filter your Chemotherapy pa ent collec on to display only male pa ents. Note: If a pa ent search is performed or a saved search is selected prior to choosing a collec on, the search is cleared and the collec on displays. The search is not used in combina on with the collec on. 2. In the list of your collec ons: Highlight the name of the collec on you want 3. to change Type in the new name for the collec on. 4. 5. OK to close the dialog box. 18 19
Collec ons Collec ons Remove a pa ent from a Collec on Method #1 Remove a pa ent from a Collec on Method #2 Step Ac on Step Ac on 1. On the Census tab: Select the name of the collec on that contains the pa ent you want to remove in the Collec ons drop down list. 2. In the List view: the down arrow for the pa ent to expand the view. 3. In the Card view: the More Hyperlink to change to the expanded List view. ( Remove from Collec on). 1. On the Census tab: Select the name of the collec on that contains the pa ent you want to remove in the Collec ons drop down list. The pa ents in the collec on are displayed. 2. the pa ent(s) to remove from the collec on. 3. Select Remove selected pa ents from current collec on in the ac on drop down list on the Census tab. The Remove from Collec on dialog box opens. The Remove from Collec on dialog box opens. 4. 4. 20 21
Collec ons Addi onal Tips Delete a collec on Step Ac on 1. On the census tab: 2. To display a list of your saved collec ons 3. next to the collec on name to be deleted 22 23
Manage Consultant Rela onships Assign yourself as a consultant Remove yourself as a consultant PCH allows the user to assign a consultant rela onship to a pa ent. Note that only the consultant rela onship can be managed by the user, not a ending or admi ng. Step Ac on 1. On the census screen (the pa ent with whom you want to create the consult rela onship): PCH allows the user to remove a consultant rela onship to a pa ent. Step Ac on 1. To remove yourself as a consultant click 2. Acknowledge the confirma on 2. On the next screen 3. On the next screen Select your name from the dropdown list 3. You are now removed from the care assignments. 4. 5. You are now assigned to the pa ent as a consultant. 24 25
Card & List view Physician Workqueue You can view the pa ents in your census in either Card or List view. Both views present the same pa ent informa on. The default view for the Census pane is the List view, but it can be easily toggled back and forth to suit your preference Card View A er performing a pa ent search or selec ng a collec on: click The window changes from the List view to the Card view format The Physician Workqueue displays on the right side of the PCH window allowing important items to be viewable by the clinician even as they are working with a par cular pa ent. That way, if a cri cal lab result comes in for another pa ent, the physician can immediately see it and take ac on if necessary. When working in pa ent context, the full workqueue remains in collapsed format on the right. The Physician Workqueue allows the physician to view all of his/her tasks, alerts and messages across all of his/her patients. It also includes coverage requests from other physicians. Note :The minimum number of cards in the view is 3 per row and the maximum number of cards depends on the window size to expand the Physician Workqueue. to collapse the Physician Workqueue List View A er performing a pa ent search or selec ng a collec on: click The window changes from the Card view to the List view format 26 27
Physician Workqueue Physician Workqueue an entry in the work queue to display addi onal informa on about it on the le side of the work queue window. Ac ons you can take on a work queue entry depend on the content of the entry. Complete Document Coverage Request Co Sign in CPOE Co Sign Physician Documenta on Medica on Reconcilia on Medica on order Renewal Sign off on Orders Assign/Remove Care Assignment Assign/Remove Care Team Sign off Reject (Wrong Physician) View ac ve or historical items Sort by: Date (Chronological or Reverse Chronological) Name (Ascending, Descending) Loca on (Ascending, Descending) The Bulk Sign Off module provides the ability to sign off for ORDERS only not all tasks. Alerts are generated in the Physician Work queue for: New Results Discharge New Results (Research) New Cri cal Results Vital Signs out of range Order Alerts (generated via Paragon Rules Engine) Cri cal alerts display at the top of the list, highlighted in red. If a cri cal alert is added during an open session of Clinician Hub, a message displays to no fy you of it. Tasks are generated as a result of ac ons taken/not taken in the Paragon. To avoid ge ng le ers from Medical Records physicians must keep task list clean. Currently, Paragon does not support any other messaging. This is reserved for future use. 28 29
Overview Window Overview Window Vitals When you choose to put the selected pa ent in focus, the Overview window opens. You can also put a pa ent in focus by double clicking the pa ent name hyperlink in the Pa ent Census (Card or List view) Pa ent workqueue is default op on for menu. It also lists Pa ent profile data. The Overview window displays when the pa ent is in focus. It allows you to view pa ent informa on: The following vital sign displays in a graphical format in this tab: Temperature Systolic and Diastolic BP Respira on Pulse Oxygen Satura on Pain Pa ent Card Results Pa ent Workqueue Orders Vitals Meds & IVs I & Os Flowsheet Pa ent Sidebar I & Os Pa ent Card This area of the Overview screen displays the most recent Intake and Output informa on in a condensed format. Pa ent Workqueue Net Input and Output totals for last 24 hours Current shi and since admission Latest weight and previous weight 30 31
Overview Window View Results Flowsheet View Flowsheet The names of recent results show in this module not the result itself. View Orders This tab displays Order date/ me and status for recent orders for the pa ent. View Meds & IV Flowsheets provides a single point of access to medical informa on, displayed in a meline format, with visual indicators to alert you to out of range values. This informa on includes: Nursing documenta on, Medica on administra ons I & Os Test results The columns of the Flowsheet represent an interval of me, displaying the data documented within that span of me. You can change the view of the data by selec ng: me interval or exact me. Flowsheet data displays in chronological order with the most recent data on the right side of the window. This tab displays summary medica on and IV order Informa on. 32 33
Flowsheet Notes View Previous Data Step Ac on 1. To include data from previous visits: click 2. Select the visits you wish to view and again to close the dropdown. 3. Data from the selected visits displays. Selec ng a visit in the header moves the flowsheet to informa on from the selected visit. 34 35
Notes Clinician Hub 13.0 Real Time Dropdown Search Results Sugges ons will generate as the end user types. The results will match text anywhere within the order or order set name. To select desired order: on choice to go directly to order. Admission & Transfer Med Rec: Make certain to scroll down to the bo om to see bulk ac on bu ons. Def (i.e. defer) means medica on not given in hospital, but stays on home med list for future use. Defer remaining home medica ons only affects home meds that are not touched. NOTE: You can pick home meds to con nue before or a er. Choosing the bu on will not change selec ons already addressed. 36 37
Clinician Hub 13.0 Discharge Med Rec: Clinician Hub 13.0 Discharge Med Rec: Amend Cont : The home medica ons can be con nued directly. DC : Hospital medica ons will be automa cally discon nued. NOTE: There is no need to discon nue the hospital med before con nuing the home med. Make certain to scroll down to the bo om to see bulk ac on bu ons. D/C remaining inpa ent orders will discon nue any order than is not labeled as home medica on. This can be done before or a er addressing any hospital meds that need to be con nued at home. It will not change selec ons already addressed. Aware remaining home meds means provider is aware of meds, but not specifically taking ac on. *See NOTE on next page* This will show up in discharge instruc ons as Provider is aware of the following medica ons. If you specifically want to con nue med, use Cont bu on; not Awr bu on. Allows the addi on of new medica ons to a previously finished med rec without star ng a new med rec. The newly added med is con nued automa cally. If changes are needed to any exis ng medica ons, a new med rec will need to be started. NOTE: There is no need to address previously ordered home meds. NOTE: *Aware is not an acceptable medica on status for pa ents going to Skilled Nursing Facili es. For a SNF discharge one needs to Con nue, D/C or Modify the medica on.* 38 39
Clinician Hub 13.0 Bulk Sign Off Orders Clinician Hub 13.0 Diagnosis Search In PCH, the bulk sign off bu on is located on the Physician Workqueue header My orders includes only telephone and verbal orders recorded by nurse for all of your pa ents. The page can show up to 250 items at one me. There may be more than one page. All items checked are marked complete. Unchecked items stay on ac on list for individual rejec on. DOES NOT INCLUDE: Countersignatures Med rec ac on items Physdoc ac on items e Rx items This func onality now looks for words in any order. The Contains bu on is present but no longer changes the search, Use addi onal specific wording to narrow your search Normal Newborn, Diabetes Type 1, Le conges ve heart failure, etc. Patient Orders Sign Off In pa ent context, the Bulk Signoff op on is located in the More menu. Pa ent orders includes all telephone and verbal orders that exist for the pa ent. Allows sign off of partner/groups orders by other members of group for that pa ent. 40 41
Prescrip on Writer Additional Tips Prescription Writer When accessing a pa ent for the first me a er e prescribing has been enabled, there may be a dialog box asking whether the pa ent has given permission to get their medica on history. This can be answered Yes as it is covered in the Ridgeview general pa ent consent. This is only answered once a year for each pa ent. If it has already been addressed by another provider, it will not display again, and the banner will display the green Med History Consent icon shown above. 42 43
Prescrip on Writer Prescrip on Writer To start Rx Writer: Select desired pa ent CPOE Medica on Reconcilia on Locate Discharge Med Rec and click: Address all medica ons in the Discharge Med Rec, click: Note: The Prescrip on icon will appear next to medica ons with prescrip ons. When in the Med Rec : Yes Select Printer Submit Address the Dispense: the Quan ty radio bu on and specify quan ty For Refills: Select the desired number of refills from the drop down. In Type/Status: The pharmacy delivery confirma on will be visible once the prescrip on is successful. ***This may take a few minutes to update *** To save a completed prescrip on as a template for future use: click 44 45
Prescrip on Writer Add New Prescription Prescrip on Writer Additional Tips There is a limit to the number of characters that can be typed in to the Sig field. If this is exceeded, the counter in the lower le of the instruc ons window will turn red and you will not be able to send the Rx electronically. If the medica on is not listed on the Discharge Med Rec, then use the Add Prescrip on bu on. To start the process, click: This warning will be displayed upon submission if the limit is exceeded. To renew a script, click: Type the desired drug in the search field, click: If the medica on or DME cannot be found, it can be free texted. Select the desired medica on form and dose. Con nue entering the Dispense informa on. both Free form and Compound boxes to send a Free Form Rx electronically. 46 47
Prescrip on Writer Create a Regimen Prescrip on Writer To Use Your Regimen To create a Regimen in Rx Writer: Then Hint: lower le of the screen Name the Regimen Select the desired regimen Select the desired medica on form and dose. Select the desired medica on form and dose. Hint: lower le of the screen Hint: lower right of the screen 48 49
Clinician Mobile Clinician Mobile Patient Census Clinician Mobile When you log in; the Pa ent Census will launch Census with Navigation Pane **no patient in focus** 50 51
Clinician Mobile Patient Overview Clinician Mobile Patient Profile To view a pa ent s overview: Tap on the desired pa ent To access the pa ent profile: Tap Profile in the Pa ent Naviga on Pane Patient Navigation Pane Additional Tips Treat your I Pad as a HIPPA document. Do not leave in area where content can be viewed by others. Alerts and ac ons items are view only. They can be addressed in WSP. The mobile app will allow you to search for any pa ent using search icon in upper right corner of census page using any part of name or MRN. You can also search for pa ents by viewing floor census in le hand naviga on pane. The pa ent naviga on pane is only available when a pa ent is in focus. To access : tap 52 53
Clinician Mobile Clinician Mobile Icons Clinician Mobile Clinician Mobile Icons 54 55
PhysDoc Addendum If you need to make change a er a document has been sign ned, the Addendum func onality in PhysDoc can be used. On the Documenta on tab: 1. Select the Final (Signed) document In the upper le corner: 2. the drop down arrow Select Addendum Note. 3. the green + 4. Enter Addendum note Scroll to Sign 58 59
PhysDoc Invalidate If you need to delete or invalidate a document, the Invalidate func onality in PhysDoc can be used. In the following example, a Preliminary Document (i.e. document that has not been signed) is invalidated. On the Documenta on tab: 1. Select the desired document to invalidate 2. 3. the invalidate icon 4. Select a reason 5. 60 61
Ordering: How to Cancel Requests Can be used if the processing status is Add Pending status The order has not been acknowledged by the receiving unit (i.e. Pharmacy, Radiology, etc.) 68 69
Ordering: How to Discon nue Requests Can be used if the order status is Ac ve The order has been acknowledged by the receiving unit (i.e. Pharmacy, Radiology, etc.) and the pa ent is currently receiving (i.e. med, lab is scheduled. Etc.) 70 71
Ordering: Label Maintenance 72 73