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> HOME ENHANCEEXPANDIDENTIFY
Using Common EHR Functionality in eClinicalWorks to Help Improve Population Health
• This document summarizes common functionality in Electronic Health Record (EHR) software and the corresponding nomenclature used by eClinicalWorks to describe a particular function.
• The functionality described in this document may help health care systems and health care providers improve clinical quality and population health through more consistent patient identification, communication, and adherence to clinical pathways.
Please note:
• This document has not been reviewed or endorsed by eClinicalWorks. The user is solely responsible for implementation, testing, and monitoring to ensure proper orientation in the EHR system. Merck does not take responsibility to revise this high-level summary if the software changes.
• The high-level summary document is for eClinicalWorks. The functionality described in this summary may not apply to all available versions of eClinicalWorks and capabilities may vary based on each individual EHR system.
• While EHRs may assist providers in identifying appropriate patients for vaccination, the decision regarding whom to vaccinate should ultimately be decided by a provider in consultation with a patient, after a review of the patient’s records to determine eligibility.
Objective Functionality
Identifying gaps in care, assess patient adherence, and practice performance
Registry ReportsRegistry Summary ReportsDashboards (Overviews)
Expanding communications with patients via the patient portal, email, or hard copy
MessengerAppointment Reminders (Patient Recall)Visit Summary
Enhancing point-of-care interactions Immunization ScheduleClinical AlertsOrder SetsDocumentation Templates
1
2
3
Imm / T. Inj Encounters Structured Data Structured Reports Referrals Reports Allergies
Demographics Vitals Labs / DI / Proc. ICD CPT Rx Chief Complaints Medical History
Results Date Range to
CPT Codes Sel90715
Save Queries Run Subset Run NewRun Subset (NOT)
Imm / T. Inj Encounters Structured Data Structured Reports Referrals Reports Allergies
Demographics Vitals Labs / DI / Proc. ICD CPT Rx Chief Complaints Medical History
Results Date Range to
ICD Codes SelE08
Save Queries Run Subset Run NewRun Subset (NOT)
Search TypeSearch in AssessmentsSearch in Problem List
Select Assessments
Switch To Classic Search IMO Selected Assessments
—No Suggestions—
Smart Search
Did you mean?
Problem List
Previous Assessment
Real Time
Mail Merge
Chart Data
Open Clear Add Edit Delete
Diabetes
ICD Diagnosis SNOMED
Go
Code Diagnosis SNOMED
E08.0 Diabetes mellitus due toE08.1 Diabetes mellitus due toE08.2 Diabetes mellitus due toE08.3 Diabetes mellitus due toE08.4 Diabetes mellitus due toE08.5 Diabetes mellitus due toE08.6 Diabetes mellitus due toE08.7 Diabetes mellitus due toE08.8 Diabetes mellitus due toE08.9 Diabetes mellitus due to
E08.0 Diabetes mellitus due to underlying
OK Cancel
<
<<
>><<
Save Registry Report
CancelOK
X
NameOverdue Influenza
Due and Overdue for Influenza …
NamePatients with diabetes with Influenza CPT code
Flowsheet to use
CDSS Enabled
ExampleHOME ENHANCEEXPAND> IDENTIFY
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OBJECTIVE 1:
Identifying gaps in care, assess patient adherence, and practice performanceFunctionality: Registry Reports
Registry Reports can be run based on many criteria, including demographics, lab results, diagnosis, procedures, prescriptions, immunizations and vital signs.
To create Patient Lists:
1. Select Registry Reports from the left navigation.
2. Select appropriate criteria from each tab.
Example: List of patients with diabetes past due for a flu vaccination
1. From Registry Reports, select the Diagnosis tab. Select an appropriate diagnosis. Select Run New. Utilize ranges of ICD-10 codes (e.g. E08-E13)
rather than adding each code individually.
2. Select the CPT tab, and enter an appropriate CPT code. Select Run Subset (NOT). Run Subset or Run Subset (NOT) should
be selected with each criteria.
• Save Queries as Registry Report to repeat them consistently with fewer steps.
• Check CDSS Enabled to enable reminders for patients meeting query criteria.
• Use the reports as part of a defined workflow for measurable improvement.
2
CPT=Current Procedural Terminology. Copyright © 2016. American Medical Association. All Rights Reserved. CPT is a registered trademark of American Medical Association.
ICD-10=International Statistical Classification of Diseases and Related Health Problems Copyright © 2016 American Medical Association. All Rights Reserved. ICD-10 is a registered trademark of American Medical Association.
Client (Facility)
*use control key to select more than one option
Patients seeing PCP at selected Client(s) /Site(s)Patients seeing Any Provider at Selected Client/Site(s)Patients Referred to a Provider with in the Selected Client/Site (s)
Registry Enabled PatientsAll PatientsOnly Active PatientsPatients continuously enrolled for the selected date rangePatients visiting PCP for the selected date range
*Site (Facilities)
*Insurer:
Provider:
NP/PA:
Patients With:
Age Group:
Date Range:
Report Name:
From
Start Date End Date… …
To
--Select NP/PA--
--select Age Group--
Registry Summary Report
Report Type: PDF Report
Generate Report
All Documents
All Insurances
Reporting Home Page
Female
REGISTRY SUMMARY REPORT
DEMOGRAPHICS TEST INFO
Gender
Age
Influenza147 50.3%
Male145 49.7%
<=140 0%
15-40
41-64
>=65
26 8.9%
160 54.8%
106 36.3%
Patients Immunized75 25.7%
% to goal Overall
% to goal Female
% to goal Male
75 57.3%
32 42.7%
32 42.7%
Tdap
Patients Immunized75 25.7%
% to goal Overall
% to goal Female
% to goal Male
75 42.7%
43 57.3%
8 10.6%
ExampleHOME ENHANCEEXPAND> IDENTIFY
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OBJECTIVE 1:
Identifying gaps in care, assess patient adherence, and practice performanceFunctionality: Registry Summary Reports
To create Registry Summary Reports:
1. Select Immunizations from the Reports menu.
2. Select the appropriate criteria, such as Patient Age.
3. Click Run.
• Reports must be preconfigured. • Run the report at standard intervals to view most current performance
levels.• Use the reports as patient lists if action is needed to close gaps in care.• Use the report to review CDSS rules to identify opportunities for rules to
close gaps.
3
Details Patient Age Status Last Visit Next VisitD001003223 70 At Target 3/6/2015 6/5/2015
D000371258 69 At Target 8/4/2014 None
D000047569 65 Not at Target 11/16/2014 None
D000205315 77 Not at Target 12/29/2014 None
D000172095 65 Not at Target 3/26/2015 9/23/2015
D000146094 69 At Target 3/10/2015 9/8/2015
Primary Care Overview
PREV Influenza Vaccination
Show All
Select Measure
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
4035.00
Patient List
Scorecard Care Opportunities Today’s Patients All Patients Measure Specs
Patient: Status Reference Date
HTN
HTN: Aspirin Use 3/25/2014
HTN: LDL Screening 3/5/2015
HTN: LDL Control (<100) 3/5/2015
HTN: BP Control (<140/90) N/A
PREV
PREV: Influenza Immunization 3/25/2014
PREV: Screening for Future Fall Risk 5/10/2014
PREV: Depression Screening 3/26/2014
PREV: Tobacco Assessment 3/27/2014
Data As Of:
4/14/2015
Status
At TargetNot at Target
Provider
(All) 17 values
Next Appointment Status
Insurance
Type to search in list
(All) 196 values
Type to search in list
Age1130
Gender
FEMALEMALEOTHER
Reset Filters
NotesThis list only shows patients who are currently attributed to you.To see all patients, go to the All Patients tab.
ExampleHOME ENHANCEEXPAND> IDENTIFY
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OBJECTIVE 1:
Identifying gaps in care, assess patient adherence, and practice performanceFunctionality: Dashboards (Overviews)
To monitor progress for reducing gaps in care:
1. Select My Dashboard (also called Overviews in eClinicalWorks).
2. Select the Care Opportunities tab.
3. Select appropriate Measure.
4. Select parameters, such as: Provider, Payer, Age, Gender and At/Not at Target.
5. A list of patients meeting the selected criteria and statistics regarding the population will be displayed for review.
• Periodic review of the Dashboard enables health care providers to evaluate and improve CDSS reminders and ensure that Quality Improvement (QI) initiatives are effective.
4
All Campaigns 38 Campaigns What’s New
Search Campaign by Name or Type Filter by Status Draft Actived Inactive Unused Select Category
+
Custom CampaignUNUSED
POLICY STATUS
0 0 0Drafts
Effortlessly send pertinent notifications to a customizedlist of patients.
Active Inactive
View Details & Activate
Custom Campaign
+
Influenza
57158 Patients
Reach out to patients who haven’t been seen in the pastyear and get them to schedule and appointment
Potential ReachAs of May 07, 2016
View Details & Activate
Preventive Program Administrative
UNUSED
+
Lab Reminder
57 Patients
Track high Priority (Stat) labs for which patients was sent,but results have not been received. Determine whether
pat
Potential ReachAs of May 07, 2016
View Details & Activate
Program Administrative Clinical
UNUSED
Select CategoryAll CampaignsDisease ManagementWellnessAdministrativeClinicalPreventiveImmunizationsCustom Campaign
Overview Details Message Example
Influenza Vaccination Reminder
Delivery:Deliverable as electronic message via portal app. or as voice or text message.Trigger:Patients who are over the age of 65 and have not received their Influenza Vaccination.Controls:Facility, provider (Rendering Provider/Primary Care Giver), enterprise.Frequency: quarterly, biannually, annually.
Category: Preventive, AdministrativeSetup Instructions Subscribe
ExampleHOME ENHANCE> EXPANDIDENTIFY
OBJECTIVE 2:
Expanding communications with patients using patient portal, email, or hard copyFunctionality: Messenger
To send campaign-focused communications to patients:
1. Select Messenger from Admin toolbar.
2. From the dropdown, select the appropriate campaign.
3. Select the appropriate type of communication: reminders, letters, or eMessages.
4. Review Delivery, Trigger, and Controls.
5. Review Program Details.
6. Select Publish.
5
Patient Recall
Run Letter
Patient Hub New Appointment Copy Flowsheet Release Lock Send eMesage Enrollment RequExclude from Search
Clear Search Analyze Data< Prev Next >
ALL Facilities / All Patients
LookUp
Protocol Provider/Facility Filter
Date (s)Report List
TestPatient
Consolidated View
DOB Sex Age Home Phone Last Done Due Date Last Visit Next
W
Influenza /1947 F 69Y No Record Now 03/17/2016 03/20/2016/1932 F 83Y No Record Now 04/23/2015
/1938 F 77Y No Record Now 11/12/2015
/1946 F 69Y No Record Now
Influenza
Influenza
Influenza
Letter 1-100
04/13/2016 Due By
of 890 records…
…Influenza
Appointment Date Patient Protocol All Labs/DI/Imm Alerts DX RX
Patients Over 65 No Encounter
ExampleHOME ENHANCE> EXPANDIDENTIFY
OBJECTIVE 2:
Expanding communications with patients using patient portal, email, or hard copyFunctionality: Appointment Reminders (Patient Recall)
To send Pre-Visit Reminders (Patient Recalls) for scheduled appointments:
1. Navigate to Recalls.
2. Select Immunization Protocol.
3. From the dropdown Report List, select a specific saved query which meets the criteria desired.
4. Click Lookup.
5. Patients meeting the criteria display.
6. Select the appropriate type of communication: reminders, letters, or eMessages.
6
Not - •Unknown • D • N • NMedical • a • wAllegri • a • w
(1 day Three tim
1 once dailyon as directed 2as directed 2
Progress Notes Scribe Orders
Appointment Facility:
Subjective:
Print Fax Lock Details SRecord
PrintPrint OptionsPrint PreviewPrint RxPrint OrderPrint LabsPrint Diagnostic ImagingPrint ProceduresPrint Visit SummaryPrint Rx, Orders and Visit Summary
Consult NotesAll Categories
Save options as my defaultShow associated assessments
Print Options
Print Preview Decline Cancel
Publish to Portal
MedicationsTestsReferralsNext Appointment DetailsHealth RecommendationsDiagnosisImmunizationsPreventive MedicineProblem ListAllergiesChief ComplaintsVitalsCare PlanProceduresCare Team Members
ExampleHOME ENHANCE> EXPANDIDENTIFY
OBJECTIVE 2:
Expanding communications with patients using patient portal, email, or hard copyFunctionality: Visit Summary
To generate the Visit Summary:
1. Ensure Immunizations are populated as structured data in Preventive Medicine.
2. Navigate to the Progress Note in the Patient Chart.
3. From the Print menu, select Print Visit Summary.
4. From the Print Options, make sure that Next Appointment Details, Immunizations and Preventive Medicine are checked.
5. To give a copy to the patient during the visit, select Print, or
6. Select Publish to Portal.
7
Immunization/Therapeutic Injections
Quick Order
Hx Imm Schedule
X
Imm. SeriesTdap3 Shots
01/27/20142M 9D
Tdap
03/20/20144M 2D
Tdap
06/11/20146M 23D
Tdap
Influenza3 Shots
01/27/20142M 9DInfluenza
03/20/20144M 2DInfluenza
06/11/20146M 23DInfluenza
Vaccine X3 Shots
01/27/20142M 9D
Vaccine X
03/20/20144M 2D
Vaccine X
06/11/20146M 23DVaccine X
Vaccine Y2 Shots
01/27/20142M 9D
Vaccine Y
03/20/20144M 2D
Vaccine Y
Add
Dose 1 Dose 2 Dose 3 Dose 4
Add
Imm Forecast:
Forecast
All
Complete
Complete
11/18/204Due Now
11/18/204Future Recom…
Treatment Billing
Immunization/T. Injections
Immunizations Add Delete Print Print Form
Therapeutic Injections Add Delete
X
Name
Influenza Vaccine Preservat…
Tdap (age 7 >)
0.5mL 10/25/2011 LD UH438AA
C3927BARD10/25/20110.5mL
S Dose Date Given By Location Lot Number
Hx IMM Schedule Flu Schedule
+
10
NameS Dose Date Given By Location Lot Number+
10
Lab: CELIAC DISEASE COMPREHENSIVE PANEL Lab: COMPREHENSIVE METABOLIC PANEL W/O ALT (Ordered for 06/26/2015Others Referral To: Arthur Smith Neurology Reason: eval
Quick SearchProgress Notes Scribe Orders
Procedures:Immunizations:Therapeutic Injections:Diagnostic Imaging:
SF CP
ExampleHOME > ENHANCEEXPANDIDENTIFY
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OBJECTIVE 3:
Enhancing point-of-care interactionsFunctionality: Immunization Schedule
To access the Immunization Schedule:
1. Navigate to the Patient Chart (called Patient Hub in eClinicalWorks)
2. From the top menu, select Imm/T.Inj
8
• The Immunization Schedule can also be accessed from within the Progress Note by clicking on the Immunization link, if included in the template.
• Immunization Schedules can be set up to identify items that are due or past due. Immunization forecasts are recommendations provided by ICE Web Service.
• Not all CDC-recommended vaccines are included by ICE, but they can be added manually.
Save Registry Report
CancelOK
X
NameOverdue Influenza
Due and Overdue for Influenza Vaccine …
NamePatients age =/> 62 with no Influenza vaccine in past 365 days
Flowsheet to use
CDSS Enabled
Name
Description
Web Ref.
Order Set
AgeLower Limit
Influenza Recommendation
Influenza Recommendation
62 year(s)
AgeUpper Limit 200 year(s)
Frequency
Gender
Once
Male
yearly
Sel
…
BothFemale
Immunization Alerts
Addl Entities …
CancelOK
DeleteAddProvider List
Provider Name
ExamplePatients who meet the criteria on the report will have a Registry Alert displayed.
—
— CDSS Alerts
Registry Alerts
Needs Annual Flu Immunization
Update registry alerts
There are no over due alerts today for this patient.
?
Overview History CDSS Alerts
X
HOME > ENHANCEEXPANDIDENTIFY
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OBJECTIVE 3:
Enhancing point-of-care interactionsFunctionality: Clinical Alerts
To create a Registry Alert to notify the health care provider (HCP) of due or past due vaccines:
1. From the Registry, create an immunization query.
2. Click Save Queries.
3. In the Save Registry Report dialog box, name the report. Enter the report criteria or flowsheet entry, if desired.
4. Check the CDSS Enabled option.
9
• Each time the CDSS- Enabled registry report is run, Alerts are updated for patients listed in the registry.
• When CDSS Alerts are used with the Immunization Schedule, they can prompt HCPs of vaccination(s) which are due or past due.
• Registry Reports can also be used to create customized Alerts.
ORDER SET: MEASURE:
Name Strength Take Freq Duration Refills Route Formulation Dispense
New
Browse
Copy Update Delete
Rx
All Age
Unknown
Immunizations
QUICK ORDER SET: NO
DIAGNOSES (TRIGGER):
DIAGNOSES (LINKED):
AGE: (TRIGGER):
GENDER (TRIGGER):
Show AllShow Favorite Lab Companies Only
Aspirin E 81MG 1 tablet Once a day 30 day(s) OrallyMega Multivitamin for men
Tablet Delayed Release 30as directed
Display Labs/DI based on PRACTICE ADMINISTRATOR
Labs BrowseDescription Lab Company Delete
Diagnostic Imaging Browse
Browse
Description DI Company Delete
Name Dose Delete Name DeleteSmart Forms
Add Follow-Up
Browse
ReferralsAppointments
Add
Add
Patient EducationPhysician Education
Add Save Add Save
Add SaveAdd Save
WEB REFERENCE
WEB REFERENCE
CBC W/ DIFFERENTIAL (CBC) -85025
COMPREHENSIVE METABOLIC (GCP0 -80053
CT CARDIAC CALCIUM SCORING ONLY (75571)RAD CHES 2 VIEWS AP (PA) & LAT (71020)
Procedures Browse
ELECTROCARDIOGRAM REPORT (93010) - DONE IN CLINIC
Tdap (age 7 >) 0.5 mL
COLONOSCOPY, DIAGNOSTIC, FLEXIBLE (45378)
Description Delete
FM/Well Male
ExampleHOME > ENHANCEEXPANDIDENTIFY
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OBJECTIVE 3:
Enhancing point-of-care interactionsFunctionality: Order Sets
To create or update an Order Set in eClinicalWorks:
1. From the EMR menu, select Order Set Administration.
2. When the Order Set window displays, select New to create, or select an existing Order Set from the dropdown list.
3. In each appropriate section, click Add to include options such as next in series, patient education, and Web references. Age triggers may be appropriate.
4. Click Save to complete each section.
10
• Order Sets can include orders for vaccines, follow-up appointments, and patient education.
• Use the Message field to display comments or information to the health care provider during use of the Order Set.
• Use the yellow Star icon to mark this order set as a Favorite.
Add As Favorite Merge Template Close
< Prev Next >
Pr Template Access New Patient Initial Visit Public Existing Patient New Visit Existing Patient Followup Visit Immunization Visit Lab Check Sick Visit Well Visit Earache Sinusitis Sore Throat
Copy And Merge Templates
Patient Encounter Date
Find
Facility
All
Relation
Contains
Template For
Choose Template
Generic
Patient Specific
Category
Sel
Go
All Options
CCHPICurrent MedicationMedical HistoryAllergiesSurgical HistoryHospitalizationFamily HistorySocial HistoryROSVitalsExaminationPhysical ExamAssessmentTherapeuticTherapy AssessmentTreatmentProceduresImmunizationsXRayLabs
ExampleHOME > ENHANCEEXPANDIDENTIFY
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OBJECTIVE 3:
Enhancing point-of-care interactionsFunctionality: Documentation Templates
To add a Template to a progress note:
1. From within the Progress Note, select Template from menu at the bottom of the progress note window.
2. When the Copy And Merge Template window displays, select Generic to see all templates.
3. In the Find text box, enter a description or key word for template.
4. Select Contains and click GO to display a list of available templates.
5. Select the appropriate template from the list and click Merge Template.
11
• To preview the template before merging to the progress note, click on the icon to the left of the template name in the list.
• Consider checking Immunizations as part of the template in the Options list.
Template Categories Configure My Favorites Add as Favorite
New Update Delete
View Close
< Prev Next >
Name AccessNew Patient Initial Visit PublicExisting Patient New VisitExisting Patient Followup VisitImmunization VisitLab CheckSick VisitWell VisitEaracheSinusitis
Template List
Templates
Facility
Category
All
All
ExampleHOME > ENHANCEEXPANDIDENTIFY
OBJECTIVE 3:
Enhancing point-of-care interactionsFunctionality: Documentation Templates
To update Template to include Immunizations:
1. From the File menu, select Templates.
2. In the Templates text box, type the name of the template to edit.
3. Click View to display the template within a progress note.
4. Make changes, such as adding the Immunizations section. Changes are automatically saved as they are made.
5. To finish editing the template, navigate away from the test patient.
Copyright © 2016 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc. All rights reserved. VACC-1182285-0000 09/1612