GENERAL MEDICINE CLINICS             

Medical House Staff Training Program in Internal Medicine
Department of Medicine - Columbia University Medical Center


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Ambulatory Read of the Week of February 2nd, 2010   Medicine's Ethical Responsibility for Health Care Reform — The Top Five List  H Brody n engl j med 2010;362:283-285

 

·        Eclipsys Issues Bulletin (updated 2/5/2010) Please refer to the most recent Eclipsys curriculum and the NYP teaching videos for detailed learning. There are still several classes open, and for anyone who wants to arrange personal individual session after the roll out classes please email me

Summary of the MD Task -  See/exam pt →→ Write note→→ update/prescribe new Rx→→ enter order (PENDING RETURN for any lab/vaccine/FOBT done after clinic discharge-inclds same day labs) →→ Save note →→ present to PIC→→ update note and assign cosignature →→print discharge med list

1.      Error Messages- there are 2 main recurring ones. The most painful one “SAVE OPERATION FAILED” gets triggered when you forget to click med reconciliation and then go back to click it. So please always click the med recon before you save the note (if you forget and you get a “note will be saved as incompete” just click to save it as incomplete, do not try to go back to click the med recon as that will cause the error).  Once the message comes up, the note is lost, so while it is still there copy and paste your 3 free text box content to WORDPAD and reload a new note. Error message #2 is a new Rx writer message “ELECTRONIC PATHWAY NOT DEFINED” this should be fixed 2/5/10.

2.      Ordering - Some of you are ordering everything under 1 set of PENDING RETURN order, and then releasing the same day RTC/radiology/referral/vaccine orders. I checked with IT,that is fine. If you do it that way I would ask you to please release the same day orders as soon as you enter the orders. This way your PFA can start to work on orders/appts while you are still writing notes or presenting to PIC. One of our goals is to use Eclipsys to decrease pt wait time in AIM. If you wait to release it (or wait for your PFA to release it) at the end of the visit, your pts’ d/c processing time would be longer.

3.      To save an extra click, you can enter your Resident Notes as COMPLETED- Eclipsys notes are modifiable after completion, I am okay with residents saving their notes as COMPLETE before the PIC presentation. If there are changes after discussion, you or the PIC can always go back and update or revise the note.

4.      use F7 to import ambulatory BP/BMI, that is prettier than the flow sheet. Also when listing labs, do not click the entire date or column (that will make your note look like a data dump), just click the individual result box and it will import only the numbers you want to display.

5.      Sorian issue - during the Eclipsys transition with attending template changes, the 1 day resource book view may not show all of your scheduled pts. The “RESOURCE APPT” view is more accurate since it doesn’t block out pts who don’t fit into the new template.

6.      Useful Lab set- there is a LAB OUTPATIENT order set available for less commonly ordered tests that are not on the AIM common test order. To search for the set just type LAB OP into the order box.

7.      If the patient is not registered yet, enter your pre-clinic draft or Rxs on a past DSC chart. Never work on a PRE chart, the data may be accidentally erased when the pt is registered for the visit. 

8.      When ordering in between visit labs/Xrays/vaccines, please order them as pending return on the last visit DSC chart. Then generate a PHYSICIAN LETTER with the pt’s MRN and mail to pt to ask them to go to the lab to have these labs released and activated.

9.      Pt message/Secure Health Message- Instead of getting email messages about pt messages you will now get SHM from nurses. The email to your CU mail is only a reminder to tell you that you have a SHM. Please do not use the URL in the email to link to your inbox as it DOES NOT work yet. To access the message, log into Eclipsys inbox to retrieve the message. The SHM should link you to the RN’s telephone triage note (blue letter link), click to open note. To confirm receipt and note your action, you can add comments to the 3rd section of the note, or click APPEND to add your comments.  If you are away you can assign proxy coverage to take your messages (this is for attendings).

10.  PFAs will no longer be looking at your notes for d/c instruction, use your RTC Order free text instruction box to remind them of the things you want them and the pt to do.   “EKG today” “ortho hand clinic”. Think of this direction box like the previous paper d/c directions we use to write to sum up d/c instructions to the PFAs.

11.  Inbox- Please clear your inboxes weekly.  If at first logon you don’t see anything in it check on the interval filter on the top bar to make sure you are bringing all result dates. Check the L hand filter to make sure you are bringing in “all items” on “My View”. Overloaded inboxes will slow down Eclipsys processing speed.

12.  Structure Note-   there are 2 radiology boxes, this will go away soon.

13.  Flow sheet- It’s hard to see vital signs on the flow sheet, use F7 to import a better ambulatory VS display on your notes. IT is helping us construct IM specific flow sheets so BP will be visible.

14.  Ordering – Please input ICD just as you did before, some forms provide options for codes already.

15.  AIM review page should show 9 tiles, sometimes it shows 7 based on your local computer screen setting, in that case, click scroll box on R upper corner to bring in all tiles.

16.  For those who write pre-clinic drafts- a pre-clinic draft it will retain the date of the original draft, not the day you saw the pts and finalized the note. Write your draft in the last DSC chart, be sure to identify it as a preclinic draft and not a visit note by using acronym expansion “drf” (this is impt since the draft will show up in WEBCIS). When seeing pts, open the active ADM chart, start a new aim structure document, copy forward the content from the incomplete draft, complete the visit note, and then delete the original draft (this removes it from webcis). Somewhat clunky relative to the hidden draft of Webcis.

 

L I N K S

UpToDate

Adult Screening &

Vaccination Guidelines

Medical Calculator and Quick Guidelines

WebCis

Amb Ed

Videos

EBM Search Page

Readings in Internal Medicine

 Reading List

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Archives 09-10

Soarian

Prescription Prior Authorization

CUMC Referrals

List

Eclipsys

(citrax)

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