Intern Eclipsys Orientation Guide 2010
Eclipsys, the new clinic EHR as of Jan 2010, has more functions than our old
program WEBCIS. However the added capabilities and complexities make Eclipsys
much slower and less intuitive to learn.
Webcis was a pretty logical program which did not require formal
training for users. Eclipsys is not
easy, and will require serious learner effort.
While the hospital has provided an Eclipsys session at intern
orientation, we have found that more detail hands-on learning is
necessary. So this somewhat tedious
guide is written for the beginner user, it is painfully detail oriented but
hopes to give you in one session a broad overview of Ambulatory Eclipsys (which
is pretty similar to inpt Eclipsys, except for layout). I recommend that you read thru this guide
once, test out some of these functions on an computer yourself, and review the online demo
videos. After using Eclipsys for a
month I ask you to please re-read this guide to pick up more nuances and
advance features.
Chapter 1: A brief review of the new AIM workflow with Eclipsys
1.
Pts
arrive in clinic, PFA will register pt in Eclipsys.
2.
MD
will see pt’s name as an active chart “ADM” in his/her AIM module’s PT LIST.
Time of arrival will be seen on a column next to your name.
3.
MAs
will record and input pts’ vitals, BMI, pain, tobacco hx in the AIM ambulatory
flow sheet.
4.
MD
will see pt, write notes, prescribe Rx, enter orders/discharge
instructions/print med list for pt.
5.
Residents
will present case to PIC and route final completed electronic note to PIC to
cosign before their next patient.
6.
Based
on the MD orders, PFA will direct pts to either MAs for testing (urine, ICON),
RN for shots/teaching, or home with discharge info sheet and referrals.
7.
If
pts call MD between visits and testing is needed to address any problem,
ordering and documentation should be performed on the pts’ last AIM visit chart
(DSC).
Chapter 2: Getting started and understanding the data layout-
Eclipsys can be accessed through the
hospital home page INFONET. Look for the
icon on top. Log in with your
CWID/password then ECLIPSYS
XA WEST. This will open several versions
of Eclipsys- PRD Acute Care icon links you to the
inpatient layout of the chart. The PRD
Ambulatory Care icon links you to an ambulatory layout of the same
chart. Both programs draw from the same
database, with just a few different function tabs to facilitate the setting of
use. Use the Ambulatory Care icon to
log in during clinic.
External Eclipsys link: You can access Eclipsys off campus
with the external link https://ita2.nyp.org/vpn/index.html.
However do not use the external link for clinic patient care as it will not
allow proper routing of your orders. You can get to this external link from
the clinic or the residency website.
Data layout - It is important to understand that
the data layout in Eclipsys is different from Webcis. While Webcis displays data in logical
chronologic fashion (which makes it ideal for viewing all labs, data), Eclipsys
data are filed in isolated chart sets associated to each single
visit/admission. This means each data
point (results, flow sheet, document, and orders) will be attached to a
separate chart generated from each registered encounter into our network,
whether it is a 15 minute clinic appt, or a 90 day hospitalization. To view all data in a chronologic fashion,
one needs to set up the proper filters to bring in ALL AVAILABLE charts. In
addition, a few categories of results like cardiac testing (stress, echo),
pathology, bone density do not currently get uploaded to Eclipsys. This
is a very important safety issue to be aware of, that for now not all data are
in Eclipsys AND labs, notes, results, can be hidden from you if you don’t have
the proper filters set.
Hardware- Each exam room will be equipped with
a local printer and Rx printer. Each module will have a scanner in case you
want your staff to scan/save paperwork brought in by pts/consult letters mailed
to you by specialists (this will be stored in the PAPER DOCUMENTS tab in
Eclipsys).
Time out- Inpatient “PRD Acute Care” Eclipsys currently
“times out” after 8 minutes of keyboard inactivity. The ambulatory time-out period will be 30
minutes of inactivity, arranged to work better with the ambulatory work flow. Extended key board inactivity resulting in a
timeouts will cause you to lose any unsaved document. Also when you are done
working on Eclipsys, hit exit or else the program will pop back to haunt you
repeatedly.
Chapter 3 Navigating the program and setting Preferences
Menu Bar (top
line)
Tool/or
Icon bar (just under the pt name), 
Chart
Section tabs (below pt name) 
are
different ways to navigate different parts and functions of electronic chart.
Although the Eclipsys interface page looks super complex, there are a ton of
built-in redundancies, so the different icons and menus often take you the same
places. Try and click on each of the
icons/title menus/tabs to explore where it takes you.
1.
Pay
attention to Top Menu “PREFERENCE” -Setting the right PREFERENCE for each
function or page view is the key to make Eclipsys more user friendly. In the later sections, I will highlight some
recommended preferences for each section.
Preference setting can usually be accessed by looking through the list
of accessible options under the
Preference, Action, or View.
Right clicking in certain sections of the chart will also occasionally
bring up short cuts to preferences.
2.
The
Icon/tool bar shortcuts to different
chart sections and functions. The user can personalize this icon list based on
individual frequency of use. To do so -go to PREFERENCE then TOOLBAR, noticed
you can move icon around or erase unneeded icons to help simplify your own
personal view.
Chapter 4 The Inbox (Only available in Ambulatory Care version of
Eclipsys) Link
to Video Demo
Once you log-on to the Ambulatory
Care Manager program, your inbox will be the first screen shot. The inbox is
set up to retrieve results for labs and radiology ordered by you on your clinic
patients. It will also retrieve
documents for signature, secure health messages (doctor/nurse messages), and
alerts. For patient safety, please do
your best to check and clear this box on a weekly basis (unless when you are on
vacation). Our clinic nurses do serve as
your backup and screen the clinic’s daily labs for a set of high risk abnormal
labs.
Other facts:
1.
The
INBOX is not active on the inpatient version of Eclipsys. So you need to log
into the Ambulatory Care Manager in order to check your inbox.
2.
The
INBOX tab is interchangeable with the PATIENT LIST tab. When you are in the
inbox, you can find your patient list link on the R upper hand grey box, and
vice versa. Both are ways to access pt charts.
3.
SET
THE PROPER FILTER- If you are not seeing results in the inbox, check the top
filter bar to be sure you have the right filters on- Expand the duration of the
filter on top to “3 months” or “ALL AVAILABLE”’; and use the left hand column
FILTER- “My View” then “ALL” items.
(see filter setting picture below)
4.
Best way to view and acknowledge results in the inbox- R-click on the top blue horizontal
row above the results and under the INTERVAL filter, this will open a “reading
panel option”, opt for the reading panel to go on the right hand side. This
will allows you to view and acknowledge results all on one screen. Notice when
you click to view a result, that pt’s entire chart opens for access and
ordering, you can then go into the pt’s RESULT tab to pull up old values to
trend.
5.
Clearing and “acknowledging” your results inbox- Once you receive a result you should
clear it by “ACKNOWLEDGE” it (link for video). To clear the result from
your inbox, just click acknowledge and it will ask for your password to be
entered. Password entry is only required one time during for each lab check
session If the result is not yours, you
can also forward a result to another provider by clicking on “Forward” in the left lower corner
column. A forwarded result will trigger a SHM email to the accepting
providers. (more on SHM later)
6.
Adding comment about a response to an abnormal result- Occasionally you will come across a
result that you have to call the pt on.
The best way to record your reaction to a result/telephone interaction
with a pt about a result is to either add an addendum to your last clinic note,
or add a new AIM free text note, e.g.
“post clinic tsh came back as high, called pt and increased levothyroid to
0.1mg daily”.
7.
AIM SHM/telephone messages- our RNs record pt messages and will direct these messages
as SHM to you. These SHM will arrive in your inbox and trigger an email alert
to your regular email. The URL lnk will bring you to the SHM log on interface.
Usually the SHM is attached to a “RN telephone triage note”, click on that to
open the content. Once you’ve taken care of the message, you should record on
the triage note your response. You have
2 ways to write down your reply. By going to one of the free text box on the
same note, or hitting APPEND option on top to add your comment. The append
option adds a time stamp to your response.
8.
Miscellaneous inbox facts-
a.
Again
not all results come to the inbox -Dexa,
CV Stress tests, Pathology/Blood Bank, and EEG/EMG do not display in Eclipsys
yet
b.
If
you don’t see any results in your inbox, check your top and L hand filters.
Ideally they should
Chapter 5 Finding a patient, and working with Patient Lists Video
Demo Link
One can open a patient chart in
Eclipsys in several ways, by searching for a pt by name or MRN, by clicking on
a pt registered in a location list (e.g. AIM Module 224), or by picking a
patient from a personally created list. When seeing pts in clinic be sure to
use the “active” ADM chart. This allows proper referral routing.
1.
By
location-You can pick a pt from the patient location list as you do on the
inpatient side. Once the pt is registered in AIM, they will show up on your AIM
module list:
·
Click
the list of your module- you can adjust the columns so you easily display the
pt’s arrival time and the MD (your) name. Click on the top of the column to
sort by arrival time or your name. This display helps with time management in
clinic. Eclipsys does not automatically
refresh sadly, so you do need to intermittently hit the green auto-refresh
button
.
2.
By searching for the individual pt-
click on the search pt icon. Use the Pt ID box for medical record number, or
search by name. (the quick ID box is not for MRN). Once you click on a pt, a
list of the pt’s visit charts will open up. Notice here that many future appts
charts are already established in the system if the pt has upcoming appts. For your clinic visit day, make sure you have
chosen the right “ADM” chart to work on. Never write notes or order on a future
(PRE) chart, the note will be lost.
3.
Create
a personal list (link
for video) in Eclipsys- Eclipsys allows you to save pts to your own list.
Unfortunately unlike our previously Webcis Outpt List function, your Eclipsys
list can’t be seen by others. This list
is mainly helpful to you to speed up searching for pts. IT is working on building a better primary
care list.
·
To
create your own personal list to facilitate easier access to your pts’ files. See
this video. This video only shows adding active pts to the
list during a clinic session with an active (ADM chart). To add a pt to your
list, always add one of their DSC (discharged) or ADM (admitted) chart visits
with you.
4.
Other
Pt List Info:
·
Go
to the 
box on the R upper corner of the inbox view.
The inbox and pt list tabs are interchangeable. When you are in the inbox, your
pt list box can be accessed on the R upper corner, and vice versa.
·
You
can unclutter your many pt location lists by going to the menu bar and hitting EDIT then delete pt list for each location you don’t need (example all the
pediatric floors). You can add new
locations or build new provider list by role, go to FILE and maintaining list
to open up options.
·
Each
patient list has an adjustable set of columns.
You can customized and adjust the width of the columns based on your
need. To do so, go to VIEW then COLUMN SELECTION.
·
I
still recommend you to keep also a list of your clinic pts in the WEBCIS
OUTPATIENT List. This list is sharable, meaning others can see who you care
for. Keeping this list really helps our practice to provide after hours
telephone coverage for each other.
Chapter 6 Result Tab- Viewing labs/Radiology click on the Result tab
1.
Eclipsys
has a clunkier data display relative to WEbcis. Most of us still go to Webcis
to make sure we see all data. When looking for data in Eclipsys: there are 3
possible views to the result. The SUMMARY view is an intimidating series of
tiny boxes. TREND VIEW is the easiest
view for seeing all lab results, your default should be already set to this
view. The REPORT BY ORDER may be the best way to see radiology reports. To see all chronologic results, be sure to
set the correct filter on the L hand side. Chart
set “ALL AVAILABLE” “3 yrs”, You can click RETAIN
FOR NEXT PT, to keep the same setting within the same log-on session.
2.
To
filter the types of results seen, go to the left hand Result Selection. This allows you to see only radiology or only
labs.
3.
For results Preference setting-Go to
Preference, Results,
and Add New, then Display Format, allows you to designate
a preference on how your result reports pull up. Trend
viewing chronologically is the current default.
4.
Again
currently Pathology, Cardiology tests, EMG, Dexa reports do not go in Eclipsys.
FOBT also displays in a somewhat hard to
see option depending on the size of your columns.
5.
Btw,
the AIM Review Page has a Lab tile that brings up favorite AIM labs that you
can trend over a yr.
Chapter 7 Note Writing Video
Demo Link
Writing clinic notes is not easy, please
refer to the AIM Clinic orientation packet on the note writing. Writing clinic
notes on a comprehensive EMR program is even more challenging. Do remember to
aim for clarity and concisely effective communication, not reduncy nor
quantity.
We have worked with help from the
Webcis Team to design an AIM Eclipsys note that will allow structuring of
certain useful items (health issues, rx, allergy), but still enough 3 major
free text area to allow physicians to freely think and articulate hx, exam, A/P
clinically. To avoid compliance
driven documentation distractions during complex patient care, we have moved
the hospital’s many “required” JCAHO documentation piece to the very end of the
note where it may appear to be out of place, but is there to avoid cognitive
distraction.
1.
To enter Documents- We use one structured template for patient care in AIM-AMB INT MED
STRUCTURE NOTE. This facilitates a predictable pattern of note writing, and
sharing (copying forward) of certain elements. This template has 3 titles and
the use of these titled documents will depend on which clinic you are in- AIM
Primary Provider note (when you see your own pt), AIM Walk-in Note (when you
are covering another MD’s pt in Walk In Clinic), AIM Preop Clinic Note (for preop
clinic residents).
a.
AIM
Free text note –DO NOT USE THIS TO WRITE CLINIC NOTES. This is useful for
recording between visit lab checks or telephone conversations..
2.
How to write the note- Moonlighters and past PMDs should
have uploaded structured data (Med list, allergy, health issues list, health
maintenance, immunization) for the nearly all of AIM’s active patient panel.
Please always start your session by double checking for this old data
upload. Please review the accuracy of the meds in the EMR and compare it to
your pts’ Rx bottles. If everything is
in place, you can now click on the AIM Primary Provider Note to start your note
writing, you can use COPY FORWARD to pull up the old content from the
pre-entered notes. You can use PREVIEW
to pin the draft to the right side of the screen as you write. Again be sure to
always write your note on either an active (ADM) chart with the pt sitting in
clinic, or a (DSC) chart if the pt is not here. Never write note on a (PRE)
future unregistered chart as you may lose the content.
a.
Health Issue Section: This is a structured component of the note. Enter your patients major
diagnosis (DM, HTN, CAD, Depression) in this list, put these diagnosis into the
CHRONIC DX category. There is no need to code everything your pt has, but you
should identify your pt’s chronic major conditions by ICD codes. Completing this section for now seems like a waste of time, but soon it will allow
us to do electronic billing, as well as quality improvement intiatives. For example, we plan to build automatic
reports for PCPs to pull up a registry of all of your diabetic pts and markers
of disease control. (Refer to chapter 9
to get details on how to enter health issues in this section)
b.
History (free text box)- a primary care
physician’s role is to clearly and concisely communicate a clinical snapshot of
the patient. This is usually done by introducing the pt with a updated list of health issues
with brief narratives (see sample note attached). When this health issue list
is constructed thoughtfully, it quickly debriefs others on who the pt is. We use the free text capability in our
history box to construct the pts’ problem list and allow ease of updating,
modification, and sorting (up or down based on disease level). This free text
history box also allows you to record the CC, HPI, ROS, Fmxhx, Sochx.
i.
(initial
visit note tip) If the pt is
previously followed in AIM, you can go ahead and copy forward the content of
their last PMD note. Certainly your note will reflect updates and changes that
you made based on your history and exam today.
c.
Medication
and Allergies may have been entered by the past MD. Be sure to review their
entry and double check with the pt’s bottles.
d.
Flow
Sheet: This flow sheet will show you
today’s and old vital signs (1 yr before visit). View it only, do not click on it to import
all data, as the display is not pretty.
e.
Physical
Free Text Box- Use FUNCTION F6 “smart
paste” to import the vital signs from the flow sheet (click F6, #1 for vitals,
then #2 for ambulatory vitals). This will import the vitals in one horizontal
line. Then type in your free text
physical exam.
f.
The
labs and radiology section- The top lab display menu brings in TREND view of
results for the past yr. The bottom “Radiology/others” box brings in past
radiology as well as past culture data for the past 2 yrs. Use these boxes simply to view the past
results. You don’t need to click all to
reproduce these data all over again in your note (why be redundant, Eclipsys is
the official EMR). If there are a few values that you want to bring into your
notes like last a1c, ldl, you can briefly note it in the free text data box.
(see note sample) . “5/2010 CXR clear” “Mar 2010 a1c is up to 16”. If you
really feel compelled to drag results into your notes, try not to click on
entire rows or column it will junk up your display, click on the individual
boxes of individual data you want to import.
g.
Assessment
and Plan Box: Write your assessment and plan in free text. This starts with an
age/gender intro to help you complete your summative case assessment line.
h.
Health
maintenance enter dates for common screening tests (colon, mammo, pap, hiv…). A
free text box is left on the bottom for any other HM comments- advance directive/proxy information can go here
too.
i.
Immunization
box- Historical immunizations should be recorded in this immunization box. Our
nurses will also record all vaccines they give in this box.
j.
Discharge Rx box: new Rx prescribed today will be checked and displayed
here.
k.
Med recon- This is a JCAHO “hard stop” requirement, you can’t save and
complete the note unless you click one of these 2 options. ERROR
ALERT(!) When saving a note, if you forgot to
complete the med reconciliation, an alert will pop up to tell you that the note
will be saved as incomplete. PLEASE DO
NOT GO BACK TO THE COMPLETE THE MED RECON SECTION when the alert comes up.
Simply go ahead and SAVE the note incomplete first THEN reopen it to complete
the med recon boxes. This is a painful yet predictable system error that causes
you to lose the note , iF you do go back to complete the med recon after
receiving the alert. Eclipsys is aware of this error and I hear there is a
solution soon.
l.
Care
provider box- If the pt will become your regular pt, add yourself as a primary
provider to the pt in this box. The benefit of doing so will allow others to
easily see who is the pt’s PCP. To do so, click ADD ME on R hand, then press P for “primary” option and hit enter.
m.
The compliance section- These check boxes are required by
NYP to satisfy JCAHO compliance. The
medication reconciliation box is mandatory and must be checked off before you
can exit the note. The tobacco and pain sections are way on the bottom, for you
to comment briefly if you did
not already cover these items in your patient care note section.
n.
Now
save the note and go present to the PIC. Once the case is discussed you can
re-open the note and assign the PIC as a cosignature.
o.
Finally
you can order the discharge orders from within the note. More on ordering later
3.
Requesting a Co-signature from a PIC Video
Demo Link
click the co-signature
check box on DOCUMENT INFO TAB. The search box will open, click other, and
search for the name of the attending who precepted your case. Then click submit, this note will be routed to
your PIC’s inbox. For safety, please be sure to route the note for signature
before the pt is discharged.
4.
Viewing Documents-Once you have a patient selected,
click on the DOCUMENT Tab. Double click
on a note will open up the document. You will notice Eclipsys has top and L
side filter to sort the type and dates of notes displayed. To Edit and Update a previously submitted
note- Find and highlight the original note in document viewing screen.
Click the note and it appears, you can then choose to MODIFY the content. For auditing purposes the EMR will track what
was altered on each modification. You can also always save notes as drafts or
delete previously completed notes entirely (this will show up as a crossed out
note).
5.
No Show Notes-AIM
providers’s need to document AIM NO SHOW NOTE on all of their regularly
followed pts (not NEW pt) when they don’t come back for planned follow up.
With one simple check box on top this note will indicate that the pt’s chart
has been reviewed by the MD, and the MD is okay with the patient receiving the
automated standard “missed appt reminder” letters at home. If the pt is sick and requires more urgent
recall by phone or telegram, you can forward the no show note to your module’s
PFA to initiate urgent recall process by phone or telegram. These notes do not
need PIC cosignature.
6.
Miscellaneous Document Info-
a.
PREVIEW-
is an option which allows you to view the note as you are writing it. You can
display the preview on the R or bottom of your note draft.
b.
Copy Forward is a function that allows the author
to copy in entire sections of the last note.
You can then update and revise the note. Copy forward is a important
function that allows us to retain complex information for complex pts.
Certainly there is risk and the goal is to avoid reproducing the same hpi,
exam, a/p over and over as that is terrible for pt care and considered billing
fraud!
c.
Acronym
Expansion (video) is a set of user defined
abbreviations that would expand out in the note. You can copy personally
designed list of acronyms from others on Eclipsys.
d.
Setting
up Favorite Set of Document entry templates. See this video to pull in the
documents you use most commonly. You can add your favorite ambulatory as
well as inpatient document template to this Personal List of favorite templates
e.
Outpatient Function F6/Smart Paste –allows you to copy in a concise and
clean list of ambulatory vital signs/BMI and recent labs.
f.
You
can also set permanent document view Preferences,
click on any patient, and then go into the document tab, then to the top tool
PREFERENCE section, then pull up Document Review. You should be default to see
“All except flow sheets” type of document. Then use the MODIFY button on the
right, you can click both “All available” Chart, since “ALL documentation”-this
way you should pull up all available notes on the pt chronologically like
Webcis. You can also select how you want
the document columns to display on one of the tabs.
Chapter 8 Health Issue (a.k.a. Problem list) Video
Demo Link
The free text problem list we write
in our notes presents a nice clinical snapshot of the pt. It’s easy to edit,
update, and prioritize illness activities by shuffling this free text list up
and down. The downside of these
“uncoded” free text problem list is that beyond clinical communication, it does
not allow higher level functions such as automated best practice reminders,
quality assessment, billing, etc. For
example, by using this health issue list, and coding your pt’s hypertension
under this structured section, in the future you will be able to run your own
panel’s average SBP report for all hypertensive 401.9 pts in your own panel.
So we do recommend that you enter
each pt’s major chronic health problems as a coded health issues:
1.
health
issue entries can be made in 3 ways
a.
by the Asclepius/serpent Icon in the tool bar
b.
Go To then health
issue entry in the menu bar
c.
Within
the Health Issue section in the AIM structured note
2.
Titling Each Health Issue- Before you search to add a health
issue, make sure on the L hand side, you have the proper title for the health
issue you want to enter. Eclipsys provides many confusing health issue title
options e.g. acute dx, chronic dx, working dx, principle dx, secondary dx,
discharge dx. Choosing the wrong title
in the clinic (like acute dx) will not allow the health issue to carry forth
from chart to chart. So in AIM we
recommend one standard approach: Use
only Chronic Dx for the major
conditions your pt has. When
toggling between titles, beware that your next entered item will default to the
last used title, the pointer is also slippery so always double check the L
handed title section to make sure you are on the right title before entering
the health issue.
3.
ADDING
THE HEALTH ISSUE (video) – a box
will open with 3 search option (full catalogue, favorites, or start of browse).
The 2 most useful are to search by full catalogue or search by favorites.
a.
In
the “Full Catalogue” search option, start by clicking the “contains” check box,
and start entering words or partial words in the search box. Click ADD button
to upload the health issue to the list. This search is quick but not initially
intuitive. The old fashion ICD-9 code
lingo contains many idiosyncratic words like “lumbago” for low back pain,
“depressive disorder” for depression, diabetes related illnesses can be
retrieved under “DM” or “diabetes”. Once you learn the common lingos, this
search is easier.
b.
Favorites-
The
option which is ideal for beginners is to search in a Favorite ICD list. You
can download the predefined AIM common
ICD list under my name (Video).
This search method is slower as diseases are categorized by organ system, but
is easiest way for a beginner to start to see the ICD lingo without being
frustrated by searching blindly. You can
also modify this favorite list on your own by deleting and adding more of your
own favorite ICD codes.
c.
If
you can’t find an ICD -9 code for your problem, you can enter the problem as an
“add uncoded issue”. This button is on
the R lower hand of the health issue entry box.
d.
Once
a coded issue is entered on a chart, you can go back and modify the text of the
name. For example, you change lumbago to low back pain. The ICD code will not
be changed.
4.
Does the structured health issue
replace our own free text problem list?- NO! Although the health issue coding is helpful for
quality of care/administrative purposes/research, it is not very informative
for communication of clinical care. For your notes, I recommend that you
continue to keep and weed your own free text problem list in the Hx box to
provide the most accurate and concise snap shot of the pt.
5.
The health issue list is an open
forum! - This health
issue list will be used by ALL providers at NYP, so any provider or specialist
can put in their own diagnosis code here. What a mess it will be. This is
another reason why I would suggest that PCPs maintain their own free text
problem list.
6.
Preference Setting – To help with improving the ease of
finding common ICD 9s. Go to PREFERENCE and HEALTH ISSUE ENTRY. A
box will open and now you can copy AIM’s favorite health issue list from
me. In the copy from box type “Chang”,
be sure to wait a second for the menu to load with “Chang, Nancy”, then click
on my name. This will bring you a comprehensive listing of ICD codes common
in AIM. In the future you can choose
to add or delete diagnosis to this personal favorite list.
Chapter 9 Entering Allergies or Adverse Drug RxnVideo Demo Link
1.
To add an allergy on any of these menu, go to Add New, New Allergy, then OK, and pull down the Select TYPE (food/drugs/environment…) enter
the Allergen. Then click on Add Reaction, and select one from list
of menu, if unknown then click unknown. If the allergen is not there, click
“other” and add the allergen in the free text comment box. Finally click ok.
2.
Try to code the medications as much as possible, as the program triggers
automated alerts.
3.
To discontinue an allergy click on the allergy and click on detail, discontinue, and apply
4.
Click all the appropriate Reaction, there is also a detail
unknown possibility.
Chapter
10 Ordering- Video Demo Link
Ordering can be done in 2 ways-
within the structure note order tab, or clicking the order clipboard icon to
the Left of the patient’s name. we have
a set of common order (AIM COMMON ORDERS) which will allow a one page ordering
of our favorite labs, radiology, CV testing, vaccines, and referrals. The return to clinic date is also part of
the orders. Completion of the RTC orders generates a printable set of bilingual
instructions for your pt. Ordering
sounds easy but there is a catch on lab orders. Remember that Eclipsys charts
and orders are driven by individual registration codes. This means sadly all
LAB orders are discontinued after the patient is discharged from the
clinic. So if you are ordering any “1
week before next appt” labs/fobt, you need to enter these items separately from
the “STANDARD” session orders. Radiology and consult orders do not run into
this problem. This is pretty confusing so check with your preceptor when you
order labs.
a.
To order same day “STANDARD” orders- click on the order icon in your note
or on the tool bar, it will open up the order page, look first in the session
type on the top left corner, it will default to STANDARD session. This default
STANDARD -works for orders that need to be scheduled or acted no today in the
clinic (same day vaccines, radiology, clinic referrals, STAT (in clinic) urine
or lab collection, return to clinic instructions). Click the AIM common order set and order and
submit the items you need.
b. Putting orders on hold- The Pending Return Orders: This is the
most confusing part of outpt Eclipsys ordering. Since Eclipsys considers
patients DSC (discharged) as soon as they walk out of the clinic. All STANDARD
orders ordered above will automatically be cancelled. If you intend the pt to get preclinic
labs/fobt/shots done in between visits you need click order a second time using
a different session- PENDING RETURN. This would put all of this type of orders
on hold until the pt returns. This
PENDING RETURN is again necessary for any labs done in our 1st floor
phlebotomy center, including any same day labs after your visit. It also
applies to FOBT cards collected after your visit, future b12 or vaccine shots. You can not add PENDING RETURN
ORDERS until the STANDARD set is submitted. Yes we know this is a pain. Some
people find it easier to enter all orders as pending return, then immediately
RELEASE and activate same day clinic orders.
c.
You do not need to set a date for the pending return lab collection since
you may not know when the pt is going to the lab. If you do want to set the
actual date for the specimen collection, you can do so by toggling the calendar
for the day to activate the pending order. This is helpful if you order several
pending orders that needs to be done on different days, like serial C7s weekly
before your next appt.
d.
For the advance user-Some of you have figured out to order everything
under 1 set of PENDING RETURN order, and then releasing the individual same day
RTC/radiology/referral/vaccine orders. This 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 these active orders/appts while
you are still in the room with the pt. This would help minimize your pts’ wait
time
e.
RETURN TO CLINIC orders
- The RTC is
a very important tool that allows you to communicate clearly to your PFAs as
well as the pt.
i.
ii.
iii.
iv.
v.
vi.
1.
Miscellaneous
order sheet details-
a.
95% of the lab test you need is on the common order set. If you can’t
find a test you can try use the “LAB OP” set. This is a set of common NYP labs.
If the test you want is still not there, you can order by name in the search box. The trick at
times is to enter the right nomenclature for the test, meaning a C7 is called a
BMP. When you are stuck, use the wildcard “%” with the search term may help you
narrow down the search. Or consider looking up ambulatory order sets like the
Rheum/cards/GI/Endo Order sets which may include some of the rare test not on
our common order set.
b.
Most common Radiology tests are also mostly on the AIM common order
sheet. Be sure to differentiate between diagnostic mammos and screening mammo
(diagnostic mammos are ordered for pts who have a breast mass or an abnormal
results previously- diagnostic mammo is not on the AIM common order
sheet).
c.
When the pt is registered in AIM, your name/contact info will prepopulate
the radiology order form. AIM’s extension 5-6354 be the contact info for all
providers as it is always covered by RNs or MD 24x7.
d.
All testing need ICD codes.
Several of them already have pre-installed drop down ICD menus.
e.
Most of the common vaccines are listed, there is still some work going
into building vaccine series like Hep B x3, varicella x2, hep A x2, HPV
x3. So for serial shot sets, it’s best
to order them as PENDING RETURNS. So the nurse can release them individually.
f.
Outpt referrals- we listed all the common clinics, and included a blank
generic referral sheet for free text name of whatever clinic is not listed.
PT/OT/DERS Colonoscopy/NYP Psych/Pain/Sleep Study are not on Eclipsys so you
will still need to use the service specific referral forms (printable versions
available on clinic website-check with your clinic preceptor).
2.
Personalize and Set Preference for Order Entry Screen- go to Preference,
order entry.
Chapter 11 Rx
Writer Video Demo Link
This Rx writer is smarter than webcis
Rx writer as it is able to prefill instructions under the “quick list”
function, but it is also much more complex to enter, given the many boxes to
fill/double check. This program will
take time to learn. To avoid the complexity and the exhaustive medication
choices in this Rx writer I have uploaded a predefined “AIM Favorite” Rx list
to the Enterprise Favorite list, all meds in this list have the dispense # and
refills prefilled (“5”), you may find it easier to upload common meds by using
the favorite list, as with one click you can “add” Rxs from this favorite list.
Please always double check the name
of the medication and the doses you enter since this multiple field menu is
pretty distracting. All Rx prescribed
routinely by you should be entered as an active Add Rx. This would ensure that you can refill this Rx later. Add Hx Rx should only be used if the
AIM PCP does not routinely refill that medication- e.g. “Valium 10mg tap o Q4hr prn from Psychiatrist
Dr. XXX”
Rx Preference Setting: click on user preference on the right, here you can
set your preference for how your personal info prints (license number, NPI
etc), whether you default to quick list or favorite list when you search for
Rxs (Favorite is easiest), whether you want MULTUM comments to be included
(No), how you want to print (setting is single). Unlicensed residents will also
need to input the name of their supervising attending here. You can use your
FIRM attendings to avoid needing to enter this with every PIC encounter. Please
use your ward attendings’ names to write inpatient Rxs.
1.
To enter meds you click on Pill Bottle Icon to open the Rx writer. Then
click on Add Rx on the L side tab.
2.
You can search for the med by going to Favorite search, and pulling up
the AIM favorite Rx list. This is easier
and all you have to do is click add once you find the Rx. All rxs are prefilled
for the 30 day quantiy and 5 refills.
4.
Click “5” refills for each med entered and make sure the “continuous”
checkbox is CHECKED. This would get rid of the confusing “x 30days” wording for
chronic medications.
5.
You can add PRN directions by clicking on the box on the R, or add free
text the instruction by clicking the EDIT button above the instruction.
6.
Click on Add then Submit All when you are uploading several meds. Or submit/print when
entering 1 Rx. When confronted with the many printer location choices, simply type
“.r” to print in your exam room Rx printer.
7.
Rx’s may have been already entered on past admissions. Please confirm the
proper doses/unit/refills here. You can use the side tab to COPY/DISCONTINUE and activate any
HISTORIC Rx (E) entered by others, though given poor quality sometimes I find
it easier to re-enter these meds myself.
9.
You can DISCONTINUE/CANCEL an Rx by right clicking on the Rx or checking
a bunch of them and going to the Detail Tab (on the L hand tab) to pull up the
discontinue/cancel button. The
prescription writer does keep a historical tracking of what has been
discontinued, you can sort thru all the
pt’s past meds by looking in the upper L hand corner and toggle between active
and historical medication history.
10.
To enter supply items not in the RxWriter dictionary, e.g. alcohol swabs
/gloves/diapers/chux/walkers/PT/speech and swallowing study, you can always
free text the Rx item (“alcohol swab # 1 box, 5 refills”)into the search box
and ADD or submit/print the rx.
11.
To Refill rx, just click on them and hit “Renew”, and submit. If you did
not originally enter the Rx you will need to click the “Renew As Me” option.
This would bring up the print screen, in the printer location button, type “.R”
to print to your local printer (You don’t need to use “.R” when printing in the
PIC room as these are network printers). Once the Rx is renewed, a refill date
is displayed.
12.
The Eclipsys Rx fax and E prescribe function is still under
development. We are still using Webcis
for all Rx faxing.
Chapter 12 –The Review Tab
The Eclipsys Review Screen takes parts
of the EHR data, and pieces together a multi-tile one page collage summary of
the pt. With Eclipsys as the hospital’s
official medical record, we hope over time this feature will unburden our notes
from the need to record routine historical contents.
Click on Review tab and it should
direct you to the default “AIM Clinic View”, if you only see 7 tiles (this
depends local computer screen resolution setting) click the small “Scroll” box
on top R corner to display 9 tiles. The
“AIM Clinic View” will show 9 tiles for
each pt: health issues, med list, allergy, immunization, visit history, our
favorite AIM labs trended over the past yr(hgb,wbc, plt, K, Cr, LDL, A1c, TSH),
AIM clinic notes, radiology, and care providers list. Some tiles links you
directly to data entry and viewing options, for example:
1.
To open the radiology report,
double click your pointer on “t” mid way in the column .
2.
To open up a document, right click to bring up document options
3.
For the sophisticated user- you can further customize the your summary
view, use Review Page Preference Setting
-to customize your view, go into “actions”
on the menu bar, and “customize current
view”. By hitting “add” you can
add in new tiles. By “modify” you
can change the layout of each item. You
can also “move up or down” each
tile. By clicking “last tile of the row”
you define that particular tile to be the most right hand box of the row.
Chapter 13 Other Eclipsys Facts-
1.
Paper Document Tab- (ER notes available here)
·
This tab button links you to hard copy of notes for services that are not
writing electronic notes, e.g. ER visits and Ophtho clinic. There is usually a
72 hr delay between visit and note upload. Of note there is a delay when
hitting the tab as it needs time to activate another program.
2.
Immunization Manager-
·
Nurses will record vaccines given here. This will automatically populate
your immunization record that will display on the Review Page. Moonlighting MDs
have been retroactively populate old vax data here for 8000 AIM pts.
3.
Medication Reconciliation/generating discharge med list-
·
Medication Reconciliation- Each time a pt is seen, the MD needs to
acknowledge in their note that med recon is performed. If the box is not
checked, the note can not be submitted!
·
Medication Reconciliation -Anytime a change is made to a pt’s med list,
pts should receive a new list of their current outpatient meds. When you discontinue an old rx, that Rx will
show up on the med reconciliation list as a medication for your pt to stop. To
print the list, go to the printer icon on top, and click Ambulatory then
Discharge Med List in English or Spanish. This list tracks what medicine is
newly prescribed and what has been terminated. Currently the Discharge Med list
default prints 2 copies each time.
·
Click “GO TO” then LETTERS. This pulls up templates for you to write
letters on. Select 1. your practice location and the 2. type of letter (missed
appt, general, missed work). This function will help print some common letters,
and stamp it with our clinic address header. Once the letter is entered here,
it can be saved on file and be viewed later under Documents (Filter-letter
view).
2.
Secure
health messaging Video Demo
Link- A secure yet slightly cumbersome way to send results and
messages to each other, a safe way to communicate with care providers (RNs,
specialists).
·
See inbox discussion on receiving SHM.
·
To send SHM, Open Eclipsys Acute Care or Eclipsys Ambulatory Care and
choose “Secure Health Messaging” under the “GoTo” menu. If you are in Ambulatory Care, you can select
“New General SHM Message” in the lower left Command box of your Inbox. Choose “Compose”
and then choose “General Message”. Click on the Magnifying glass, this
will open a new window where you can type in the provider’s last name, you may
also include the first name, and hit Search. Click the checkbox next to the
provider you want to message and select “Add to List”, and then click OK if you
are done adding providers. Type your subject line and body of the text. In the
upper right hand corner, you can change the priority of the message and alter
send options. You can also choose Yes or
No to the option “Attach to record” – if this is selected as yes, when you
click on Send, you can search for the patient and attach that patient’s visit
to the message. Click Send.
1.
Patient Information Section- you
can see pt visit history at CUMC (past and future), update best contact info
including phone numbers, identify yourself as primary provider, or record
significant events including advance directive info here (this section is still
under development so for now leave your advance directive in the HM section of
your note). This is a pretty useful section that we should start to take
advantage of as a standardized way to share important patient specific info.
2.
Wellness Manager- will be developed in the future to generate automatic
reminder for AIM pt health maintenance.
For now use the HM boxes and the free text box below for disease
specific HM.