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1. 1 Save and Continue gt Here an appointment for the selected patient is designated as a 20 minute Acute visit The patient needs a urinalysis before the appointment Select the Save and Continue gt link to schedule the appointment The appointment will appear on the schedule and a menu box will open to allow the immediate generation of a note if desired Appointment gt Test Darla Patient Home Patients Documents S Test Darla 1D 09238 DOB 09 Mar 2009 Scheduling New LCD Admin x Address Phone Q Thursday April 26 3 Go to patient s facesheet Appointment 9 April 27 10 00 AM 20 minutes Type Acute Status No Status Comments Blood Pressure check Needs urinalysis prior to appointment Created Today 12 55PM by New LCD Admin 10 History E show notes Today 10 00AM appt Acute od No status selected 11 12 Pi New Note Exit 21 Appointment gt Test Darla Patient Test Darla ID 09238 DOE 09 Mar 2009 Address Phone Go to patient s facesheet Appointment April 27 10 00 AM 20 minutes Type Acute Status No Status Comments Blood Pressure check Needs urinalysis prior to appointment Created Today 12 55PM by New LCD Admin History a E show notes Today 10 00AM 3 Appt Acute No status selected A New Note A new note may be
2. amp add V interval every 1 year s x A Generate Report i Save Changes Exit The report may be named as desired by selecting the Clinical Decision Support option 206 Section XIV The Visit Summary A visit summary may be generated to provide the patient at the completion of each visit The visit summary is generated from data entered into the clinical encounter note The visit summary includes e Diagnoses from the current visit e Vital Signs from the current visit e Laboratory and Radiology study results if available and documented into the note e Patient instructions in patient friendly language e Outstanding orders e Documented Medication Allergies e Medication Changes e The current medication list The visit summary may be generated from the patient console or from the patient facesheet It is recommended that the visit summary be generated after the lab orders are generated The visit summary may be generated either before the note is signed or at the conclusion of the visit after the note is signed and locked The visit summary is saved under the Clinical Data and Documentation section of the chart To generate a visit summary after the note is completed select Visit Summary from the top menu bar File Edit Help Admin Save As Sign Lock a2 Orders _ Visit Summary E Download Clipboard Clear Unda Freetext Exit Console De File Runner Road Medical Note Sunday 26 A
3. After selecting a patient from either the patient menu or the calendar the patient Facesheet will appear 91 l Home Patients Documents Sched Track Scan Lab Report NQF Logan Arnold 8 Upload Quick Links ID 345634 DOB 05 Jan 1946 Age Sex 66 male Address 654 Broadhead Place Lexington KY 40515 Phone s 888 825 4258 Primary B New Appointment lth Record Today s Vitals iz Medica Note Z Medical Note i Medical Note 28 May 2012 27 Apr 2012 07 Feb 2012 iz Create New Document E New Message Diagnoses CORONARY ARTERY DISEASE 414 01 HYPERTENSION 997 91 Medical Surgical History Immunizations Pneumococcal Clinical Decision Support BMP WITH DIURETIC USAGE COLONOSCOPY PROSTATE EXAMINATION PSA TETANUS BOOSTER AAA SCREENING ASPIRIN USAGE RECOMMENDED Clinical Data and Documentation 08 Jun 2012 04 Jun 2012 01 Jun 2012 31 May 2012 28 May 2012 27 Apr 2012 Proc Result Document Document Proc Result Document Proc Result Proc Result Document Order Order The Demographics Section Logan Arnold 8 Upload ID 345634 DOB 05 Jan 1946 Age Sex 66 male Address 654 Broadhead Place Lexington KY 40515 Phone s 888 825 4258 Primary Rx Pharm Rx Status 1 Review Msg Download Print Q Search for patient lug Open A s Add Notes Active Allergies lad PENICILLINS Severe Anaphylaxis amp SULFA SULFONAMIDES M
4. Reporting Hyperlipidemia Patients H Patients AGE at least 18 and DECEASED is empty having HH Diagnoses Any Another ea add Selecting Any from the diagnosis category will allow further drilling down to more specific criteria Diagnoses Criteria ICD Code el Description Date Date Closed Active Status User Prompted 203 Each category will have multiple criteria from which specific data may be chosen Not all fields are necessary Add data only to those fields which are appropriate for the desired report Under Diagnoses the Description category allows searching for a verbal diagnosis whereas ICD code searches for an ICD coded diagnosis Multiple criteria may be added to the same report To add Hyperlipidemia Hypertriglyceridemia and the ICD code 272 4 first add Hyperlipidemia under Description We recommend using the Contains option as it allows broader searches Diagnoses Criteria ICD Code A Description contains h Date A Date Closed A Active Status x User Prompted le o 3G Delete Cancel Reporting Hyperlipidemia Patients HH Patients AGE at least 18 and DECEASED is empty having H Diagnoses DESCRIPTION contains hyperlipidemia Another add Ece Next choose Another to add additional criteria Reporting Hyperlipidemia Patients Hl Patients AGE at least 18 and DECEASED i
5. Patient Note Entry allows you to document any notes regarding the prescription such as side effects Remember to click the lt Save Note gt button after you have typed in your patient note Patient Education adds instructions that appear here and on the Patient Face Sheet As with the Patient Note Entry remember to click the lt Save Note gt button to retain any information you typed in this area At any time while viewing this Detail Rx page you can click on Close Return to previous page to go back to your page of origin Remember changes will be saved only if the lt Save Note gt button is clicked prior to exiting the page 181 Administrative Page Functions The Admin Page lists a variety of functions designed to make your office run more efficiently that don t necessarily fit directly into writing a prescription Come here to print reports or forms build lists add patients and review our supporting materials Clinical staff can enter the Admin Page by selecting the lt Admin gt tab on the far right of the Navigation Bar Clerical Admin staff come directly here Select a task on the Admin Page and click on the Help link at the bottom of each page to learn more This entire reference manual can be viewed and printed from the Reference Manual link on the Admin Page Add Patient is present if your account includes this function Note that a search for duplicates is required prior to adding a new patient Coming soon 1
6. You should rest your voice as much as possible Ordered Today BMP CK MB Page fof 2 209 Runner Road Visit Summary Sunday August 26 20712 LCD Solutions LLC Date Produced 26 Aug 2012 06 25PM Culture Throat Medication Changes Add Zithromax 500 mg Tab 2 tablets on day 1 and 1 tablet on days 2 5 Current Medication List Depotest 200 mg mL IM Oil 7 mL every two weeks intramuscular inject Lipitor 10 mg Tab 1 tablet at bedtime by mouth lisinopril 10 mg Tab 1 tablet daily by mouth Synthroid 100 meg Tab 1 tablet daily by mouth Toprol XL 50 mg Tab 1 tablet daily by mouth Zithromax 500 mg Tab 2 tablets on day 1 and 1 tablet on days 2 5 Page 2 of 2 210
7. surfing the Internet the lt Back gt button will not take you to the previous screen This is a safety measure the previous screen may not show current patient information Instead if you 140 wish to revert back to a previous screen use the navigation bar at the top of the screen or the buttons that say lt Return to Prior Page gt lt Cancel gt etc Turn off Autocomplete This browser feature displays previously entered information while you are typing New Crop s search features work well with only the first 3 or 4 letters of a word so Autocomplete is unnecessary and could be confusing We suggest that you deactivate this feature by going to Internet Explorer and clicking Tools at the top Then click lt Internet Options gt lt Content gt lt Personal Information gt lt Autocomplete gt Uncheck the box for Forms Turn off the Google Auto Fill Function While this function allows automatic entry of your own name and address on web sites it can cause text fields on your ERx pages to appear yellow In order to avoid any confusion we suggest that you disable this Google feature while using ERx To disable this function click on the button on the Google taskbar which says HHH Blocked You may restore the function after exiting ERx by clicking on the button which now states pop ups okay Help ERx is designed to be simple and intuitive In the event that you need it there is a link to the Help Pag
8. Clicktates User Manual User Manual www clicktate com Welcome to clicktate com With Clicktate you will be able to quickly and inexpensively generate office notes manage a physician schedule save notes into patient folders write electronic or paper prescriptions develop user customized templates and create multiple accounts for one practice with sharing of acommon patient database within the group Since Clicktate does have a learning curve we encourage you to take a few moments and familiarize yourself with the system by reviewing this Users Manual We also encourage you to take a few days fourteen to be exact during your free trial and get to know the system During your FREE NO OBLIGATION trial you can create as many notes as you like maintain a schedule and send The Best Way to Learn interoffice messages all at absolutely no expense Clicktate is to use to yourself or your practice UE CHL olate Me practice Start witha We pride ourselves on being responsive to our few notes daily and users Don t hesitate to contact us anytime if you increase as you learn have questions or comments the system We may be reached at info clicktate com or you may call us at 1 888 8click8 1 888 825 4258 Table of Contents Section I About LCD Solutions and Clicktate Section Il Configuring Your Browser Section Ill Getting Started Section IV Navigation through the System and Scheduling Section V Starting Patient Do
9. To specify with whom a patient is to be scheduled use the Scheduling dropdown menu To Link providers within the practice please contact Clicktate Home Patients Scheduliiig Dr LCD 24 User Customization Options within Scheduling and Patient Management Multiple options may be customized to user or practice preferences within Clicktate To customize the calendar module select the Customize button in the upper right corner above the calendar i Logged in as ledadmin4 My Profile ICD Admin Logout o Home Patients Documents Sched Track Scan Lab Report NQF Rx Pharm Rx 71t Scheduling New LCD Admin x Q Thursday April 26 Friday April 27 2012 s 20 View entire week Customize Schedule Here the work week may be specified and Calendar Display time slot intervals may be entered according to Work Week Start Monday Length 5 days Time Slots By selecting From 09 00 AM To 05 00 PM size 45 minute Customize Appointment Types or provider preference Appt Label ppt Customize Arrival Last F Phone 7 Status these may be Fl Save Changes Reset to Default set to user preference as well To customize appointment types enter the types of E Customize Appointment Types appointments to be Ey Customize Arrival Status scheduled for the selected provider 25 Customize Appointment Types Active Acute Active Follow up Active New patie
10. current Allergy History With checked x Remove from List C3 Add an Allergy Exit Select the medication or type in a new medication in the free text other box 96 Allergies Cipro Hydrocodone other Select Free Text And then select the reaction and save changes Allergies Reactions for Cipro Augmentin Morphine Cephalosporins Erythromycin NSAIDs Rash F constipation FP Itching E Hives Anaphylaxis Generalized Swelling E Swollen Mouth E Swollen Tongue Abdominal Pain E Abdominal Upset Nausea E Vomiting E Diarrhea E other Shortness of Breath E Cough E Headache E Dizziness Chest Pain E Syncope E Bleeding E Bruising Epistaxis E Sore Throat E Dysphagia al Save Changes 97 Contrast O ye Breast Pain Breast Swelling E Urinary Frequency Urinary Retention E Dry Mouth Vaginal Dryness Excessive Sedation Myalgias E Fatigue E Liver Dysfunction Renal Failure Clicktate Test Patient Allergies Current Allergies CIPRO Rash EI With checked x Remove from List oF Add an Allergy The allergy will appear in a highlighted section on the Facesheet and will also automatically be inserted into notes Active Allergies m 1 CIPRO Rash To review the allergy history select the Allergy History tab on the Allergy Pop up 98 Clicktate Test Patient Allergi
11. Discontinue Discontinue Medi Refilled Select to Print RX button to generate a prescription 8 A prescription pop up will appear Clicktate Print Medications ma Mark Winters MD A Complete Care Medical Group 100 Caring Way Suite 200 Sunnyville KY 40356 688 625 4258 Lic 00000 KY DEA BMOOO0000 NPI 000000000 Medication TOPROL XL EQ 25MG TARTRATE Take 1 daily Noe gt O Print checked as RX 4 per page O RX 1 per page Final edits to the prescription such as number of refills and substitution status may be selected Selecting OK will generate a prescription for printing In addition prescriptions may be printed as one per page or four per page Mark Winters MD Complete Care Medical Group 100 Caring Way Suite 200 Sunnyville Kr 40356 COAL 42S Lic 00000 Kr DEA BM0000O0O NFI 000000000 Date 1 30 2010 Cuppy Bobbi 03 10 1970 TOPROL XL EQ 25MG TARTRATE Sig Take 1 daily Disp 30 Refills 0 signature 88 The prescription may then be printed Once this page is displayed the prescription information will appear in the note EVEN IF THE PRESCRIPTION IS NOT PRINTED Add TOPROL XL EQ 25MG TARTRATE 1 daily Disp 30 Pri Add Med Discontinue Discontinue Med Refilled Refill Med To add additional medications again select the Add Med button To discontinue a medication select the Discontinue Med button Add RX 1 30 2010 Disp 30 R
12. Medicare PartD O Lizer displays choices available to the patient and a summary of drug coverage click on the click here to add a new patient link Fill in ata minimum the required fields marked with an asterisk Don t forget Gender and Zip code These are needed to access RXHUB formulary eligibility and patient Rx history The following data formats are used The medical record number should always be entered exactly in your format including any dashes or other characters type amp 182 nbsp Valid format Dates Month Day Year or MMDDYYYY Example 3 20 2004 0320 Phone Number NNN NNN NNNN or NNN NNN NNNN or NNNNNNNNNN Zip Code Five numbers Zip4 Four numbers SSN Nine numbers or NNN NN NNNN To change information for a current patient click the lt Pt Details gt tab on the Navigation Bar Make the desired changes and click lt Save gt Note the check box labeled Current at the top of the page If unchecked the patient will not appear for prescription writing Uncheck the box for those patients that have moved away etc They can be made Current again at any time by coming back to the Pt Details page and checking the box Pharmacy Communication Log Summary The Pharmacy Communication Log provides a record of all electronic communications with pharmacies via the Surescripts network Use your mouse to highlight and print reports if so desired Note that an Rx denied without a patient appears only here
13. Select the desired formulation that then appears above as Pending where the sig can be added To add the sig click Edit Note the check box at the bottom of the Edit box Checking this box adds the entire Rx to the Doctor s Drug Rx List for future reuse However drugs are automatically added to the Doctor s List as they are selected To view the Doctor s Drug list leave the Search box blank and click lt Drug Search List gt Drugs can also be added or subtracted from lists by using the check boxes which appear to the right of each drug search result Multiple Current Medications can also be selected for renewal by checking the boxes to the left of each current med that is listed All newly selected drugs will appear at the top of the page as Pending Prescriptions The Instant Renewal button in the Current Medications section of the page allows sending a batch of renewals directly to the patient s pharmacy Pending Prescriptions are part way through the process but have not yet been added to the patient s Current Medication list Any incomplete Rx are highlighted for example an incomplete or missing sig In addition to those newly selected you will also see 1 Rx left at any point in the process Stage InProc 2 Rx left by Clinical Staff for doctor review DR An Rx that has been approved by the doctor left for Staff processing but has not yet been printed or sent to a pharmacy is staged NS and is highlighted You can click on the drug to
14. Severe appears in yellow and indicates action may be required to reduce the risk of adverse reaction Moderate appears in yellow and generally indicates a need to adjust medications Herbal interactions are not characterized as to severity due to lack of standardized content and dosage Use the More Info link to see complete information on any potential interaction listed Allergy compares the rx to the patient allergies as entered on the Compose page are passed from an EMR Detail is not available as it relates to the individual patient response 167 The Drug Condition check is activated when the Diagnosis ICD or pregnancy V code is passed from the EMR or PM system Direct users you can enter the Pt Dx via the Diagnosis tab on the Nav Bar Detail is not available as it relates to the individual patient response Pending Prescriptions from all workgroups in your account are displayed You may deselect a prescription to transmit it individually All selected prescriptions will be transmitted as a batch Clicking lt Proceed to Print Transmit gt takes the current batch to the Routing Page where it will then be transmitted If neither printing nor transm itting is needed such as for a Schedule 2 drug click lt Finish Add to Current Meds gt This adds the Rx to the patient s Current Medications but does not allow any further transmission of the Rx Doctors who choose to have their staff finish transmissions may click the lt App
15. Test Darla Label Medical Note Date of Service 11 May 2012 HE E Use as patient s standard Medical Note a Save Note Cancel 42 Sign Lock Signs and locks a document in a permanent form preventing further changes Confirmation Required L fa j You are about to digitally sign this document and lock it from further edits Are you sure File Edit Help Admin H New YOpen l Save As Sign Lock 32 Orders Download jijClipboard C Clear Undo YX Delete Freetext Exit Console Template Map gt lt Customize FAMHX IOL IMPR PLAN PROC RTO TIME cc Test Darla Medical Note Friday 11 May 2012 Send To None a Main A q Acute Bronchitis B 4 Acute Gastroenteritis 4 Constipation Constipation Follow up LE Cough Cough Follow up H S Fever 1 4 Hypothyroidism Follow up J Otitis Media LK q Otitis Media Follow up Quick Note M q1 Skin Lesions LN 4 Tobacco Abuse Disorder Upper Respiratory Infection 4 Urinary Tract Infection R Viral Syndrome 5 Complete list Abdominal and or Pelvic m Pain Female Lv 4 Abdominal and Pelvic Pain W Follow up 4 Abdominal and Pelvic Pain Male Abdominal Aortic Aneurysm Follow up 4 Abnormal Labs Hematuria Abnormal Pap Follow up q Abrasion Abscess q Acidosis q Acne q Acne Follow up Selecting Yes History of Present Iliness As relates to hypo
16. This Log provides you a way to view a record of prescriptions that have been received from pharmacies electronically and then processed back through to oharmacies If a prescription is denied particularly for an incorrect patient a record of the transaction will only appear here Approved prescriptions are added to the patient Current Medication List Click the Pharmacy Communications Log link from the Administrative Functions page to see the log of transactions To print 1 Use the mouse to select the desired content 2 Click lt File gt on the browser navigation bar and select lt Print gt 3 Select a printer and click the Selection option in the Page Range Box 4 Click the lt Print gt button 183 Prescriber Report Summary Prescriber Report provides a printable log of all Rx authorized by a doctor This report generates a Summary of all prescriptions authorized by a doctor 1 Select the desired doctor from the drop down list for this location 2 Select a date range for the report by clicking on the calendar days For a one day report click the same day on both calendars 3 For sequential reports note the date of last report Use this date to generate a new report using the ending date of the previous report as a start date 4 Click the Printer Friendly link and use browser buttons to print Patient Details Page Summary The Patient Details page displays the selected patient s general information addr
17. a report type may be selected Reporting Type All Audit Logs Clinical Decision support Meaningful Use Patient Reports e Audit Logs are Audits of System Use within Clicktate e Clinical Decision Support reports are reports that are based on Clinical Decision support rules and appear on appropriate patients facesheets as clinical reminders Clicktate includes a preconfigured set of Clinical Decision Support rules The preconfigured reports cannot be altered at the user level Users may also create their own practice specific Clinical Decision Support Rules e Meaningful Use reports are reports that generate meaningful use data e Patient reports are reports that can be used to quickly gather data regarding your patient population To generate a report select the report from the list and it will automatically run and generate the report based on the report characteristics 199 Reporting Medicare and Medicaid EHR Incentive Program New LCD Admin LCD Solutions LLC LCD Headquarters Lexington KY 40536 NQF 0013 X Configure this repot Q Return to list Hypertension Blood Pressure Measurment Percentage of patient visits for patients aged 18 years and older with a diagnosis of hypertension who have been seen for at least 2 office visits with blood pressure recorded Patients AGE at least 18 e having at least one of Diagnoses ICD CODE contains 401 and ACTIVE is Yes ICD CODE Patients AGE at least 18 contains
18. e Example1 A receptionist may enter medications into the patient s record that a docior outside of this practice has previously prescribed e Example2 A receptionist takes a phone call from a patient asking that the Doctor Prescriber renew a prescription That information is entered into the queue from this screen and Is available for review and processing by an authorized prescriber The Patient s Name and DOB Date of Birth are displayed on the left side of the page below the Navigation Bar On some pages the patient s insurance plan will be displayed on the right side of the screen If the patient has more than one plan the drop down box will permit you to scroll through the list of this patient s plans You may use the drop down box to select the particular plan which applies to a prescription Comprehensive users only RxHub is an on line managed care information source If the patient is a designated RxHub patient current eligibility will be displayed directly below the patient s name along with an RxHistory RxHub link Click the check box to view the patient s eligibility Click the Rx History RxHub link to view this patient s all doctor prescription history as provided by the patient s healthplan Confirmation of physician status and selection of a time span is needed first If the patient is not an RxHub patient these links will not appear Doctor Mid Level Staff Selection All users must ensure that a Desig
19. lt SPAN Medicare PartD O Lizer Summary The Medicare PartD O Lizer displays choices available to the patient and a summary of drug coverage Medication Entry and Refill Page Summary The Medication Entry and Refill Page is used to 1 quickly record medications for new patients or those prescribed by doctors outside your account These medications are added to the patient record and can be selected for modification and re use on the Compose Rx page 2 add an Rx request to Pending Rx for further processing by doctor or clinical staff The Medication Entry and Refill Page may be accessed by clinical users via the link on the Compose Rx Page or the link on the Admin Functions page This page allows staff not authorized to finalize prescriptions to still enter medication information into the patient record for reference or future processing For new patients use this page to enter medications initially You search for a drug the same as you would on the Compose Rx page however you will notice that once 186 selected the checkbox to the left of the drug name is highlighted in blue and a complete sig is not required Drug review does not occur when adding an Rx on this page however the Drug Review can be used to perform this function after entry Any doctor s name can be entered as the prescriber and any start date can be entered Be sure to enter that information prior to searching for and selecting the drug The medications enter
20. transferred to the NewCrop system you may check the delete box and delete the medications from the Imported Rx list Alternatively the medications may be retained on this list for reference Rx Date ETENE Dispense Refills DAW Reported Dr Memo Delete vaeane BREVACD GMS fey O ONO 12 24 09 TOPROL XL yee 25MG TARTRATE To transfer Legacy allergy information to the NewCrop system select the Allergy from the imported allergy list 127 Enter optional Outside Doctor and or Original Start Date before selecting drug Replace current doctor Enter Original Start Date Month Day Year Doctor s List 3 letter min 5 recommended Include obsolete drugs No Allergies have been entered Click to include Name Severity Notes Allergy Intolerance Search Enter at least 3 letters of drug or non drug allergy to search Cipro Search For Allergy Click on drug intolerance to select Cipro Cipro HC Cipro I V Cipro in DSW Cipro AR CIPRODEX Ciprofloxacin Click here to add a non drug allergy if not found Rx Date Drug Refill Doc Loc Source Toprol XL 50 mg 4 hr Tab Prevacid 30 mo Cap From the Allergy Intolerance Search box make the appropriate selection Adjust severity or enter additional information then save Cipro Select Severity Previous note may appear Delete as needed and enter an additional note Swollen Mouth Abdominal Pain Save Add Additional Allerg
21. 40515 Reporting Type Clinical Decision Support Name Description a Wi AAA Screening Ultrasound Abd Aorta A one time screening for abdominal aortic aneurysm AAA by ultrasonography in men aged 65 to 75 years who have ever smoked is recommended Wi ACE Inhibitors in Patients with Congestive Heart Failure ACE inhibitors are recommended for routine administration to symptomatic and asymptomatic patients with left ventricular ejection fraction LVEF 40 Wi ACE Inhibitors or ARBs in Diabetic Patients ACE or ARB in DM Use of ACE Inhibitor or Angiotensin Receptor Blocker is recommended for Diabetic Patients Wi Advanced Directives Advanced Directives Record Advanced Directives for patients aged 65 and older mii Aspirin Usage Recommended Aspirin Use Recom Men Aspirin usage is recommended in men age 45 79 years when the potential benefit due to a reduction in myocardial infarctions outweighs the potential harm due to an increase in gastrointestinal hemorrhage Pi Aspirin Usage Recommended Aspirin Use Recom Women Aspirin usage is recommended in women age 55 79 years when the potential benefit of a reduction in ischemic strokes outweighs the potential harm of an increase in gastrointestinal hemorrhage Wa Beta Blocker Therapy in Patients with Congestive Heart Failure Beta blockers shown to be effective in clinical trials of patients with HF are recommended for patients with an LVEF 40 The combination of a beta blocker and an ACE inhibitor is recom
22. 997 1 and ACTIVE is Yes ICD CODE contains 405 and ACTIVE is Yes having at least one of Diagnoses ICD CODE contains 401 ICD CODE contains 997 1 ICD e having Vitals SYSTOLIC has a value and DIASTOLIC has a value CODE contains 405 e having at least 1 Sessions TEMPLATE is Medical Note having at least 1 Sessions TEMPLATE is Medical Note Patients Diagnoses Vitals Sessions ig Biltmore Troy Essential 01 11 11 Pulse 64 Medica Note hypertension Resp 20 BP 140 52 Unspecified 401 9 RUE Temp 97 8 Wt 155 Height 69 BMI 23 ig Cuppy Ronald Essential 12 26 09 Pulse 82 Medical Note hypertension Benign Resp 12 BP 128 82 401 1 LUE Temp 99 Wt 132 Show Denominator 6 records Height 66 02 94 Room Air BMI 21 Q Rogers Tim 405 12 24 09 Pulse 80 Medical Note Resp 12 BP 134 74 RUE Temp 98 9 Wt 156 Height 72 BMI 21 x Numerator record s returned 4 Download Total 66 67 The report parameters are displayed on the report If a Configure this report link is present on the top of the page the report may be altered by the user Creating a New Report To create a new report select New Report located at the bottom of the Reporting page Reporting Type Name Description Audit Logs Clinical Decision Cholesterol for Hyperlipidemia A ee Support Meaningful Use HG Patient Reports 7 HIV Disease Patients diagnoses with HIV or AIDS w Lipitor 7 NOF 0
23. Admin Page 4 Order Log shows these manually written items that are not put on the Current Meds list le wheelchair When writing an order the user can choose to put the item in either location 5 Denied shows these items only when an advanced feature Accept Send is in use This feature allows ie a nurse to assign an rx to a doctor This rx cannot be cancelled or deleted It can only be denied lt SPAN RxNorm is a drug index an alternative to First Data Bank If you are reading this via the link on the prescribing pages your system is utilizing RxNorm If you are reading it as part of the Reference Manual it may not apply as many accounts do not utilize RxNorm To see which you have look at the bottom of the Review Page RxNorm was created by the National Library of Medicine The goal was to supply a drug list meant for electronic prescribing that was available free of charge Several high quality drug lists already exist First Data Bank Multum Gold Standard etc However the licensing cost from each supplier was seen as an impediment to large scale implementation of erx 165 A second goal was to supply a cross walk between all proprietary indexes a metathesaurus This would allow a patient s drug history to be easily converted to alternate drug indexes important for interoperability RxNorm does deliver these goals to varying degrees however it re
24. Any changes will be saved only if the lt Save Send gt bution is clicked The Print Transmission Log is also displayed on the Detail Rx page If the prescription was transmitted electronically you will see the details of that transmission A successful transmission will display the word Success Occasionally a pharmacy will report that they did not receive an electronically transmitted prescription even though the log states success If this occurs please click the lt Report Missing Rx gt button immediately upon hearing from the pharmacy or patient This will allow us to verify that the transmission was indeed complete This feature is only to be used for prescriptions sent electronically For missing successfully faxed Rxs contact the pharmacy directly and suggest they check their fax machine before requesting renewals Clicking on the lt Reprint Transmit gt button provides you the ability to retransmit or reprint the prescription If the prescription was part of a batch you have the option of retransmitting or reprinting the entire batch or an individual prescription Any retransmissions or reprinting will be documented in the Print Transmit Log You may use this feature when you need to resubmit a prescription or an entire batch of prescriptions Sig History displays a log of all sig changes made to this prescription The authorizing doctor and user are both displayed The sig changes will be listed on the patient record
25. Decision Support Patients Any amp add ab Select Procedure EH Generate Report z Save Changes Exit Select Select Procedure and the Procedure selector appears Test Procedure Selector Test Procedure A G Ratio ELT Repair Endovascular EETA Repair Endovascular EET Repair Surgical M2 Abdominoplasty I Abd Wall Hernia Repair M Accucheck BB ACE Antibodies Category 5 A G Ratio Labs Endovascular AAA Repair Surgical Endovascular ASA Repair Procedures Surgical AAA Repair Surgical Abdominoplasty Surgical Abdominal Wall Hernia Repair Surgical Accucheck Blood Glucose Labs ACE Antibodies Labs The items denoted by a green icon are generic to the system The items denoted by a red icon are practice specific icons From this menu select the item for which a Clinical Decision Support rule is desired Searching for Albumin gives the following result Test Procedure Selector albumin Test Procedure E Albumin Urine Albumin Murine Microalbumin P A G Ratio E asa Repair Endovascular DERT Repair Endovascular EET Repair Surgical E Abdominoplasty D inti Albumin Urine Albumin Urine Microalbumin A G Ratio Labs Endovascular AAA Repair Surgical Endovascular AAA Repair Procedures Surgical AAA Repair Surgical Abdominoplasty Surgical db Add Custom 112 Choosing Albumin from the list will allow Albumin to be tied to a Clinical Decis
26. Document From test clicktate com m While files from the Intemet can be useful some files can potentially ham your computer f you do not trust the source do not open or save this file What s the isk ila File Download Do you want to open or save this file Name Simon Sara doc Type Microsoft Office Word 97 2003 Document From www clicktate com While files from the Intemet can be useful some files can potentially ham your computer f you do not trust the source do not open or save this file What s the risk e Clipboard Copies a note onto the computer clipboard where it can be pasted into any system that accepts pasted documents e Clear Clears the document and allows the user to start over 45 e Undo Reverses the last action taken To reverse further actions continuing to press the undo button will reverse actions sequentially starting from the most recent e Delete Deletes text that is selected from a document To delete a section of text select and highlight the section to delete and then press the Delete button 7 Download sic Test Darla Medical Note Friday Send To None Delete Freetext Exit Console As relates to hypothyroidism the py went reports a good energy level She reports no hair ic She is taking her medication as prescribed gt heat intolerance cold intolerance diarrhea co
27. E Nephrology Follow up E Nephrology Referral E Nutrition Follow up E Nutrition Referral E Oncology Follow up E Oncology Referral E Ophthalmology Follow up E Ophthalmology Referral E Personal Trainer E Plastics Follow up 57 E Plastics Referral E Probiotics E Surgery Follow up E Surgery Referral E Urology Follow up E Urology Referral FP Vitamin D 1000 U Daily E Vitamin D 1200 U Daily E Vitamin D 1500 U Daily E Vitamin D 2000 U Daily E Vitamin D 400 U Daily E Vitamin D 800 U Daily E Wt Loss Recommended E Wt Loss Clinic Follow up E Wt Loss Clinic Referral E Wt Watchers Recommend E Continue Meds E Adjust Meds F Add Med The green boxes at the top are SINGLE SELECTION BOXES checking these boxes will close the window and input the selection with no further action The smaller check boxes at the bottom are MULTI SELECTION BOXES where multiple selections may be chosen Click the apply checkmarked button when you have made the appropriate selections The other box at the bottom may be used to input items not found in the other multi or single choice options 58 The Free Text Box Because we realize that it is not possible to anticipate every scenario that a patient may report we have included a free text option To turn on the Free Text Option select the Free Text button from the menu or the File menu dropdown la Save 2 SignandLock M Download 4 C
28. ID 8203 490 DOB 16 Apr 1958 Age Sex 54 female Address 7 3 Fhonelst Open for date Select the date and time to begin the appointment entry process Select the correct provider from your group in7 LCD Admin G Sunday February amp 18 Patient Selector Search for a patient 3 Customize Last Name Patient ID 8203490 al Winter Snowy R 16 Apr 1958 092384 j Rogers Tim 15 Jun 1937 345634 al Logan Arnold 05 Jan 1946 987543 isl Fila Chick 09 Mar 1995 2304892 Walker Randy 02 Jan 1991 987354598 al Cuppy Ronald 20 Aug 1963 2343254 E Thumb Tom 08 5ep 1981 345345 8 Melendez Michele 13 Jan 1982 039458 E Bower Mandy 08 Nov 1979 O07 3 A Tf Ares ree 4131 ul 1 0A0 Or mark time as unavailable Unavailable From this window a new patient may be created or you may search for an established patient by entering a Patient ID Partial Patient ID Name or Partial Name Selecting the Cancel button will return you to the scheduling page Patient Selector Search for a patient 3 Customize Last Name test First Patient ID pa Search op Create New Patient 09238 Test Darla 09 Mar 2009 123456 a Test Paula 31 Dec 1969 09238023 al Test Troy 02 Jun 1959 84593 A Tester Tony 01 Jan 2010 Or mark time as unavailable Unavailable Here a search for a patient with the last name test has returned four patients By s
29. Location Workgroup where you are working Some users will have only one Location Workgroup listed while others may have several If your list is incomplete or inaccurate contact your 144 Account Manager To return to this page at any time you may click on your Location Workgroup name in the upper left corner of your screen Your last login date and time can be found at the bottom of this screen When you reach this page you should verify that the date time stamp is correct If it is not it may indicate unauthorized use of the system Contact your Account Manager about any discrepancies The Logout link is located in the upper left corner of the screen Click on this link when you are away from your computer for an extended period of time or when you are done with your e prescribing session Logging out will deny unauthorized users access to the system lt SPAN The Select Patient Statf Page Navigation Bar Summary The NavBar at the top of each page provides a quick way to change tasks pages Note your name the current user on the left and the current Designated Doctor Prescriber whose name will go at the top of the prescription to the right Make a change on the Select Staff or Select Patient Page A drop down list for changing doctors also appears on the Compose Rx page Pt Detail displays the selected patient s address insurance etc and allows updating in some configurations An insurance plan must be entered fo
30. Navigation Bar in the center of the page is the Status Bar The Status Bar is a link which reads Pharm Fax _Pend and indicates the number of Assigned Rx Messages for this account requiring review The numeral indicates the quantity of pharmacy requests faxes needing attention and prescriptions pending review This information helps the user keep current with the Account s workflow By clicking on this link the user is directed to the Status Page where these prescriptions may be reviewed and then redirected or acted upon Directly below the tabs on the Navigation Bar to the left of the screen is Your Location Workgroup Name In some instances the name may be abbreviated Clicking on this link takes you back to the Select Location page where you may change your Location Workgroup logout reset your password review the bulletin boards or use the quick drug reference tool Your Login Name followed by the word logout appears as a link to the right of your Location Workgroup link Click on this link to logout and complete your session returning you to the Login page It is a good habit to click on this link when you are going to be away from your computer for an extended period of time or when you are done with your e prescribing session Logging out will prevent unauthorized users from accessing the system If you have two different logins you may use this link to toggle between the two For example You have one Login as Account Manager and
31. Order Entry CPOE and Tracking System thereby allowing users to save and track orders as they are entered into a note This is explained in detail in the Order Entry and Tracking section of this manual Download Downloads a note to Adobe Acrobat Reader Click the open button to open the document If you desire to print out a document you may do so from Adobe Acrobat by pressing the DOWNLOAD button at the top of the console When the Download button is activated a dialogue box will appear to ask if you would like to Save or Open the Document To Open the Document to Acrobat Press the Open button The appropriate Header and Footer will appear on your document automatically This includes the patient s birthday page number physician name and date of service Both notes that either open or signed locked may be opened from the menu bar in Adobe Acrobat If a user desires to open a note in Microsoft Word this may be accomplished from the File Menu which is found in the upper left corner of the Console Open the file menu and select Download as Word from the Menu Edit Help New Note New Replicate New Replicate Test Darla Mec Open Note Send To None Save Note As Sign and Lock x Delete Note Apply Custom Template Manage Custom Templates p Exit Console 44 Do you want to open or save this file Name Cuppy Ronald doc Type Microsoft Office Word 97 2003
32. a separate Login as Doctor Prescriber To the far right of the Login Name is the Designated Doctor Prescriber person whose name will be listed at the top of the prescription The name listed here will appear at the top of any prescription written The Designated Doctor Prescriber can be changed on the Compose Rx page or Med Entry page by selecting the name from the Drop Down box on the each of those screens Alternatively you may change the Designated Doctor Prescriber from the Select Staff Page Select Patient Page for Direct Users See information pertaining to the Select Patient Staff below At times some or all of the following links will appear below the Navigation Bar depending upon the page you are viewing 147 The lt Progress Note gt Link This link appears on the Compose Rx page and provides a progress note to print and place in the patient s chart This note lists the patient s known allergies as well as all current medications with the dosages and dates dispensed Additionally it affords the practitioner the ability to enter information such as height weight or chief complaint for this visit The lt Face Sheet gt allows you to display and optionally print a Face Sheet for the examining physician s reference This Face Sheet displays the medications that the patient is currently taking as well as allergies patient demographics and diagnoses in a printable format The lt Pt Face Sheets is intended to be given to the
33. behind another and be hidden Training and Help Videos and illustrated pages are posted on the Admin Page For more detail each page has 132 a Help link at the bottom The Help pages are compiled in the Reference Manual posted on the Admin Page Use the customersupport address at the bottom of the page for any remaining questions Look for user tips to the right of the title bars Patient Education Use Control key to multiselect and add text as needec The Navigaton Bar The NavBar at the top of each page provides a quick way to change tasks pages Note your name the current user on the left and the current Designated Doctor Prescriber whose name will go at the top of the prescription to the right Make a change on Select Staff or Select Patient Page or for nurses with the drop down on the Compose Rx page To the left the RxHub RxHistory may appear click to view an all doctor Rx history from the patient s healthplan Pt Dx displays the patient s diagnosis list Admin has reports and other supporting functions IMPORTANT Pt Details is where the patient s preferred pharmacy can be set to automatically receive all approved rx 1 click for you Many steps for the rx The Location Resources Page This page is accessed by clicking the link to the left of the Nav Bar Use for a drug reference and to change locations as needed NOTE for multiple Location Workgroups you will see all prescriptions written by all
34. clicking in the box and overwriting it with the appropriate physician s name NOTE If the code you are searching for is not displayed then you should change your search criteria and click lt Search gt again Once you have filled in the fields click the lt Save gt button This will add the diagnosis to the patient s list of current diagnoses If you have finished searching for the diagnoses you can click the lt Close List gt button which will display the patient s current diagnoses list and Previous Diagnosis List To move a current diagnosis to a prior diagnosis check the Move box associated with the chosen diagnosis and then click the lt Move to Prior Dx gt button You may choose to move more than one at a time by selecting more than one checkbox Similarly to move a previous diagnosis to the current diagnosis list check the Move box associated with the chosen diagnosis and then click the lt Move to Current Dx gt You may choose to move more than one at a time by selecting more than one checkbox 191 In addition you may type any Medical History for this patient in the Past Medical History text box by clicking in the white box and typing any desired information Then click lt Save Notes gt to record the information Any information entered and saved here will be displayed on the Face Sheet or Patient s Face Sheet which can be printed from the lt Admin gt page or from the Compose Rx page To print from the Admin page cli
35. dilated eye examination on a yearly Diabetic Eye Examination basis DM Nephropathy Screening Perform an annual test to assess urine albumin excretion in type 1 diabetic Diabetic Nephropathy Screening f Sle z patients with diabetes duration of 5 years and in all type 2 diabetic patients starting at diagnosis Creatinine Measure serum creatinine at least annually in all adults with diabetes regardless of the degree of urine albumin excretion The serum creatinine should be used to estimate glomerular filtration rate GFR and stage the level of chronic kidney disease CKD if present 7 Diabetic Serum Creatinine Measurement PT INR Patients on chronic coumadin or warfarin therapy should have an INR at a minimum of every four weeks and possibly more frequently depending on clinical circumstances INR Due to Coumadin Usage Mammogram Screen Biennial mammography is recommended for women between the ages of 50 74 A discussion should be undertaken with younger women regarding mammography between the ages of 40 50 Physicians should discuss with each woman the potential benefits and harms of breast cancer screening tests and develop a plan for early detection of breast cancer that minimizes potential harms These discussions should include the evidence regarding each screening test the risk of breast cancer and individual patient preferences al Mammogram It is recommended that a Pap smear be completed at least every 3 yea
36. doctor approval or for later use by the nurse Entering a pharmacy here allows the Doctor Prescriber or other authorized prescriber to bypass having to select a pharmacy at authorization time thereby saving him her some processing time The pharmacy selected here automatically receives this prescription once it is authorized and transmitted Viewing Detail of a Current Medication Once the prescription has been reviewed and transmitted it becomes part of the patient s permanent file and is listed as a Current Medication on the Compose Rx page If you click the magnifying glass icon on a Current Medication you will see different features have been added to this screen Below the Original Rx section the prescription is listed along with any other prescriptions that were transmitted or printed at the same time Emailed Copy of Rx allows notification to be emailed to the patient or any other authorized party that this particular prescription has been transmitted to their selected pharmacy Rx Processing Notes records information about the prescription This information is not transmitted to the pharmacy but is used for internal messaging documentation only 180 Any text written in the Patient Education box or chosen from the drop down box below will display on the Detail Page as well as the Patient Face Sheet At any time during the review of this page clicking on lt Close Return to Prior Page gt takes you back to your page of origin
37. dz Until Eee ed Comments 28 The calendar will reflect the change for the current and each additional date C Logged in as lcdadmin4 My Profile ICD Admin Logout ry Home Patients Documents Sched Track Scan Lab Report NQF Rx Pharm Rx Status 1 1 to review Msg Scheduling New LCD Admin x X Customize amp Print Thursday April 26 Friday April 27 2012 Saturday April 28 View entire week It will still be possible to overbook even blocked time periods such as lunch by selecting the area on the calendar in the desired time period beside the blocked time 29 Customization of the Patient Search Option Depending on personal preference the patient search option may be customized to reflect whether the user desires to search by name or by medical record number From the Patient Selection menu select the Customize link Patient Selector Search for a patient Last Name Patient ID op Create New Patient 09238 amp j Test Darla 84593 B Tester Tony 09238023 Test Troy 123456 8 Test Paula 8203490 amp Winter Snowy R 092384 Rogers Tim 345634 a Logan Arnold 987543 Fila Chick 2304892 Walker Randy og724509 Al unn Danald EN Customize Cancel 09 Mar 2009 01 Jan 2010 02 Jun 1959 3 1 Dec 1969 16 Apr 1958 15 Jun 1937 05 Jan 1946 09 Mar 1995 02 Jan 1991 ThA TORS The user will have the option of searching by either name or
38. g insulin Pala ese His injection sites are rotated appropriately The patient r in shortness of breath orthopnea paroxysmal nocturnal dyspnea dyspnea on exertion The patient takes his medication as prescribed does check his feet daily at home H He denice edema palpitations or syncope Based on this change additional information will appear in the note To add additional free text click on the Free Text button in the menu bar A series of Free Text toggles appear Free text can be inserted by clicking on any of these boxes at the appropriate point Let s click the FT box that is after the He is taking insulin sentence The patient reports that he checks his blood sugars athome W His sugars are checked daily W The average sugars are in the 100 150 range W He denies hypoglycemic symptoms ki The patient denies polyuria polydypsia or polyphagia The last eye exam was within the j e been normal H He reports no symptoms of neuropathy The patient takes his medication as prescribed W He is taking in din E BAGA His injection sites are rotated appropriately The patient does check his feet daily athome k He denies che paroxysmal nocturnal dyspnea dyspnea on exertion edema palpitations or syncope A ortness of breath orthopnea As relates to the patient s Coronary Artery Disease he denies diaphoresis The patient reports that he is diabetic but he is not a smoker hypertensive or hyperlipid
39. gt button allows you to simply select all the drugs you wish to renew select the appropriate pharmacy and click lt Instant Renewal gt This process will send the selected prescriptions to the chosen pharmacy and move the original prescription to Previous Medications If no pharmacy is selected or a prescription is incomplete it will move to Pending Rx instead The selected prescriptions will then be listed at the top of the Current Medication list lt O p gt Finally at the bottom of this page are selection boxes to view additional rx flow detail With all of the selection boxes checking the box will display the items 1 Discontinued Previous Medications When selected all previously dispensed medications are displayed under the Current Medications list By using the Previous Medications list the physician has the ability to review the patient s total prescription history The lt Move to Current Medications gt button which appears within the Previous Medications area allows you to move a medication to the Current Medication list by selecting the box to the right of the medication and clicking 164 the lt Move to Current Medications gt button 2 Cancelled Mid Process shows any medication that has been deleted with the X icon prior to being added to Current Meds 3 Pharmacy Communications show all PharmCom Surescripts transactions Denials will only appear here and on the Pharmcom report on the
40. gt button takes you to the Transmit Confirmation Page You will see a printable 174 220 receipt of the completed transaction along with any additional selected copies or leaflets Use the Print link to access your network printer Note the adjacent Return to Routing link that displays any remaining prescriptions for this patient on the Routing Page Note the Pharmacy ID listed to the right of the DEA number is a unique identifier that may be requested by a pharmacist to confirm the source of the Rx lf there are no prescriptions left on the Route page use the tabs on the Navigation Bar to select your next task Note There is a sight delay with transmitting so please make patients aware of this especially if the pharmacy they are going to is within 5 10 minutes of your clinic lt SPAN Pharmacy Communication Processing Pages PharmCom Summary The PharmCom pages process renewal requests submitted electronically by pharmacies using a Federally mandated sequence the pharmacy request cannot be modified Only of refills can be changed If the pharmacy is not correct you must deny the prescription Some or all of the following steps may not occur depending on the amount of information sent by the pharmacy On the PharmCom Patient Select Page select from the displayed search results If the patient is not seen correct the name or spelling and re search if needed Select the patient before denying or the Rx will not app
41. has been recorded in the Pharmacy Communications Log which is accessible from the Admin page or from the Compose Rx page by checking the Show Patient PharmCom box You will also note that the PharmCom Review page like the PharmCom Compose page provides you with the lt Deny and Rewrite gt option as well as the lt Deny gt option in the event you find yourself on this page and realize you are unable to accept the request as submitted by the pharmacy for this patient Once you have replied to the request you will view a PharmCom Confirmation page From here use the tabs on the Navigation Bar to take you to your next activity task End of REFErncE MANULA The Rx Detail Page Summary Accessed via the magnifier icon adjacent to each Rx this page displays additional information regarding the Rx Coming soon as the Rx is being processed Pre Select Pharmacy allows instant sending of the Rx upon doctor approval or for later use by the nurse The Email function will send a copy of the Rx as appropriate Rx Processing Notes allows attaching a message to the Rx and or assigning it for review on the Status Page Patient Education adds instructions that appear here and on the Patient Face Sheet After the Rx is final and on the Current Med list the Rx Detail page changes An Rx batch can be RePrinted Transmitted recording a duplicate transaction in the Print Transmit Log Sig changes are tracked and displayed Pt Notes about the Rx such as
42. meals Disp Name Search Results oS as a gt a I X Spe J 7 ar a I i Type in a partial name and hit ENTER for results Cancel Click the SEARCH button 1 Name Strength augm Amount Freq As needed With meals Route Length Disp i Available options for the medication will appear 83 ag A e Ba Clicktate Med Selector Name Strength Amount D As needed With meals Route Length Disp Name Search Results AUGMENTIN 125 125MG 5ML EQ 31 25MG BASESSML AUGMENTIN 125 125M6 EQ 31 25MG BASE AUGMENTIN 200 200MG 5ML EQ 28 SMG BASE 5ML AUGMENTIN 200 200 MG AUGMENTIN 250 250M6 ASE 5ML AUGMENTIN 250 250M6 AUGMENTIN 250 250M6 EQ 125M6 BASE AUGMENTIN 400 400M6 5ML EQ 5 MG BASE 5ML AUGMENTIN 400 400M6 EQ 57M6 BASE AUGMENTIN 500 500M6 EQ 125M6 BASE AUGMENTIN 875 875M6 EQ 125M6 BASE Next select the desired formulation of Augmentin from the list Here we ll select Augmentin 875mg 84 Clicktate Med Selector Name Strength AUGMENTIN 675 875MG EQ 125MG BASE Amount Freq ElAs needed With meals Disp Amount Options You may now select the AMOUNT FREQUENCY ROUTE and LENGTH Adding of Length to a medication will result in the medication expiring and being moved to the inactive medication list 85 If the desired selection isn t present in the selection box just t
43. medical record number and the search box will default to place the cursor in the appropriate text field upon opening the customization tool Users may also specify other parameters to include in the search This includes address phone number e mail and items located in the custom fields Customize Patient Search Primary Search By ID By Name Include in Search E E E Address Fhone Email Custom Fl Save Changes Reset to Default 30 Section V Working with Patient Documents and Notes Working with Patient Documents Patient documentation may be started at multiple entry points throughout the system e From the Scheduling Page e From the Documents Section of the home page e From a Patient Facesheet Starting Notes from the Scheduling Module To begin a patient note from the scheduling module start by selecting a patient from the schedule or placing a new patient on the schedule as previously shown Select the patient for whom a note is to be created View entire week 00 00 i te 30 30 z z 15 15 2 30 45 ne Se 45 00 31 Clicking on Darla Test will produce the appointment status pop up Selecting the New Note button will begin a new note on the patient console Appointment gt Test Darla Patient Test Darla ID 09238 DOB 09 Mar 2009 Address Phone Ey Go to patient s facesheet Appointment April 27 10 00 AM 20 minutes ure check Needs urinal
44. patient It is identical to the Face Sheet however all medical terminology is replaced with terminology that a patient will more easily understand Medical terms such as bid tid and sig have been removed and replaced with common terms such as twice a day etc To print the Progress Note Face Sheet and or Patient Face Sheet click your browsers Print button to send this form to the network printer The lt Med Entry gt Link This link appears on the right side of the screen above the dropdown box containing the patient s insurance Click on this link to go to the MedEntry Refill page where you can enter previously prescribed medications into a patient s record without writing a prescription You may also enter medications prescribed for the patient by another physician A complete sig and dispense number are not required Any prescription information entered here will appear in the patient s list of Current Medications Additionally prescriptions entered here can be entered into the queue for review and renewal FONT FAMILY Arial gt Similarly for any med school students the MedEntry page goes to the Review page and back The med student can enter a patient s meds and can try out an Rx by looking for interactions etc but the student is unable to send the Rx A doctor then logs in and sends the Rx as appropriate To set up med students enter them in the 148 system as clerks just like you would enter any clerk user
45. selected drug from the displayed choices Deny or Accept and specify refills on the PharmCom Review Page Admin Functions accessed via the NavBar or directly by Admin Clerical 137 Staff provides a variety of work flow and processing tools Account Healthplan List Build your list of insurance formularies here The list becomes a oick list for each patient on the Pt Detail page Maintain Pharmacies shows each location s list of selected pharmacies It can be built from here or allowed to accumulate as selected for each patient Rarely used pharmacies can be deleted Pre assign on Pt Detail Support Materials Review or print out as desired You just did Don t forget the audio Tour if you want a quick overview start on the Resource Page Direct Users start on the Log in Page Use Help at the bottom of each page for more detail or use the support link The Medication Entry and Refill Page also accessed by a link on the Compose Page is used for 1 quickly recording medications for new patients or those prescribed by doctors outside your account 2 entering and leaving as a Pending Rx for further processing by doctor or clinical staff Prescriber Report provides a log of all Rx authorized by a doctor Pharmacy Communication Log provides a record of all electronic communications with pharmacies Note that an Rx denied without a patient appears only here Direct Users Add Patient is present if your account includes th
46. separate processing For instance Schedule 2 drug must be printed while the rest of the batch can be transmitted to the pharmacy Routing Page and Printing Prescriptions A batch of prescriptions ready for printing or transmission is displayed Note only the rxs for the Current Location are pre selected Check or uncheck boxes in accordance with office policy prior to choosing lt Print gt The printed Rx will match your state format If not contact customersupport newcropRx com Note a fake signature is not affixed as this is illegal in many states Specify the number of printed chart copies if desired Transmitted prescriptions always have a single printable receipt Change the desired Language for patient education Leaflets Some accounts will also print Rx Support a one page handout designed to encourage Rx filling Click lt Transmit gt sending selected Rx to the next page where a pharmacy can be selected and leaflets and copies printed A displayed pharmacy can be pre selected here and will appear on the Transmit Page Upon arriving on the print page or upon transmission the rx will have been added to the patient record at the top of the Current Meds List If an error has occurred go to the Compose Rx page and move the rx to Previous Meds and rewrite An explanatory note can be recorded in the Rx Detail Note a set of insurance ID s appear to the left on the prescription This is a drug discount program YourRx pro
47. side effects can be recorded Note the Report Missing Rx section above the pharmacy transmission log If electronic Success is displayed yet the pharmacy states they did not receive the Rx please send us this information ASAP it will be fully investigated For missing successfully faxed Rxs contact the pharmacy directly and suggest they check their 179 fax machine before requesting renewals Rx Detail displays the complete information about the Rx for your review This page displays different information before the prescription is transmitted Pending Rx and after transmission Current Med In each case you reach this page by clicking the magnifying glass icon on the prescription line To obtain specific information concerning the medication click the Monograph or Leaflet_ links located on the Rx Detail page Viewing Detail Prior to Transmission Pending Rx At the top of the Rx Detail page the Sig information is presented The Sig information is meant for review only To change any Sig information listed on this page return to the previous page and click on the Edit link To obtain specific information concerning the medication click on Monograph To review the information that will print on the patient s leaflet regarding this medication click on Leaflet Select Pharmacy for Auto send with Approval coming soon As the Rx is being processed the user can pre select the pharmacy for instant sending of the Rx upon
48. start a note using one of the standard Clicktate templates first specify a note type from the Template menu and then choose Blank Medical Note To replicate or reuse a prior note select the middle box Replicate from Patient History This function is not available for notes created prior to June 2009 To start a note using a user defined custom template from the bottom note creation box first select the name of the custom template from the drop down list Here a template that the user has specified as dm htn has been chosen Then select Apply Custom Template To specify a user from within the practice group who will receive the note for review select the desired user from the Send To menu The Date of Service can be changed by selecting the appropriate date from the Date of Service menu 36 Section VI The Patient Console Generating Notes and Letters The Patient Console The patient console is the Documentation component of Clicktate From the console notes of various types may be generated and custom templates may be designed File Edit Help Admin oe ma T agara i y 2 Ral ASAQ IAA i Clicktate com 40 USOY 330491 U H New Open la Save As Sign Lock 3 Orders Download fyjClipboard C Clear JUndo YX Delete sFreetext Exit Console Template Map 2 Customize RTO TIME cc Test Darla Medical Note Friday 27 Apr 2012 r Send To
49. started by selecting New Note or selecting Exit will close this menu A link also appears at the top of the box which will navigate directly to the patient s Facesheet Appointments may be double booked or more by selecting the same time and again adding another patient Thursday April 26 00 30 s 00 19 o 141 22 By selecting the patient name from the appointment calendar the appointment window will open To cancel or indicate that a patient has arrived select either the Edit link or the Status link Appointment gt Test Darla Patient Test Darla ID 09238 DOB 09 Mar 2009 Address Phone a Go to patient s facesheet Appointment A assure check Needs urinalysis prior to appointment Created Today 12 55PM by New LCD Admin E Show notes ae Appt Acute No status selected 23 From within the Edit link the appointment Status may be changed or the appointment may be deleted Appointment gt Test Darla Eg Patient Test Darla Edit ID 09238 DOB 09 Mar 2009 Address Phone Ey Go to patient s facesheet Appointment Date 27 Apr 2012 ia Time 10 00 AM Type Acute n Customize elsme na pgoeee Taree Scheduling for Multiple Providers within the Same Practice Schedules may be created and maintained for multiple providers within the same practice The scheduling module can even be used to create nurse schedules providing the nurse has a user ID
50. the start time of the appropriate time period i Logged in as Icdadmin4 My Profile ICD Admin Logout 9 Home Patients Documents Sched Track Scan Lab Report NQF Rx Pharm Rx Status 1 1 to review Msg Scheduling New LCD Admin x 2X Customize G Print Q Thursday April 26 Friday April 27 2012 Saturday April 220 View entire week 1 The Create Appointment menu will appear i J Patient Selector Search for a patient SE Customize Last Name Patient ID op create New Patient 09738 Test Darla 09 Mar 2009 84593 Tester Tony 01 Jan 2010 09238023 Test Troy 02 Jun 1959 123456 a Test Paula 31 Dec 1969 8203490 Winter Snowy R 16 Apr 1958 092384 Rogers Tim 15 Jun 1937 345654 al Logan Arnold 05 Jan 1946 987545 a Fila Chick 09 Mar 1995 2304892 al Walker Randy 03 Jan 1991 ORT2ACOR El runn Banal OL Aun 10 Or mark time as unavailable 27 Choose Unavailable and the Edit Unavailability menu will appear where the title time and repeat status may be added Edit Unavailability Unavailability Event Title tenets Date 2012 04 27 E8 Time 12 00PM Duration and 0 minutes 7 All day Repeats cme Comments To block one hour for lunch change the menu settings as shown and set a daily repeat Edit Unavailability Unavailability Event Title Lunch Date 20120427 lad Time 12 00PM Duration and 0 minutes 7 All day Repeats gay
51. the template map select Customize which is found in the title bar of the template map Template Map 2 Customize DOS VISIT WEC History of Present Illness HPI Fa Acute Bronchitis DATA BL T Acute Gastroenteritis idii 4 Benien Prostatic By utilizing the Customize function users may select those items which should appear in the Main section of the template map and unselect those that should not The section which appears when the console appears may also be preset Another feature is the ability to auto include a section in each note This will automatically insert any Auto include paragraph into each note created Customize Template Map Section HistoryofPresentiliness Start up with this section M Auto Includer B12 Deficiency Anemia y Auto Include tain C Auto Include GERD Follow up Adult Main Auto Include Health Maintenance Visit Main Auto Include Hyperlipidemia Follow up V Main Auto Include Hypertension Follow up Wf Main Auto Include Hypothyroidism Follow up Maint Auto Include AE Urinary Tract Infection x Auto Include Main Auto Include Main L Auto Include i Save Changes Reset to Default Main Check the paragraphs you want at the top Main section of the Template Map Auto incude Check any paragraphs you want automatically inserted into future documents for this template 39 Searching the Template Database To search th
52. to the note Clicktate is designed to minimize repetition within notes Therefore if chest pain appears in one paragraph it will not appear in a subsequent paragraph In this example we will add Coronary Artery Disease to the note by selecting it gt ACUTE oroncnitis Histc Acute Gastroenteritis B Benign Prostatic Hypertrophy The pg PMHX 4 Coronary Artery Disease denig T Diabetes Mellitus Type 2 usual Ros E Follow up MEDS K Fever Thep 4 GERD Follow up Adult short ALLER H 4 Hyperlipidemia Follow up FAMHY EE Hypertension Follow up Any option in the template map that is included in the note will appear in purple in the template map Re clicking an included purple option will remove it from the note NOTE Some paragraphs are denoted by a double paragraph symbol These paragraphs are repeatable and may be inserted into a note multiple times To remove these paragraphs from a note deselect them from the In Note section at the bottom of the template map 51 The note will now contain paragraphs related to the patient s Diabetes and Coronary Artery Disease Jones Frank Medical Note Wednesday 30 Sep 2009 Send To Michael Mckinney M D History of Present Illness The patient presents for a follow up of diabetes and reports that he checks his blood sugars at home His sugars are checked daily The average sugars are inthe 100 150 range He denies hypoglycemic symptoms The patient de
53. type will open a menu containing possible procedures A quick result and notes may also be added by using the Quick Result link Selecting Reconcile To will open all outstanding orders currently pending for a patient allowing the result to be reconciled to an order The order will subsequently be automatically marked complete and closed The Reconcile To option is only available for patients who have outstanding orders Documents for multiple patients may also be scanned and input into the system in bulk by using the upload scanned PDF batch option The system will divide the document into individual pages for indexing To index a batch file select all pages that are part of a document and enter them into the appropriate chart Logged in as lcdadmin4 My Profile ICD Admin Logout Home Patients Documents Sched Track Scan Lab Report NQF Rx Pharm Rx Status 1 Review amp 1 unread Scanning Center Unindexed Files Indexed Folders Create New BN jpg ps_fg4 gif Upload Files Upload Scanned PDF Batch 198 Section XIII Reporting Clicktate has a robust and easy to utilize reporting system Reports may be generated across multiple parameters across varied date ranges and for one or multiple providers To access the reporting system select the Report tab in the top menu bar Home Patients Documents Sched Track Sci From the reporting page
54. up box will appear with disease process specific items Endocrinology Plan Continue Current Further Plans After Tests Next Visit E Alcohol Decrease E Alcohol Discontinue E Bariatric Follow up E Bariatric Referral E Calcium 1000 mg Daily E Calcium 1200 mg Daily E Calcium 1500 mg Daily FP Calcium 2000 mg Daily E Calcium 400 mg Daily E Calcium 600 mg Daily E Calcium 800 mg Daily E Dairy Decrease E Dairy Discontinue E Dev Peds Follow up E Dev Peds Referral E Diabetic Education E Diabetic Insulin Teaching F Diet AHA E Diet Low Fat E Diet Low Salt E Diet 1000 cal ADA E other Further Plans Wed Change Med Added Endocrinology and Metabolism Plan PF Diet 1200 cal ADA PF Diet 1500 cal ADA F Diet 1800 cal ADA F Diet 2000 cal ADA E Dietician Follow up E Dietician Referral E Endocrine Follow up E Endocrine Referral E ENT Follow up E ENT Referral PF Exercise E Exercise Aerobic Daily E Exercise Wt Bearing E Exercise Wt Lift 3x week E Fluid Restrict 1000 mL PF Fluid Restrict 1500 mL PF Fluid Restrict 2000 mL E GI Follow up E Gl Referral E Genetics Referral Fam E Genetics Referral Pt E Gym Membership Recom Home Glucose AC HS Home Glucose BID Home Glucose Daily A A E Home Glucose TID E Hospital Admit E Increase Fiber E Increase Fluids E Metabolism Follow up E Metabolism Referral E Monitor Closely
55. 013 Hypertension Blood Pressure Meas we older with a diagnosis of hypertensi pressure recorded N QF 0024 Weight Assessment and Counseling age who had an outpatient visit wit percentile documentation counselir measurement year NOF 0027 Tobacco Use Cessation The percent smokers or tobacco users who were received advice to quit smoking of tc smoking of tobacco use cessation m 7 NOF 0028 Preventive Care and Screening Meas who have been seen for at least 2 of within 24 months 200 Next select the report type New Report Patient Reports Clinical Decision Support Creating a Patient Report To create a patient report select Patient Reports from the New Report pop up A blank patient report page will appear Reporting Medicare and Medicaid EHR Incentive Program Patient Reports a Add Denominator Patients Any 6 add EE Generate Repon I Save Changes Exit All new reports have the default name Patient Reports The change the report name select Patient Reports and enter and save the name of the new report A description may also be entered Report Entry Name Hyperlipidemia Patients E Application level Description Patients who are over age 16 who have a diagnosis of hyperlipidmia e Count By REWER lal save Changes 201 Reporting Medicare and Medicaid EHR Incentive Program Hyperlipidemia Patients 3 Add Denominator P
56. 2011 22 53 Current Med 1 DAILY LCD Solutions LLC New LCD Admin N Patient Education Use Control key to multiselect add text as needed Save Note Not recommended when breast feeding Call MD or RPh re timing of taking with other meds E Tell doctor your complete medical history a Review all drugs you are taking with your doctor Take before meal s at same time s each day a To add additional or non legacy medication use the Drug Search feature and follow the same steps To return to the Clicktate system select Return to Clicktate in the upper right hand corner of the window Return to GClicktate Clicktate Diagnoses Admin Designated Dr Prescriber New LCD Admin ne select healthplan manually RAHUB Formularies not automatically available select healthplan 130 Upon returning to Clicktate the medication list will now contain both Legacy and NewCrop entered medications After a final reconciliation to assure that all medications are correct the Legacy medications may be removed Clicktate John Jimmy Medications Current Medications LEGACY PREVACID 30MG 1 DAILY PREVACID 30 MG 1 DAILY BY MOUTH LEGACY TOPROL XL EQ 25MG TARTRATE 1 DAILY TOPROL XL 50 MG 1 DAILY BY MOUTH 131 The following pages 131 191 are provided by NewCrop LLC How to Write a Prescription Powered by NewCrop Welcome These pages provide an overview of your new e rx system Although ou
57. 28 20 03 56 k DM HTN Medical Note 2009 10 28 19 59 01 MM 2009 10 28 19 59 01 7 John Template Medical Note 2009 10 16 11 29 42 MM 2009 10 16 11 29 42 kl HL HTN HOTHY Medical Note 2009 09 03 23 35 27 MM 2009 05 03 23 35 27 W Hyperlipidemia on Lipitor Medical Note 2009 09 03 23 12 30 MM tiffany note hyperlipidemia Medical Note 2009 07 31 11 52 21 MM 2009 07 31 12 07 30 MM k test template hl hin dm 072409 Medical Note 2009 07 24 11 11 25 MM 2009 07 24 11 11 25 Medical Note 2009 03 31 14 19 12 CM 2009 03 31 14 19 12 Smoker with Bronchitis Medical Note 2009 03 30 19 26 10 CM 2009 03 30 19 26 10 7 Smoking Problem Medical Note 2009 03 30 19 24 47 CM 2009 03 30 19 24 47 C Create New Custom Template To revise the template COPD Still Smoking that was just created select it from the list of available templates 75 When the note opens in the console it will not be attached to a particular patient and no patient name will appear on the console File Edit Help B New yOpen j Save As 9 Sign and Lock w Download im Clipboard Undo Clear A Freetext Exit Console A Template Map gt Customize COPD Still Smoking Custom Template Medical Note z Acne Follow up Acute Bronchitis J Acute Gastroenteritis As relates to her COPD rescue inhaler usage is reported to be two to three times weekly The patient reports that she has no known triggers Since the 4 812 Deficiency Anemia last o
58. 8 03PM by Michael McKinney M D Any desired changes can be made and the template can be e Saved under the same name by selecting Save Template from the File menu New Note New Replicate Download bo word Copy to Clipboard Delete Template Manage Custom Templates p T GERD Follow un 76 e Saved under a different name by selecting Save As from the menu bar J New Yop lH Save As eg 290 and Lock WE Download yy Clipboard Undo Clear Freetext Exit Console Template Map 2 Customize COPD Still Smoking Custom Template Medical Note File Edit Help New Note wi Download Sign and Lock B3 New Replicate bal Save Template FT Sign and Lock E EA eee re S History of Apply Custom Template z wh Download to Word As relates t last office x iw Copy to Clipboard i X Delete Template hemoptysis F LUipen lemoliate p i H a q GERD Folia lel Save As Template SOCHX F T Health Maintenance Visi By selecting Save As Template the template will be saved under the new name and will be retained under the previous name as well Clicktate COPD Smoking 2 saved 77 Document Manager Showing Customized templates Manage notes Records 1to 11 DC ee er 2009 10 28 20 14 49 2009 10 26 20 03 56 2009 10 28 19 59 01 2009 10 16 11 29 42 2009 10 28 20 14 49 MM 200
59. 9 10 28 20 03 56 MM 2009 10 28 19 59 01 MM 2009 10 16 11 29 42 MM Medical Note Medical Note Medical Note Medical Note 4 COPD Still Smoking a John Template Patient Specific Templates After creating a note on the patient console it may be saved as a patient s Template note This is the note that will be preferentially replicated from the note generation initial menu First create a note for a patient as normal on the patient console Here a note has been created based on the Clicktate Hyperlipidemia template This note has changes that are specific to the patient Thomas Tony Medical Note Wednesday 28 Oct 2009 Send To Michael Mckinney M D The patient presents for follow up of hyperlipidemia He is following alow fat diet He reports that he is exercising He is taking Lipitor and over the counter omega 3 fish oils The patient is taking his medication as prescribed He reports no medication side effects including muscle cramps abdominal pain headaches or weakness He denies chest pain shortness of breath edema palpitations or syncope Medications Reviewed Allergies Reviewed per Nurses Note To save the note as the template for this patient select Save As from the menu bar File Edit Help New GYOpen Hj Save As Gy Sign andLock M Downoad iy Clipboard Undo C Clear X Freetext Exit Console Template Map 2 Customize Thomas Tony Me
60. Allows a new note to be started from the console e New Replicate Allows the note on the screen to be replicated as a New Note e Open Note Opens the patient note menu so that previously created notes may be reviewed Patient History Test Darla 8 Choose another Signed Today 5 00PM 11 May 2012 Medical Note Updated Today 17 47PM 27 Apr 2012 Medical Note Updated 27 Apr 2012 3 26PM 11 Aug 7009 Discharge Letter Updated 11 Aug 2009 6 30PM 47 e Save Note As Allows a note to be saved with an alternate name or date of service e Sign and Lock Allows a note to be signed and locked and prevents further changes e New Addendum Allows an addendum to be added to a note that has been signed and locked Test Darla Medical Note New Addendum gd save Addendum e Generate Orders Sends patient orders to the Computerized Order Entry CPOE and Tracking System thereby allowing users to save and track orders as they are entered into a note This is explained in detail in the Order Entry and Tracking section of this manual e Download as PDF Copies a note to Adobe Acrobat so that it may be printed e Download as Word Copies a note to Microsoft Word so that it may be printed This function is only available for notes that are NOT signed and locked e Copy to Clipboard Copies a note to the computer clipboard where it may be pasted into ano
61. CD Solutions LLC Pharm 1 Fax 0 Pend 0 Clicktate pa Select Dr Staff Compose Rx Med Entry Pt Details Pt Notes Diagnoses Admin e LCD Solutions T C Resourc es Ne CD Ad Med Entry z i k l l EEES New LCD Admin Patent Jimmy John oos 9 14 1964 Gender Male Self Pay No Insurance Selected Dispense Refills DAW Reported Dr Memo Delete PREVACID 30MG 12 2409 TOPROL XL EQ 25MG TARTRATE 1 daily 30 N F 5 Enter optional Outside Doctor and or Original Start Date before selecting drug Replace current doctor Enter Original Start Date Month Day Year m Click to include Delete Name Sever ity Notes Current Medications for Jimmy John F Discontinued Previous T Cancelled Mid Process L Pharmacy Communication Rx Date Drug sig Dispense Refills DAW Reported Dr Memo Delete tasoa PREVACDGIMG hey 12 24 09 TOPROL XL EQ 25MG TARTRATE I Enter optional Outside Doctor and or Original Start Date before selecting drug Replace current doctor Enter Original Start Date Month Day Year Include obsolete drugs Click to include Current Medications for Jimmy John Takes No Meds Discontinued Previous Cancelled Mid Process Pharmacy Communication 121 To transfer a medication to the NewCrop system select the medication from the Imported Rx list Selecting a medication from the Imported Rx list will open the Drug Search Results window Sig ig Dispense Refills
62. DAW Reported Dr Memo Delete Enter optional Outside Doctor and or Original Start Date before selecting drug Replace current doctor Enter Original Start Date Month Day Year fo Doctor s List 3 letter min 5 recommended Include obsolete drugs Drug Search Results Peptic Ulcer Proton Pump Inhibitors Prevacid 15 ai Cap Generic Available Prevacid 30 mg Cap Generic Available si 2 1 AE eae Vionograph Leaflet Peptic Ulcer Proton Pump Inhibitors Lansoprazole Monograph Leaflet Peptic Ulcer Proton Pump Inhibitors Prevacid SoluTab 30 mg Rapid iP Click here if drug not found Select the appropriate medication for the Drug Search Results list The selected medication will appear in the Current Meds edit list 122 Dispense Refills DAW Reported Dr Memo Delete al N ii Enter optional Outside Doctor and or Original Start Date before selecting drug Replace current doctor Enter Original Start Date Month Day Year select to Move to Current Meds or leave for further processing Open Edit for Dosing Rx Date p l Doc Loc Stage Drug Sig mows Source Doctors List Click to include Name Severity Notes a Swollen Mouth Abdominal Pain Current Medications for Jimmy John Takes No Meds Discontinued Previous Cancelled Mid Process Pharmacy Communication Selecting the Edit tab beside the medication will open the medication edit page 123 iais Rx Drugs are not
63. Home Patients Documents Sched Track Scan Lab Report NQF Rx Pharm Rx Status 1 Review MJ Msg Message Center My Inbox JP Show sent messages EJ Hello Last post Cuppy Ronald 14 Oct 2011 2 39PM by Cuppy Ronald to New LCD Admin Prescription Refill Last post Emerson Waldo 09 Jan 2011 11 03PM by New LCD Admin Compose New Message p Quick Links CA New Appointment th Record Today s Vitals 2 Medical Note 01 Jun 2012 i Create Docume E Message E Portal Message After a new message is created the Message center will appear and will allow the message to be created The Messaging system works in a manner similar to most email messaging systems Messages may be sent to one or multiple recipients may be marked routine or stat and may have attachments included Logged in as Icdadmin4 My Profile ICD Admin Logout Home Patients Documents Sched Track Scan Lab Report NQF Rx Pharm Rx Status 1 Review EJ Msg Message Center Back to Inbox New Message Test Darla EJ Subject Priority Normal 1D 09238 DOB 09 Mar 2009 3 Choose a Template J Initial Message jj Response _jj Message Completion Contact Free Text Area None on file Emergency None on file Allergies amp Attach None Current Medications None To Office 8 Select Recipient s Pharmacy 2 Save and Mark Complete None on file Vitals Send Now Patient F
64. MEN EXAM Abdomen Soft benign non tender with no masses hernias organomegaly or scars Oe aed eR daieceeaeg Feet The feet are symmetric with normal boney landmarks There is no tenderness to palpation bilaterally The feet have normal posterior tibial and dorsalis pedis pulses and normal capillary refill bilaterally The monofilament examination is normal bilaterally al bilaterally There are no skin nail lesions present There are no ingrown nails There are no bunions noted Impression and Assessment DM controlled Coronary Artery Disease systolic Heart Murmur 53 Other options may be added as appropriate including other diagnoses or symptoms labs X rays impressions and even multiple plans for different diseases In the above example to add a Urinalysis and Accucheck select IOL from the Template Map Menu Template Map History of ROS Follc LF T Fever GERL 4 Hype q Hype T Hype K T Otiti PE titi IOL ON RAD ffo app IMPR P 4 urin PLAN 4 viral R PROC Comple _ q Abde Folle TIME Abdc Male T Abdc Feme T Abdec Follc 54 Then select Urinalysis and Accucheck from the Paragraph Menu Template Map g In Office Labs DOS WEC HPI 4 Hematocrit R T Influenza A gE T Influenza B ROS Ka 4 KOH Prep MEDS H 4 KOH Prep Non Gynecologic EA q Limited Urinalysis ALLER T Mono Spot FANMHX T O2 Saturatio
65. None Main AL 4 Acute Bronchitis B 4 Acute Gastroenteritis c 4 Benign Prostatic Hypertrophy 4 Coronary Artery Disease q Diabetes Mellitus Type 2 G Follow up q Fever 4 GERD Follow up Adult 4 Hyperlipidemia Follow up 4 Hypertension Follow up M q Hypothyroidism Follow up N 4 Inpatient Note o Otitis Media 4 Otitis Media Follow up Quick Note q1 Skin Lesions Tobacco Abuse Disorder u Upper Respiratory Infection 4 Urinary Tract Infection W 4 Viral Syndrome Complete list Abdominal and or Pelvic Pain Female Abdominal and Pelvic Pain Follow up Abdominal and Pelvic Pain Male 4 Abdominal Aortic Aneurysm Follow up 4 Abnormal Labs Hematuria 4 Abnormal Pap Follow up q Abrasion q Abscess q Acidosis q Acne 4 Acne Follow up Acne Neonatorum q Actinic Keratosis In Note E l OK Created 27 Apr 2012 3 26PM by New LCD Admin 37 The Template Map The Template Map is the section of the console where various notes and templates may be selected for Template Map 2 Customize DOS VISIT wee E T Acute Gastroenteritis 4 Benign Prostatic D Hypertrophy E Coronary Artery Disease T Diabetes Mellitus Type 2 Follow up T Fever T GERD Follow up Adult T Hyperlipidemia Follow up T Hypertension Follow up M T Hypothyroidism Follow up N 4 Inpatient Note O otitis Media m q Otitis Media Follow up al T Quick Not
66. Page Clicktate uses SSL security https from the login page forward clicktate loqugessittimgdows Internet Explorer gt gt E httos v awclicktate com sec 12 Section IV Navigation through the System and Scheduling The Home Page The Home Page is the initial page when you access Clicktate From the home page you can navigate to any other section of Clicktate You can navigate by schedule by individual patient or you can create a new patient You can also change your personal profile or create or modify custom designed templates from this page Logged in as lcdadmin4 My Profile ICD Admin Logout Home Patients Documents Sched Track Scan Lab Report NOF Rx Pharm Rx Status 1 2 to review J Msg Welcome New LCD Admin LCD Solutions LLC Lexington KY 40536 2 Patients ie Documents 12 Scheduling re Patient Notes List all patients Open today s schedule List unsigned notes for me Search by Last Name Open this week s schedule Go List all notes Search by ID a Start a new note for patient Open for date Create a new patient Custom Templates Manage my templates My info Change my password G My Profile i SPR i Practice info Manage support logins Patient Data Entry Entering New Patients into Clicktate 12 Scheduling There are multiple methods to enter new patients into Clicktate Patients may be entered from the scheduling Open today ahali module at the time
67. Please decrease your sodium intake by eating a low salt sodium diet It would be in your best interest to lose weight You may use over the counter Acetaminophen Tylenol for fever or pain A cool mist humidifier should be used Please be sure to drink plenty of fluids You should make sure to get plenty of rest You should rest your voice as much as possible Select Print to generate the visit summary 208 Runner Road Visit Summary Sunday August 26 2012 LCD Solutions LLC Date Produced 26 Aug 2012 06 28FPM Vital Signs Pulse 56 Beats Per Minute Respiratory Rate 10 Breaths Per Minute Blood Pressure 124 Systolic 62 Diastolic Temperature 97 0 F Today s Diagnoses Hypertension Hyperlipidemia Upper Respiratory Infection Allergies No Known Drug Allergies Today s Results 06 26 2012 Urinalysis O8 26 2012 Color yellow SpGr 1 010 pH 5 0 Leukocyte Esterase negative Nitrite negative Protein negative Glucose normal Ketones negative Urobilinogen nomal Bilirubin negative Blood negative Your Plan Please follow a low fat diet Please decrease your sodium intake by eating a low salt sodium diet It would be in your best interest to lose weight You may use over the counter Acetaminophen Tylenol for fever or pain A cool mist humidifier should be used Please be sure to drink plenty of fluids You should make sure to get plenty of rest
68. Prescriber s name and Location Workgroup An asterisk after the word SIG indicates there has been a change in the Sig Also available to the right of each prescription is an Edit link and a magnifying glass icon Both of these features were described above in the Pending Rx section The Edit button allows you to alter the Sig and Directions after a prescription has been added to the Current Medication list if a patient has been instructed to take a medication differently than originally prescribed After you have made the changes reflecting the new prescription instructions click the lt Save gt button to save the Sig 163 modifications Changes are recorded on the Detail RX along with the authorizing doctor and user Remember an altered sig displays an asterisk The lt D C gt button is used to discontinue current medications Discontinuing a current medication moves it to the Previous Medications list To discontinue a current medication select the check box to the right of the magnifying glass icon and then click the lt D C gt button To renew one or more of the current medications click on the check box es to the left of each medication you want to renew Then click the lt Select gt button This moves all the selected prescriptions to the Pending Rx section for further processing transmission The Drug Review link when clicked performs a drug review of all the patient s current medications The lt Instant Renewal
69. Provided A MU CPOE for Medication Orders MU Electronic Copy of Health Information A MU Generate Permissible Prescriptions Electronically MU Patient Specific Education Resources A MU Preventive Care Reminder Sent MU Provide Timely Electronic Access AIMU Record and Chart Changes in Vital Signs MU Record Demographics More than 80 of all unique patients seen by the EP have at least one entry or an indication that the patient has no known medication allergies recorded as structured data More than 80 of all unique patients seen by the EP have at least one entry or an indication that the patient is not currently prescribed any medication recorded as structured data More than 50 of all unique patients 65 years old or older admitted to the eligible hospital have an indication of an advance directive status recorded More than 40 of all clinical lab tests results ordered by the EP or by an authorized provider during the EHR reporting period whose results are either in a positive negative or numerical format are incorporated in certified EHR technology as structured data Clinical Summaries provided to patients for more than 50 of all office visits within 3 business days More than 30 of unique patients with at least one medication in their medication list seen by the EP have at least one medication order entered using CPOE Based on ALL patient records Any EP who writes fewer than 100 prescriptions during the EHR reporting p
70. Staff for doctor review DR An Rx that has been approved by the doctor and left for staff processing NS To continue choose lt Proceed to Review gt to access the The Review Page with multiple processing options To instantly send the rx click lt Approve Send gt It will auto process as predetermined by patient and staff preferences These are set in Pt Details and RxDetail 134 lt Approve Send will automatically send an rx to any pharmacy email a patient send your denial to office staff or any combination thereof All routing information is pre entered from the Pt Detail and RxDetail pages then activated with a single click The Instant Renewal button below the Current Medications will send multiple rx directly to the patient s pharmacy bypassing the ability to print leaflets and other optional steps Current Medications can have multiple Sources 1 prescriptions written by all doctors within your account are displayed with the Location Your current Location is bolded 2 medications entered by staff from the Med Entry page 3 additional prescription records that may have been loaded from outside sources such as RxHub RHIO or IPA Click Edit to the right of a Current Med to record a sig change To discontinue a drug or eliminate duplicate records use the check boxes and lt D C gt At the bottom of the page are links accessing Discontinued Medications Cancelled Prescriptions and a log of the patient s Pharmco
71. Upload Now Cancel Selecting Upload Now will move the selected file into the unindexed files area of the scanning center 196 Scanning Center Unindexed Files Indexed Folders seas See RN Sv ne Sr PS TI ETAT Sey os i TD O_Colonoscopy_Report pdf ii Create New i uj LZ Adobe Your file s were uploaded successfully You may now select more files to upload or click Cancel to begin indexing lq Upload Now Cancel Selecting a file from the unindexed files will move the file to the indexed folder and open the indexing box Indexed Folders To New LCD Admin From this area the file may be indexed to the patient date type provider and area Marking the Reviewed boy indicates that the document has already been reviewed by a provider and the document will therefore NOT go to the document review section for that provider Leaving the Reviewed button unchecked will send the document to be reviewed 197 A provider index may be built by selecting the magnifying glass beside the Provider section This may be built as documents are entered Practices will find that their individual provider directory builds quickly as they enter documents Any document that is entered as a Test Procedure will require that the procedure type be entered Date a Reconcile To 3 Select Order Type Test Procedure Result for J Quick Result Provider Pat E Mia Typing the procedure
72. acesheet 193 One or more templates may be chosen or the message may be entered via free text e lf atemplate is utilized the subject heading will be auto completed e Any document in the patient s chart may be attached to the message e Messages will be date and time stamped and will remain in the patient s chart Once a message is completed and is ready to be recorded in the patient chart choose the Save and Mark Complete button The message will be closed and recorded in the patient chart A quick note may also be recorded using the Message system and immediately choosing the Save and Mark Complete button without sending the message to a recipient When messages need to be reviewed the Msg tab at the top right of the screen will turn red and indicate the number of messages to review Rx Pharm Ex Status 1 Review 11 unread Selecting the Message option will open the message center Message Center My Inbox Show sent messages Acute Illness Last post Test Darla Today 12 14AM by New LCD Admin to New LCD Admin Hello Last post Cuppy Ronald 14 Oct 2011 2 39PM by Cuppy Ronald to New LCD Admin Prescription Refill Last post Emerson Waldo 09 Jan 2011 11 03PM by New LCD Admin to New LCD Admin Fi Compose New Message Unread messages will appear in green Messages that are read but not completed acted on will appear in grey To view a history of all sent messages select Sh
73. ad me first pages by clicking on lt Administrative Functions gt on the navigation bar and looking under the section titled Support Practicing Be sure to take the time to practice entering prescriptions before you go live The easiest way to do that is to use the demonstration accounts that were preloaded on your system The last names of the demonstration accounts all start with zzz Take the time to enter information into these accounts to learn how each screen works If you need further directions remember to click the lt Help gt link at the bottom of each page ERx Basic and Comprehensive Two versions of ERx are available which offer different features The Basic version is our base version which has the drug list indexed healthplans indexed pharmacies RxHub and SureScripts The Comprehensive version adds automated allergy drug and disease condition review herbals and patient leaflets as well as managed care information which will identify which drugs reside on the patient s insurance formulary Summary The Location and Resources Page This page is seen at the start of each day after logging in or by clicking the Resources link on the top left side of the page below the Navigation Bar Location Workgroups reflects the workflow needed for prescription management within your practice NOTE for multiple Location Workgroups you will see all prescriptions written by all doctors within your practice from all l
74. al Signs select the Create Charts link on the vital sign pop up WHO and CDC growth charts may be plotted 117 The Immunization Record Immunizations may be recorded and tracked from the Facesheet Immunization section Immunizations Lud Pneumococcal Selecting Immunizations will open the immunization record From here immunizations may be entered immunization charts may be created and the CDC immunization schedules may be accessed Clicktate Logan Arnold Immunizations Ga Immunization Schedules Information Statements Date Given Vaccine Manufac Lot Dose Route al 01 Jun 2017 08 37PM Pneumococcal fi Create Chart p Download dE Add Immunization Choosing Add Immunization will open the immunization entry field where new immunization information may be entered Clicktate Logan Arnold Immunization Entry Date Given 15 Jun 2012 07 56PM D Immunization _ Administered By New LCD Admin Lot Number Expiration Date Manufacturer Unknown Dose Route Site VIS Given 1 Select CDC VIS Date VIS Given 2 Select CDC VIS Date VIS Given 3 Select CDC VIS Date g Save Changes Cancel CDC Vaccine Information Sheets VIS may be accessed and printed from this page as well 118 Section X Electronic Prescribing Users who elect Electronic Prescribing e prescribing will be able to receive prescription refill requests directly from pharmacies transmit refill requests direct
75. al features will not appear on your screen For example our Partner users who access this eRx system via one of our Partners EMR PMS etc may not need to login to the system and thus will not access a Login Page Alternatively our Direct users must log in directly to the eRx system and require a Login Page There are other instances where users will have different functionality All of our eRx users have the basic features of our Basic version which allows electronic prescribing along with RxHub medication history eligibility and formulary Some users will have the Comprehensive option which includes patient specific formulary information drug drug allergy drug and OTC drug review along with patient leaflets If you are using the Basic version only the Comprehensive described in this document will not apply e Example1 Most of our Partner Users add new patients directly into their EMR or PM software Therefore they will not see the Add New Patient function in their eRx e Example2 A Direct user chooses to use the Basic version and thus does not have drug interaction information Their screens will not display the link lt Proceed to Review gt for drug interaction review 139 If at any time if you wish to upgrade to another version please contact your Account Manager Now it is time to provide you with some overall information General Tips That Might Help You Connectivity Our eRx system is Internet based Therefore i
76. and Powers of Attorney may also be recorded in this section These items if recorded will be reflected on the face sheet under the demographics section 93 The Patient Notepad Section Immediately to the right of the Demographic information is a Free Text box This box can be used to record any data that isn t found elsewhere or data that the user wants to notice each time a patient comes to the office Add Notes Selecting the Add Notes link will open a text box Clicktate Patient Notepad Ta Save Changes x Clear Note 94 The Workflow Section In the workflow section Quick Links are provided for rapid access to e The patient s most recent appointment as found on the scheduling calendar Record the current vital signs The three most recent unsigned notes A link to quickly start a new note A link to start a new patient message Quick Links a New Appointment ih Record Today s Vitals Ei Create New Document New Message 95 The Allergies Section The allergies section will allow the quick entry and review of patient allergies and adverse reactions To add new allergies select either the expand option or the None Known designation Active Allergies Lad D PENICILLINS Severe Ana phylaxis 4 SULFA SULFONAMIDES Moderate Rash To add a new allergy select the Add an Allergy button Clicktate Test Patient Allergies Current Allergies
77. atients Any amp add ay Generate Report kd Save Changes X Delete Report Exit Do define the patient criteria select and modify Any beside the patient link Patients Criteria Patient ID Last Name First Name A Birth Date e Deceased B Race l Ethnicity B Language O H Living Will e POA O H User Prompted 706 ne The report may be narrowed to any patient criteria found in the pop up fields Patients Criteria Patient ID isd J Last Name O H First Name oO H AH g Age atleast 18 Birth Date ss Deceased is empty Race H Ethnicity Oooo H Language oO HWH Living Will O H POA H User Prompted 706 ne To add additional criteria to the report select the add option 202 Reporting Medicare and Medicaid EHR Incentive Program ttamia Patients 3 Add Denominator 5 Patients AG least 18 and DECEASED is empty 62 add EJ Generate Report iol Save Changes Delete Report Exit The Add Criteria Group pop up will appear Additional criteria may be added for Address Diagnoses Medications Medication History Allergies Procedures Results Tobacco Usage Immunization Status Vital Sign Parameters Documents and Encounters Office Visits Add Criteria Group Patients iagnoses Medications Documents Encounter To add a diagnosis select the Diagnoses option The selected criteria will be added to the report
78. available 14 In addition new patients may also be entered from the Patients menu By selecting the Create New Patient tab a new patient may be entered into the system u Ss Patients List all patients Search by Last Name Go Search by ID EJ Go EJ Create a new patient After selecting the Create a new patient link the Initial Patient Editor window will appear In this window the initial patient data such as ID Name Gender and Date of Birth will be entered Create a Patient Patient ID Last Name Middle Gender Female Birth RR ig Create and Continue gt Cancel 15 Create a Patient Eg Patient ID 8203490 Last Name Winter First Snowy Middle R Gender Female Birth 16 Apr 1958 HA gt After entering the initial patient data select Create and Continue gt After creating the patient the patient Facesheet will automatically open C Logged in as Icdadmin4 My Profile ICD Admin Logout Home Patients Documents Sched Track Scan Lab Report NQF Rx Pharm Rx Status 1 1 to review Msg Winter Snowy R Download Print Q Search for patient ID 8203490 DOB 16 Apr 1958 Age Sex 54 female T Address Upload ome Add Notes Quick Links Active Allergies lad QB New Appointment th Record Today s Vitals None Known iz Create New Document New Message Selecting the Open icon in the Patient Data
79. batch can be 168 transmitted to the pharmacy lt SPAN The Routing Page Summary A batch of prescriptions ready for printing or transmission is displayed Note only the Rxs for the Current Location are pre selected Check or uncheck boxes in accordance with office policy prior to choosing lt Print gt or lt Transmit gt Specify the number of printed chart copies if desired Transmitted prescriptions always have a single printable receipt Check the box s for a printable patient leaflet as needed Select or change the patient language first If you would like each Rx printed on a separate page check the Print Singles box Click lt Transmit gt to send all selected Rx to the next page where a pharmacy can be selected and leaflets and copies printed A displayed pharmacy can be pre selected here and will appear on the Transmit Page The printed Rx should match your state format If not contact custiomersupport newcroprx com The RX Support feature not always present provides printable information designed to encourage the patient to fill the Rx as written This information will print out with the Rx or Transmit receipt unless you uncheck the Rx Support box Upon arriving on the print page or upon transmission the Rx will have been added to the patient record at the top of the Current Meds List If an error has occurred go to the Compose Rx page and move the Rx to Previous Meds or Edit to modify an incorrect si
80. ble to access and process all The Status Bar appears at the top of all pages The link displays 3 items The first is Pharm or pharmacy The number listed here is the number of pharmacy communications requiring attention for the entire Account These are either refill requests or messages from SureScripts pharmacies Clicking on lt Pharm gt will take you to the Status page where you can view the transactions The next link is Fax The number after the word Fax is the number of faxes which were not successfully transmitted Possible causes for their being on this list include wrong fax numbers or a malfunction at the pharmacy Clicking on lt Fax gt takes you to the Status page where you can view the transactions Once the fax has been successfully transmitted it will be removed from this list The Pending link displays the number of incomplete or pending prescriptions for your Account Clicking on lt Pending gt takes you to the Status page where you have the ability to view all transactions requiring your attention Although all transactions for your Account are listed on the Status Page those which need attention from your Location Workgroup are bolded Any transaction listed here however can be accessed for pr 153 ocessing Be sure to follow your office policy on handling prescriptions written in a different Location Workgroup The Status Page is split into five sections 1 The Pharmacy Renewal Requests section lists all mes
81. cKinney M D Set as default Template Medical Note Set as default Selecting DM HTN and then Apply Custom Template will start a new patient note with this template From the file menu on the note console templates may also be applied to an active note by selecting Apply Custom Template Creating a New Template from a Patient Note Once a PATIENT note has been created it can also be saved as a custom template The first step in this process is to create a patient note Patient Cuppy Ronald Medical Note Friday 06 Mar 2009 Created 06 Mar 2009 11 18PM by LCD Admin As relates to his COPD rescue inhaler usage is reported to be two to three times weekly The patient reports that he has no known triggers Since the last office visit the patient has not sought emergency care He currently reports no wheezing cough sputum production or dyspnea The patient is using an inhaled steroid He does rinse his mouth after using his steroid inhaler He doesn t report thrush symptoms or a sore mouth He denies hemoptysis He is smoking The patient smokes He smokes 1 pack per day He has smoked for 15 20 years See wena 72 In this example a note has been created for a COPD patient who continues to smoke To save this note as a custom template under the FILE menu select Custom Templates and then Save As Template New Note New Replicate Open Note Save Note As Sign a
82. cal Note Friday 11 May z pean Send To None History of Present iliness As relates to hypothyroidism the patient reports a good energy level She reports no hair los constipation sweats or palpitations She is taking her medication as prescribed AA Resulting in Download iClipboard Clear Undo X Exit Console Test Darla Medical Note Friday 11 May 2012 Send To None History of Present iliness As relates to hypothyroidism the patient reports a good energy level She reports no hair los constipation sweats or palpitations ve 65 REMEMBER ANY WORDS IN CLICKTATE THAT ARE BLUE OR PURPLE MAY BE CHANGED EXPLORE THE SYSTEM AND NOTES TO LEARN THE FUNCTIONALITY AND PURPOSE OF EACH SMART PROMPT 66 Section VII Custom Template Design and Creation One of the advances seen in Clicktate is the ability to work with custom templates Custom templates are templates that are based on existing Clicktate system templates but they are user defined or modified and saved for use with the same patient or different patients at a later time The custom templates have a user defined name Working with Custom Templates There are two main entry points for designing building and working with custom templates e From the Home Page F 1 j 1 r Welcome LCD Admin LCD Solutions LLC Lexington KY 3 Patients Documents 12 Scheduling Home Patients Documents Schedulin
83. change the strength or click on the formulary status to view the drug alternatives Rx may also appear in a box above the Pending section when information for full processing is not available The drugs listed in his section are not used for drug review Convert these to a Current Med by clicking and selecting from the search results To complete an Rx click Edit if the Sig box is not already open Select number sig and adjust the directions or pre calculated 30 day supply as needed Check PRN or DAW dispense as written Check 90 days to generate a 3 month Rx in addition to the original Rx you are writing Enter any additional sig such as insulin dosing for the Rx label Pharmacy data standards allow only digits in the Disp field Therefore for dose packs tubes insulin etc click Packaging and select for the pharmacist Place the number of packages in the Dispense field as the last step Add any additional directions for the pharmacist Open the Diagnosis list 156 and select for this Rx if desired Save your changes by clicking lt Save gt Change your mind for the sig by clicking Undo Use the X to delete the entire Rx Finally click lt Proceed to Reviews All Rx must be complete before proceeding The Dosing feature is accessed via the Edit option on the Compose Page Once in edit view you can access the dosing by clicking on the dosing link which displays below the drug name Several indications will display Select th
84. ck on the lt Admin gt tab Under the Patients section click on the Face Sheet Patient Face Sheet link which takes you to the Patient Face Sheet page Your patient s name will already be displayed From here you can select the Face Sheet or Patient Face Sheet checkbox depending upon which format you want to print Clicking the Printer Friendly link displays the Face Sheet in a new window Choose lt Print gt from the Windows File menu to send the sheet to your network printer Click on the lt X gt in the upper right hand corner of the new window to close the window and return to the Print Patient Face Sheet To return to the Patient Diagnosis page click lt Patient Diagnosis gt on the Navigation bar If you are done click on any tab of the Navigation bar to go to another function or start another task 192 Section XI Messaging Clicktate offers a robust messaging system which allows messages to be sent within the office as well as to patients via the patient portal The messaging system is accessed from e A specific patient Facesheet in the Quick Links Section e The Navigation menu found at the top of most pages in Clicktate followed by the Compose New Message button Logged in as Icdadmin4 My Profile ICD Admir yuu Home Patients Documents Sched Track Scan Lab Report NQF Rx Pharm Rx Status 1 WR T Patient Database d Print Q Search fo Logged in as Icedadmin4 My Profile ICD Admin Logout
85. cuments and Notes Section VI The Patient Console Generating Notes and Letters Section VII Custom Template Design and Creation Section VIII Other Features Section IX The Facesheet Section X Electronic Prescribing NewCrop Electronic Prescribing Manual Section XI Messaging Section XII Scanning Section XIII Reporting Section XIV The Visit Summary 11 12 30 36 66 80 90 118 131 192 194 198 206 Section About LCD Solutions and Clicktate Clicktate was released to the medical community in 2006 by LCD Solutions Inc a group dedicated to developing an inexpensive intuitive and easily accessible system for medical documentation Our goals were to develop a system that e the average provider could master in a short amount of time e would create complete and accurate medical notes e would save money cut cost and provide revenue generating opportunities in the form of increased efficiency e would improve the medical care received by patients Since this time the user response to Clicktate has been overwhelmingly positive Over the past five years of development Clicktate has become more than just a note writer and now has become the Electronic Health Record of choice for many practices in nearly every state Our users will find that Clicktate is continually improving with many new features many of which are user requested During our design process we take every effort to ensu
86. dical Note Wednesday 28 Oct 2009 Camedd Tes hAire ol AAs KAO 78 Save Note As Thomas Tony Label Medical Note Date of Service 28 Use as patient s standard Medical Note cre Next give the template a name and check the Use as patient s standard Medical Note box Save Note As Thomas Tony Label Hyperlipidemia Follow up Date of Service 28 Oct 2009 ai Use as patient s standard Medical Note Select Save Note and the note will become the standard note for the patient Upon opening a new note for the patient in the future this note will appear in the menu box as an option to use as a template for the new note Create New Document Thomas Tony Choose another Date of Service 28 Oct 2009 a SendTo Michael McKinney M D Set as default Template Medical Note Set as default Apply Custom Template a Medical Note Deleting User Created Templates To delete a template e Open the template as already outlined e From the File menu select Delete Template File Edit Help New Note 23 Open Note el Save Template al Apply Custom Template lt s Manage Custom Templates p Exit Console re 1 41 GERM Follew un This will permanently delete the template Free Text in User Created Templates When free text is inserted into a document that is saved as a template it will appear in documents which are based on the template It is important to n
87. dication list 124 Dispense Dispense Refills DAW Reported Dr CELE Delete Enter optional Outside Doctor and or Original Start Date before selecting drug Replace current doctor Enter Original Start Date Month Day Year Doctors List 3 letter min 5 recommended Include obsolete drugs No Allergies have been entered PE Click to include Name Severity Notes Swollen Mouth Abdominal Pain Current Medications for Jimmy John Drug Review The same approach may be taken with other medications on the Imported Rx list If a medication isn t listed after the search of the database a help screen will appear 125 Rx Date Date Sey Sig Dispense Dispense Refills DAW Reported Dr Memo Delete amaa PVCS a TN rr a al 12 24 09 TOPROL XL pee Z5MG TARTRATE Replace current doctor Enter Original Start Date Month Day Year Doctor s List Drug Search Results Your requested drug has not been found Miss spelled try fewer letters Search is performed on the full entry for an exact match only A spelling error at the 5 letter will result in a null search Try fewer letters 3 4 are usually enough Too many results Hydrocortisone comes in tablets tubes OTC hundreds of ways Add more information ie hydrocortisone 10 to find a 10mg tablet Too much information leave off the chemical suffix The drug list uses chemical suffixes only when there are multiple fo
88. doctors within your practice from all locations Be sure and follow your office policy as to when to process an Rx from another location or doctor If locations are missing contact your Account Manager The Status Page The Status link above the NavBar goes to the Status page listing all prescriptions needing further processing Pharmcom electronic pharmacy renewal requests Faxes Needing Attention those that did not transmit correctly Failed Electronic Rx will also be listed and require reprocessing Pending Rx that have not been completely processed Pending Rx can be in one of 3 stages DR has been assigned by staff for a doctor to review NS has been reviewed and approved by a doctor but still needs staff to send to a pharmacy InProc incompletely processed has been left unfinished by the displayed user Any prescriptions left on the Status Page at the end of the day represent unfinished business 133 Access to a Patient Only the current patient the selected patient from the EMR is available for processing on the Status page Direct users can process all Exceptions are re faxing and NS both of which are already part of Current Meds Compose Rx Page Displaying the patient s Current Medications and any Pending Prescriptions this page is the center of the prescribing process Mid page note Allergies Start the prescribing process by looking up a drug Type 3 or more letters and click lt Drug Search List gt Up
89. dosage on the Doctor Prescriber s Favorite list When completed click lt Save gt or click lt Undo gt to return and not save changes Note on Medical Rx Terminology qd daily bid twice a day tid three times a day qid four times a day q4h 6h etc ever 4 hours 6 hours etc HS bedtime q a m p m daily in the morning evening qod every other day orn as needed DAW dispense as written do not substitute 161 Imported Rx lf Rx are imported from another system they will be listed in their own imported Rx category If they are imported without adequate information for full processing they will be labeled Note these Rx are not included in drug review To replace with an Rx on the Current Meds List click the drug name and proceed Delete the Imported Rx as desired Some Imported Rx may have enough information to be included in drug interaction review and thus will not have the warning label Any Rxs imported into Current Meds are considered to be from an External Source and will have a tan background Examples of External Sources include meds imported from RxHub and meds entered on the MedEntry page that were written by doctors outside of the account Change Designated Doctor Prescriber To the right of the Drug Search List is the Change Designated Doctor Prescriber area which displays the selection box for the Doctor Prescriber authorizing the Rx Click to change if necessary Patient Allergies I
90. e Signed __ Medical Note Signed __ Medical Note Signed __ Medical Note Signed __ Medical Note Tests Tests Tests New LCD Admin Bacterial Vaginosis Labs Bacterial Vaginosis Labs 115 The Vital Signs Section This is the section where vital signs may be entered saved and reviewed Vital Signs 04 Jun 2012 a Pulse 80 Resp 12 BP 120 70 RUE Temp 98 6 11 May 2012 02 34PM Pulse 58 Resp 12 BP 124 58 LUE Temp 98 6 This section may be expanded to the Vitals pop up Clicktate Logan Arnold Vital Signs 120 70 RUE 124 58 LUE i i To add vital signs from a visit select the Add Vitals button Clicktate Logan Arnold Vitals Entry Date 05 Jun 2012 5 07 53PM 5 Pulse Resp Blood Pressure Temp Weight Height BMI Waist Head O72 Sat on Save Changes 116 Vital signs that are added will automatically populate into the note The BMI Body Mass Index will automatically calculate if the Height and Weight are added Any changes to the vital signs that are made in a note will reflect on the vitals table once the note is signed and locked To add multiple or repeated vitals on the same day enter a new set of vitals and use the Time stamp to input the time that the vital signs were recorded MULTIPLE SETS OF VITAL SIGNS FROM THE SAME DAY SHOULD BE ENTERED ON THE FACE SHEET To view Growth Charts or Graphs of other Vit
91. e qi Skin Lesions T Tobacco Abuse Disorder T Upper Respiratory Infection T Urinary Tract Infection Viral Syndrome Complete list T Abdominal and or Pelvic Pain Female T Abdominal and Pelvic Pain Follow up T Abdominal and Pelvic Pain Male T Abdominal Aortic Aneurysm Follow up T Abnormal Labs Hematuria T Abnormal Pap Follow up T Abrasion T Abscess q Acidosis T Acne q Acne Follow up T Acne Neonatorum T Actinic Keratosis 4 4 i Ed insertion into the note being created This is the template map for the med note The med History of Present Illness note is divided into sections including DOS the Date of Service VISIT Visit Data WCC Well Child Checks HPI History of Present Illness DATA Data Elements PMHX Past Medical History ROS Review of Systems MEDS Medications ALLER Allergies FAMHX Family History SOCHX Social History PE Physical Examination IOL In Office Labs RAD Radiology IMPR Impression PLAN PROC Procedures RTO Return to Office TIME Documentation of Time CC Carbon Copy In this example HPI is selected and various HPI elements are visible in the scrollable list starting with the MAIN commonly selected items section and then an alphabetical list of all HPI templates available 38 Customizing the Template Map The template map may be customized to reflect those items that a provider encounters more frequently To customize
92. e at the bottom of each screen You have two types of help screens to choose from The Popup Help link displays the help screen in a separate screen for your review Alternatively you may choose the Help link which will add the help information to the bottom of the screen you are working on After reviewing the help information you may close the screen by clicking on lt Hide Helo gt We want to be sure you have all of the information you need so if the help screen did not provide you with enough information then click the adjacent Comments Questions to send an email to Customer Support We ll email you back Also look for user tips to the right of the title bars An example of the Patient Education title bar is below Notice the italicized user tip located to the right Patient Education A complete listing of the Help pages is compiled in the Reference Manual posted on the Admin Page Orientation videos are also posted on the Admin 141 Page along with several screen shots Use the support link at the bottom of the page for any remaining questions lf you prefer an audio tour to reading try the Tour starting on the Resource Location Page before continuing on with this summary Read Me First Pages A good way to begin is to review the read me first pages How to Write a Prescription These pages are screen shots and will show you the major components of each screen and how they are used You can access the re
93. e database for a desired template enter the desired search term in the search box which is found above the template map Template Map 2 Customize Template Map 2 Customize lt lt mm omore e y WCC stole RI SOA T a Te Se eee aC HPI a Fa Acute Bronchitis i B T Acute Gastroenteritis PMHX 4 Benign Prostatic This will search the entire template database for all mentions of the search term Template Explorer Fe rheumatica P HPI Polymyalgia Rheumatica History of Present Illness g As relates to the polymyalgia rheumatica the patient reports no body pain stiffness tender points fatigue headaches numbness irritable bowel Fibromyalgia Follow up symptoms bone pain or muscle pain His pain is most prominent in the select Neuropathy Follow up location His numbness is diffuse The patient s bowel habits are Paresthesias Initial characterized by select bowel symptoms The symptoms have been present Impression for 1 month He states that the symptoms are are stable He is currently not Paresthesias using any type of treatment or medication for his symptoms P Diagnoses Polymyalgia Rheumatica Impression Fiotonyalgia Polymyalgia Rheumatica The Template Explorer displays each instance that the search term is used in the Clicktate system and allows the paragraph to be placed into a template if desired 40 The Menu Bar The Menu Bar is the control panel for the Clicktate console File Edit Help Ad
94. e desired indication and you will be presented with the dosing calculations based on the patients age and weight The dosing calculates for pediatrics so make sure to enter or adjust the weight as needed Current Medications can have multiple Sources 1 prescriptions written by all doctors within your account are displayed with the Location Your current Location is bolded 2 medications entered by staff from the Med Entry page or 3 additional prescription records that may have been loaded from outside sources such as RxHub RHIO or IPA Click Edit within the Current Meds to record a sig change To discontinue a drug or eliminate duplicate records use the check boxes and lt D C gt At the bottom of the page are links accessing additional lists previously Discontinued Medications Prescriptions Cancelled after leaving the Compose Page and a log of the patient s Pharmcom activity including denied renewals The tan shading tinting behind meds on the Current Meds list indicates that these medications are from an external source Examples of external sources include meds imported from RxHub and meds entered on the MedEntry page that were prescribed by doctors outside of your account Additional features on the Compose Rx Page Use the MedEntry link to a adda drug to Current Medications for a new patient or when prescribed by a doctor outside your practice an External source with any doctor s name start date or b leave an Rx for Cl
95. e is following a low fat diet She reports that she is not exercising She is not taking medication D Hypertrophy PMHX for hyperlipidemia She denies chest pain shortness of breath orthopnea paroxysmal nocturnal dyspnea dyspnea on exertion edema palpitations or E 4 Coronary Artery Disease syncope ROS F 4 Diabetes Mellitus Type 2 m2 Follow un MEDS 5 As relates to hypertension the patient reports that she has had no headaches or blurred vision She states that she is ALLER T GERD Follow up Adult taking her medication as prescribed D She is not having medication side effects D She does not check her blood pressures at home FAM j 1T Hyperlipidemia Follow up S Hypertension Follow up i edications SOCHX M Hypothyroidism Follow Reviewed Otitis Media Follow up Quick Note Once a paragraph is selected for insertion it will change to purple in the template map The paragraph may be removed by reselecting the title of the paragraph Paragraphs that were inserted automatically based on entries into other paragraphs cannot be removed in this manner Double Clicking Options from Multi choice Boxes e Double clicking an item in a Multi Choice Box will remove the item from a document ALELY ALLEL LARLL Lis WSL LUS LYELL Ste gle LULALSUA a eb Pe Le Pee UUES DR LMES LEL AALY AL L He denies chest pain shortness of breath orthopnea paroxysmal nocturnal dyspnea dyspnea on exer
96. ear in the patient s record Direct Users can add a new patient by clicking the click here to add a patient link Again the Rx cannot be modified so if the sig tablet size or dispense has changed use lt Deny and ReWrite gt to generate a replacement Rx All PharmCom transactions including denials are displayed in the Pharmacy Communications Log on the Admin Page as well as the patient s Current Meds or if denied in the Cancelled Denied Log at the bottom of the Compose Rx page Scheduled drugs 175 cannot be sent via Pharmcom so they will follow a different outgoing path They cannot be sent electronically but in many states can be faxed Thus when responding to the renewal you will see the Route Page where you ca make your choice The sending pharmacy is displayed on the Transmit page On the PharmCom Drug Selection Page match the exact selected drug from the displayed choices Make your final decision on the PharmCom Review Page The sig as sent by the pharmacy cannot be changed You may use this page to process renewal requests and other messages submitted by pharmacies via the SureScripts and other electronic networks The number of pending pharmacy communications is displayed on the Status Bar at the top of all pages Click the bar to view the Status Page and the patient list Depending upon the amount of detail the pharmacy sends with the renewal request there may be certain steps that can be omitted from this process suc
97. ect Diabetes Mellitus Type 2 Follow up nacme The Diabetes Note template will appear Template Map 2X Customize Jones Frank Medical Note Wednesday 30 Sep 2009 Send To Michael McKinney M D History of Present Illness al a Main LA 4T Acne Follow up History of Present Illness eB J Acute Bronchitis c Acute Gastroenteritis The patient presents for a follow up of diabetes and reports that he checks his blood sugars at home His sugars are checked daily The average sugars a B12 Deficiency Anemia are inthe 100 150 range i He denies hypoglycemic symptoms i The patient denies polyuria polydypsia or polyphagia The last eye exam E Benign Prostatic was within the past year He usually sees an ophthalmologist for his eye examinations The eye examinations have been normal J He reports no F Hypertrophy e Coronary Artery Disease symptoms of neuropathy The patient takes his medication as prescribed He is not taking insulin The patient does check his feet daily at home H Diabetes Mellitus Type 2 He denies chest pain shortness of breath orthopnea paroxysmal nocturnal dyspnea dyspnea on exertion edema palpitations or syncope Follow up l J S Fever K T GERD Follow up Adult Medications 4 Health Maintenance Visit Pitas Reviewed m Hyperlipidemia Follow up N 4 Hypertension Follow up o Hypothyroidism Follow up Allergies P q Otitis Media a SI Ot
98. ect Staff gt and allows the user to choose Staff The next tab lt Compose Rx gt appears for any user whose category or role allows them to e prescribe See the Status Page section below for further discussion of categories and roles The lt Pt Details gt tab is accessible to all users Use this screen to add or edit patient demographics insurance contact information etc The lt Pt Notes gt section allows free form notes for the patient to be entered You may use this section to document course of treatment instructions patient special requests etc Previous or Existing Note will be displayed here The lt Diagnoses gt page allows the patient s diagnoses to be searched and stored Finally the lt Administrative Functions gt tab takes the user to a screen which allows reports and manuals to be printed pharmacy information to be added DOQ IT information to be listed etc For more information on these pages see the help screen for that particular page In addition to the tabs on the Navigation Bar there are links that navigate the user from screen to screen These links like the Navigation Bar are available throughout the pages In some cases a doctor and or patient must be selected before navigating to another page In those instances you will be prompted to enter the doctor and or patient first lt SPAN 146 style FONT FAMILY Arial gt The following is an overview of these links Directly above the
99. ectronic Health Record technologies that are easy to use easy to learn easy to implement and easy to afford We strive to be a leader in the development of medical record technology that is complete certified and secure We want to lead the market in innovation and assist medical providers in their efforts to provide better care to their patients All the while we will strive to keep our system so easy to use so that providers can t imagine using any other system Our Business Goals Our goals are to add an additional 48 medical practices per year to our existing customer base by continuing innovation and development and striving to continue to be the easiest to use implement learn and afford EHR on the market Our Business Objectives Y Continue innovative development of Clicktate Ongoing i Continue on line advertising to continue to attract a strong customer base Ongoing Better follow up of on line trial sign ups Ongoing Improved customer experience for trial sign ups 1 Month Continue our high level of customer satisfaction Ongoing Convert 10 20 of on line sign ups to clients Ongoing Ny NS Ae Hire 2 4 dedicated sales staff with regional responsibility utilizing a base salary incentive payments for sales and ongoing usage 6 Months x Sales dinners demonstrations for providers in 4 6 large cities 1 Per Quarter v Monthly ads in a major medical journal Start in 3 Months v Phase 2 Meaningful Use Ce
100. ed on this screen can later be selected on the Compose Rx Page for a refill or to change a sig and are included in drug interaction review Note Be sure and select the drug first Not doing so will cause the other information to be re entered You are able to place an entered medication on the patient s current medication list for viewing by the doctor To do this select the checkbox to the left of the entered medication and click lt Add to Current Medications gt Note it will not have a ReWrite box because it cannot be renewed Detail will not show either print or transmit information since neither has occurred If you do not add the medication to the patient current medication list it will appear on the Compose Rx page as a pending medication You can enter the Detail Rx Page by clicking on the magnifying glass icon to add a message if needed or to assign a DR or NS for the next step in processing of refills A compete sig is not required at this point Click lt Save gt and the Rx will display on the Pending list of the Compose Rx page In addition to adding medications you may also enter Allergies from this page Patient Face Shee Summary The Patient Version uses a non medical sig and displays additional educational materials from Rx Detail The Patient Face Sheet feature provides a summary of the patient s medications allergies diagnoses and demographics in a printable format You may access this screen from the
101. ed or created in Clicktate may be selected for a side by side comparison Once all medications are in agreement select Record as Reviewed Reconciled and the system will record the date and time that the reconciliation occurred 109 The Clinical Decision Support Section The clinical decision support section of Clicktate is design to allow the tracking of routine tests for health maintenance and screening as well as patient specific tests related to a patient s disease conditions Clinical Decision Support ua Item Frequency Last Recorded BMP WITH DIURETIC USAGE Every 1 year s None COLONOSCOPY Every 10 year s None PROSTATE EXAMINATION Every 1 year s None PSA Every 1 year s None TETANUS BOOSTER Every 10 year s None AAA SCREENING N A None ASPIRIN USAGE RECOMMENDED N A None Expanding this section allows data to be input regarding a test filtering of tests and the addition of more tests to the list A comprehensive set of Clinical Decision Support rules are included in Clicktate These rules are disease and demographic specific and are automatically applied to the appropriate patient population Current Clinical Decision Support rules may be accessed from the Report menu found at the top of most pages in Clicktate oo AL Home Patients Documents Sched Track Scan tab Report NO Logan Arnold ID 345654 DOB 05 Jan 1946 4ge Sex 66 male Address 654 Broadhead Place Lexington KY
102. efills 0 89 Med Selector Name Strength Amount As needed With meals Disp Name Search Results Active Long Term PREVACID 30MG il Save Changes Cancel Then select the desired medication from the list in the medication pop up The medication will be listed on discontinued and the Facesheet medication list will be updated after the note is signed and locked 90 Section IX The Facesheet The Facesheet allows e The ability to input retain and work with medication lists e The ability to input retain and work with allergy lists e The input retention tracking and graphing of vital signs e Patient demographic recording e Health Maintenance and recurring tests tracking maintenance and reminders e Quick Viewing of Prior Patient Data e Quick input and review of past medical history past surgical history family medical history and psychosocial history e Immunization records e Growth charts e Workflow tracking e Review and reconciliation of patient history medications and allergies chronologically and as they relate to medical notes Each section of the Facesheet has an expand toggle This toggle when activated expands the section allowing the user to input and update data Data from the allergy vital signs and medication sections and certain data from the Health Maintenance section will automatically populate notes Also data from signed notes will automatically update the Facesheet
103. electing one of these patients an appointment for that patient may be added to the schedule 19 New Appointment gt Test Darla Patient Test Darla ID 09238 DOB 09 Mar 2009 Address Phone Ey Go to patient s facesheet E Choose another Appointment Date 2012 04 27 al Time 10 00 AM Type No Type Customize Duration 0 hours l and 0 minutes A Status No Status Customize Comments al save and Continue gt Now entering an appointment is easily accomplished by selecting the appointment type and duration The appointment status may be changed to arrived late DNKA rescheduled or other options as needed There is also a field for comments if additional notes need to be included The Cancel button is to cancel the entering of an appointment not the actual appointment To cancel an already scheduled appointment use the Status Dropdown menu Appointment type and status are user customizable fields and may be changed according to individual practice needs 20 New Appointment gt Test Darla Patient Test Darla ID 09238 DOB 09 Mar 2009 Address Phone al Go to patient s facesheet Ey Choose another Appointment Date 2012 04 27 HE Time 10 00 AM cD Type Acute a Customize Duration 0 hours and 20 minutes gt Status No Status Customize Comments Blood pressure check Needs urinalysis prior to appointment
104. emic 4 EXQUEtetitaieenetan He takes an aspirin daily 7 A Text Insertion Box will appear 59 Insert Free Text Free text can now be inserted Insert Free Text The patient reports anxiety after taking his insulin Click OK and the Free Text will be inserted into the document 7S a oO E TaT a rE eee EE BE l CC a een ee nn ie The last exam was within the past year W He oe sees an MpESLINE ORE for his si examinations The hide examinations have been The Free Text will be highlighted in yellow making it easier to recognize You may change add to or delete the free text by clicking on the highlighted area To turn off or hide free text toggles click the free text button on the menu bar When the toggles are turned off any free text that you have added to your document will be retained and remain visible 60 Options for Deleting Text from Clicktate There are several options for deleting unwanted or unneeded text from Clicktate notes e Delete Toggles e Paragraph Removal e Highlight and Delete e Double Clicking Options from within Multi option Pop ups e Removing Physical Exam Options by Selecting the Section Title Delete Toggles Clicktate documents also contain delete toggles to remove unwanted text from a document The delete toggles are denoted by a small blue D or by a more descriptive blue delete box As relates to the patient s Coronary Artery Disease he denie
105. er Warn me when dosing multiple tabs Always switch to new tabs when they are created Enable Quick Tabs requires restarting Internet Explorer Open only the first home page when Internet Explorer starts F Open new tabs next to the current tab Open home page for new tabs instead of a blank page en pop up is encountered Let Internet Explorer decide how pop ups should open 0 Always open pop ups in a new window O Always open pop ups in a new tab Open links from other programs in Anew window Anew tab in the current window The current tab or window 11 Section Ill Getting Started Logging On To log on to clicktate com go to the home page www clicktate com You will see a link that will direct you to the secure log in page There you will find the log in box Home Take a Tour Pricing Free Trial Signup cure Login for Cicktate Users gt Clicktate 4 0 User ID Password Login gt Forgot your login ID or password Looking for legacy version Type in your User ID and your Password If you forget your user ID or Password select the link at the bottom of the sign in box Both the User ID and Password are CASE Sensitive For instance the Password SamPle3 is NOT the same as sample3 Each Password must contain at least 6 characters at least one of which must be numeric After you input your User ID and Password press the Login gt button You will be directed to the Home
106. ergies currently in Clicktate will need to be transferred to the NewCrop system When you enter the Facesheet of a patient who has Legacy medications and or allergies a banner will appear at the top of the screen alerting you to this fact In addition the Legacy medications and allergies will appear in Italicized Red Type Logged in as bedadmin4 Logout TEST Home Patients Documents Scheduling Tracking My Profile ICD Lookup Admin E Messages 0 Rx Pharm 1 Fax 0 Pend 0 Facesheet for John Jimmy g Print Search for patient ID 239480 DOB 14 Sep 1954 Age 56 EP Expand i Address 45678 Sesame Seed Lane McDonaldLand CA 90210 Add Notes 888 825 4258 primary Workflow Active Allergies E cD New Appointment 2 CIPRO Swollen Mouth Abdominal Pain ih Record Today s Vitals i i eee E A eee eee ee P LES AE ATENTE J Pi Create New Document New Message Diagnoses amp Current Medications i HYPERLIPIDEMIA PREVACID 30MG 1 daily TOPROL XL EQ 25MG TARTRATE 1 daily By selecting a legacy medication a legacy allergy or the alert banner the e prescribing module will be accessed and the medications and allergies will transfer to this area The patients name address and pharmacy information must be present in Clicktate in order to access the e prescribing system The Med Entry page of the NewCrop system will include the Legacy Medications and Allergies 120 Return to Clicktate L
107. eriod would be excluded from this requirement Exclusion from this requirement does not prevent an EP from achieving meaningful use Prescriber details and a printable list of all prescriptions written may be found in the administration section of the electronic prescribing module More than 50 of all patients of the EP who request an electronic copy of their health information are provided it within 3 business days More than 40 of all permissible prescriptions written by the EP are transmitted electronically using certified EHR technology More than 10 of all unique patients seen by the EP during the EHR reporting period are provided patient specific education resources More than 20 of all unique patients 65 years or older or 5 years old or younger were sent an appropriate reminder during the EHR reporting period More than 10 of all unique patients seen by the EP are provided timely available to the patient within four business days of being updated in the certified EHR technology electronic access to their health information subject to the EP s discretion to withhold certain information More than 50 of all unique patients age 2 and over seen by the EP have height weight and blood pressure recorded as structured data que patients seen by the EP have demographics recorded as structured data 111 Select Clinical Decision Support Hew Report lt Patient Reports Clinical Decision Support Reporting Clinical
108. es Current Allergies CIPRO Rash Ie With checked x Remove from List oF Add an Allergy The Allergy History section will render a chronologic list of all allergy information in the chart It will also give a quick link to notes related to the addition or deletion of any allergy data 99 The Diagnoses Section The diagnoses will automatically populate the Facesheet from notes that are created in Clicktate This applies only to notes that are signed and locked after the release of the Facesheet In addition diagnoses may be added or changed by using the ICD function found in the diagnosis section Diagnoses lad CORONARY ARTERY DISEASE 414 01 HYPERTENSION 997 91 q Lookup ICD To add new diagnoses select either the expand option the None Recorded designation or any diagnosis listed in this section Clicktate Logan Arnold Diagnoses Diagnoses List Diagnoses Documented Show Active Only rae Effective CORONARY ARTERY DISEASE 414 01 04 Jun 2012 HYPERTENSION 997 91 14 Jan 2012 Download oP Add a Diagnosis Jone Active Selecting the Add a Diagnosis button will open the ICD Pop up 100 Clicktate Logan Arnold Diagnosis Entry Date 16 Jun 2012 j status Active e Description ICD Lookup Diagnoses may be searched for either by the ICD code or by a description Type a diagnosis description and then press the Lookup icon You may al
109. es page provides a means of entering and storing patient information To reach this page select a patient on the Patient Select page and click lt Pt Notes gt on the Navigation Bar To write a note type in any information you choose There is no set format Your name and date time of entry are automatically added to the note Each note is added to the Patient Notes list with the most recent appearing first No changes are possible once a note is lt Saved gt Correct any error by writing a second note 190 Patient Diagnosis Page The Patient Diagnosis page displays diagnoses and past medical history To add a diagnosis to the patient s Current Diagnosis List either select a diagnosis from the list displayed by clicking on the ICD9 code or enter at least the first three characters of the diagnosis and click lt Search gt If you know the ICD9 code you may enter it into the search box The search results will display below the search box Click on the appropriate ICD9 code to select it Doing so returns you to the Patient Diagnosis page with the selected ICD9 code and description entered in the appropriate boxes You may then move down to the Date of Onset field This field is pre populated with the current date You click on the box and overwrite today s date If the exact date is not known or necessary click on the Check box if exact date not known box In the Treating Physician box the current doctor s name can be overwritten by
110. ess mailing address contact information insurance information etc and allows updating in some configurations An insurance plan must be entered for formulary coverage information to appear with drug selections Note the dropdown specifically for Medicare Part D On the left hand side of the page below the patient s name the RxHub RxHistory link may appear Click to view an all doctor Rx history from the healthplan All users will access the Patient Details page from the Navigation Bar to enter any needed information You can come back to this page at any time to modify a patient s information 184 Note for Partner users You will see much of the information already filled in and read only Some items such as patient language or pharmacy choice will still be changeable After a patient has been selected or added you may enter patient specific information here Those users who have Formulary access may choose the patient s Health plan from the drop down box located under the General Patient Information heading Listed in this drop down box are all health plans which have been previously selected for your Account If the patient s health plan is not listed you may proceed to the Admin Page and select the Account Healthplan List link Any health plan added to this list will be available for all users to access The Pharmacy section indicates the patient s pharmacies The Patient Information section stores the patient demographic
111. evel Practitioner user can write or renew prescriptions although the Mid Level Practitioner user cannot have their name listed at the top of a prescription The Staff Category is split into 3 roles e The Clinical Staff role typically a nurse or medical assistant may access the same pages and func tions as Doctor Prescribers and can Call a prescription into the pharmacy however Clinical Staff cannot sign a prescription o Example1 An office nurse receives a request from a patient to renew a prescription The office nurse in accordance with office policy may then transmit the prescription with the Designated Doctor Prescriber listed as authorizing physician o Example2 A doctor asks his Medical Assistant to call an Rx in for a patient The MA then enters the prescription into the system listing the requesting physician as the Designated Doctor Prescriber e Clerical Admin Staff are not authorized to call a prescription to the pharmacy However within ERx Clerical Admin staff may enter renewal 150 requests into the queue for Doctor Prescribers Mid Level users or Clinical Staff to review and or authorize Clerical Admin Staff can also enter and edit patient s information as well as print Face Sheets o Example A receptionist receives a phone call from a patient requesting a prescription renewal In accordance with office policy the receptionist may enter the renewal request into the queue for a Doctor Prescriber Mid Leve
112. f spelling use part of the name and add a street if known To edit or add a fax number click on the desired pharmacy change the number and then click lt Save gt To remove pharmacies check the boxes on the left and click lt Delete gt 188 Account Healthplan Formulary List Page Summary Use the Account Healthplan List link to build and maintain your list of insurance and formularies The list becomes a pick list for each patient This page allows selection of the insurance plan formulary used by your account s patients f the account has the Meai Media Formulary feature coverage status for each drug will be displayed specific to the patient s insurance coverage To accomplish this healthplans must be listed for the account and then assigned to each patient If NewCrop is electronically linked with another application in the office such as practice management or patient record healthplans may be selected there as part of the patient set up process Once selected the account s healthplans and associated formularies are displayed as a drop down list for each patient on the Patient Detail pages Formularies Formularies are more specific than the insurance coverage For instance Blue Cross may provide a different formulary with each plan i e PPO vrs HMO In addition coverage may differ by employer Therefore you must closely inspect the list of alternative formularies to find the one matching your patient s co
113. fax number in the field labeled Via Fax Corrected numbers are stored and displayed for future use lf your pharmacy is not on the list there is an Add a pharmacy to the list above link located at the bottom of the page that opens a Pharmacy Search box where you can search for the desired pharmacy by entering 1 or more fields Zip codes alone generally work well Once you have entered your search criteria click lt Search gt The search results will display below Select the pharmacy by clicking on the pharmacy name This results in the selected pharmacy being added to the patient s list of pharmacies as well as your Location Workgroup s list of pharmacies lf the pharmacy you are searching for is missing from the list or if any displayed information is incorrect please click on the missing incorrect pharmacies inform Support Services email link at the bottom of the page to inform us so that we may correct the database Finally when you have the correct pharmacy selected click the lt Transmit Rx Add to Record gt button sending the Rx and adding the new information to the patient s record Once the prescription has been transmitted these prescriptions can no longer be cancelled or modified If an error has occurred go to the Compose Rx page and move the incorrect Rx to Previous Meds OR use the Modify Sig feature Edit where you can record an explanatory note in the Detail Rx if desired Clicking the lt Transmit Rx Add to Record
114. ffice visit the patient has not sought emergency care She currently reports no wheezing cough sputum production or dyspnea The patient is T ihr using an inhaled steroid She does rinse her mouth after using her steroid inhaler She doesn t report thrush symptoms or a sore mouth She denies Coronary Artery Disease hemoptysis She is smoking i Mellitus T T nar een pire ues The patient smokes She smokes 1 pack per day She has smoked for 15 20 years iSasags el 3 vara aes q Fever GERD Follow up Adult Health Maintenance Visit 4 Hyperlipidemia Follow up Reviewed Hypertension Follow up History of Present Illness Medications Hypothyroidism Follow up Otitis Media Allergies Otitis Media Follow up 4 Tobacco Abuse Disorder Upper Respiratory Infection Urinary Tract Infection Viral Syndrome Physical Examination Reviewed per Nurses Note In Note FREE TEXT OPTION Vitals Reviewed per Nurses Notes fig Chronic Obstructive Pulmonary Disease ALE AN HEENT Facies Within normal limits Pinnas Normal texture and shape bilaterally Canals Normal bilaterally TMs Normal bilaterally Nares Patent bilaterally Nasal Septum is normal There is no tenderness to palpation over the frontal or maxillary sinuses Lids Normal bilaterally Conjunctiva Clear bilaterally Sclera Anicteric bilaterally Oropharynx Moist with no lesions Tonsils No enlargement Created 28 Oct 2009
115. g Admin Logged in as ledadmin4 My Profile Logout EY jic Seti Patient Notes List all patients Open today s schedule List unsigned notes for me Search by Last Name Open this week s schedule Go List all notes Search by ID Start a new note for patient Open for date Ej Go Custom Templates Create a new patient Manage my templates T My info Change my password My Profile Practice info Manage support logins From the home page select Manage my templates 67 e From the Patient Console New Note New Replicate Open Note save Note As Sign and Lock 5 B be m pr Hew ddendum Generate Orders Download as PDF Download as Word Copy to Clipboard Delete Note Apply Custom Template From the patient console select either New Template or Open Template from within the File Menu A note that has been created for a particular patient may be saved as a template using the Save As Template function This note could then be used for other patients in the future 68 Starting a New Template To start a new template from scratch select New Template from the File Menu as noted above or select Start a New Template from the Home page by selecting Manage my templates and then Create New Custom Template Document Manager Showing Customized templates W John Template k HL HTN HOTHY i Hyperlipidemia on Lipitor k tiffany note hyperlipidemia i test
116. g An explanatory note can be recorded in the Rx Detail You will find yourself on the Route page after having clicked lt Proceed to Print Transmit gt on the Review page All prescriptions will be displayed on the Route Page but only the Rx for the Current Location are pre selected You may make changes by unchecking a box For example if you want to print 2 prescriptions and transmit the other 3 you would uncheck select the two you want to print 169 The first option on this page allows you to choose the number of chart copies of this prescription that you wish printed on paper By clicking on the Number of copies drop down box you may choose from 0 to 3 copies to print The default setting is zero printed copies If the prescription was transmitted electronically you will have the option of reviewing a printable proof of transmission when you reach the Transmit Page The copies on this page are in addition to the one printable from the Transmit Page lf you want a Patient Leaflet to print select a patient language If the patients language was entered on the Patient Details page that will be the default language that appears here If not select the appropriate language and check the box s for a printable patient leaflet as needed These boxes appear to the right of each prescription allowing you to select which leaflets to print if you do not want a leaflet printed for each prescription This is a Comprehensive account option only A
117. g changes are tracked and displayed Note the Report Missing Rx section above the pharmacy transmission log If electronic Success is displayed yet the pharmacy states they did not receive the Rx please send us this information ASAP it will be fully investigated For a missing successfully faxed rx contact the pharmacy directly and suggest they check their fax machine before they request renewals Pharmacy Communication Pages PharmCom The PharmCom pages process renewal requests submitted electronically by pharmacies The pharmacy request cannot be modified Only of refills can be changed Some or all of the following steps may not occur depending on the amount of information sent by the pharmacy From the PharmCom Patient Select Page EMR users must return to select the displayed patient before proceeding Select the patient before denying or the Rx will not appear in the patient s record Direct users if needed correct name or spelling and re search If needed click here to add a patient If the requested sig tablet size or dispense now differ from what the patient is taking use lt Deny and ReWrite gt to generate a replacement Rx All PharmCom transactions including denials are displayed in the Pharmacy Communications Log on the Admin Page as well as the patient s Current Meds or if denied in the Cancelled Denied Log at the bottom of the Compose Rx page On the PharmCom Drug Selection Page match the exact
118. gt By not clicking on the Print Prescription link on the next Print Rx page you will not print the Rx on paper You can then handwrite the Schedule 2 s Pharmacy If an Rx is a refill and was previously sent to a pharmacy the pharmacy name address amp phone number will be displayed to the left of the prescription If the Rx has no pharmacy name in this box you will choose a pharmacy on the Transmit Page Coming Soon A lt Send gt next to each pharmacy that will transmit the prescription immediately bypassing the Transmit Page No leaflet or receipt will be generated Routing Prescriptions You have two options on this page for routing prescriptions 1 For those prescriptions you do not wish to transmit electronically or via fax to the pharmacy use the lt PrintRx Add to Current Meds gt button Doing so automatically adds the selected prescriptions to the patient record and takes you to a print page where each prescription will be displayed along with any requested leaflets and additional copies NOTE In the event an error has occurred the RX cannot simply be deleted at this point You need to go to the Compose Rx page and move the incorrect Rx to Previous Meds OR use the Modify Sig feature Edit where you can record an explanatory note in the Detail Rx if desired lf you want to print the prescriptions leaflets and copies click on the Print Prescription link that appears above the prescriptions to access your networ
119. h as the PharmCom Patient Select page and the PharmCom Drug Selection page Begin by selecting a patient under the Pharmacy Renewal Requests heading located on the Status Page The Status Page can be reached by choosing the lt Pharm x Fax x Pend x gt link at the top of each page Once you have selected a patient from the list you will be taken to the PharmCom Patient Select Page Select the correct patient from the displayed search results le FONT FAMILY Arial gt lf the patient is not found be sure the pharmacy has not misspelled or used a different name from what your account uses i e Larry vs Lawrence Use date of birth to confirm identity Perform another search using fewer letters or last name only If after trying all alternatives you believe that the patient is truly not there Direct Users add the patient to your account by clicking the click here to add a patient link Once you have completed entering the necessary information to add the patient return to process the pharmacy message EMR users return to add the patient there You may deny a prescription at this point Use the drop down box to select a reason for the denial If none of the reasons are applicable you may type in your reason for denial in the box provided Click lt Deny gt A notification of denial will be transmitted to the appropriate pharmacy and you will be shown a confirmation to that effect If a 176 message is left in mid sequence it w
120. he pharmacy is highlighted in green A list of matching drugs is displayed below that area From the Search Results match the exact drug by clicking on the requested drug formulation or tablet size i e Prozac 10 mg Cap The sig as sent by the pharmacy is text that cannot be entered for dose checking or easy refills Therefore it is recommended that you Edit the Rx to enter the sig as written by the pharmacy and delete the unneeded pharmacy text sig before accepting the prescription For example the pharmacy request sig reads take one capsule twice a day You would edit the sig and a enter 1 b confirm the type is capsule c enter BID d delete the take one capsule twice a day text that is in the additional sig box and e click lt Save gt 177 Remember Ihe sig and dispense number from the pharmacy have already been entered and cannot be changed If you need to modify the medication dispense number or sig the prescription must be denied Thus a message to that effect is listed as one of the choices in the Deny drop down reason list Denied new prescription to follow Scheduled drugs cannot be sent via Pharmcom so they will follow a different outgoing path They cannot be sent electronically but in many states can be faxed Thus when responding to the renewal you will see the Route Page where you ca make your choice The sending pharmacy is displayed on the Transmit page Once
121. hitis Acute Gastroenteritis Benign Prostatic Hypertrophy Coronary Artery Disease Diabetes Mellitus Type 2 Follow up Fever S GERD Follow up Adult Hyperlipidemia Follow up Hypertension Follow up 4 Hypothyroidism Follow up Otitis Media Otitis Media Follow up S Quick Note 4 Tobacco Abuse Disorder 4 Upper Respiratory Infection Urinary Tract Infection 4 Viral Syndrome Complete List Abdominal and Pelvic Pain Follow up Abdominal and Pelvic Pain Male Abdominal and or Pelvic Pain Female J Abdominal Aortic Aneurysm Follow up Abnormal Labs Hematuria 06 Mar 2009 11 58PM by LCD Admin e History of Present Illness The patient presents with a 1 day history of constant tactile fevers The patient does not have a dry cough a wet cough wheezing nasal discharge facial pain a headache eye drainage ear pain ear drainage a sore throat night sweats abdominal pain neck stiffness dysuria a rash bone pain joint pain chills myalgias nausea vomiting diarrhea decreased appetite or congestion The patient has not used anything to treat this illness Medications Reviewed Allergies Reviewed per Nurses Note Physical Examination agiz PaA Vitals Reviewed per Nurses Notes RAOVA WAeau Eesen EA SHOW BMI HEENT Facies Within normal limits Pinnas Normal texture and shape bilaterally Canals Normal bilaterally TMs Normal bilatera
122. ill be returned to the Status Page list for processing at a later time Scheduled drugs cannot be sent via Pharmcom so they will follow a different outgoing path They cannot be sent electronically but in many states can be faxed Thus when responding to the renewal you will see the Route Page where you ca make your choice The sending pharmacy is displayed on the Transmit f a patient is not selected before denial the record will appear only on the Pharmcom Log on the Admin Page SureScripts and the participating pharmacies have required specific data standards that limit doctor choices the medication dispense number and siq cannot be modified f any of the above are incorrect the prescription must be Denied and a new prescription must then be sent A message to that effect is one of the choices in the Deny drop down reason s list denied new prescription to follow All PharmCom transactions are recorded and displayed in the Pharmacy Communications Log which can be accessed from the Admin Page PharmCom transactions can also be viewed from the Compose Rx page by checking the Show Patient PharmCom Log box to view the accepted PharmCom transactions or by checking the Show Cancelled Medications box to view denied PharmCom transactions If desired these can be highlighted and printed lt SPAN PharmCom Drug Selection Page Upon patient selection you will be on the PharmCom Drug Selection Page The drug that is being requested by t
123. in The patient does check her feet daily at home She denies chest pain shortness of breath orthopnea paroxysmal nocturnal dyspnea dyspnea on exertion edema palpitations or syncope As relates to hypertension the patient reports that she has had no headaches or blurred vision Eq iar She states that she is taking her medication as prescribed She is not having medication side effects including rash headache vivid dreams fatigue dyspnea wheezing sexual dysfunction edema cough or abdominal pain She does not check her blood pressures at home Mediratinn lt s Any needed changes may be made and the Save As Button is selected to save the template File Edit Help New SJOpen la Save As 70 4 Sign and Lock iy Download Ww clipboard Y Undo Clear i Freetext Exit Console emplate Map A C 7 ew File Custom Template ical Note T te Map New File Custom Template Medical Not A template pop up will prompt the template to be named Name of new customized template LT LITE ae Clicktate DM HTN SS aaa ee Le ee a ee ee ee a Cicktate i J Custom template DM HTN saved 71 The template name DM HTN is now available for use with other patients and in other documents It can be accessed for any New Note under the Custom Templates dropdown tab Create New Document Jones Frank Choose another Date of Service 28 Oct 2009 HA Send To Michael M
124. in Interaction Allergy Condition Formulary checking a aan aD azarae Osa 12 2409 PREVACID 30MG 1 daily 12 24 09 TOPROL xL EQ 25MG TARTRATE 1 daily 30 N Enter optional Outside Doctor and or Original Start Date before selecting drug Replace current doctor Enter Original Start Date Month Day Year or leave for further processing Adjust Disp only after completing Sig Prevacid 30 mg Cap Dosing capsule by mouth Capsule X 0 N He aa 1 7 PRN DAW DNS as directed 10 day elect packaging for pharmacis 1 3 DAILY 14 day 2 3 BID 2iday Available packaging 0 5 half One Time TID 30 day 80 each BLIST PACK E 15 QD 90 day T each BOTTLE Q4h 10 each BOTTLE 25 Save this sig and add to Doctor s List Q6h Days 14 each BOTTLE z 3 Q h supply A d Q12h 0 5 7 NIGHTLY 6 BEDTIME ad EX T in AM 90 Day 0 Q h WA g EVERY OTHER DAY 10 3 TIMES WEEKLY Save Rx Cancel 11 Qhiwk o 12 Qewks 15 Q3wks 20 nce a month 30 z Add l Sig Additional Sig will appear on rx label Pharmacist Message will NOT appear on rx label no sig allowed Select Diagnosis Enter the appropriate medication information and select Save Rx select to Move to Current Meds or leave for further processing Open Edit for Dosing ee eee 2 ee stage SOUTCE a Hee Prevacid 30 mg Cap 1 daily noe Eon 3 InProc Next select Select to Move to Current Meds The medication now appears on the current me
125. ing a report Reporting medicare and Medicaid EHR Incentive Program Hyperlipidemia Patients 3 Add Denominator 5 Patients AGE at least 18 and DECEASED is empty amp having at least one of Diagnoses DESCRIPTION contains hyperlipidemia aE Diagnoses DESCRIPTION contains hypertriglyceridemia Diagnoses ICD CODE contains 272 4 Another ea add a Generate Report ld Save Changes X Delete Report Exit Patients Diagnoses 8 Barnaby Jonas Hyperlipidemia 272 4 8 Bear Pooh Hyperlipidemia 272 2 ig Biltmore Troy Disorders of lipoid metabolism Other and unspecified hyperlipidemia 272 4 8 Bower Mandy Hyperlipidemia Hyperlipidemia 272 2 hyperlipidemia object Text hyperlipid object Text object Text object Text 272 2 Hyperlipidemia 272 2 El Cuppy Ronald Disorders of lipoid metabolism Mixed hyperlipidemia 272 2 Hyperlipidemia 8 Demo Khani Hyperlipidemia El Emerson Waldo Hyperlipidemia 8 Fife Barney Hyperlipidemia Hyperlipidemia ICD 8 Frances Frank Hyperlipidemia 272 2 Henthorpe Millie Hyperlipidemia i ee T a E TE inidamis 9774 Numerator record s returned 30 Download 205 To add a denominator and generate a percent calculation select Add Denominator and enter the criteria as above The criteria from the Numerator will be copied into the denominator fields Creating a Clinical Decision Support Report Clinical decision supp
126. ing glass icon takes you to the Rx Detail page which provides complete information on the prescription including any additional directions prescription batch and previous pharmacy transmission information You also are able to add notes for both the patient and for other users to reference To delete a pending prescription click on the X to the right of the prescription you want removed The Dosing feature is also accessed via the Edit link of Pending prescriptions Once in edit view you can access dosing by clicking on the dosing link which displays below the drug name Several Diagnoses indications will display Select the desired indication and you will be presented with the dosing calculations based on the patient s age and weight o The dosing calculates for pediatrics so make sure to enter or adjust the weight as needed and click the lt Update weight in Kilograms gt button o If you want to calculate the dosing based upon a different frequency ie BID in instead of Daily select a different frequency from the drop down box o Similarly if you decide you want a different strength i e 500mg instead of 250 mg than what you originally selected you can select the new strength from the box of that displays the various strengths Scrolling down will allow you to view the prescription that you are editing You can make any changes as necessary and then click lt Save gt and you will be taken back to the Compose Rx page Dr
127. inical Staff or Doctors for later review and processing To the left the Progress Note and Face Sheet links each generate a Current Meds list in a printable format Patient Version substitutes twice a day for bid and displays Patient Education materials See Rx Detail below These features can also be accessed by clerical staff from the Admin Page The Compose Rx Page is the center of the eRx prescribing system as each new prescription begins here 157 Pending Prescriptions Beginning at the top of the page you will note all pending prescriptions for this patient These prescriptions have not yet been added to the patient s Current Meds list and as indicated on the Status Page each is coded with an NS DR or InProc denoting Needs Staffing Doctor Review or In Process respectively These Rxs are not yet part of the permanent record but are included in drug interaction checking on the Review page If your Account has the Comprehensive functionality you will see the Formulary status You can click on the formulary status to display the drug alternatives This is especially useful if the drug is non formulary and you want to select a drug that is on formulary You can also click on the drug name to change the strength if you need to do that You will also see an Edit link associated with each pending prescription Clicking on this link expands the fields to allow you to make changes to the prescription A click on the magnify
128. ion Support and any number of conditions demographics medications or other criteria Reporting Clinical Decision Support Albumin 3 Patients Any Interval every day s x amp add HE Generate Report z Save Changes Exit In addition a time interval for applying the rule may also be implemented To implement a rule to apply Albumin every three months simply check the interval box and input the interval Reporting Clinical Decision Support 2 Albumin Patients Any 7 interval every 3 month s amp add FE Generate Report io Save Changes Exit The Clinical Decision Support Rule may be renamed by selecting Clinical Decision Support In addition a description may be entered Report Entry x Name iter Bizet eg mestl yeaa Description lz Save Changes Cancel Report Entry Name Albumin in Diabetic Pts Description This is a rule to remind providers to check an albumin in diabetic patients as part of an ongoing clinical trial throughout our organization To see a list of every patient who is due for a Clinical Decision Support item choose the item from the Clinical Decision Support list or select Generate List from within the specific Clinical Decision Support window 113 Creating Clinical Decision Support Rules is tied to the Reports section of Clicktate An in depth discussion of creating reports is found in the Reporti
129. is function A search to avoid duplicate entry occurs before adding a new patient Welcome again Be sure and send us your suggestions for improvements That s where we get some of our best ideas Location and Resources Page 138 It s time to begin Electronic Prescribing By using this eRx system you are taking the first step in enhancing your office s prescription handling You will find this process to be both intuitive and easy to use However we strongly recommend a full orientation period prior to beginning Ata minimum you should review the How to Write A Prescription summary available on the Administrative Page or use the Tour link at the bottom of each page for an audio orientation In order to help you navigate the system each screen is described in great deal on the following pages You will also find definitions for specific terms and fields that appear on the screens We suggest that you review these pages prior to your eRx implementation Each help page has a summary and detail section If you need just a quick overview of the page the summary section might be all you require If you desire a more detailed explanation continue on to the detail section Do these instructions apply to you This eRx software has several different features available If your system does not have all available features installed you will read about features that might not pertain to you In most cases links to these option
130. isplayed as links In many instances your search may result in more than one patient with the same name You may verify your selection by noting the DOB Date of Birth SSN Social Security number and phone number that are displayed If the desired patient is displayed click on his her name In the event that the patient you are seeking does not appear try searching with a different identifier such as SSN or MRN lf you are sure the patient is not already in the database and no patient is found matching the selection criteria use the Click here to add a patient link that appears below the search results or go to the Admin Page and click on Add Maintain Patient You may also want to check with your account manager Clicking the patient search button without entering any information will open the search box with the last 20 patients selected for this location When you have located the desired patient click on the patient s name You will then be taken to the Compose Rx Page If this does not happen automatically click lt Compose Rx gt on the Navigation Bar Patient Search Results Displays the last twenty 20 patients selected for your location If you do not see the patient you are looking for on this list use the Patient Search to locate the patient Office Bulletin Board The bulletin board may be used to informally display messages to all staff throughout the day Type any message that you wish to send and click the lt Save gt butt
131. itis Media Follow up Reviewed per Nurses Note R Tobacco Abuse Disorder s Upper Respiratory E Infection T q Urinary Tract Infection Physical Examination a Viral Syndrome mee FREE TEXT OPTION Vitals Reviewed per Nurses Notes B SHOW HEIGHT ff SHOW WC Ly csc Mellitus Type 2 eae Pe eels aA HEENT Facies Within normal limits Pinnas Normal texture and shape bilaterally Canals Normal bilaterally ollow u TMs Normal bilaterally Nares Patent bilaterally Nasal Septum is normal There is no tenderness to palpation over the frontal or maxillary sinuses Lids Normal bilaterally Conjunctiva Clear bilaterally Sclera Anicteric bilaterally Oropharynx Moist with no lesions Tonsils No enlargement ervthema or exudate 50 The selected paragraph indicators will change color to indicate which paragraph has been chosen In addition paragraphs found in a note will appear in the In Note section found at the bottom of the template map 3 ACUTE Broncnitis Histc WEC T Acute Gastroenteritis HPI T Benign Prostatic Hypertrophy The E 4 Coronary Artery Disease denig D ee Diabetes Mellitus Type 2 usual pr Follow up LE q Fever The F 4 GERD Follow up Adult short ALLER H Hyperlipidemia Follow up FAMHY 4 Hypertension Follow up 4 Viral Syndrome hal In Note Diabetes Mellitus Type 2 Follow up Selecting an additional diagnosis or problem will add additional information
132. k on the upper leit of the page Canada formulations RxNorm users may see a formulation not marketed in the US Let us know and we will label it as such customersuppor newcroprx com Click here if drug not found Select the Click here if drug not found link OR try typing in an alternative spelling in the Drug Search box Doctor s List Toprall 3 letter min 5 recommended Include obsolete drugs Drug Search Results Your requested drug has not been found Miss spelled try fewer letters Search is performed on the full entry for an exact match only A EER cee nea Be sy E ee ee eee ae ee Me Seep eee fen eee Tat lee A E ie 126 Dispense Refills IDAW Reported Dr Memo Delete a Rx Date Drug 12 2409 PREVWACID 30MG Replace current doctor Enter Original Start Date Month Day Year Doctor s List Toprol 3 letter min 5 recommended Include obsolete drugs Drug Search Results 5 rol XL Beas Monograph Leaflet Beta Blockers Cardiac Selective Metoprolol Succinate Toprol AL 100 mg 24 hr Tab Generic Available Toprol XL 200 mg 24 hr Tab Generic Available Toprol AL 25 mg 24 hr Tab Generic Available Toprol XL 50 mg 24 hr Tab Generic Available Click here if drug not found en 11 a B E a e Erm on a oon me a B C al o E ao o_o 2 oe Select the appropriate medication and enter the dosing as before Once all Legacy medications are
133. k printer lf there are any remaining prescriptions for the patient you will see a Return to Routing link adjacent to the Print Prescription that will display the number of prescriptions remaining on the Route Page Clicking this link takes you back to the Route Page where you can continue processing the other prescriptions 2 Your second option for routing prescriptions is to use the lt Transmit RX gt button Clicking 171 this button will send all selected prescriptions to the next page where a pharmacy can be selected and leaflets and copies printed lt SPAN The Transmit Page and Transmit Confirmation Page Summary Choosing the lt Transmit RX gt option on the Route page takes you here with the selected prescriptions You can send prescriptions as mail order by clicking on the mail order home delivery link verifying the shipping address and selecting the pharmacy The patient s previously selected pharmacies are at the top of the list followed by an alphabetized location pharmacy list The patient s available mail order pharmacies are denoted with a blue dot Add to the displayed pharmacy list from the link at the bottom of the page Report incorrect or missing pharmacies so we can correct the selection list After transmitting use your network printer for the receipt and Patient Leaflet Note There is a slight delay with transmitting so please make patients aware of this especially if the pharmacy they are going
134. l Practitioner or Clinical Staff to address via the Med Entry Refill page e Full Access Staff are granted the same capabilities as the Account Manager This allows more than one user to share password maintenance and other chores Patient Selection Only Direct users will have the ability to select a patient on this page Partner users select their patients prior to entering the eRx program and thus will not see this section on their page It is important to avoid duplicate patients For that reason you must first verify that the patient is not a current patient by using the Search function On this page you will select a patient using one of several criteria To search by name enter at least three letters of the last name Entering a first name only will cause an error message to be displayed Add a few letters of the first name in addition to the last name for common names i e if searching Smith or Garcia gives too many results To search by number enter at least 2 characters of the Medical Record Number MRN 3 digits of the Social Security Number SSN with or without dashes or 3 digits of the phone number with or without dashes Note only the MRN requires exact entry of any dashes spaces etc In the event that the patient you are seeking does not appear try searching with a different identifier 151 Once you have entered your search criteria click lt Search gt to display the results All matching names will be d
135. lly Nares Patent bilaterally Nasal Septum is normal There is no tenderness to palpation over the frontal or maxillary sinuses Lids Normal bilaterally Conjunctiva Clear bilaterally Sclera Anicteric bilaterally Oropharynx Moist with no lesions Tonsils No enlargement erythema or exudate Neck Thyroid non enlarged symmetric and has no nodules or bruits ROM Normal Range of Motion with no rigidity Exit Console History of Present Illness The patient presents with a 1 day history of constant tactile fevers The patient does not have a dry cous pain ear drainage a sore throat night sweats abdominal pain neck stiffness dysuria a rash bone pain joi Clicking the Page Layout Expansion button a second time will cause the Template Map to reappear 81 The Med Pop up and Writing Prescriptions To select medications a medication Pop up Icon is present in most templates Add Ennai Discontinue Peete t aee Refilled FEE The Med Pop up Icon will state ADD MED DISCONTINUE MED or REFILL MED By selecting this icon the Med Pop up box will appear Clicktate Med Selector __ EE EE EE EEE EEE eee Search As needed With meals Disp Name Search Results Cancel To Search for a medication type a medication name or partial medication name in the Name Box Let s search for Augmentin 82 Clicktate Med Selector Name Strength augm Seach _ Amount As needed With
136. lt Pt Face Sheet gt on the Compose Rx page The patient s 187 medication list is also listed This list replaces terms such as tid with three times a day etc for easier patient understanding To print this page choose lt File gt lt Print gt and then select your desired ctions on the use of the work flow and reporting functions of NewCrop Electronic Prescribing follow This information also appears at the bottom of each page via the Help Screens A summary is included in How to Write a Prescription Maintain Pharmacy List Summary Maintain Pharmacies shows each location s list of selected pharmacies It can be built from here or allowed to accumulate as selected for each patient Rarely used pharmacies can be deleted Use this page to add pharmacies to the Location list edit incorrect fax numbers and delete seldom used pharmacies You may reach this page by clicking on the link lt to add a pharmacy click here gt from the Transmit Page or you may access this page from the Administrative Functions page The Location pharmacy list is automatically generated as pharmacies are selected for patients on the Transmit Page You may also choose to add pharmacies from the Admin Page at set up to provide a starting selection list search by for a new pharmacy by zip code city phone name or state Add a state for common names such as Riverside Note that a pharmacy name must be entered exactly If you are not sure o
137. ly to pharmacies check drug drug interactions check drug allergy interactions check drug disease interactions provide medication information to patients and check formulary status of prescribed medications Clicktate has partnered with NewCrop LLC to provide an easy to use fully integrated state of the art e prescribing system NewCrop is a Surescripts Gold Solution certified electronic prescribing provider Gold Solution Provider status recognizes physician technology vendors that are advancing electronic prescribing and healthcare interoperability with customers in the United States This certification is designed to recognize physician technology vendors products that leverage the complete resources and capabilities of Surescripts and its network to improve the safety efficiency and quality of the prescribing process Electronic prescribing will require certification and verification of licensure and DEA status Please contact us directly for details regarding activation of e prescribing In addition electronic prescribing will require a free 1 2 hour training session which is accomplished via webinar The average set up and training time for electronic prescribing is 4 6 hours The cost and set up for e prescribing is included in the price structure of Clicktate Additional or advanced set up options may be billed an excess hourly service fee of 70 per hour 119 Legacy Medications Historical Legacy medications and all
138. m activity including denied renewals Imported Rx may also appear above Pending when information for full processing is not available These are not used for drug review Convert to a Current Med by clicking and selecting from the search results Experimental Drug entry is done via the Orders link at the top left of the page When entering a new patients current medication or those prescribed outside your practice use the Medentry Page via the Navigation Bar Additionally non clinical staff can enter and leave an rx for further processing by doctor or clinical staff The Review Page Interactions and allergies comparing the Pending Prescriptions to the patient s Current Medications and each other are displayed If this is an RxHub patient drug interactions are automatically checked against a 90 day all doctor history as well The Drug Condition check is activated when ICD or V codes i e pregnancy are passed from your EMR or entered on the Pt Dx page Delete an offending drug and or select a next step at the 135 bottom lt Approve Leave for Staff gt allows doctors to sign off leaving the batch to the Staff list on the Status Page as an NS for further processing Nurses may select lt Leave for Doctor Review gt placing it on the Doctor s review list on the Status Page The Batch Concept Note the check boxes to the left of the meds being processed On this and subsequent pages un checking a box splits the batch for
139. mains a work in progress as recognized flaws continue to be addressed The primary problem is that the mapping from one index to another is not fully quality controlled by RxNorm Each provider of proprietary indexes supplies QA to varying extents You are using a First Data Bank version quality controlled by NewCrop RxNorm is a drug index only It does not have clinical content such as drug interactions and allergies Within NewCrop this content is supplied by First Data Bank If you have a Comprehensive version of our software you are seeing this A deficiency of RxNorm is that some drugs cannot be mapped to First Data Bank These are labeled Unreviewed RxNorm Since they cannot be reviewed for drug interactions or allergy they appear in a so labeled box on the Review page Drugs are unreviewable for several reasons 1 They may be Canadian and thus not part of First Data Bank Only current FDA approved drugs are listed by FDB For instance Crestor is marketed in a 2 5 mg tablet in Canada only 2 Compound drugs are not completely indexed Thus for instance some oral contraceptives will be shown as Unindexed 3 Over the Counter drugs are not always included in FDB although most are These too may appear as unreviewed As stated RxNorm is a work in progress We anticipate ongoing improvement and changes Look for a category of Canada Only in the near future Please send along your suggestions customersupport ne
140. me partial name or close the Patient Selector Box to select a note from the Notes List From the notes list you may select from all notes all unsigned noted or notes for a specific provider from within a practice group Document Manager Showing All notes for Everyone Show unsigned notes only Patient Lists in Clicktate are defaulted to show the patients that have been reviewed recently This list appears with the most recently viewed patient chart listed first Choosing a Note Type Date of Service and Note Recipient When you start a patient note you will need to specify a note type For most providers the note type will default to Medical Note which is the standard medical note found in Clicktate In addition from this page notes may be sent to another provider or support person nurse lab technician front office staff from within the same office Notes may also be started from a user defined custom template that has been saved by the specific user To change the default value for the Send To or Template field choose the Set as default link beside the appropriate field 35 Create New Document Eg Test Darla Date of Service 27 Apr 2012 BEI Send To Set as default Document Type Medical Note Set as default LC Blank Medical Note 4 Replicate from Patient History Medical Note DOS 07 Jul 2009 Apply Custom Template cad patient Medical Note Cancel LL he ee oe To
141. mended as routine therapy for asymptomatic patients with a LVEF lt 40 Beta blocker therapy is recommended for patients with a recent decompensation of HF after optimization of volume status and successful discontinuation of intravenous diuretics and vasoactive agents including inotropic support Whenever possible beta blocker therapy should be initiated in the hospital setting at a low dose prior to discharge in stable patients Beta blocker therapy is recommended in the great majority of patients with HF and reduced LVEF even if there is concomitant diabetes chronic obstructive lung disease or peripheral vascular disease Wi BMP with Diuretic Usage BMP Patients on diuretics should be considered for a metabolic panel to include BUN Creatinine and Potassium yearly or more frequently as clinically warranted Wii Chlamydia Screening Chlamydia Vaginal It is recommended to screen for chlamydial infection for all sexually active non pregnant young women aged 24 and younger and for older non pregnant women who are at increased risk ih oP New Report 110 Reporting Type Clinical Decision Support SOMIVISSLSIUL IOI MypPerlipmueciiia v ry x Colonoscopy Colonoscopy Suggested Every 10 years for Patients over 50 years old May be suggested more frequently for patients with certain diagnoses or a family history of colon polyps or colon malignancy Colonoscopy Examination Ophthalmology Patients with diabetes should receive a
142. methods above you used to find the drug s click on the lt Select gt button to add the prescription to the pending Rx section From the Pending Rx section enter the Sig and Dosage information from the drop down boxes Click PRN as needed and DAW Dispense as written where applicable The Disp number dispensed will calculate and display a 30 day supply You may overwrite that number at this time if you choose Use the Select Packaging dropdown to display information on sizes of tubes liquids tablets 160 per bottle etc NOTE The pharmacy data standards allow only digits in the Disp field therefore for dose packs tubes insulin etc click packaging and select for the pharmacist then place the number of packages in the Dispense field as the last step For purposes of CCHIT compliance the ability to denote an Rx as Short Term or One Time has been added as a check box within the EDIT view of the Pending Medications and Current Medications Checking this box causes one time to be displayed in the SIG display Selecting the 90 Day box generates a 3 month Rx Any additional information that you wish the patient to have on the label should be entered in the Additional Sig box Any pertinent information for the Pharmacist should be entered in the Pharmacist Message box You may also select a diagnosis from the patient s record in the Select Diagnosis box Clicking Add to Doctor s Drug Rx List incorporates this drug and
143. min E New 4 Open lal Save As 24 Sign Lock 32 Orders Download uj Clipboard Clear W Undo Delete e Freetext Exit Console The functions found on the Menu Bar Include e New Opens the New document creation pop up which allows users to select template type specific note type and date of service Create New Document Test Darla 8 Choose another Date of Service 27 Apr 2012 ne SendTo A Set as default Template Medical Note x Set as default LC Blank Medical Note 4 Replicate from Patient History Medical Note DOS 27 Apr 2012 Apply Custom Template cad patient Medical Note 41 e Open Opens alist of previously created documents for the patient allowing the user to review previous notes Patient History Test Darla 8 Choose another 11 May 2012 Medical Note E Updated Today 12 42PM 27 Apr 2012 Medical Note Updated 27 Apr 2012 3 26PM 11 Aug 2009 Discharge Letter Updated 11 Aug 2009 6 30PM 11 Aug 2009 Discharge Letter Updated 11 Aug 2009 6 28PM 11 Aug 7009 Discharee Letter Cancel e Save As Saves a note in a format that allows the note to be re opened reviewed and changed later and also allows the user to assign a name to a note This function allows users to specify that this note is to be the standard template note for a patient and therefore sets the note as the default to replicate note Save Note As
144. n apply checkmarked and the exam will now appear as follows ae HEENT SHOWING Beeline me Normal bilaterally Pinnas Normal texture and shape bilaterally Canals Normal bilaterally TMs Diane Neck Thyroid non enlarged symmetric and has no nodules or bruits ROM Normal Range of Motion with no rigidity Other examination sections of Clicktate have similar functionality Please explore each examination section to see the specific features inherent to each section 64 Drag and Delete Function Any text except for the medication list allergy list and medication manager sections may be selected and deleted by using the drag and delete function The patient presents for follow up of hyperlipidemia She is following alow fat diet She reports that she is not exercising She is not taking medication for hyperlipidemia She denies chest pain shortness of breath orthopnea paroxysmal nocturnal dyspnea dyspnea on exertion edema palpitations or syncope SHOW DIETARY As relates to hypertension the patient reports that she has had no headaches or blurred vision Tsai She states that she is taking her medication as prescribed She is not having medication side effects She does not check her blood pressures at home After the text is selected clicking the Delete button will delete that section of text SE Download fyClipboard C clear Und X Delete reetext Exit Console Test Darla Medi
145. n SOCHX M Oxygen Saturation Repeated aga E T RSV Swab PE P ES IOL DSS Urinalysis Ir RAD Urine Pregnancy Test IMPR T Wet Mount Ww Fn Complete List PROC T Accucheck RTO Albumin Creatinine Ratio 4 AST ALT TIME ELA cc ELE l CBC CMP T EKG kd Accucheck and Urinalysis will now appear in your document The arches are normal bilaterally There are no skin nail lesions present There are no ingrown nails There are no bunions noted 55 To change the Accucheck value click on the 100 in blue A number box will appear Input the correct value and click OK It will appear in your document In this case let s change the value to 243 Accucheck 243 Urinalysis Color yellow SpGr 1 010 Ketones negative Urobilinogen 0 2 Bi You will see that the value has changed to 243 in your document The Plan section of the note will list a plan for each separate disease process Click on the blue options i e diabetes options heart murmur options to input your plan 56 CAD PLAN cado diabetes options HEART MURMUR PLAN heart murmur options COMMON E CHEMISTRIES CARDIOLOGY TESTS REFERRALS S TREATMENT HEME TESTS ONCOLOGY RENAL TESTS ENDOCRINE TESTS URINE TESTS ULTRASOUND RHEUMATOLOGY TESTS MRI SCANS INFECTIOUS DISEASE TESTS MISCELLANEOUS TESTS By selecting the blue diabetes options choice a pop
146. n order to use Our product you must be connected to the Internet A high speed connection cable DLS etc is necessary for efficient use Dial up will work but it is slow for regular use You will also need an Internet Web Browser installed on your computer We recommend Internet Explorer version 6 0 or higher Maximize your work space Be sure to click on the single square on the upper right corner of your browser screen The larger the screen the easier it will be to read Another tip you might try is to push the F11 key This will remove some of your browser tool bars and will allow you more space on your screen Pushing the F11 key again will restore your tool bars lf you have a choice of screen orientation use the longer portrait view If you are purchasing a flat panel display look for one that rotates You might also want to consider purchasing a tablet pc which allows you to travel around the office and still be connected to the Internet Saving information Any information that you enter on the screen will not be updated or recorded until you save the information by clicking the appropriate button The name of the button will vary from lt Proceed gt or lt Save gt etc depending on the application Clicking the appropriate button will then save your information Alternatively you may also use the tab key to move the cursor to any highlighted button and use the space bar to activate it Using the back button Unlike
147. n the search results to the left of the drug name and dosage NOTE for formulary to work correctly the patient s insurance must be displayed in the upper right corner of the screen below the Navigation Bar If you have Formulary coverage and the appropriate health plan does not appear either click the insurance dropdown list on this page to see if the patient has other insurances listed or go to the Pt Details Page and select the patient s insurance formulary from the drop down list Contact your account manager if your desired health plan is not listed If there is no insurance displayed at all you will need to go to the Pt Details Page to select it lf the Formulary states Not in Formulary then the patient s insurer has not placed this drug on its Formulary At this point you may click the Not in Formulary link to bring up a new window which lists the equivalent drugs that are approved and should be considered instead At your discretion a drug that is listed as Not in Formulary may still be selected If an Rx is covered on the Formulary the Covered link will appear Clicking this link provides the Preferred Approved status If Generic Available appears click the ingredient name displayed in parentheses to the left of the Monograph link to display all formulations If searched by ingredient and no generic is available the brand name appears in parentheses When all drugs and proper dosages have been selected regardless of which of the
148. n you would find in this section Location Workgroups divide an Account into smaller units Your Account Manager has setup your Location Workgroups to match the actual flow of prescriptions within your practice A Location Workgroup need not have a different address you may have multiple workgroups or locations within a single office location e Example If you have several satellite offices each satellite office might be considered a separate Location Workgroup Example Crestview OB GYN has two satellite offices Crestview West Side Clinic is one Location Workgroup and Crestview East Side Clinic is the second Location Workgroup e Example2 Similarly you may have more than one workgroup within a single location If Crestview OB GYN has one large office they might have two separate areas where physicians see patients Each handles their own prescriptions In this case Crestview Area 1 would be one Location Workgroup and the other would be Crestview Area 2 Although a nurse and a doctor might be assigned to different Location Workgroups within the practice they will see the other s work at all times A prescription written by any user regardless of Location Workgroup will always be displayed in the patient record It is important to follow your specific office policy as to whether you are authorized to process prescriptions written by users in your or other Location Workgroups On this Location Workgroup page click on the name of the
149. nal materials for printing Select the appropriate language If the drug information is not available in the specified language the default language will be English To return to the Location and Resources Page click lt Cancel Close gt If you have the Comprehensive option you are able to check the Formulary for a specific insurance plan First select the desired insurance plan from the dropdown box Next enter at least the first 3 letters of the drug name and click on the lt Look up a drug gt button The popup screen will then indicate if this drug is approved non formulary preferred prior authorization required etc for this insurance plan To obtain further formulary information click on the coverage information link Example lf a drug displays a Non Formulary link click on that link to find a drug which is covered This functionality is used as a general reference only All patient specific formulary information will be obtained from the Compose Rx Page Click lt Cancel Close gt to return to the Location and Resource Page 143 Account Manager s News displays any information that the account manager wishes to post and can function as a daily blog The information listed here can be only entered or deleted by the Account Manager Rx News and Announcements displays any information that ERx wants to share or convey to its users New features and important updates are examples of the type of informatio
150. nated Doctor Prescriber s name is selected from the drop down box as a Designated Doctor Prescriber must always be selected before any prescription can be written Both are always selected on this page Click on the dropdown box to make your selection if the displayed name is incorrect The nurse or doctor you select will stay in place until changed by you The docior prescriber can also be changed on the Compose Rx or Med Entry Refill Pages Physicians who log in will be unable to change the doctor s name Similarly staff members are unable to change the staff name Return to this page to make a different selection as needed Only doctors for this location are listed Contact your account manager for missing names or incorrect information 149 lf you want more information Doctor Prescriber Midlevel and Staff are further explained below The Doctor Prescriber is authorized to submit prescriptions to a pharmacy under his her own name Example DDS DO MD PA They are the only individuals whose name may appear at the top of a prescription This could be the name of a physician but it could also be the name of a PA or NP if allowed under your State statutes When a user transmits a prescription they must choose a Designated Doctor Prescriber from this list The Mid Level Practitioner NP APRN PharmD etc is authorized to sign a prescription and submit prescriptions to a pharmacy under the supervision of a Doctor Prescriber The Mid L
151. nd Lock Apply Custom Template As relates to his COPD rescue inhaler usage is reported to be t last office visit the patient has not sought emergency care Hi using an inhaled steroid He does rinse his mouth after using hemoptysis He is smoking Download bo Word Copy to Clipboard Delete Note k LInen ann aT CHIggers ie Save As Template z ppr OTs SOCHX T Cholecystitis u aaae Clicktate J Name of new customized template Next assign a name Then Click OK pl Clicktate D Name of new customized template COPD Still Smoking And the template will be available under the custom templates list 73 Clicktate J Custom template COPD Still Smoking saved 74 Working with Existing User Defined Templates Existing templates may be selected for modification from the Home page or from the Patient Console To select a template from the home page choose the Manage My Templates option from the Document menu Documents Patient Notes List unsigned notes for me List all notes Start a new note for patient emplates Manage my templates This will bring up a list of available user defined templates Choose the template which you would like to modify Document Manager Showing Customized templates Manage notes Records 1 to 10 Custom Template Bas E COPD Still Smoking Medical Note 2009 10 28 20 03 56 MM 2009 10
152. ng Chapter of this manual 114 The Clinical Data and Documentation Section In the Clinical Data and Documentation section users will find a chronologic running list of all data in the patients chart The list may be filtered and sorted Clinical Data and Documentation 08 Jun 2012 Proc Result 7 Lipid Profile aj 04 Jun 2012 Document _ Medical Note Signed 01 Jun 2012 Document __ Medical Note Signed Proc Result Urinalysis 31 May 2012 Document __ Medical Note Signed Proc Result A HgAic Proc Result Hematocrit 28 May 2012 Document __ Medical Note 27 Apr 2012 Order f TSH Order 3 CRP x Expanding the section will allow the user to filter notes based on multiple criteria Clinical Data and Documentation Type Any a Proc Result Any 22 Jul 2012 21 Jul 2012 09 Jul 2012 26 Jun 2012 18 Jun 2012 01 Jun 2012 29 May 2012 21 May 2012 Type Document Document Document Proc Result Proc Result Document Proc Result Document Message Document Document Document Document Proc Result Document Proc Result Document Document Document Document Document Document Item __ Medical Note __ Medical Note __ Medical Note M CHAT A PEDS DM _ Medical Note Signed Tympanogram __ Medical Note Acute Iliness __ Medical Note Signed __ Medical Note __ Medical Note __ Medical Note KOH prep __ Medical Note Signed KOH prep __ Medical Note __ Medical Not
153. nies polyuria polydypsia or polyphagia The last eye exam was within the past year He usually sees an ophthalmologist for his eye examinations The eye examinations have been normal Hereports no symptoms of neuropathy The patient takes his medication as prescribed He is not taking insulin The patient does check his feet daily at home He denies chest pain shortness of breath orthopnea paroxysmal nocturnal dyspnea dyspnea on exertion edema palpitations or syncope As relates to the patient s Coronary Artery Disease he denies diaphoresis The patient reports that he is diabetic but he is not a smoker hypertensive or hyperlipidemic ERR ERie ieee He takes an aspirin daily Medications Reviewed Since chest pain is mentioned in the Diabetes paragraph it will not be repeated in the Coronary Artery Disease paragraph Also note that the system recognizes that the patient is diabetic and automatically includes diabetes as a risk factor in the Coronary Artery Disease paragraph From within a note any of the BLUE highlighted phrases may be Clicktated to select other options this will also make other changes in the note For instance if you select the phrase no murmurs under the cardiac exam a pop up containing other options will appear LILA RO CAAM LUNES AUSCWULALIVIL IEAI LO AUSCHULALLIUL OUALEPally LOPE Are OO Peleus CIUODLIE ine CXPIrALUTY L Inspiratory ratio is equal Hga Cardiovascular There are n
154. ns that have been set aside by the Mid Level Staff or other Doctor Prescribers for this Doctor Prescriber s review as well as incomplete rx InProc The prescriptions are designated DR Prescriptions left incomplete after review by this Doctor Prescriber will be returned to the patient s pending list and designated InProc Selecting that Rx will take the user to the Compose Rx Page Note to Partner regarding access to a Patient For some accounts only the selected patient from the EMR active patient on your side is available for processing on the Status page Users are unable to change patients on the Status page The user must return to the Partner s application to select another patient and then return to the Status page to continue processing Exceptions to this are re faxing and NS status prescriptions both of which are already part of Current Meds Direct users are able to access and process all lt O p gt lt SPAN The Compose Rx Page Summary Displaying the patient s Current Medications and any Pending Prescriptions this page is the center of the prescribing process Mid page note Allergies to drugs 155 foods etc There is a Memos section as well as a drop down that allows you to change the Designated Doctor Prescriber which is handy for nurses processing multiple doctor s refills Start the prescribing process by looking up a drug Type 3 or more letters and click lt Drug Search List gt or use the Enter key
155. nstipation sweats or palpitatio Medications e Freetext Allows the insertion of free text into a document The patient is on Prevacid for his gastroesophageal reflux Wf The medication is taken on a regular bas 2 equires no other treatments for his GERD k He reports no heartburn chest pain abdominal pain burning belching dysphagia unexpl ed ght loss rectal bleeding nausea vomiting diarrhea odynophagia or early satiety f The GERD has no known aggravating factors k There is no family history of Barrett s esophagus or esophageal cancer The patient has never had an EGD W k e Exit Console Exits the console and returns to the last page opened prior to entering the note generation console e Addendum This toggle only appears for notes that are Signed and Locked It allows the addition of a Dated and Time Stamped addendum to a signed and locked note TA Download 3 Clipboard L w x A Exit Console 46 File Menu Dropdown Functions include many of the same functions found on the menu bar including New Note Open Note Save Note Sign and Lock New Addendum Generate Orders Download as PDF Download to Word Copy to Clipboard Apply Custom Template Manage Custom Templates and Exit Console New Replicate Open Note ay Y Mote 5 it Download as Word Copy to Clipboard Delete Mote Apply Custom Template Manage Custom Templates p Exit Console e New Note
156. nt Active Exam Active Physical Active Family Consultation Active Medicine Check Active Well Child Active Procedure Simple Active Procedure Complex Active Pre operative Consultation Active Suture Removal Active Prenatal Consultation Active Gynecologic Examination Save Changes Customize Schedule Status Active Arrived Active test Active Late arrival minor seen Active Late arrival severe seen Active Late arrival severe rescheduled Active Late arrival severe cancelled ative s lt i sSSCS Active Duka o Active P Active Patient cancelled before cutoff Active Patient cancelled after cutoff Active Patient rescheduled before cutoff Active Patient rescheduled after cutoff Active DO E Active Office rescheduled Active Office cancelled Active A Save Changes Reset to Default l omm 26 minutes minutes minutes minutes minutes minutes minutes minutes minutes minutes minutes minutes minutes minutes Reset to Default In the Customize Arrival Status the patient status may be set as well as the color of which each status will appear on the schedule Blocking Time Periods To block time periods when a provider is not available choose a start time on the schedule and select it as if you are scheduling an appointment For instance to block the time period from Noon 1 PM for lunch each day first choose
157. ntolerances Notes Below the Drug Search List box the allergy and the memo boxes are displayed To add or delete allergies for this patient click the lt Allergy Intolerance Search gt button The allergy intolerance Search box will display with a blue border along with a list of common allergies intolerances At this time you can either search for new allergies to enter delete previously entered information or search and click on No known allergy when appropriate Search for an allergy by entering all or part of a brand ingredient drug category or non drug item in the box and click lt Search for Allergy gt The results display below the lt Search for Allergy gt button Select the appropriate allergy by clicking on it Use the click here to add a non drug allergy if not found feature to add non drug items This feature allows you to type in the non drug allergy After doing so click the lt Add Non Drug Allergy gt bution Whether you added the allergy by sea rching and selecting it or by typing it in as text the next step is to indicate a severity or type in comments specific to this allergy Use the Select Severity drop down box to assign a severity to the allergy Severity is not a required step If you do not know 162 the severity of the allergic reaction you are still able to enter comments into the text box that displays and then click lt Save Allergy gt or lt Save Add Additional Allergy gt to add the allerg
158. o carotid bruits Heart Normal Rate with Regular rhyth and no murmurs The eare no Feet The feet are symmetric with normal boney landmarks There is no tenderness on bilaterally The Neck Thyroid non enlarged symmetric and has no nodules or bruits ROM Normal Range of Motion with no rigi Lungs Auscultation Clear to auscultation bilaterally Th Inspiratory ratio is equal CardioVascular Heart Murmur aadA Cardiovascular Heart Normal Rate with Regular rhythm a SHOW PULSES OR ADD PULSE TABLE aa Abdomen Soft benign non tender with no masses hernias BEARR 2 4 diastolic SHOW ABDOMINAL BRUIT 3 4 diastolic 4 4 diastolic CMe dadoa Feet The feet are symmetric with normal boney la k at have normal posterior tibial and dorsalis pedis pulses and normal capillary refill bi other The arches are normal bilaterally There are no skin nail lesions present There a 52 CardioVascular Heart Murmur By selecting one of these options the note will be appropriately changed You will also notice that Heart Murmur now appears in the Impression and Plan Ee a LS co r ease Cardiovascular There are no carotid bruits Heart Normal Rate with Regular rhythm anda 3 6 crescendo decrescendo systolic murmur heard loudest over the entire precordium with no radiation There are no gallops There are no rubs In the lower extremities there is no edema The upper extremities do not have edema DELETE ABDO
159. ocations Be sure and follow your office policy as to when to process an Rx from another location or doctor If locations are missing contact your Account Manager 142 Now that you are ready to e prescribe you will begin on the Location and Resources Page This page has several functions You may use this page as a quick resource to find drug or formulary information This page also displays Bulletin Board text Additionally this page allows the user to select the location where they will be working Select your location or workgroup by clicking on it If you do not see an approp riate group or location contact your account manager At all times you will see prescriptions written by all doctors within your practice regardless of location workgroup Drug and Formulary Look Up The Drug function allows you quick access to drug information Type at least the first 3 letters of the drug name then click lt Look up a drug gt or use your Enter button You will be directed to a screen which displays all drug names that fit your 3 letter criteria The more letters you type in the more specific your search results will be Scroll down to find the appropriate drug You will find the different dosage information following the drug name If you are using the Comprehensive option clicking on Monograph displays the complete information on side effects dosing etc in a popup window Likewise clicking on Leaflet displays patient educatio
160. oderate Rash L Medications DYAZIDE 37 5 MG 25 MG CAP 1 capsule DAILY by mouth LIPITOR 10 MG TAB 1 tablet QHS by mouth Q Lookup ICD EE Prescribe Family History Li Psycho Social History lug Tobacco L Order Entry amp Tracking lad CRP TSH Ls Frequency Last Recorded Every 1 year s None Every 10 year s None Every 1 year s None Every 1 year s None Every 10 year s None N A None N A None Vital Signs Lipid Profile 04 Jun 2012 Medical Note Signed Pulse 80 Resp 12 BP 120 70 RUE Temp 98 6 Se ee aie ppm e BP 124 58 LUE Temp 98 6 A Urinalysis __ Medical Note Signed HgAic Hematocrit __ Medical Note 22 TSH i rop ba jA Download Print Q Search for patient lad Open Add Notes Expanding the demographics section will allow the user to input additional demographic data including family members emergency contacts and insurance information 92 Patient Information Logan Arnold Patient ID 345634 Gender Male Birth 05 Jan 1946 Age 66 Race Ethnicity Language Primary Phys Contact Insurance Legal Family Custom Contact Home 654 Broadhead Place Lexington KY 40515 888 825 4258 Primary Emergency Pharmacy Insurance ihe Edit Group Policy Effective Plan sl Edit Group Policy Effective Legal In addition under the demographics section is an area to include spouse and parents names and information Living Wills
161. of appointment scheduling Cree ee To enter patients from the scheduling module first select one Open for date of the options from the scheduling menu on the home page 13 yy tt yy lt Any of the options may be selected including Scheduling Open today s schedule Open this week s schedule or Open for date Selecting any of these options will open a calendar box and from any date a patient may be entered into the system C Logged in as lcdadmin4 My Profile ICD Admin Logout 9 Home Patients Documents Sched Track Scan Lab Report NQF Rx Pharm Rx Status 1 2 to review Msg Scheduling New LCD Admin x X Customize amp Print Q Thursday April 26 Friday April 2r 2012 Saturday April 220 View entire week Selecting any time slot will allow a new patient to be entered into the system or you may search the Clicktate database for an existing patient Patient Selector Search for a patient 3 Customize LastName First i Patient ID m i A EEE 092384 E Rogers Tim 15 Jun 1937 ae 345634 Logan Arnold 05 Jan 1946 987545 EA Fila Chick 09 Mar 1995 2304892 al Walker Randy 02 Jan 1991 F 98734598 Cuppy Ronald 20 Aug 1963 2343254 E Thumb Tom 08 Sep 1981 345345 a Melendez Michele 13 Jan 1982 039458 Bower Mandy 08 Nov 1979 90234020 A Green Cowan 13 Jul 1949 CARTACZA Ali muranra Thalma 17 lan 1007i i Or mark time as unavailable Un
162. on To erase a message highlight the text and choose the delete key on your keyboard Click lt Save gt lt SPAN The Status Page Summary The Status link above the NavBar takes you to the Status Pag where all the prescriptions needing further processing are listed Click the status link to go to the Status Page Pharmcom electronic pharmacy renewal requests Faxes Needing 152 Attention those that did not transmit correctly Failed Electronic Rx will also be listed and require processing Pending Rx that have not been completely processed Pending Rx can be one of 3 stages DR has been assigned by staff for a doctor to review NS has been reviewed and approved by a doctor but still needs Staff to send to a pharmacy InProc incompletely processed has been assigned un reviewed or left unfinished or forgotten by the displayed user Any prescriptions left on the Status Page at the end of the day represent unfinished business Note to Partner regarding access to a Patient For some accounts only the selected patient from the EMR active patient on your side is available for processing on the Status page Users are unable to change patients on the Status page The user must return to the Partner s application to select another patient and then return to the Status page to continue processing Exceptions to this are re faxing and NS status prescriptions both of which are already part of Current Meds Direct users are a
163. on selection the drug will appear as an InProc incomplete Pending Rx at the top of the page Drug or formulary links allow further choices at this point Use the lt Doctor s List gt for multiple selections from your previously prescribed drugs Delete seldom used drugs to keep the list manageable To complete an Rx click Edit Select number sig and adjust the directions or pre calculated 30 day supply as needed Check PRN or DAW dispense as written Check 90 days to generate an additional 3 month Rx Enter any additional sig such as insulin dosing for the Rx label For dose packs tubes insulin etc select from displayed Packaging for the pharmacist Data standards allow only digits in the Disp field Add any additional directions for the pharmacist lt Save gt your changes Change your mind by clicking Cancel Note Save this Sig check box This adds the complete rx to search results and the Doctor s List for reuse The Dosing feature is accessed by clicking below the drug name on the left One Time denotes a med not for chronic use Current Medications can also be selected for renewal by checking the boxes to the left and clicking lt Select gt or select a single rx by clicking Pending Prescriptions are part way through the process but have not yet been added to the patient s Current Medication list To reiterate these come in several Stages 1 Newly selected or left unfinished at any point InProc 2 Rx left by Clinical
164. ons listed on the transmit page will be submitted as mail order prescriptions when the mail order home delivery link is clicked After verifying the patients mailing address select the pharmacy as you normally would and click the lt Transmit RX gt button Selecting a Pharmacy A in the eRx column indicates that this patient utilizes an electronic mail order pharmacy In this case the Mailing address is displayed and is required for all mail order pharmacies A under the eRx column indicates that this pharmacy is a participant in our electronic pharmacy network In other words pharmacies listed with the green dot can accept prescriptions electronically If there is not a green dot in the eRx column then the prescription will be automatically faxed to the pharmacy All oharmacies listed can accept prescriptions by fax provided the fax number is listed or you input the fax number prior to transmission However there are a few instances when a participating pharmacy cannot accept a prescription electronically 1 If there is a Schedule 2 or other non compliant drug in the batch or 173 2 A doctor has not yet been approved by the network or 3 A connection to the electronic network is not possible In either of these cases the pharmacy will require a fax You must be sure that a fax number is provided Verify that the correct fax number is listed for the chosen pharmacy If the fax number is incorrect or is not listed enter the
165. opy Undo Clear Exit Console In the current example if the patient is taking insulin but it makes him very nervous the anxiety will need to be documented In the first paragraph of our note let s input that she is taking insulin The patient reports that he checks his blood sugars at home His sugars are checked daily The average sugars are in the 100 150 range D He denies hypoglycemic symptoms D The patient denies polyuria po uypaa or polyphagia Ey The last eye exam was within the past year He usually sees an ophthalmologist for his eye examinations The ey on The patient takes his medication as prescribed He is not t shortness of breath orthopnea paroxysmal nocturnal dyspnea al D He reports no symptoms of neuropathy his feet daily at home sj He denies chest pain tations or syncope As relates to the patient s Coronary Artery Disease he denies diaphoresis D The patient reports that he is diabetic but he is not a smoker hypertensive or hyperlipidemic Fua aee Eea He takes an aspirin daily The patient reports that he checks his blood sugars at home His sugars are checked daily The average sugars are in the 100 150 range He denies hypoglycemic symptoms The patient denies polyuria polydypsia or polyphagia The last eye exam was within the past year He usually sees an ophthalmologist for his eye exar aation The eye examinations have been normal He reports no symptoms of neuropathy
166. ort reports are reports that will generate clinical reminders on the patient facesheet Examples might include e All patients over a certain age who are due for a certain test e All patients with a specific diagnosis who need to be on a certain medication e All patients who meet specified clinical criteria who are due for a certain immunization To generate a Clinical Decision Support report select Clinical Decision Support from the New Report option New Report Patient Reports Audit Logs Clinical Decision Support Reporting Medicare and Medicaid EHR Incentive Program Clinical Decision Support ab Select Procedure Bal Patients Any amp add FH Generate Report lz Save Changes Exit Add the PATIENT CRITERIA on the left criteria area of the report builder IT IS NOT NECESSARY TO THE ADD THE TEST THAT IS DUE OF THE INTERVAL THESE ARE ADDED UNDER THE Select Procedure AREA OF THE REPORT A report to generate reminders for all male patients who are over age 50 who have a diagnosis of tobacco abuse who haven t add counseling for smoking cessation is shown below Reporting Medicare and Medicaid EHR Incentive Program Clinical Decision Support Counsel Smoking Cessation FH Patients SEX is Male and AGE at least 50 and DECEASED is empty amp having at least one of Social Tobacco RECODE equals 1 H Social Tobacco RECODE equals 2 5 Social Tobacco RECODE equals 5 Another
167. oses will also automatically populate the Facesheet from notes generated in Clicktate after the notes are signed and locked by the user 105 The Medication Section From the medication section it is possible to e Add or inactivate medications e Print a patient medication list e Write prescriptions e Review the refill history of a medication e See the last actions taken for a medication e Review the notes related to a medication To work with medications select the Expand link on the medication section of the Facesheet Any changes made to medications on the Facesheet will be reflected in notes Any changes to the medications in a signed and locked note will be reflected on the Facesheet Medications F DYAZIDE 37 5 MG 25 MG CAP 1 capsule DAILY by mouth LIPITOR 10 MG TAB 1 tablet QHS by mouth EE Prescribe When the medication list is expanded the medication list pop up will appear 106 Clicktate Logan Arnold Medications Current Medications Current History Show Active Only Medication DYAZIDE 37 5 MG 25 MG CAP 1 capsule DAILY by mouth LIPITOR 10 MG TAB 1 tablet QHS by mouth xl es To print a medication list for the patient select the Print button The Print Medications pop up will appear Clicktate Print Medications x New LCD Admin A LCD Solutions LLC LCD Headquarters 1 888 825 4758 Lic 16275 KY DEA DE1627384 NPI 1627384950 Dyazide 37 5 mg 25 mg Cap 1 caps
168. ote that the free text will appear EXACTLY as it was typed including gender specific terms While other gender specific terms in user created templates will change to reflect the correct gender of the patient free text gender terms will not change The same applies to the age of the patient For this reason it is best to avoid gender specific terms and ages in free text boxes that are part of documents that you intend to save as templates Document Synchronization with User Created Templates User created templates will stay in sync with the remainder of the document just as other templates do This means that if you select a chest pain option from a check box the system will remember the response and other paragraphs that may be inserted will stay synchronized with this paragraph The exception to this rule involves Free Text The system will not synchronize Free Text throughout the document Therefore it is important to carefully read each document to assure that all options are appropriately checked 80 Section VIII Other Features Page Layout Expansion The available document reading area may be expanded by closing the Template Map To close the template map click the Page Layout Expansion button Template Map Henthorpe Millie Medical Note Friday 06 Mar 2009 History of Present Iline lt lt ESl lt i claielai Ol wMOyVSVS lr All Tia lmn imio loa llw gt gt Main Acute Bronc
169. ow sent messages 194 Section XII Scanning The scanning center allows the input of scanned documents into the patient chart It allows employs a closed loop ordering function that easily allows scanned documents to be reconciled with orders The scanning center is accessed from the top navigation menu Home Patients Documents Sched Trare Scan Le Report NOF Selecting Scan opens the scanning center Logged in as Icdadmin4 My Profile ICD Admin Logout Home Patients Documents Sched Track Scan Lab Report NOF Rx Pharm Rx Status 1 Review 1 unread Scanning Center Unindexed Files Indexed Folders i Create New BN jpg ps_fg4 gif ma Upload Files Upload Scanned PDF Batch The scanning center has unindexed files on the left side of the screen and files which have been indexed to a patients chart on the right side of the screen Any scanner may be used with the scanning system 195 To upload files into Clicktate Upload the files to your computer using your scanner After the files are uploaded to the computer they may be selected from the desktop e Use the Upload Files option to upload a file for a single patient e Use the Upload Scanned PDF Batch to upload a file containing documents related to multiple patients Upload Scanned Files Upload Scanned Files Wsers Owner Desktop Colonoscopy Report pdf H
170. pane will open the option box for entering detailed patient data This includes emergency contact information family information insurance and legal information and several custom fields Patient Information Winter Snowy R Patient ID 8203490 Gender Female Birth 16 Apr 1958 Age 54 Race Ethnicity Language Primary Phys Contact Insurance Legal e Family Custom Contact Home Emergency Pharmacy Insurance Plan Group Policy Effective Plan Group Policy Effective Legal Family Release Preference 16 In the New Patient Entry window required fields include the Patient ID Last Name First Name Gender and Birthdate The birthdate and gender are important as Clicktate will assign certain questions only in age and gender appropriate situations In addition the notes generated from Clicktate templates will automatically assign the correct gender identifiers For instance questions regarding sexual activity and smoking will be deleted for children Entering an Appointment To enter an appointment first select one of the scheduling options from the Clicktate home page or select Sched from the navigation bar which is found at the top of all pages in Clicktate You will then be directed to the physician schedule The schedule will default to the current date 12 Scheduling 7 7 D it i k Scan Lab Report NQF Open today s schedule Winter Snowy R Open this week s schedule 7
171. r formulary coverage information to appear with drug selections Note Medicare Part D should go in the first slot To the left the RxHub RxHistory may appear click to view an all doctor Rx history from the healthplan Pt Notes enters information in the patient record Pt Dx displays the patient s and doctor s diagnosis list Admin has reports and other supporting functions Direct users only Select Staff is on the Select Patient page Log out by clicking your name Compose Rx displays the patient record and is where a new Rx is written Before explaining the main sections of this page it is important to describe the Navigation Bar that appears at the top of the page The Navigation Bar is made up of a series of labeled buttons or tabs used to move from page to page within the website The Navigation Bar is common to most pages Some users having different 145 responsibilities than others might have different tabs on their Navigation Bar In all cases clicking on a tab will take you to the designated page Use these tabs to navigate between pages DO NOT use the lt Back gt or lt Forward gt keys The first tab lt Select Patient gt appears for Direct Users only This tab allows the user to search for and select the correct patient Before Direct Users can enter patient information or compose a prescription they must first select a patient See Below for how to select a patient Partner Users will see a tab which says lt Sel
172. r pages are designed to be easy to use electronic prescribing is inherently different than the rx on paper We strongly suggest that at the very least these 5 pages be completely reviewed prior to prescribing or watch the video on the Admin Page Button names are denoted with lt gt Most of you will enter e rx from your EMR Direct user s information will be italicized Doctors for best results we suggest that initial use of e rx be by your office staff This will build drug rx pharmacy and healthplan lists as refills are processed Bonus direct staff to view the Renewal Processing videos on the Admin Page The Accept Send feature allows staff to predetermine where an rx goes with your one click approval Transform office workflow If you are not used to accessing software over the Internet e Save all entries A page must be activated to record your information Typing or selecting on a page will not be recorded in the patient record unless lt Save gt or the appropriate activating button is clicked e Don t use the browser Back button This will cause you to loose any unsaved information and may show a stored page that is no longer accurate Use buttons or links on the page to change tasks e Maximize work space F11 will do this on most browsers e Funny looking page Check your browser settings for text size etc e Button not working Check the open window display at the bottom of the screen A window can open
173. re that Clicktate remains user friendly and has the features necessary to allow a medical practice to function smoothly and efficiently Before a new feature is put into Clicktate we make sure that it will accomplish three goals e Improve Practice Efficiency e Improve Provider Productivity e Improve Patient Care In 2011 Clicktate made significant improvements including 5 v Added additional modules including laboratory interfaces reporting and document imaging v Partnered strategically to provide a fully integrated practice management system including billing and coding v Developed a Data exchange solution to allow true EMR to EMR communication and CCD documentation v Achieved ONC HIT certification to allow customers to achieve the full incentive available under the Medicare EHR Incentive Program During your trial period you will be contacted by a Clicktate representative in order to discuss further options and to schedule a demonstration and or training webinar at no cost to yourself This manual will serve as a guide for new Clicktate users It will also provide an oversight into new features found in Clicktate for our long term customers We will continue to be responsive to our customers so we welcome feedback and suggestions We may be contacted at 1 888 8click8 1 888 825 4258 or via email at info clicktate com Our Mission Statement Clicktate s mission is to lead the market in developing El
174. record of the leaflet selection is added to the Rx Detail If the requested language is not available the leaflet will print in English Prescriptions will print up to 4 to a page or as required by your state The Print as Singles option allows you to print each prescription on a separate page if you have multiple prescriptions being transmitted and you want each printed on a separate sheet of paper RxSupport This feature although not always present provides printable information designed to encourage the patient to fill the rx as written These will print out with the Rx or Transmit receipt unless the box is unchecked _If the Rx Support information is available for the medication being prescribed the Rx Support box will be checked If the box is not checked then there is no Rx Support information available Schedule 2 s Note the Drug Schedule Sch column to the right of the prescription selection boxes Schedule 2 s such as Percodan must be individually signed by the physician on state mandated paper forms and cannot be transmitted ERx can support specialized printer set up if needed Contact customersupport newcroprx com to set up your state s format 170 How can you add Schedule 2 drugs to the patient record You can use the lt Finish Add to Current Medications gt option on the previous page Review Page Alternatively you can add them to the record from this Route Page by clicking lt Print Rx Add to Current Meds
175. rms of a drug i e when clinically relevant For instance erythromycin will show estolate and ethyl succinate and each appears In contract hydrocodone tartrate will not be found because tartrate is not clinically relevant Search as hydrocodone Obsolete Drug use the check box The drug list shows only currently available drugs Recently pulled drugs will not show on routine search but will show ifthe Search Obsolete Drugs box is checked Note these drugs are retained for a few months only and then drop of the obsolete list also Missing Brand try an ingredient search Older drugs may still be available generically when the brand is no longer marketed le Elavil will not show but amitriptyline will e Missing OTC Herbal The brand names on these are variable and too numerous to track With few exceptions however searching the ingredient will find the product Read the labell Really missing This is possible only if you have the RxNorm drug index Most accounts have First Data Bank Check the bottom of the Review Page to see if you have RxNorm and report the missing drug customersuppori newcroprx com We will correct the data base In the meantime record the rx using the Orders link upper left hand side of the page Experimental or foreign Only US FDA approved drugs appear for selection Non US users will see their respective list To add unlisted drugs to the patient record use the Orders lin
176. ropriate box es to the right of the prescription line of those drugs you would like removed from the doctor s favorites list and click lt Remove gt If a new prescription is not already on the Doctor Prescribers Favorite List type at least the first 3 characters of a brand or generic name into the search text box You may also expand your search by clicking the Include Obsolete Drugs check box to add any withdrawn drugs to the list and click lt Drug Search List gt This action brings up the list of drugs that match your search query The more letters you enter the closer the search will be With the drug s name you will find a description of the drug along with Monograph and Leaflet links The Monograph link when clicked displays the drug Monograph on a separate page Similarly the Leaflet link displays the drug information in a format for patients You are able to print a leaflet for the patient when you print transmit the prescription 159 3 Another way to start a prescription is to select a prescription from the patient s Current or Previous medications list You can do this by clicking on the check box to the left of a Current or Previous prescription and then click the lt Select gt button This moves all checked drugs to the Pending Rx area along with the appropriate sig disoense number and directions lf your Account has Formulary functionality you will note that the patient s health plan formulary information is listed i
177. rove Leave for Staff gt button This transfers the Rx to the doctor s assigned nurse marks the prescription with an NS status and places it in the Staff Processing List on the Status Page for further processing lf the user logged in is not a doctor and proceeds to the Review Page the above described lt Approve Leave for Staff gt button will be replaced with a lt Leave for Doctor Review gt button This transfers the prescription to a Doctor Prescriber marks it with a status of DR and places it in the Doctor Review List on the Status Page for further processing Clicking lt Return Additional Rx gt returns you to the Compose Rx Page where you may add another prescription You may delete a prescription at this point in the process by clicking on the X Note the select check boxes to the left of each pending Rx on the Review Page If left unchecked no action will be taken on this Rx at this time Below the Rx on the page are lt Print Add to Current Meds gt and lt Transmit gt buttons If you desire to skip the Route page you can use these buttons to add the prescriptions to Current Meds and print them locally or go directly to the Transmit page by clicking the lt Transmit gt button The Batch Concept Note the check boxes to the left of the meds being processed On this and subsequent pages un checking a box splits the batch for separate processing For instance a Schedule 2 drug must be printed while the rest of the
178. rs to screen for cervical cancer for women who have ever had sex and have a cervix NOTE This report is set with a default of EVERY 3 YEAR PAP SMEARS To change the default for individual patients update the report on the patient s Facesheet in the Clinical Decision Support Section Fai Pap Smear Pneumococcal Vaccination Pneumococcal Vaccine Patients over age 65 should have a pneumococcal vaccination Examination Prostate The current evidence is insufficient to assess the balance of benefits and harms of prostate cancer screening in men younger than age 75 years The current evidence recommends against screening for prostate cancer in men age 75 years or older THIS CLINICAL DECISION SUPPORT ITEM ADDS A DIGITAL PROSTATE EXAMINATION YEARLY TO DEACTIVATE SELECT FROM THE CDS MENU AND DESELECT Prostate Examination Additional tests and procedures may be added to this list and are PRACTICE SPECIFIC Adding a Clinical Decision Support Rule To add a Clinical Decision Support Rule for a practice first select Report from the top menu Then select New Report Reporting Type Any Description a A1C with Zip Cholesterol for Hyperlipidemia Cholesterol Check every year for those with hyperlipidemia HG HIV Disease Patients diagnoses with HIV or AIDS Lipitor MU Active Medication Allergy List A MU Active Medication List MU Advanced Directives Recorded A MU Clinical Lab Test Results MU Clinical Summary
179. rtification 2013 Our Values Clicktate is committed to providing excellent service in an ethical honest and customer based approach If our customers aren t happy we aren t happy and will do what it takes to rectify the situation in an honest and fair manner In general we will treat our customers the way that we want to be treated Fairly Ethically Honestly Our Vision To continue to promote the use of the Clicktate Electronic Health Record for the improvement of patient care and the provider experience in providing that patient care Section Il Configuring Your Browser System Requirements Clicktate is designed to work optimally with Internet Explorer versions 7 8 and 9 Safari and Google Chrome In addition for full functionality you will need Microsoft Word Adobe Acrobat and Microsoft Excel or comparable spreadsheet software on your computer Pop Up Blockers Clicktate relies on pop ups to function properly and they are an integral part of the ability to navigate through Clicktate It is important to allow your browser to accept pop ups from Clicktate To configure the pop up blocker to allow Clicktate to work follow these steps Go to the TOOLS Dropdown menu at the top of the internet browser E https www clicktate com ser File Edit View Favorites Tools Help we de 20 clicktate sessions ws kcas Open the TOOLS Menu Select Pop up Blocker and choose one of the following option
180. s OPTION 1 Select Turn OFF Pop up Blocker This will completely disable the pop up blocker and allow all pop ups OPTION 2 Recommended Select Pop up Blocker Settings Under Address of Website to allow type www clicktate com and then press ADD Pop ups are curently blocked You can allow pop ups from specific i websites by adding the site to the list below Address of website to allow Add i Press the close button Using Clicktate with Pop Ups and Tabbed Browsing With Clicktate users have the option of formatting how the patient console window appears The browser can be set to allow the console to open in a new tab window OR as a pop up To change this setting go to the tools menu at the top of the internet browser https www clicktate com se File TE Edit View Favorites ae ag gt clicktate ses sessions Select Internet Options from the Drop down menu and Select Settings under the Tab Menu Tools gt gt Internet Options gt gt Settings Tabs Menu Then choose how pop ups should be handled based on your personal preference 10 e T To create home page tabs type each address on its own line http www insightbb com Browsing history e Delete temporary files history cookies saved passwords A F and web form information Search pP Change search defaults Tabs Enable Tabbed Browsing requires restarting Internet Explor
181. s Please note that all fields indicated with an asterisk are required fields Insurance Formulary information is not required for each patient However if you wish to utilize the NewCrop Formulary feature the health plan information must be entered on this screen Choose from the drop down list for your account Formularies are more specific than the insurance coverage Therefore you may see multiple choices for each health plan For instance Blue Cross may provide more than one formulary i e PPO vs HMO In addition coverage may differ by employer You must closely inspect the list of alternative formularies to find the one matching your patient s coverage as listed on their card or benefit information If you can t find a match speak with your Account Manager This patient s previously selected pharmacies and entered allergies are also displayed at the top of the page If you make any changes or additions to this page be sure to click the lt Save gt button to record the updates weenie by request DoctorR 17 s Office Quality Information Technology is a new quality improvement program sponsored by Medicare It may evolve into pay for performance Go live is 185 scheduled for Fall of 2005 In the meantime the account can monitor practice quality measures such as percent of coronary artery patients receiving aspirin Participation is optional for NewCrop accounts Your account manager can activate this feature
182. s diaphoresis f The patient reports that he is diabetic but he is not a smoker a He takes an aspirin daily hypertensive or hyperlipidemic E The delete toggles remove the sentence immediately following the toggle Clicking on the highlighted D above will remove the eye exam sentence in the 100 150 range Bi He le reports no symptoms of etv er taking his insulin a rome D He denies chest pain Hawes His injection sites are rotated appropriately The patient does check his feet da shortness of breath orthopnea paroxysmal nocturnal dyspnea dyspnea on exertion edema palpitations or syncope A new toggle will appear allowing reinsertion of the eye exam if it is needed The more descriptive delete toggles will remove items from the document that do not immediately follow the toggle The DELETE INSULIN TABLE toggle above will delete the insulin table which is found in the medication section of the document 61 Paragraph Removal Paragraphs that were inserted and need to be removed may be removed by re clicking on the paragraph name in the template map Template Map 2 Customize Cuppy Bobbi Medical Note Saturday 30 Jan 2010 Send To Mark Winters MD History of Present Illness Main DOS ra a A T Acute Bronchitis History of Present Illness WCC LB Acute Gastroenteritis HPI LC Benign Prostatic The patient presents for follow up of hyperlipidemia Sh
183. s empty amp 2 having all of H Diagnoses DESCRIPTION contains hyperlipidemia E Diagnoses Any Another a add Choose Any again to add additional criteria Add the additional criteria as already stated 204 Reporting Hyperlipidemia Patients H Patients AGE at least 18 and DECEASED is empty amp 2 having all of 5 Diagnoses DESCRIPTION contains hyperlipidemia 3 Diagnoses DESCRIPTION contains hypertriglyceridemia 3 Diagnoses ICD CODE contains 272 4 Another amp add EH Generate Once all criteria are entered choose the Join Criteria here defaulted to having all of to change the options and indicate the join parameters Criteria Group Type not having any of not having a of In this example we ll change the Criteria Group Join Parameter to having at least one of Reporting Medicare and Medicaid EHR Incentive Program Hyperlipidemia Patients 3 Add Denominator H Patients AGE at least 18 and DECEASED is empty 5 having at least one of 1 Diagnoses DESCRIPTION contains hyperlipidemia 4 Diagnoses DESCRIPTION contains hypertriglyceridemia H Diagnoses ICD CODE contains 272 4 Another amp add E Generate Report io Save Changes E Delete Report Exit At this point the report may be saved or generated to view the data Selecting Generate Report will render the report It is recommended that the report be saved prior to runn
184. sages and refill requests received from the SureScripts pharmacies The request lists the patient name date of birth date received drug name Doctor Prescriber Location Workgroup and pharmacy Clicking on the Patient Name takes you to the PharmCom page which displays the message in detail From this screen you may deny the refill or continue on to approve or respond to the pharmacy message 2 The Failed Electronic New Prescription Needs Reprocessing section lists electronic prescriptions which were not successfully transmitted The Patient Name date the Rx was created drug Doctor Prescriber and user are listed You may click on the patient name to take you to the RxDetail screen where you will see the prescription details and can retransmit the prescription This particular section title bar will not appear on the Status Page unless there are electronic prescriptions that have failed 3 The Failed Fax Transmission Needs Reprocessing section lists any fax which was not successfully transmitted Faxes listed in this section have not been transmitted The Patient Name date of fax drug Doctor Prescriber and Location Workgroup are listed You may click on the patient name to take you to the RxDetail screen where you will see the prescription details as well as the transmission information From the RxDetail screen you may reprint or retransmit the entire batch of prescriptions if applicable or just an individual Rx If you are forwarding
185. sired The diagnosis may also be designated as inactive resolved or rule out by using the Status menu The date of diagnosis may also be placed into the record 103 Clicktate Logan Arnold Diagnoses Diagnoses List Diagnoses Documented Show Active Only l ae Effective HYPOTHYROIDISM NOS 244 9 Active 15 Jun 2012 CORONARY ARTERY DISEASE 414 01 04 Jun 2012 HYPERTENSION 997 91 i 14 Jan 2012 i Diagnoses HYPOTHYROIDISM NOS 244 9 CORONARY ARTERY DISEASE 414 01 HYPERTENSION 997 91 Q Lookup ICD From within the expanded diagnosis pane other functions are available to see diagnoses linked to office notes download a diagnosis list or select None Active To download a Public Health Surveillance file select the download button from the expanded Diagnoses List pane This file may be downloaded as an encrypted or unencrypted file File Download Filename Logan 345634 ADT hl SHA 1 Hash 195b5f62dbe335fedc2212b4894e18ef99e5586c H ponnn 104 By selecting the Documented option from the expanded Diagnoses List pane users may view and open notes where diagnoses were documented Clicktate Logan Arnold Diagnoses Documented Diagnoses Diagnoses Documented Show Any Date Di F 04 Jun 2012 4 Medical Note Signed Coronary Artery Disease 14 Jan 2701 E Medical Note Signed Hypertension As already stated diagn
186. so add diagnoses in free text non ICD form to the chart by simply typing them into the box and immediately selecting Save Changes bypassing the ICD Lookup Clicktate Logan Arnold Diagnosis Entry Date 15 Jun 2012 3 Status Active Description hypothyroid Lookup ICD J Lookup Selecting the appropriate diagnosis from the ICD pop up will place the diagnosis onto the Facesheet 101 Clicktate ICD Codes Search For hypothyroid 244 0 Postsurgical nanan 244 2 lodine hypothyroidism 244 3 latrogen hypothyroid NEC 244 8 Acquired hypothyroid NEC 244 9 sm NOS show all 244 x 243 Congenital hypothyroidsm Selected Code 244 Acquired hypothyroidism Notes Let s select 244 9 Hypothyroidism NOS and Click OK 102 Jo lt Prev Next gt ae rc Clicktate ICD Codes EJ Search For hypothyroid 244 Acquired hypothyroidism 244 0 Postsurgical hypothyroid 244 2 lodine hypothyroidism 244 3 latrogen hypothyroid NEC 244 8 Acquired hypothyroid NEC show all 244 x 243 Congenital hypothyroidsm Selected Code lt Prev Next gt 244 9 Hypothyroidism NOS Notes Unspecified acquired hypothyroidism Status Active Description Hypothyroidism NOS J Lookup ICD 244 9 Lookup Saving changes will place the diagnosis in the patient chart The wording of the diagnosis may be changed if de
187. te for patient Document Manager page with the Patient Selector pop up to allow the selection of a Custom Templates patient Manage my templates From the Patient Selector choose the patient for whom you wish to create a note Document Manager Showing All notes for Everyone ad SEF SSS Patient Selector Search for a patient 3E Customize Document DOS s K Ipdated A Medical Note Today Last Name 10 20AM A Medical Note 04 26 Patient ID p 9 35PM F SVC ep ri 2 i 9 56 i Psychiatric Note 04 26 9 56AM Psychiatric Note Signed 04 24 8 10PM A Medical Note 04 24 09238 aj Test Darla 03 Mar 2009 amp 059P 4 Medical Note O4 24 84593 Tester Tony 01 Jan 2010 4 27PM J Psychiatric Note 04 24 cia a Test Troy diada 4 23PM 173456 Test Paul 31 Dec 1969 Psychiatric Note Signed 04 24 8 Test Paula 3 48PM 8203490 a Winter Snowy R 16 Apr 1958 S CNIAatric Te Si 1 O4 1 49Ph Psychiatric Note Signed 04 24 oe Aue 15 Jun 1937 Li4SPM 4A Psychiatric Note 04 23 345634 al Logan Arnold 05 Jan 1946 F 2 47PM A Psychiatric Note 04 23 987543 Fila Chick 09 Mar 1995 p 2 42PM 4 Psychiatric Note 04 23 2504832 8 Walker Randy 02 Jan 1991 2 41PM z oe724c0a i Pes Beal 20 Ain ORF Psychiatric Note 04 23 241PM A Devwrhiatric Mata ma fy Amarrar kaarnrche nMa 92 T JADMA mags TAADA 34 From this pop up either select a patient name from the list of recent patients or input a patient na
188. template hl htn dm 072409 Smoker with Bronchitis Smoking Problem Based On Medical Note Medical Note Medical Note Medical Note Medical Note Medical Note Medical Note Records 1 to 8 2009 10 16 11 29 42 MM 2009 09 03 23 35 27 MM 2009 09 03 23 12 30 MM 2009 07 31 11 52 21 MM 2009 07 24 11 11 25 MM 2009 03 31 14 19 12 CM 2009 03 30 19 26 10 CM Create New Custom Template Manage notes 2009 10 16 11 29 42 2009 09 03 23 327 2009 07 31 12 07 30 MM 2009 07 24 11 11 25 2009 03 31 14 19 12 2009 03 30 19 26 10 2009 03 30 19 24 47 After starting a new template you will be prompted to select the note type on which the template will be based Custom Template i John Template k HL HTN HOTHY A Hyperlipidemia on Lipitor a tiffa ny note hyperlipidemia i test template hl htn dm 072409 Eil Smoker with Bronch itis 1 Smoking Problem Based On Medical Note Medical Note Medical Note Medical Note Records 1to 8 Created 2009 10 16 11 29 42 MM 2009 03 30 19 26 10 CM 2009 03 30 19 24 47 CM Last Updated 2009 10 16 11 29 42 2009 09 03 23 33 27 2009 09 03 23 12 30 2009 07 31 12 07 30 MIM 2009 07 24 11 11 25 2009 03 31 14 19 12 2009 03 30 19 26 10 2009 03 30 19 24 47 You will then be directed to the patient console where a blank document with the selected Template Map will be presented This note is NOT patient connected this is denoted by
189. the banner at the top of the console which doesn t have a patient name It instead will state New File Custom Template Medical Note 69 File Edit Help _ New Open ind Save sa gn and Lock Template Map History of Present Illness Main Acute Bronchitis Acute Gastroenteritis Benign Prostatic Hypert 2 Coronary Artery Diseas Diabetes Mellitus Type 2 Follow up S Fever 4 Hyperlipidemia Foll Hypertension Follo Otitis Media Otitis Media Follo S Quick Note 4 Upper Respirator Urinary Tract Inf cti Viral Syndrome Complete List Abdominal ani P Follow up Abdominal a Female Abdominal o Follow up kkil ekkel M Wey Ag I E Aros LJ eal i Ie Le AL Lal From this screen create a note as you normally would Here a note is created for Diabetes and Hypertension History of Present Illness The patient reports that she checks her blood sugars at home Her sugars are checked daily The average sugars are in the 100 150 range She denies hypoglycemic symptoms The patient denies polyuria polydypsia or polyphagia The last eye exam was within the past year She usually sees an ophthalmologist for her eye examinations The eye examinations have been normal She reports no symptoms of neuropathy The patient takes her medication as prescribed She is not taking insul
190. ther document e Delete Note Allows the user to delete an unsigned note A warning prompt will appear prior to this action being taken THIS ACTION RESULTS IN PERMANENT NOTE REMOVAL AND IS NOTE 48 e Apply Custom Template Allows user defined templates to be brought into open unsigned notes on the console Apply Custom Template Name Based On Last Updated Plant Sterol Cholesterol Plan Medical Note 11 May 2012 2 30PM Brief HTN Note Medical Note 11 May 2017 2 08PM My Translator Medical Note 11 May 2017 10 31AM Translation Name Medical Note 11 May 2017 9 25AM With Translator Medical Note 11 May 2017 9 22AM hyperlipid lab set Medical Note 26 Dec 2011 5 42PM dm test temp Medical Note O7 Aug 2010 1 41PM Cancel e Manage Custom Templates Discussed in detail in the Custom Template Section of the manual 49 Generating a Note To generate a medical note select the appropriate disease or symptom A good starting point is usually the HPI section but this is not always the case To start a note let s generate a note for a diabetes follow up visit First from the patient console Template Map under the HPI Section and the MAIN tab Template Map 3 Customize 4 DOS WCC HPI fain DATA A Acute Bronchitis B Acute Gastroenteritis PMHX Benign Prostatic ROS D Hypertrophy MEDS E Coronary Artery Disease PMHA P F7 Diabetes Mellitus Type 2 ROS Follow up Sel
191. this prescription for another user s review you may add an explanatory note at this time Additionally you may add patient education notes to the prescription which display on the Patient Face Sheet To return to the Status Page click on the Close Return to previous page link 4 The Staff Processing List indicates prescriptions which are pending further review Those prescriptions that are listed in bold type represent items that were entered at this Location Workgroup If a transaction is not listed in bold type thus originating from another Location Workgroup it can still be processed if permitted 154 under your specific office policy Pending prescriptions can be of three types NS InProc or DR NS Needs Staffing attention have been approved by the Doctor Prescriber and are waiting further processing from Staff If for example a Doctor Prescriber approves a prescription and elects to wait and have his staff transmit it it would be listed as NS Selection of this patient listing will take the user to the Route Page for printing or transmitting to a pharmacy InProc in process prescriptions are those which are left unfinished at any point in the Rx process Selection of this transaction takes the user to the Compose Page for completion or deletions DR awaiting Doctor Prescriber Review indicates that a user has determined the prescription requires a Doctor Prescriber s review 5 The Doctor Review List shows prescriptio
192. thyroidism the patient reports a good energy level F She reports no hair loss heat intolerance cold intolerance diarrhea cons Medications Reviewed amp e Update Prescribe Allergies Reviewed per Nurses Note E4 Update Prescribe Physical Examination FREE TEXT OPTION DELETE VITALS Vitals D Reviewed per Nurses Notek e uiiuri t 02 SAT A SPECIALIST EXAM DELETE HEENT EXAM HEENT Head Normocephalic At we You are about to digitally sign this document and lock it from texture and sh further edits Are you sure Bt with no lesior DELETE NECK EXAM Neck Thyroid non enlarged symmetric and has n Yes No cance rigidity 7 DELETE PULMONARY EXAM Lungs Auscultation Clear to auscultation bilaterally There are no retractions clubbing or cyanosis A The Expiratory tc Nasal Septum is normal Lids Normal bilaterally Conjunctiva DELETE CARDIAC EXAM Cardiovascular Heart Normal Rate with Regular rhythm and no murmurs i Impression and Assessment Hypothyroidism 244 9 results in a signed and locked document Once a Document is Signed and Locked the functions on the menu bar which allow document changes are no longer active The document can still be downloaded and copied to the clipboard Confirmation Required This note has open or unanswered questions Do you still wish to proceed Sign and lock note anyway 43 Orders Sends patient orders to the Computerized
193. tion edema palpitations or syncope Associated Symptoms Associated Symptoms E hair loss E heat intolerance E cold intolerance E other Apply Checkmarked 62 In this example Orthopnea PND and DOE were double clicked This results in the following sentence in the document wt He denies chest pain shortness of breath edema palpitations or syncope Removal of Physical Exam Option Physical Examination Normal Se onjunctiva Clear bilaterally Sclera Anicteric bilaterally Oropharynx Moist with no lesions Tonsils No e erythema or exudate By clicking on HEENT a pop up box will appear where the desired elements of the HEENT exam may be selected Title HEENT DEFER HEENT INSERT Selecting HEENT DEFER will cause the exam to read HEENT Deferred Selecting HEENT INSERT will insert the entire HEENT examination Selecting HEENT SELECT will result in a pop up allowing selection of the elements of the exam for display DELETE HEENT EXAM HEENT SELECT ITEMS TO SHOW l Then choose SELECT ITEMS TO SHOW 63 To Show Select Items to Show FP Facies FP Eyelids E Pinna E Conjunctiva F Canal E Sclera E TMs Oral Membranes E Nares E Tonsils E Nasal Septum E Head A Sinuses To Show Select Items to Show Facies F Eyelids E Conjunctiva E Sclera F Nares F Tonsils E Nasal Septum E Head A Sinuses Apply Checkmarked Click o
194. to is within 5 10 minutes of your clinic The Pharmacy ID located next to the DEA on a prescription is a unique identifier that may be requested by a pharmacist to confirm the source of the Rx The Transmit page is the last page in the prescribing process You reached this page by selecting lt Transmit RX gt from the Route Page for electronic or fax processing On the top of the page the prescription s you have selected Is listed Each faxed prescription is accompanied by a message to the pharmacist explaining the nature of the electronic Rx system along with the office contact information 172 lf a pharmacy name was pre selected on the Routing Page the pharmacy name and fax number will already appear If no pharmacy was pre selected you must now choose one from the list The patient s previously selected pharmacy is denoted at the top of the list with a black dot to the left of the pharmacy name Those pharmacies without the black dot are also used by this patient but not as recently Mail Order If you desire to send the prescriptions as mail order there is a mail order home delivery link on the transmit page directly beneath the prescriptions Clicking on this link will open up the shipping mailing address of the patient Verify the address by checking the box If the patient s mailing address is not populated fill in the information It will be saved in the patient detail for future mail order requests NOTE all prescripti
195. ug 2012 Send To None Template Map 2 Customize DOS VISIT Laboratory Data i en z Lipid Profil HPI J Accucheck Ipea OTE pata LB qf Exe DATE Chol HDL LDL Trig ne q Hematocrit 08 26 2012 200 50 100 150 ROS TI Influenza A Norms lt 200 255 lt 100 lt 150 oe E S Influenza B 7 l p ia 4 KOH Prep Urinalysis 08 26 2012 Color yellow sf SpGr 1 010 sf pH 5 0 a Leukocyte Este ALLER K TT KOH Prep Non Gynecologic Urobilinogen normal sf Bilirubin negative 7 Blood negative sf FAMHX 4 Limited Urinalysis SOCHX M J Lipid Profile PE O 4 Mono Spot Impression and Assessment TOL PY fT Reviewed Data Hypertension 997 91 7 J RSV Swab ype 4 Spirometry Hyperlipidemia 272 2 6 IMPR J Strep Swab PLAN q Urinalysis Upper Respiratory Infection 465 9 s PROC J Urine Pregnancy Test RTO q Wet Mount PI an TIME Complete list cc J Accucheck Hypertension Plan He was instructed to eat a low fat diet Instructions were given to eat a Ic 4 Albumin Creatinine Ratio SHOW EDUCATION RESOURCES ral 4 AST ALT Hyperlipidemia Plan The current plan was continued DELETE ORDERS The following tests w q BMP 207 The patient instruction pop up will appear This is generated from data entered into the patient note Additional patient instructions may be added or instructions may be deselected Print Visit Summary Patient Instructions Flease follow a low fat diet
196. ug Review lf your Account provides the functionality you will notice a lt Proceed to Review gt button This Drug Review process will notify you of any possible drug drug drug allergy or drug OTC interactions All new prescriptions will be added to the Pending 158 Rx section as InProc and will remain there until reviewed for interactions if your account has that functionality or printed transmitted Adding a New Prescription The area below Pending Rx labeled Drug Search List is where you start to add a new prescription A new prescription can be generated several ways when it comes to finding and selecting the drug 1 2 If the prescription is one that is commonly used by the Doctor Prescriber leave the search field empty and click on lt Drug Search List gt first This action brings up the Doctor Prescriber s drug list which is automatically built by storing the names of the drugs the physician has prescribed From here you may select the appropriate drug if it is displayed To select a single drug click on the drug name which appears in blue underlined font To choose more than one drug click the check box es to the left of the drug name Drugs are automatically added to the Doctor Prescriber s favorites list when they are prescribed To remove drugs from the Doctor Prescriber s favorites list click on the lt Drug Search List gt icon to display the doctor s favorites list and then proceed to check the app
197. ule DAILY by mouth Lipitor 10 mg Tab 1 tablet QHS by mouth Print checked as Exit 107 From here a patient medication list may be printed The patient medication list is printed in a patient understandable manner without abbreviations or jargon that might confuse or not be understood by patients LCD Solutions LLC New LCD Admin LCD Headquarters 1 860 825 4256 Medication List for Printed 15 Jun 2012 6 47PM MEDICATION DIRECTIONS Dyazide 37 5 mg 25 mg 1 capsule daily by mouth Cap Lipitor 10 mg Tab 1 tablet at bedtime by mouth To see a medication history of a given medication select the medication name from the history on the left Clicktate Logan Arnold Medications Medication History Current History Source NewCrop New Crop Date Action Medication RX 14 Jan 2012 Added Dyazide 37 5 mg 25 mg Cap B Disp 30 Refills 2 Added Lipitor 10 mg Tab 108 The Review Reconcile feature allows a side by side comparison of the current medication list in Clicktate with another medication list from another note a hospital summary or another provider i Medication Check Current Medication s kd Check All DYAZIDE 37 5 MG 25 MG CAP 1 capsule DAILY by mouth Last Reviewed Today 9 06AM by New LCD Admin LIPITOR 10 MG TAB 1 tablet QHS by mouth Last Reviewed Today 9 06AM by New LCD Admin Select document amp Record as Reviewed Reconciled A document that has been scann
198. verage as listed on their card or benefit information One bit of good news preferred drugs will generally be the same across formularies for a given healthplan Unfortunately there is no formulary index system The group number may be of some help Be sure and enter this as part of patient demographics Contact employer benefit managers for additional information Medicare formularies are now included Part D Handle these as you would an insurance plan formulary 189 Building Your Account s Healthplan Formulary List To build your account list start by clicking the add additional healthplans link You will see all healthplans formularies that include your state name Use the Add check boxes to the left of the healthplan formulary name to select the ones you want and then click the lt Add to List gt button to start building your account list Next use the Search box to find additional choices Large employers may be listed nationally and do not appear by state search the employer name There are also national healthplans and Medicare formularies that do not appear by state search the plan s name Unable to Find a Healthplan If you cannot find the desired plan try a different or shorter version of the name Contact customersupport newcroprx com_ with the missing plan Medimedia currently provides information for 3400 plans nationally and will endeavor to add any missing ones Patient Notes Page The Patient Not
199. vided at no cost for your patients You need do nothing it works automatically Transmit Page and Transmit Confirmation Page Choosing the lt Transmit Rx gt option on the Route page takes you here with the checked prescriptions The patient s previously selected pharmacies are at the top of the list followed by an alphabetized location pharmacy list Pharmacies can also be assigned to a patient from Pt Detail The patient s insurance mail order pharmacy may appear with a blue dot Click the Mail order Home Delivery link if desired Use the lt Add gt button to find a new pharmacy Report incorrect or missing pharmacies After transmitting use your network printer for the receipt and Patient Leaflet Note There can be a few minutes before arrival when faxing so please make patients aware of this especially if the pharmacy 136 is within 5 10 minutes of your clinic The Pharmacy ID on the Rx may be used by a pharmacist to confirm the source of the rx Rx Detail back on the Compose Page Accessed via B adjacent to each rx this page displays additional information Rx Processing Notes allows attaching a message to the Rx and or assigning it for review on the Status Page Patient Education adds instructions that appear here and on the Face Sheet After the rx is final and on the Current Med list the Rx Detail page changes An rx batch can be RePrinted Transmitted recording a duplicate transaction in the Print Transmit Log Si
200. wcroprx com For more information http www nlm nih gov research umls rxnorm 166 The Review Page Summary Interactions and allergies comparing the Pending Prescriptions to the patients Current Medications and each other are displayed If this is an RxHub patient drug interactions are automatically checked against a 120 day all doctor history as well as Pending and Current Medications if your account has this feature The Drug Condition check is activated when the Dx or pregnancy indicator is passed from the EMR or PM system Direct users enter a Pt Dx via the Nav Bar Choose the next step from the buttons at the bottom to determine the fate of the selected Rx s Uncheck a box to split the batch as needed lt Approve Leave for Staff gt allows doctors to add the batch to the staff list on the Status Page as an NS Nurses may select lt Leave for Doctor Review gt changing the selected Rx to DR placing it on the Designated Doctor s review list on the Status Page lf your Account has the functionality the top of the Review Page displays drug drug drug allergy and drug condition interactions and additional alerts The rx is checked against Current and Pending meds If the patient is an RxHub patient drug interactions are automatically checked against a 120 day all doctor history as well as Pending and Current Medications Contraindicated appears in FB and indicates a predictably severe consequence of concurrent use of two drugs
201. y Select a severity level Reactions will transfer from Clicktate into the Note section Once the severity has been entered from the dropdown list select Save Allergy or Save Add Additional Allergy 128 Enter optional Outside Doctor and or Original Start Date before selecting drug Replace current doctor Enter Original Start Date Month Day Year Include obsolete drugs Drug Review Rx Date a Doc Loc stage ig cid aa Source r Current Medications for Jimmy John Drug Review Rx Date Doc Loc Stage Drug Sig Refill E 129 11 oprol XL 24 hr Tat laih 4 Admin a FI Prevacid 0 ma Lan 1h HL i 1 i E j i i iG Wa el LF Le a LA G L a T 7 l 129 Close Return to previous page Original Rx Return to edit view to modify Finalized Date Original Entry Date 01 29 2011 Rx Source MedEntry Drug Prevacid 30 mg Cap Monograph Leaflet Dispense 30 Refills 5 PRN No Doctor Entered by New LCD Admin Dispense as Written N Dx Patient s Preferred Language No Category Peptic Ulcer Proton Pump Inhibitors Hide Diagnosis Pharmacy Sig 1 capsule by mouth daily Add l Sig Pharm Message sureScripts Formulary Benefit confirmed No Drug Review Override select drug review override reason Notes Save Rx Notes ae Save Note Print Transmission Log sig History Action Date Status Sig Doctor Location PRN Leaflet 1 29
202. y to the patient s list Or you can use the lt Close gt button to close out of the Allergy Intolerance Search box The magnifying glass on the right hand side of the Allergy Intolerance Search title bar allows you to view the Allergy Maintenance Log This log displays the user what they did add view etc with each allergy the date the allergy was viewed added or modified the severity and any notes that were entered To close out of the Maintenance Log simply click the lt Close gt button located on the right hand side of the Allergy Maintenance Log title bar To delete an allergy that was previously entered click on a specific allergy This will open the Allergy Detail box which allows you to modify or delete the allergy To delete it simply click the lt Delete this Allergy gt button Use the lt Save Allergy gt button after making changes or modifications to the severity and or additional info The deletions and modifications will appear in the Maintenance Log for future reference The allergy field is not required and can be updated at any time by returning to the Compose Rx page and entering the allergy information Current Medications Current Medications prescribed or modified for this patient by all physicians on your account are listed below the Patient Allergies Notes area at the bottom of the page Each medication is listed along with the date drug name SIG number dispensed number of refills Ref Doctor
203. you have selected the correct match you will be taken to the PharmCom Review Page where you will make your final decision PharmCom Review Page After you have selected the appropriate drug and formulation you are taken to the PharmCom Review Page Here you will see the patient s pending prescriptions along with any allergies and drug interactions if your account has Comprehensive features The patient s list of current medications is also displayed If there is a prescription pending that is a duplicate of the Pharmacy request you received you can click on the X that is located to the far right of that pending prescription to remove it from the pending list and add it to the patient s cancelled denied list This helps avoid generating duplicate prescriptions Scheduled drugs will follow a different outgoing path They cannot be sent electronically but in many states can be faxed Thus when responding to the renewal you will see the Route page where you can make your choice to transmit via fax or print If proceeding to transmit the sending pharmacy is displayed on the Transmit page 178 After doing so confirm that the requested drug and the drug you selected match If not use the lt Return to Correct Errors gt button to start over Otherwise if applicable enter the number of authorized refills and click lt Accept gt The medication has been added to the patient s current medication list and a record of the request
204. ype in what you would like to have appear in your document You can do this in any field of the Med Pop up For instance if you prescribe a special formula for an infant this could be placed into the Med Pop up Cicktate Med Selector Name Strength Similac Advance Formula Amount Freq as lib C As needed With meals Route ength Disp Amount Options Here Similac with Iron was typed in manually as was the amount Another feature of the Med Pop up is that if you don t type anything in to the Add Med Discontinue Med Refill Med selector in the PLAN section of most templates this section will not appear in the final document Add PEEine Discontinue PPE Refilled 86 Printing Prescriptions Once a medication has been entered a prescription may be printed e prescribing is a future feature which is currently in development Med Selector Name Strength TOPROL AL EQ 25MG TARTRATE Search Amount Freq 1 daily As needed With meals Length Disp 30 Name Search Results TOPROL XL EQ 100MG TARTRATE TOPROL XL EQ 200MG TARTRATE TOPROL XL EQ 25M6 TARTRATE TOPROL XL EQ 50MG TARTRATE By entering a medication Amount Frequency and Length Clicktate will calculate the Dispense amount for the prescription After the medication is entered into the document a PRINT RX button will appear Add TOPROL XL EQ 25MG TARTRATE 1 daily Dfsp 30
205. ysis prior to appointment Created Today 12 55PM by New LCD Admin E Show notes Today 10 00AM 3 Appt Acute r No status selected The patient appointment status can also be changed from this page to Arrived Cancelled etc by clicking the Edit button OR by selecting the No Status field in the above example This feature is useful if the front office or nursing staff want to track a patient s progress through the appointment or to let the physician easily track the patient s appointment status In the example below the appointment status has been changed to Arrived After changing the Appointment Status select Save and Exit 32 Appointment gt Test Darla Patient Test Darla 1D 09238 DOB 09 Mar 2009 Address Phone Edit Go to patient s facesheet Appointment Date 27 Apr 2012 al Time 10 00AM Type Acute Customize 33 Starting Notes from and Navigation from the Documents Module Documents Notes may also be created from the Patient Notes Documents section of the Home page List unsigned notes for me l l a To start a note from this section select Start List all notes a new note for patient This will open the L Start a new no

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