Physician's Guide: Paragon Clinician Hub 1
Physician's Guide : Paragon Clinician Hub 2
Table of Contents Title Slide Color Index Mmodal- Fluency Direct 4-6 Login 7 Navigation Bar 8 My Workqueue 9 Census Screen 10-16 Schedule 17 Deficiencies 18 Patient In Focus (Selecting A Patient) 19-22 Ordering 23-28 Medication Reconciliation 29-33 RX Writer- Electronic Prescriptions 34-49 Flowsheets 50-53 Documentation 54-67 Medical Records 68 Logging Off 69 3
Dictated Command Delete That, Delete Selection Undo That, Undo Last Actions Deletes selected word(s) Undoes last word/command MModal Fluency Direct Voice Recognition program used for dictation into the Clinician Hub EMR. Correct <Test To Correct> Correct Selection New Line A selection box opens, user can choose alternatives or type in new term for Dictionary Cursor moves down one line Commands Only Speech Box New Paragraph Select All Select <Text to select> Uppercase That Uppercase Selection Next Field, Previous Field Paste That or Paste Selection Cut That or Cut Selection Copy That or Copy Selection Show Speech Box Open Speech Box *(select desired text first)* Save This Text Macro That Cursor moves down two lines Selects all text Selects specific text Capitalizes selected word(s) Moves the cursor to the next or previous fields within the brackets Pastes copied/cut text or recovers the last Speech box content Cuts Selected text Copies selected text Launches Speech Box Opens a selection box to add a new text snippet command Record Previous Field Bracket Left Click F1 Correct That F2 Spacebar Mmodal Support Hetwarth Shah M-F 8am-4pm 845-331-3131 ex. 2479 After Hours: Terri Chodkiewicz 845-339-3422 Technical Issues: 845-334-2800 Transfer Text and remove all fields [] Next Field Bracket Right Click F3- Tab F4- Back Tab 4
Mmodal Tips 5
MModal To use voice recognition you must use a delegated Mmodal computer. 1. Double click the MModal Icon. 2. Enter User ID and password to log on to MModal Fluency Direct voice recognition application. To Log Off: Click on Sign Out and then click on Quit to exit MModal Fluency Direct. 3. Double click the Clinician Hub icon 4. Enter User ID and password to log on to Clinician Hub Click on Log Out to sign out of Paragon Web Station. 6
Click on Clinician Hub Paragon Clinician Hub Login with your assigned User Name and Password. If you do not have your assigned user name and password OR cannot remember your sign-on, contact the Help Desk at 845-334-2800 or email: help@hahv.org If you are using your personal computer, the device must have Citrix installed. To access Clinician Hub go to https://citrix.hahv.org or navigate to http://home.hahv.org for further information and instructions. Nursing Informatics Physician s Guide 7
Navigation Bar Refresh icon- click to refresh the tab that is currently being viewed. Hover your mouse pointer over the Refresh icon to display the length of time in minutes since the last refresh. Appointment Reminder icon- to view the current day's appointment information. The information includes: Time of the appointment, covering doctor information (if applicable), title of appointment, description of appointment, and date of appointment. Referential Content and Patient Education icon- to perform a search for specific health-care-related educational materials. You can also choose to do a patient-specific search (if a patient is in focus). Personal Web Links icon to manage or view your personal links The name of the current user signed on to the application and the Clinician Hub mode: Acute Care or Ambulatory. The Super User icon displays in the upper left corner. With a patient is in focus, click the down arrow to display the Super User option. Select Super User to open the Super User Authority window and unlock a "lock" applied to the patient visit. Help icon to open the Help for the application. Secures the application. Will open to the window you were viewing at the time you secured the session. 8
My Workqueue After logging on to Clinician Hub, the Workqueue is expanded at the right side of the window. My Workqueue can be collapsed by clicking the double right arrow on the right side of the window. To expand it again, click the double left arrow. You can view the alerts and tasks associated with all of your patients, as well as coverage requests from other physicians, and coverage replies to your requests. ALERTS TASKS Click on the task or alert to access the associated drop down menu. Select the appropriate action. 9
Census Screen Patient Search Box - You can search for patients by name, medical record number (MRN), or visit number. CCS 10
Census Screen Cont. Predefined Saved Filters- My Patients is a group of saved filters established by the facility. This will be the default setting unless a different filter group is Set as default. Each time you log, the system will search for patients based on the saved filters. Click to view more information The Patient list populates based on selected filters. View patients in a list, or a card format. To see more information for patient, click the arrow for the Expanded List View. 11
Available Filters Census Screen Cont. User Created Saved Filters- Click on any filter and place a check next to the desired search options within each filter. Use the X to close and save each filter. When you are satisfied with the filter selections, click Save. The SAVE FILTER box will open. Enter a Name for the filter search you have created. If you are updating a previously saved filter search click the Save icon in the Update box. Search options of the selected filter The user created filter may be set as your default filter. Click the Saved Filters, select the saved filter name and click Set as default. 12
Census Screen Cont. Collections- Click the drop-down under Collections. Click on + Create New Collection. Type in your title and save. To add a patient to a collection, expand the patient list ( expanded list view ) by clicking the downward arrow. Click the + icon and select the desired collection and save. This is a static list of patients. Select desired collection and click ADD. The patient will be saved to the collection until you remove. 13
Select An Action: Census Screen Cont. Rounding Report- Patient/visit information includes the patient s age, sex, admit date, attending physician, primary care physician, and admitting complaint if entered at the time of registration. The report also includes a calculated length of stay. SBAR Report- A standardized clinical report (Situation, Background, Assessment, Recommendation) format. My Requests Report- A list of patients documents requiring co-signature by an authorized physician or a preliminary document requiring a signature. My Deficiencies Report- Generated from Medical Records 1. Missing Text deficiencies: Users complete missing text deficiencies by editing the document. 2. Signature deficiency for the document. 3. Dictation deficiencies. Dictation deficiencies indicate that the patient record is missing a document that is expected to exist. 14
Census Screen Cont. Pre-Registration- To pre-register a patient from the census tab, find the patient name and expand the patient list, click the Patient Pre-registration icon. Complete the information in the Patient Pre- Registration box. Click Continue. 15
Census Screen Cont. Assigning a Patient- Click Assignments, the Manage Assignments box will open. The ability to self- assign and to assign others is available. You can also remove yourself as a consulting physician. Click the X next to your name. 16
Schedule You can request that another caregiver cover your scheduled appointments for a partial day, an entire day, or a range of days. When you submit a request, the person you identified must accept the request from the Workqueue. 17
Deficiencies The deficiency tab is generated from Medical Records. This list will include documents with missing signatures, missing dictations or missing text within your documents. Complete the required actions to remove items from your deficiency list. 18
Patient in Focus (Selecting a Patient ) To actively begin working on a specific patient, click on the patient name. This brings the patient into focus (*To return to your patient list click census tab). The patient s overview will open. The patient sidebar provides access to the Patient Workqueue and the Patient Profile data for the patient visit in focus. The patient overview shows a quick view of flowsheets, medications and orders. To see further detail, click the which opens the associated tab. 19
Patient Sidebar Patient in Focus Cont. To edit the patient information located in the sidebar, choose from the drop down and click Manage. Note: Problems and procedures from the Full List for a previous visit carry forward to a new visit; however, problems and procedures from the Current List do not carry forward to a new visit. Click ADD to open a search string, or click Historical Sources to import data placed by nursing. 20
Patient in Focus Cont. Overview- This screen provides a quick view of the patient s medications, orders, vitals, results, and I&O. To see greater detail click which will open the corresponding area. You can also access these areas directly by going to Flowsheets, the MAR or ordering tab directly. 21
Patient in Focus Cont. MORE- Drop down used to access the following: MPF Assignment- Not used MPF Deficiencies- list of signature, missing text, or dictation deficiencies generated from medical records. Medical Record- Access to the patient s current and previous medical record. External Documents- Not used PDL- Not used Bulk Order Sign- Allows the user to sign off multiple orders 22
Ordering Bring the patient into focus and click the ORDERING tab. The gray highlighting identifies which subcategory is currently selected. The Order Queue is a list of the patient s orders and the status of the order. Click Search to find new orders. Enter order in Search box and click go 23
Ordering Cont. Click on desired order Click on flag (it will turn blue) to create Favorite Orders. These orders will be saved and can be found in Favorite Orders tab The order detail box will open. Complete information for the order. * Indicates a required field. Click submit to immediately send order. If you save an order you MUST submit the order later. 24
Ordering Cont. Order Sets Click the drop down arrow next to the GO button and click on Order Sets. Available order sets will populate under description. You may limit fields retrieved by typing a description in the Search field. Click on the desired order set. The orders on the left side of screen are the orders available from which to choose. On the right side of screen are the orders that have been selected. To add additional information, for a selected order, click on the order located in the right column. Click in check box by desired order. The order will become a Selected Orders and move to right column Add information to the order by double clicking on the specific order. The Order Detail box will open to add additional information or change order details. Added Information Click Save when complete 25
Ordering Cont. Order Queue Tab If you have opted to SAVE orders you will need to submit them. Highlight Order Queue tab. Check the Processing Status column to check status of your order. Un-submitted: Orders that need to be submitted (placed) Add Pending: Orders that have been submitted and are in nurses processing queue. Discontinue Pending: Orders that have been discontinued and are in nurses processing queue. Current visit orders and orders for previous visits when the start date of the order is within 90 days of the current date are displayed. 26
Ordering Cont. Order Queue Tab Cont. Discontinue active and future orders. Click on Discontinue a pop-up box of the orders available to discontinue will open. Place a check in box by orders and click discontinue. Check for medications that will expire! Cancel Req : Click on Cancel Req to cancel orders that are un-submitted or have not been processed by the nurse or pharmacy. Hold/Resume: Not used Renew: Allows you to extend the duration of an active order. Reorder: Displays orders that can be renewed. 27
Ordering Cont. Order Que Tab- Cont. To Submit orders that were saved click the submit button A pop-up box opens. Click in checkbox by orders you want to submit. Then click the submit button. 28
Medication Reconciliation Bring a patient into focus and click on Ordering tab. Click on Medication Reconciliation. Admission- completed on admission to hospital, determines which home meds will be used during hospitalization. Transfer- when transferring a patient to or from the ICU within the facility. Discharge- completed when a patient is discharged, so the patient will know what medications to take at home. When the provider clicks the start button, the corresponding Medication Reconciliation will open. 29
Medication Reconciliation Cont. Home icon indicates a medication that the patient was taking at home. No home icon indicates a medication that was ordered after admission to the hospital. 30
Medication Reconciliation Cont. 31
Medication Reconciliation- Cont. 32
Medication Reconciliation Cont. 33
RX Writer Electronic Prescriptions- Controlled and non-controlled medications 34
RX Writer Cont. Go to Ordering tab, select Medication Reconciliation, click Start under Discharge The pop up will occur annually. This consent allows providers to request and use the patient s prescription medication history from other healthcare providers and/or third party pharmacy benefit payors for treatment purposes. 35
Rx Writer Cont. Complete the discharge medication reconciliation, if a prescription is needed for a medication click Prsb Type any special instructions, such as a titrating dose The Prescription Writer box will open for the medication. This acts as an electronic prescription pad. Complete all required information. Pay Special Attention: Dispense As Character limits Dispense requirements Click Save when complete Use the drop down or search to select the Preferred Pharmacy 36
Rx Writer Cont. Quantity Sufficient For If Quantity Sufficient For is selected, confirm that the correct number auto fills in Quantity. The Quantity box must have a number in it to electronically transmit the prescription. 37
Rx Writer Cont. Pre-Packaged For medications that are available in a pre-package dose, click next to Pre-Packaged and use the drop down to select from the pre-packaged amount. In Message to Pharmacy you can type any additional instructions. 38
Rx Writer Cont. Add Prescription To prescribe a medication not on the discharge medication reconciliation click add prescription 39
Rx Writer Cont. Add Prescription Cont. Type the medication into the search box. Medications will populate under Description (adjust the check marks near Filter Results if needed). Select medication closest to desired medication. The Prescription Writer Pad will open for the medication. Complete all necessary information. 40
Rx Writer Cont. Facility Template- Click on Facility Templates The available templates will populate. Select the desired facility templates. 41
Rx Writer Cont. Facility Template Cont.- The type of cane is selected from the Dispense As drop down. Fill in the dose, unit and route OR check Free Form box to type the specifications. When complete click save. 42
Rx Writer Cont. Completing the Med Rec.- Click Complete and yes to the submit pop-up box. 43
Rx Writer Cont. Pending Tab- The prescriptions will be listed. To edit if needed, Quantity to Dispense and Additional Refills, use the available drop downs. Click continue to select the pharmacy and submission method. If information is missing a STOP sign icon will be in the Status column for the prescription. 44
Rx Writer Cont. Confirm : 1. Status is Ready for Submission 2. The pharmacy is chosen 3. Transmit is selected as method. 4. Click Submit. 45
Rx Writer Cont. Controlled Substance- After submitting a prescription for a controlled substance the Dr. First EPCS Gold screen will open. Place a check next to the controlled substance. Enter your passphrase and VIP Access pin number from your hard token or smart phone. The confirmation box that the prescriptions have been accepted will appear, click to close. 46
, CCS, April Rx Writer Cont. Submitted- Click the Refresh icon and confirm that prescriptions were successfully transmitted. They will have a Electronic Delivery Completed Refresh Arrows 47
Rx Writer Cont. Adding a Prescription Directly for RxWriter- Click on Rx Writer and click add new, a pop-op box will ask to confirm if you would like to add the prescription to the Discharge Medication Reconciliation. Selecting Yes will reopen the medication reconciliation for the drug to be added. Selecting No will bypass the discharge medication reconciliation and open the prescription search box. 48
Rx Writer Cont. Adding Prescription to Completed Med Rec.- The search box will open with the previously completed med reconciliation. Search and complete the new prescription. Click Complete and yes to submit any new prescriptions. 49
Flowsheets I&O Intake and output will be listed in chronological order. The time span can be set. You may also go directly to a specific date. Data can be viewed in graph format by clicking the graphing icon Flowsheet Key Trend View click 50
Nursing- Vital signs, IV management, Pain and assessments can be viewed. Flowsheets Cont. Hovering over the data will reveal more detail. Clicking on the data will open a detail box. Click the note icon to see multiple entries 51
Flowsheets Cont. Result- Lab, Microbiology, Diagnostic imaging (radiology) and Cardiology reports. Click on the the complete report. The test can be Re-ordered, Printed and Reviewed. to see Clicking REVIEWED removes the lab from My Workqueue 52
Flowsheets Cont. The Medication Administration Record (MAR) - flowsheet provides an organized view of the patient's current Medication Administration Record medications. The MAR enables you to quickly locate and determine the administration schedule and status of medications. Click the clock icon to see when the medication was given. Click on the medication to open the medication detail box. 53
Documentation Bring the patient into focus and click on the Documentation tab. The subcategory that is highlighted gray is what has been selected. Documents- a list of existing documents, to view click the notebook icon on left of document title. The document will open in a separate window. Search Note Templates- Charting templates for new documentation. Favorite Note Templates- Saved charting templates for new documentation. *Note Status Definitions A note can be in one of the following status definitions: Preliminary: The note has been initiated, but not yet signed. A note is not Final until it is signed. Notes that are in Preliminary status are unsigned, but can only be re-opened and edited by the user who originally saved the draft. Co-sign Requested: An attending physician has been requested to edit/sign the note. Co-sign Preliminary: An attending physician has viewed and/or edited the note without signing it. Note If any documents exist in Preliminary or Co-sign status, the user is prompted when exiting the program Final: The note has been signed by a physician. Final with Addendum: An addendum has been added to a signed note. Invalidated: The note has been invalidated. Documents labeled with VR (voice recognition) are notes designed to be used in conjunction with Mmodel 54
Documentation Cont. Search Note Templates- To begin documentation, highlight the Search Note Templates subcategory. Click on the blue paper icon to open a new template. To save this note type to your favorites, click the flag silhouette to the right of page. Title of note Note Type Specialty Favorite Blue Flag Favorite Note Templates Click on the flag icon in the right column which will turn to blue and add it to your favorites list. After a note is added to the favorites list it may later be removed by clicking the remove icon. 55
Documentation Cont. Physician Documentation Tools The following navigation controls are at the top of all notes. Icon Description The Save icon allows you to save a draft of the current note. A draft can only be opened again by the user that initially created the note. A saved draft is labeled as "Preliminary". Once a note is signed electronically, it is labeled as "Final". The Clipboard icon displays all data currently on the clipboard. See About the Clipboard Tool on page ##. The Print icon prints the document in its current state. The Keyboard icon toggles between Keyboard input mode and Pen mode. When Pen mode is activated, the Keyboard icon displays with a red "x". The Pen icon indicates whether Pen mode is the active input mode. When the Pen is active, the Pen icon is blue. Once activated, the cursor changes to a dot. Click the left mouse button and drag the cursor to "write" on the note. The Eraser icon deletes the digital "ink" from the page that was created with the Pen tool. When the eraser is active, the cursor changes to an "eraser." Touch the cursor to a line to delete that line. You cannot delete a portion of a line; rather, the entire line is deleted. The Previous Page and Next Page icons scroll forward and backward through the note. The Previous Document and Next Document icons allow you to close the current document and view the previous document or the next document for the patient. You can hover the mouse over the icons to display a popup of the name of the document that will display if you click the icon. The Invalidate icon, in effect, deletes the current note. The note is saved and labeled as "invalidated". When this icon is clicked, a reason must be chosen as to why the note is being invalidated "wrong patient", for example. The Close Document icon closes the current note. If the note is unsaved, you are prompted to save. The Zoom drop-down menu provides pre-set magnification options. Selecting Custom Zoom or modifying the value on the Zoom Slider allows you to choose a custom magnification level. 56
Documentation Cont. Entering data in a note/document Depending on how the template is setup, there can be several different ways to enter/select data in a note. For text fields, click the field and enter the desired text. Some fields that correspond to the Patient Profile, open a specific module in the Patient Profile when you click in the field. After data is entered and saved in the Patient Profile module, it automatically populates in the field as shown in the example below. Some fields allow you to click a hyperlink to open a window in which to select/enter the data. In the example below, click the Select Date hyperlink to open the Calendar window and select a date for populating the field and click the Select Time hyperlink to open the Time window to select a time for populating the field. If the field is a check box, click the check box to select it. To deselect it, click it again. Certain fields automatically populate when they are a gallery item in the template and cannot be modified (for example: Blood Pressure, Pulse, etc.). 57
Documentation Cont. Clipboard Tool The clipboard tool allows users to copy values and paste those values into a note template. The clipboard can hold data for multiple patients at the same time. The data added to the clipboard is available to the current user until the user logs out. The clipboard is cleared when the user logs out. 58
Documentation Cont. Adding Lab Results to the Clipboard To add Lab values to the clipboard, open Flowsheets and select results. Click on the desired value, this will add the value to the clipboard. Vitals To clipboard vitals click flowsheets. Vitals are in the Nursing subtab. Hover over the data (the cursor will appear as a hand), left click and a box will open with the saved value. 59
Copying Orders to the Clipboard To add orders to the clipboard: 1. Click the ordering tab. 2. Ensure that you are on the Order Queue sub-tab. 3. Click the Clipboard button. Documentation Cont. A box will open with the available orders that may be clip boarded. Select the checkbox next to each order to add to the clipboard. Click the Add to Clipboard button. 60
Documentation Cont. Viewing the Clipboard Contents You can view all patient-specific items on the clipboard and choose which items to paste into a note. To view the clipboard contents, do the following: 1. Click the Documentation tab. 2. Open the desired note template. 3. On the note s toolbar, click the View Clipboard Data icon. The main Clipboard window opens: The main clipboard window will show the number of values that exist on the clipboard for the selected patient. The complete clipboard contents can be displayed by clicking the ALL button on the left side of the window. To view the values by category, click one of the following buttons on the left side of the window: Vitals Labs I&O Measurements CPOE Orders When viewing results by category there is a checkbox associated with each specific result. 61
Documentation Cont. Adding Values from the Clipboard to a Note *There must be a corresponding text field in the Note to receive the Clipboard data. If there is no corresponding text field for the data to be pasted into, the message "No field exists on note for selected data" displays below the Clipboard Data heading on the Clipboard window. To add all values: Click the ALL button. Click Add all Clipboard Data to document. To add specific values: Click the corresponding button on the left side of the window, such as vitals. Click Add selected data to document. 62
Documentation Cont. Copy & Paste- Open the result. Left click and highlight the desired information, right click on the highlighted area and select copy. Open the document, place the cursor where you would like to put the copied information. Right click and select paste. Highlight desired text 63
Electronically Signing Notes Mid-Level Provider Signature To electronically sign a note: 1. On the Documentation tab with the note open, scroll to the bottom of the note to the Signature section 2. In the Mid-level Signature field, click the "Click here to sign" hyperlink. The system populates your name and credentials in the Mid-level Signature field and the current date/time in the Date field on the note, and the Co-Signature window opens. 3. Type in the last name of the physician who should co-sign the document in the field provided and click the Search arrow button. The field is populated with the first person found matching the search value and a drop-down arrow displays. Click the drop-down arrow to view all names retrieved in the search. To clear the field, click the Clear button to the right of the field. 4. After selecting the physician for co-signature, click ok. The document closes and the status of the document is "Co-Sign Requested". Documentation Cont. Click Here To Sign *If a note is unsigned it remains in a preliminary status, it can be reopened by the author and changes can be made. 64
Documentation Cont. Physician Signature To electronically sign a note: 1. On the Documentation tab with the note open, scroll to the bottom of the note to the Signature section. If there is a Mid-level Signature, the name displays with the date/time it was electronically signed; otherwise it is not populated. 2. In the Attending Physician Attestation section, select the check box(es) that apply to the document. If a midlevel provider was not applicable, it is not necessary to select any of the check boxes. 3. In the Physician Signature field, click the "Click here to sign" hyperlink. The system populates your name and credentials (if Credential Initials are entered in Logon Maintenance in Application Security) in the Physician Signature field and the current date/time in the Date field on the note, saves the note and changes the status to Final. *If a note is unsigned it remains in a preliminary status, it can be reopened by the author and changes can be made. 65
Documentation Cont. Creating an Addendum If a document has been signed it becomes FINAL and is only READ ONLY. To make changes an addendum note will need to be created. 1. On the Documents sub-tab, click the Open Finalized Document button.the final (signed) document opens. 2. Click the Select an Addendum Template drop-down and select the desired addendum template in the drop-down list. 3.Click the Create addendum button. The addendum note opens in preliminary status for data entry. 4.Enter the desired data for the addendum and click the Save button. 5.Click the Close document button. The system returns to the Documents sub-tab and the addendum template name and its status (preliminary or final signed) displays underneath the document to which it is associated in the Document column. The Status displays "Final With Addendum". *When you open a final document that has an addendum, the addendum opens first. To view the final document associated to the addendum, click the Previous document arrow button in the upper left corner of the document. Click the Next document arrow button to return to the addendum. 66
Documentation Cont. Closing and Invalidating a Note If you want to discard the note you have started or completed click on the Invalidate icon To close a document click the Close icon. When you open a note that was left in preliminary status, a pop-op box will open- click no *If you can not sign a note in preliminary status confirm that the correct visit ID was used during documentation. 67
Medical Record Access to current and prior medical records. Access Medical Record from the drop down list Select Encounter# to view documents grouped together by the visit ID number 68
LOGGING OFF When finished using Workstation for Physician application, you must exit the session by clicking Log Out If you experience a technical issue with WebStation for Physicians or you cannot log in with your user name and password, please contact the HealthAlliance Help Desk at 845-334-2800 or via email: help@hahv.org 69
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