Health Central Hospital Clinical Portal Training for Medical Staff V1 Clinical Informatics

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1 Health Central Hospital Clinical Portal Training for Medical Staff 2016 V1 Clinical Informatics

2 Remote Access of Health Central Hospital Clinical Portal: -Remember your User Name and Password will be required. -ID badge tap access is only available when one is actually using the onsite Health Central network.

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4 Remote Access-2 nd webpage

5 Remote Access-3 rd webpage - Save this website on your office computer or professional laptop/tablet used to access clinical portal This button will be take one to the remote access Citrix webpage to enter their personal: Clinical Portal User Name Clinical Portal Password Challenges with User Name/Password or Citrix call : Call

6 On-Site Access & Use of Clinical Portal with your Health Central ID Badge

7 Proper Log In/Out & Tap In/Out for Physicians and Medical Professionals At the start of the day, tap in using the ID badge. Next, log into Portal manually with username and password. At the end of the day, log out & tap out as shown below. *Make sure to never click on the button If the clinician is more than arms length from the computer itself, please tap out using your badge. If the computer is not performing optimally, log out & tap out, wait 15 seconds and then tap-in and log in. If these steps do not resolve the issue(s), please call the Help x1050 or (407)

8 Physician Census List After logging into portal select the census tab to view your patient list. The working patient list defaults to My Patients. To view the group s patients, select the down arrow in the census type field. Scroll down and select My Groups Patients. The screen will refresh and display the group s patient list.

9 Search/Find a Patient To search for a patient select the Find Patient tab. To search for a patient select the Find Patient tab. Enter the patient last name and first name in the appropriate fields or you can enter the patient s medical record number in the last name field. Then select the search button. To add a patient to your list select the Add checkbox and then select Add to Patient List. Select visits to see an expanded list of specific encounters.

10 Setting up Hotlinks Tabs - Hotlinks tabs are 6 quick links to easily access patient s results for review. Once Hotlinks are initially set up they will remain the same until they are revised again by the user. At anytime you are able to revise your Hotlinks.

11 Setting up Hotlinks Tabs Choose your top 6 Hotlinks to view on your flow sheet. #1 When displayed on Flow sheet Hotlink 1 will be seen first on the Left then each Hotlink link will follow from 1 to 6 in a Left to right order. #2 Don t forget to Click save on the bottom of the screen.

12 Setting up Hotlinks Tabs It is not necessary to put Sepsis Screening as a Hotlink. Sepsis Screening can be viewed on the every Physician 24h summary.

13 Review of Hotlinks Tabs #1 Selecting Meds/VS/I&O Hotlink tab allows you to review the following below all on one flow sheet: Medications given IV Fluids Vital Signs Pain Assessment I&O Summary

14 Placing Basic Orders

15 Placing Basic Orders #2 Select the appropriate orders from the given choices #3 Confirm that the order was placed correctly (In Bold BLUE Text) **ARNP s and PA s Order Source include Protocol Verbal For Placing orders #1 Type name of order in this box

16 Placing Basic Orders #4 When you have finished entering all orders on your patient select Done to save orders

17 HCH EHR-Horizon Clinical Therapeutic Medication Duplication Alert Medication Examples Duplication Examples clonazepam LORazepam Same Medication Group Insulin Lispro Insulin Lispro Same Medication with Different Dose valsartan telmisartan Automatic Substitution Duplication due to HCH P&T Policy Duoneb Xopenex Same Medication Group Duplication alerts will be have to be addressed for each medication duplicated To Prevent Unintentional/Inadvertent Therapeutic Medication duplication a Pharmacy Warning is now available in CPOE for the Medical Provider

18 HCH EHR-Horizon Clinical Therapeutic Medication Duplication Alert #1 Medication Example #1: Medication ordered for Antianxiety clonazepam 0.5 mg PO three time a day

19 HCH EHR-Horizon Clinical Therapeutic Medication Duplication Alert #2 Medication Example #1: Secondary Medication ordered for Antianxiety LORazepam

20 HCH EHR-Horizon Clinical Therapeutic Medication Duplication Alert #3 Pharmacy warning must be attended to for each medication to Prevent Unintentional/Inadvertent Therapeutic Medication Duplication Select appropriate override response If not Addressed Medication order will not be placed

21 HCH EHR-Horizon Clinical Therapeutic Medication Duplication Alert #4 If selected to override the Pharmacy warning for Medication Duplication Select the override reason for the warning or type in free text appropriate override reason If not Addressed Medication order will not be placed

22 HCH EHR-Horizon Clinical Therapeutic Medication Duplication Alert Pharmacy Alerts for Therapeutic Medication Duplication will appear on Top of Left Pane of Current orders in Any view available (i.e. ADC VAAN DISML or Current Order display).

23 #1 HCH EHR-Horizon Clinical Therapeutic Medication Duplication Alert Medication Example #2: Medication to order: Insulin Lispro (HumaLOG) 5 units In AM and at bedtime

24 HCH EHR-Horizon Clinical Therapeutic Medication Duplication Alert #2 Pharmacy warning must be attended to for each medication duplicated to Prevent Unintentional/Inadvertent Therapeutic Medication Duplication Select appropriate override response If not Addressed Medication order will not be placed

25 HCH EHR-Horizon Clinical Therapeutic Medication Duplication Alert #3 If selected to override the Pharmacy warning for Medication Duplication Select the override reason for the warning or type in free text the appropriate override reason If not Addressed Medication order will not be placed

26 HCH EHR-Horizon Clinical Therapeutic Medication Duplication Alert Pharmacy Alerts for Therapeutic Medication Duplication will appear on Top of Left Pane of Current orders in Any view available (i.e. ADC VAAN DISML or Current Order display)

27 HCH EHR-Horizon Clinical Therapeutic Medication Duplication Alert #1 Medication Example #3: Medication ordered valsartan 160 mg PO daily

28 HCH EHR-Horizon Clinical Therapeutic Medication Duplication Alert #2 Medication Example #3: Placing a Secondary Medication ordered telmisartan 80 mg PO daily

29 HCH EHR-Horizon Clinical Therapeutic Medication Duplication Alert #3 Medication Example #3: According to Health Central P&T Policy the telmsartan will automatically be substituted for valsartan.

30 HCH EHR-Horizon Clinical Therapeutic Medication Duplication Alert #4 Substitution will Duplicate the Medication previously ordered. Select appropriate override response If not Addressed Medication order will not be placed

31 HCH EHR-Horizon Clinical Therapeutic Medication Duplication Alert #5 If selected to override the Pharmacy warning for Medication Duplication Select the override reason for the warning or type in free text appropriate override reason If not Addressed Medication order will not be placed

32 HCH EHR-Horizon Clinical Therapeutic Medication Duplication Alert Pharmacy Alerts for Therapeutic Medication Duplication will appear on Top of Left Pane of Current orders in Any view available (i.e. ADC VAAN DISML or Current Order display)

33 HCH EHR-Horizon Clinical Therapeutic Medication Duplication Alert #1 Medication Example #4: Selecting multiple bronchodilators Duoneb QID updraft Xopenex TID updraft

34 HCH EHR-Horizon Clinical Therapeutic Medication Duplication Alert #2 Pharmacy warning must be attended to for each medication duplicated to Prevent Unintentional/Inadvertent Therapeutic Medication Duplication Select appropriate override response If not Addressed Medication order will not be placed

35 HCH EHR-Horizon Clinical Therapeutic Medication Duplication Alert #3 If selected to override the Pharmacy warning for Medication Duplication Select the override reason for the warning or type in free text appropriate override reason If not Addressed Medication order will not be placed

36 HCH EHR-Horizon Clinical Therapeutic Medication Duplication Alert Pharmacy Alerts for Therapeutic Medication Duplication will appear on Top of Left Pane of Current orders in Any view available (i.e. ADC VAAN DISML or Current Order display)

37 Placing Timed Orders #1 After selecting medication. With your mouse click on letter D to select: When to start medication & For How Long. #3 Your medication order is now ready to be saved with the start date and end date. # D(ays) # H(ours) # Do(ses) Or Enter = Until Discontinued #2 Now you can type here: For How long the medication will be given using the allowed abbreviations as see above.

38 Placing Timed Orders Now the order can be profiled correctly by pharmacy with the correct Dose and Duration

39 Placing Timed Orders Now Pharmacy is able to see the: correct duration for the medication and will be able to profile the medication correctly

40 Placing Timed Orders- Incorrectly #2 It may look OK here, however when the order is sent to Pharmacy the order instructions for dose and duration may not appear in the correct location, so the order will not be entered correctly. #1 After selecting medication. Entering a comment for a duration or dose in the comment section does not communicate to pharmacy the correct information.

41 Placing Timed Orders- Incorrectly Placing the duration in the comments section of the order does not communicate correctly to clinical staff in Pharmacy

42 Placing Timed Orders- Incorrectly No Dose Limit communicated to Pharmacy, so unless manually entered no dose limit will be set on order

43 Scheduling Surgical Procedure #1 From HEO display screen type Preop in this bottom right HEO pane.

44 Scheduling Surgical Procedure #2 Ordering Options appear in top right HEO pane. Select Pre-Operative Orders iform to Schedule Surgery and place pre-operative orders

45 Scheduling Surgical Procedure #3 You can now select your Surgical Procedure Date and time. Automatic order of Anesthesia consent is placed once the Surgical Procedure check box is selected

46 Scheduling Surgical Procedure #5 #4 Additional Specialty options are available at the bottom of page. Automatic order of Anesthesia consent is place once Surgical Procedure check box is selected Once completed with orders select Submit Orders

47 Scheduling Procedures #1 From HEO display screen select Pre-Procedure Orders iform.

48 Scheduling Procedures #2 Select Procedure Select Location of procedure Enter any addition orders #3 Once completed Select Submit Orders

49 Cosigning Orders in CPOE #1 Select CPOE #2 Select Enter Orders

50 Cosigning Orders in CPOE #3 Select Cosign Note- If there are orders to Cosign, the Cosign button will be RED If there are no orders to Cosign the button will be Grey.

51 Cosigning Orders in CPOE #4 Options to Select All My Orders or Single check box orders #5 Options to Select All Orders or Single check box orders #6 Select Submit selected for signature

52 Cosigning Orders in CPOE #7 Once Once completed with the Cosigning the Cosign button is Grey again. #8 completed Select Done to Save orders.

53 Cosigning Orders in CPOE #9 Select Accept Orders and Exit.

54 Placing Basic Orders- Helpful Tips #1 Where ever you see a chevron, you are able to click on the tab directly and it takes you to that orders field **Necessary fields needed completion before entering orders: Height Weight Allergies Diagnosis #2 You can now place orders **Remember search here for iforms or Protocols by using 3 letters first, then by 4 letters (not case sensitive )**

55 Placing Basic Orders- Helpful Tips HEO and iforms do not communicate punctuation marks when placing orders (i.e. &, ; ) in the application. If punctuation marks are used at any point orders will not be communicated correctly in the application.

56 McKesson s Horizon Clinical Electronic Medical Record module: Horizon Medication Reconciliation (HMR) -Is used at Health Central Hospital to perform all 3 phases of medication reconciliation.

57 Initiating Medication Reconciliation (Med Rec)

58 Admission Medication Reconciliation After logging into Portal select the Census tab Select the Data Monitor button When the Home Meds have been entered you will see the indicator below that the Admission Med Rec is ready to be completed.

59 Admission Medication Reconciliation After selecting the patient from the Census tab, click on the CPOE & Med Rec tab Click on the Reconcile Medications button. The Med Rec page launches. Click on Start to initiate the Admission Med Rec.

60 Admission Medication Reconciliation Radio buttons to sort meds Ord order the med as is Mod order the med with modifications Don t Don t order the med Clar Clarification order is placed for the nurse to get more information. Bulk action button. If this is selected, no home med orders are placed.

61 Admission Medication Reconciliation- Modify To modify a home medication select the Mod button. Select the medication name.

62 Admission Medication Reconciliation Modify Update the fields by clicking the drop downs arrows and making a selection. (For the dose field only if you do not see the dose in the drop down you can type it in) Select the Save button

63 Admission Medication Reconciliation Add New Med Enter your med search After home meds have been reconciled. Additional meds can be entered DON T select meds beginning with ED for inpatients.

64 Admission Medication Reconciliation Add New Med. Complete or update the fields by clicking the drop downs arrows and making a selection. (For the dose field only if you do not see the dose in the drop down you can type it in) Select the Save button When you have finished adding new medication orders select the Complete Reconciliation button.

65 Admission Medication Reconciliation Special Considerations-Respiratory Meds **Note: ordering the patient s home respiratory medications will not notify Respiratory Therapy of the patient s home medication orders. Home Respiratory Medications will need to be Discontinued from the Admission Medication Reconciliation form. New Orders will need to be placed using the Respiratory Therapy iform from CPOE.

66 Admission Medication Reconciliation Complete After a Final review of the orders Click OK Admission Med Rec displays as completed

67 Transfer Medication Reconciliation If there is a change in level of care (e.g. from medical/surgical units to or from intensive care unit), a Transfer Med Reconciliation should be completed. After selecting the patient from the Census tab, click on the CPOE & Med Rec tab Click on the Reconcile Medications button. The Med Rec page launches. Click on Start to initiate the Transfer Med Rec.

68 Transfer Medication Reconciliation The Transfer Med Reconciliation defaults to Cont (Continue) Hospital Meds. Select the DC (Discontinue) button, if the med. is to not to be continued. - Home Med icon - Home Med / Hospital Med icon - Hospital Med icon Select Add New Med and add meds as needed. Select Complete Reconciliation.

69 Discharge Medication Reconciliation After selecting the patient from the Census tab, click on the CPOE & Med Rec tab: Click on the Reconcile Medications button. The Med Rec page launches: Click on Start to initiate the Discharge Med Rec.

70 Discharge Medication Reconciliation The Discharge Med Reconciliation defaults to STOP the Hospital Meds. Always address the home meds. first followed by the hospital meds. Sort meds by selecting Home/Hospital Bulk action buttons to Continue or Don t Resume all home meds.

71 Discharge Medication Reconciliation Once you have completed reconciling meds. Select Add New Meds to add any additional meds. Select Complete Reconciliation.

72 Completion of Medication Reconciliation for ARNPs and PAs #1 Once you have completed reconciling meds. Select Complete on Behalf of..

73 Completion of Medication Reconciliation for ARNPs and PAs #2 Select Clinician from the drop down. #3 Select Source from the drop down. #4 Select Next once you have completed

74 Medical Staff Notes & Reports: The Horizon Clinical Portal does not include the following electronic functions: History & Physical Daily Progress Notes Consult Report/Notes Surgical or Procedural Report or Notes Discharge Summaries Medical documentation as outlined above must be either: Dictated for transcription of a report (e.g. surgical report) Spoken into a voice-to-text software (e.g. ED medical staff use Dragon-Naturally- Speaking software to enter ED notes in the Horizon Emergency Care-HEC application) Handwritten into the progress notes or consultation forms Each of the above non-electronic medical documentation items will be either scanned or cold-fed into the EHR medical record for future reference.

75 For portal badge access/access or computer function issues call: IS Help (407) or on-site call #1050 For assistance with clinical portal navigation, please call: Clinical or on-site call # 2600

76 1. It is necessary to put the Sepsis Screening as a Hotlink since it can not be view on the Physician 24 hour summary. True or False. F-Answer 2. When selecting the Meds/VS/I&O tab which of the following is not viewed from that tab: a) IV Fluids b) Vital Signs c) Pain Assessment d) Home Medications ----Answer 3. Placing medication duration in the comments field of the order is the correct communication field for Pharmacy to correctly profile the medication. True or False (False- Answer) 4. To correctly order a patient s home respiratory medications it will need to be placed from: a) Admission Medication Reconciliation b) Respiratory iform from CPOE ---- answer

77 5. From which tab in Portal will the indicator for Patient s Medication Reconciliation state the status Needed a) Results b) Review c) Current Orders d) Census ---Answer 6. To correctly enter a medication duration in CPOE it is necessary to enter it in after selecting which line? a) Comments b) Route c) How often d) When to start Routine --- answer