AMEDD AHLTA User Basic Needs and Default Setting

AMEDD AHLTA User Basic Needs and Default Setting Expanded Provider Tips and Tricks For AHLTA Efficiency 8 – 9 May 07 Ron Moody MD LTC, MC Program Manager, AMEDD AHLTA Note: It is strongly encouraged to review the document titled “AMEDD AHLTA Guide to Improved Outcomes” which outlines a clinic use strategy for AHLTA and provides a best practice recommendation for meeting Medication Reconciliation and other JCAHO requirements along with Periodic Health Assessment (PHA) screening.

Decrease Desktop Clutter • AHLTA has many ways to do the same thing • Customize your personal view so that you optimize your clinic “speed” • Limit mouse movements – Only place items in Physician Shortcuts you use during appt – Place in order you use them – Don’t include items presented elsewhere (alerts, actions)

2 MINUTE PEARLS AHLTA Shortcut Menu • Tired of having to scroll through the lengthy folder menu on the left side of the screen when your in clinic to find the button want? • Would you rather have a customized pick list that matches your personal workflow? • Would you like the ability to change the order of the buttons whenever you want? • All this is available in AHLTA today using the AHLTA Shortcuts Menu Note: No change with 3. 3.

Folder Menu View Although it is nice to have access to all these items, there are many times (like when your in clinic) that you need a limited number of easy to find folders?

Shortcut Menu View (also known as Physician Shortcuts) Do you like having all of these items This area is a duplicate of physician shortcuts. cluttering your view? Turn in off by using the view option To get a personally customized list you only need to take a few steps: 1. Identify which items you use during clinic? Note: Do not duplicate items displayed elsewhere? 2. Follow the steps that follow

To view your current shortcut menu: 1) Select View 2) Select Shortcuts 3) Select Small or Large Icons (Small icons are recommended to allow more icons and to increase size of AHLTA screen) Setting the Shortcut Menu view

**You now see both your Folder and Shortcut menus To Remove Folder Menu from view: Removing Folder Menu 1) Select View 2) Click on Folders to remove check mark 3) The Folder Menu will now disappear (see next slide)

Customizing your Shortcut Menu 1) Select View 2) Select Tool Bar 3) Select Customize Customizing the Shortcut Menu

This side shows what items are available to add to your Shortcut Menu This side shows what items are present/selected in your Shortcut Menu Customizing the Shortcut Menu INSTRUCTIONS

Reordering Items on the Toolbar To Reorder Items on the Tool Bar 1) Left click and hold on item you wish to move 2) Drag item to desired location 3) Release left mouse button 4) Note in this example I moved the A/P button from the top of the list to the bottom

Edited Shortcut Menu View Congratulations! Your Shortcut Menu is now ready to use. Notes: This is a dynamic screen which will show options from the current AHLTA screen that is in use. The action navigation bar compliments these actions The duplicate shortcut list should be turned off so that there is more space for the action navigation bar. Go to next slide for one more helpful tip…

Action Bar Separator can be moved to create more room Moving the Action Bar Separator 2) Notice that the items listed on this tool bar are identical to your Shortcut Menu. 3) Turn this off by unselecting >>>> give a single screenshot 1) Do you sometimes get frustrated when buttons on the top tool bar aren’t visible?

Moving the Action Bar Separator By moving this Action Bar Separator to the left, you will create more room for the items on the right To move line: 1) Click and Hold the left mouse button over this line 2) Drag Line to the left (can drag all the way to the edge of the screen) 3) Release mouse button 4) You should now be able to see all the available buttons on the right You only need to make the changes to your Shortcut Menu and Action Bar adjustments one time. AHLTA should remember your settings every time you log in.

Health History Module • Why use it – Loads all patient’s data in background while you are doing something else – Saves you time as later retrieval is faster and you can ask fewer questions (Don’t repeat what is known) • When to use it in clinic – Open appointment and immediately click HHM so that it loads at beginning of appointment (in hallway if wireless) – Do something else while patient data is loading – When you click on Rads and Labs they will appear faster (on that PC) • How to set it up – Requires a one-time set up Note: As of 3. 3, the format is set but not the timeframes which are still user defined options.

HHM: Must set user options Default setting under Tools > Properties

User-Defined Settings • AUTOCITE – Only set for current meds, allergies, problems (speeds A/P loading) – Adding labs and rads only slows the system and you are legally liable for any autocite results – Close patient record when not using • Autosave - Set at every eight minutes. This will save data if event occurs. More frequent saves slow system. • No printing of charts • LAB and Rad Settings can be ALL if Health History Module is used so that data loads in the background Note: With 3. 3, the timeframes that you set will remain in place, but the timeframes must be set once.

Autocite: Set User Preferences

Other User Settings • The filter used for medication and ancillary results display will impact that modules view and autocite along with speed. – Medication options: Outpatient current/Inpatient All/All current – Rad options: Recommend all or 24 months (2 years) – Labs: Recommend all or 24 months (2 years) • If opening Health History Module at beginning of appointment and letting it load while you do something else – Set Labs to all (two locations to set, make them the same) – Set Meds to all (two locations to set, make them the same) • If NOT using HHM approach – Set labs to last 2 years or time frame that is usually reviewed – Set rads to last 2 years or time frame that is usually reviewed – NOTE : Longer = Slower

Setting Ancillary Defaults

• Recommended Provider Encounter Workflow Before Clinic (one-time investment) – Set User Preferences/Defaults – Establish clinic favorite DXs and CPTs (only the most common) – Create personal default template (can be clinic- or MTF-specific) • • • Team Documentation – Same Template or Clinic Enter room, greet PT, open appointment, read screening entry and click HHM Take history and do exam (Most people will not write note while taking history) Complete A/P with PT in room (limit A/P jumps) Dx, orders, and Instructions reviewed with PT – PT leaves If the clinic staff began the note, use Edit-No-Yes to take over screening note THEN write note with default template Augment default template with Dx. Prompt (if needed) to complete note Remember to put positive ROS into HPI (using flip button) Disposition and Sign with a cup of coffee Note: Changes with 3. 3 1. Health history loads when provider open encounter and remains open 2. No HPI flipping (if you so choose), Dx Prompt loads with diagnosis in encounter and patient problem list. 3. Simultaneously logged into A/P and S/O module 4. Edit-No-Yes is a single Macro button with a clear label

Creating Order Sets In The A/P Module • Order sets can be huge time savers! • Enables you to select commonly used orders from pick list instead of having to search each time • Order sets can be created and edited from the A/P page within your normal workflow • You can easily modify orders in your order set to adjust for an individual patient (i. e. type impression for x-ray or consult order, change sig for medication orders) Note: As of 3. 3, this can be done without an encounter being open.

To edit the Order Set of an ENC template in the current encounter A/P module – 1) Select template you wish to modify in the drop down menu OR 2) If you don’t have a template yet, start one by following the steps on the next slides Selected Template

1) Go to appropriate order module and search for the medication, lab or radiology study 2) Select appropriate order 3) Click on Save To Queue For example, order UA IMPORTANT: You must select Save To Queue, NOT Submit

You will know you are successful if the order appears here and is Underlined. Repeat previous steps to add as many orders as you would like.

1) Once you have completed entering your orders and saving them in the queue, go to the Order Sets tab 2) You should see the new orders you entered at the top and underlined (Any previous orders in the order set will be listed below) 3) Select Save As Order Set

1) From this menu, select the template you wish to add the orders to. Make sure that the name appears below after Template Name 2) If you are creating a brand new template, simply type in your desired template name. 3) Once you have the correct name in place, select SAVE

This menu will appear if you are editing an existing template, not if you are creating a new order set From this menu, Select ADD TO. If you select Replace, you will lose all your previous orders

1) You have now successfully added an order to your Order Set without leaving the A/P module. (*You can finish ordering the tests/meds you had Saved To Queue by clicking SUBMIT ALL or you can Delete them. )

2) Select orders by clicking boxes, then click SUBMIT 1) To access your newly modified Order Set on the next patient, simply select your template from drop down menu here and go to Order Set tab. 3) To modify an order, pick select box on left and modify box on right—you will get prompts to make modifications.

Additional Suggestions • Take a minute to list what orders you plan to add. The orders you add will appear in the sequence in which they were ordered so if you want to group orders by type (lab, xray, med), then group those together. • Note: Long term medications should be renewed from medication list to avoid adding duplicate meds to patient’s medication list. • Future: New enhancement will allow the building of order sets and full templates without being in an encounter (present in build 3. 3)

Default Template • This function allows you to set an encounter template to load automatically as soon as you open a patient’s encounter. – An encounter template can include an S/O template, diagnosis list, procedure list and order set • Can still load other templates if needed • Many of the new functions in future builds of AHLTA will greatly benefit users who have a default template

Start in Template Management with open encounter

Select and right click on the template that will be set as the default template. A drop-down list appears.

Select Default Encounter Template on the drop down menu to set Default. (Can undo a Default Template by selecting Reset Encounter Template) **Important: A template must be saved as a personal template. To save as personal template, highlight desired template, then click Save As in top bar and rename. Then follow steps above to make template the default template.

The selected template is designated as the Default Template.

The Default Encounter Template is automatically loaded in the S/O and A/P module when either module is accessed.

Prompt and Diagnosis (DX) Prompt • Prompt and DX Prompt are useful tools to populate your note with symptom or diagnosis relevant terms • Prompt works better for symptoms while Dx Prompt works best formal diagnoses (Cough vs. Acute Bronchitis) • Prompt and Dx Prompt both bring up HPI, PMH, ROS and PE terms related to the desired symptom or diagnosis • Easy to filter number of terms to choose from using List Size button (3 levels = small, medium and large)

Prompt and Dx Prompt can only be used from the Medcin Tree page For AIM Form users, the process to access Prompt or Dx Prompt is outlined on the next slide…

From an AIM form, you cannot access Prompt or Dx Prompt directly, but can access them by going to the Note View which will take you to the Medcin Tree page (see prior slide) To get to Prompt and Dx Prompt, Select NOTE VIEW

PROMPT FUNCTION 2) Select Prompt button 1) Highlight symptom you wish to expand (Could use Find Term to locate symptom if needed)

Now select HPI, PMH, ROS and PE to yield related bullets List of bullet items can be increased/ decreased using List Size (up to 3 levels)

Note relevant PMH items for cough

Note relevant Physical Exam bullets for cough

DX Prompt 1. Click on the Dx Prompt button at the top of S/O module.

2. Type ‘Acute Bronchitis’, and click ‘OK’

3. Select ‘Acute Bronchitis’ and click ‘OK’

4. Notice that HPI, PMH, ROS, and PE terms related to Acute Bronchitis come up.

5. Click on the ‘List Size’ button to increase/decrease number of terms shown. (3 levels)

6. Now, repeat steps for PMH, ROS, PE, and tests as necessary.

Ba ck Bu tto n If you wish to return to an AIM form that you were using after using Dx Prompt or Prompt, then select the Back Button

Consult Log—How this Helps • Provides an easy to use menu to track status of consults to include being able to see: – Status of consult (has it been booked, has patient been seen, did patient no-show) – Access completed consult easily – Way to see all consults and pertinent info easily (reason for consult, location of consult) Note: No change with 3. 3.

To access Consult Log, select from folder list

1) Click here to select parameters 3) If you always want to see consult display the same way, select this as default. 2) From this box, select manner which you would like to track consults to include dates, status of consult 4) OK when finished.

1) Can sort by any of topics listed on this bar. (Status, Dx, Clinic, Appt Date, etc. . . ) 2) Double click on consult and completed encounter will load if available.

1) Select HISTORY and you can track date/time of progress. (see box below)

Patient Handouts Template • A great tool to quickly access patient education materials directly through AHLTA! • Enables easy documentation into progress note that patient education occurred • Can be used by any member of the health care team (RN, LPN, Medic, Patient Educator, Provider) • Handouts available in English or Spanish • Many handouts have great pictures • Can link easily to other related handout information • Usage Directions: – Go to S/O Template Management from the S/O Module – Search for: all--patient handouts – Select and Add to Favorites for easy access in the future Note: No change with 3. 3.

General patient education topics across top of form

Selecting Left bullet will document that educational materials were given to patient

Documentation is added automatically under Counseling/Educatio n

Selecting RIGHT “? ” button will direct you to the Health Library patient handout that can be printed and given to patient.

Many are available in Spanish as well

*Information includes Causes, Risks Factors, Symptoms… *Blue text provides link to other related diagnoses or procedures *Some procedure topics also include short summary video of what the patient should expect with the procedure

*Also includes Diagnosis Methods and Treatment Options (both prescribed and OTC) and Prevention Strategies *Can be printed directly from site and handed to patient at the close of the visit or emailed to patient

Copy Forward • Function – Uses documentation from previous encounter to create a unique “template” – Template indicates patient’s status at previous visit – Autoenter can be used to rapidly enter finding – New status is adjusted or added • Best Use is for Serial Exams – Well Woman and other physicals – Post-operative serial exams – Patient with multiple problems and regular visits

Copy Forward Scenario • Well Woman – Review previous encounters – Copy forward last well woman exam – Yellow buttons indicate previous status • Cancer patient with regular post-surgical visit – – Find previous cancer follow-up visit Copy forward Patient past events do not change Update patient status • In both cases, use patient’s problem list to speed entry of diagnosis.

Lab Module Flowsheet View

Update Patient History and Family History • Update the following directly on problem list while getting Coding Credit by stating “Reviewed and updated” as needed in your note. This is part of the AMEDD Screening AIM form and will be included on all new AIM forms. – Past procedures – Family History – Allergies • Best done for all information at hospital discharge. • Patient list can be printed out to provide a summary consolidated view.

EUD Performance Issues: Things to Check to Help Yourself 1. 2. 3. 4. 5. User settings Number of clinics where the user is mapped Spyware/other non-work-related software Incorrect version of AHLTA Extraneous running software (Music, email, etc) 6. User perception (workflow) 7. Network issues

Expanded: Top EUD Performance Issues • User settings – – • • • User-configurable Users requiring extensive encounter lists will operate slower Number of clinics the which the user is mapped – • • – Auto-cites (Extensive Auto-cites will slow system) Appointment Search Criteria - Allows the user to return all unsigned encounters for all Clinics they are mapped to as well as selecting all Providers in that Clinic Database call to “get Clinic data” is used throughout AHLTA - The “get Clinic data” call retrieves: Appointment Data Types for each Clinic Information for each Clinic Amount of and users in each Clinic Amount of templates assigned to each Clinic (only for the Template Management Module) User mapped to more clinics then required will slow system

Expanded: Top EUD Performance Issues • Spyware – – • What is in your internet files? Have you deleted your cookies? Incorrect version of AHLTA Client Software not in sync with CDR (Database) indexes Extraneous running software – • Streaming music/Instant Messaging User perception – Users are not aware of what takes place in the background when they use a function in AHLTA. • For example: Going between the S/O and A/P modules – – The system saves the S/O data, updates and saves the Encounter, updates and saves the Appointment, then opens the A/P module, updates the Appointment, updates the Encounter, retrieves A/P data This item is corrected with the coming performance enhancements.

Leading the Way Across the Chasm Present Care Seamless Soldier Care – Theater to MEDCEN Single Standard of Care – All Patients/MTFs Slide #71 Clinical Guidelines/Population Health Business Optimization Post Deployment Surveillance Evidence Based Medicine/Research Bio. Chem Early Warning Improved Access and Efficiency Longitudinal Care Decreased Cost Possible Care