Overview of Optimus EMR v. 8.2.11.x Release September 20, 2017 1
OBJECTIVES This document will outline the new features, enhancements, and the issues addressed in the OEMR system. The notes contained within will highlight important changes. Red and blue font items require follow-up; blue font indicates Group permissions that may need adjusted. T his document is sorted by system modules and includes information on permissions and workflow. It is important that the information is shared with all staff. Your facility should determine how this information is going to be communicated and how to plan for the update. If after reviewing the Clinical Overview Release Notes, you have any additional questions related to the new modules or workflow, please contact Optimus Support. Permissions Add new report permissions through Tools>Staff and Security>Group Permissions>Reporting> 1. Administrative Reports>Progress Notes>Medication Regimen Review e-signing Summary. TR459930 2. Administrative Reports>Care Plan Reports> Care Plan and Orders Summary. TR457662 See the Reports section below for further information. ecc (Electronic Control Center) 1. ecc> Quality Indicators>Psychotropic drugs->details window will display two columns for Most Recent GDR Date Attempted and Most Recent GDR Date Contraindicated from the most recent GDR Physician Comments. These dates are for the last GDR for this resident and may not be specific to the medications listed; refer to the Medication Management-GDR Progress Note history for details. TR459930 echart 1. Due to 10/1/2017 MDS changes to Section P, Restraints and Alarms, the Alarm types have been updated to include types: Bed, Chair, Floor Mat, Motion Sensor, Wander/Elopement, and Other. Alarms choices are updated in the following areas: a. Adm/Gen Observation>Restraints and Devices>Devices Used b. PC View>eChart>ADL and Observations>Restraints and Devices>Devices Used c. Kiosk View>Observations>Restraints> Devices Used TR456904 2. To assist with meeting the requirements from the State Operations Manual and MDS Gradual Dose Reduction for antipsychotic medications, two new Progress Notes, Medication Management-MRR, and Medication Management-GDR, were added. a. Medication Management-MRR Progress Note: 1) Medication Management-MRR (Medication Regimen Review): used by the pharmacist and other staff as needed. Displays pertinent information on Diagnoses, Allergy information, and Orders including a link to the order text for reference (this reference information is not included in the saved note). The fields include Sources Reviewed, Medication Management- 2
MRR Potential Medication Irregularities/Adverse Consequences, Irregularities Report To, Resident has Refused Care and Treatment, Potential Inadequate Medication Indications for Use, Clinically Significant Considerations, Other Medication-Related Adverse Consequences, Medication Dose, Frequency, Route of Administration, Duration and Duplicate Therapy Considerations. 2) Comments: May be used to document free text comments related to medications. 3) There is a new report located in the Progress Notes folder to review dates/users for these Medication Management-MRR Progress Notes during the date range. Reports> Administrative Reports> Progress Notes> Medication Regimen Review e-signing Summary. Add permissions for groups when applicable located in Tools>Staff and Security>Group Permissions>Reporting>Administrative Reports>Progress Notes>Medication Regimen Review e-signing Summary. b. Medication Management-GDR (Gradual Dose Reduction): 1) GDR section: a) Displays Current Diagnoses, Allergy information, and Orders including a link to the order text for reference (this information is not included in the saved note). b) Includes fields for the Reason for GDR Evaluation, displays the Date(s) of last attempted GDR or Date GDR was contraindicated (if documented historically in the Medication Management>GDR Physician Comments by physician/prescriber). The note also includes fields for documenting Evaluations Used in Review, End-of-Life/Palliative Care information, Care Refusal, Physical and/or psychosocial signs, symptoms, or related causes persistent and/or clinically significant to warrant continuation of therapy, Non- Pharmacologic Interventions Considered, History of prior and current meds and nonpharmacologic interventions(including if therapeutically effective, and adverse consequences, Intended/actual benefit and potential risk or adverse consequences with the medication, dose, and duration. 2) GDR Physician Comments: a) Only users set up as Physicians, NPs, and PAs can enter this note section. b) Current Diagnoses, Allergy information, and Orders including a link to the order text for reference (this information is not included in the saved note). c) Information from the most recent completed GDR Note displays for reference and the user may select if they would like to include that GDR information in this note using the Include Last Completed GDR Information in Note (Strikethroughs omitted). i. If the prior note GDR note was edited, the information that was struck through is excluded from the new saved note. d) Information which may be documented by the prescriber include GDR Physician Comments, Sources reviewed, Assessment and Rationale of Medication-Related Issues and Concerns, Gradual Dose Reduction Clinically Indicated and the date (future date allowed), and Gradual Dose Reduction Clinically Contraindicated and the date. The information on GDR and dates will flow from this section when applicable to MDS Section N0450, Antipsychotic Medication Review. c. Permissions for these new Progress Notes are included with the existing Progress Notes Permissions in echart>progress Notes. d. Reminder: users can sort and view only the Medication Management Progress Notes in echart>progress Notes or Progress Notes module using the filter for Medication Management- GDR and Medication Management-MRR. e. Reminder: Reports>Administrative>Progress Notes by Resident (By Note Type) is available and may be run for these Medication Management Progress Note types. 3
f. Reports>Administrative>Notifications Report will include information from the Medication Regimen Review information notifications. g. ecc> Quality Indicators>Psychotropic drugs->details window will display two columns for Most Recent GDR Date Attempted and Most Recent GDR Date Contraindicated from the most recent GDR Physician Comments. These dates are for the last GDR for this resident and may not be specific to the medication(s) listed; refer to the Medication Management-GDR Progress Note history for details. TR459930 3. echart>adv. Directives (upper right) was expanded to accommodate 50 characters to display the full text on the screen. 9122-4620671/TR 452499, 452508 4. MD Notes including History and Physical, Medical Interim, and Transfer Note: Adv Directives>Other fields have been added to these notes. The Advanced Directive information in the MD Notes is now read-only (from ADT) and the user may select whether they would like to include the directives in the Progress Note. 9122-4620676, TR 452508 MDS 1. Changes for 10/01/2017 CMS MDS 3.0 Release a. SPEC_VRSN_CODE has been incremented to "2.01"; ITM_SET_VRSN_CD has been incremented to "1.15". b. New items added to existing sections, applied only to ARDs on or after 10/1/17: 1) N0410H (Opioid Medications Received) 2) N0450A (Resident received antipsychotic medications) 3) N0450B (Gradual dose reduction (GDR) attempted) 4) N0450C (Date of last attempted GDR) 5) N0450D (Documented GDR contraindicated) 6) N0450E (Date documented GDR contraindicated) 7) P0200A (Bed Alarm) 8) P0200B (Chair Alarm) 9) P0200C (Floor Mat Alarm) 10) P0200D (Motion Sensor Alarm) 11) P0200E (Wander/Elopement Alarm) 12) P0200F (Other Alarm) c. New validations: 1) Fatal Errors: a) N0410H (Opioid Medications Received) cannot be greater than 7. b) N0450A (Resident received antipsychotic medications) cannot be blank. c) N0450B (Gradual dose reduction (GDR) attempted) cannot be blank when N0450A (Resident received antipsychotic medications) is not 0. d) N0450C (Date of last attempted GDR) cannot be blank when N0450B (Gradual dose reduction (GDR) attempted) is 1. e) N0450D (Documented GDR contraindicated) cannot be blank when N0450A (Resident received antipsychotic medications) is not 0. 4
f) N0450E (Date documented GDR contraindicated) cannot be blank when N0450D (Documented GDR contraindicated) is 1. g) P0200A (Bed Alarm) cannot be blank. h) P0200B (Chair Alarm) cannot be blank. i) P0200C (Floor Mat Alarm) cannot be blank. j) P0200D (Motion Sensor Alarm) cannot be blank. k) P0200E (Wander/Elopement Alarm) cannot be blank. l) P0200F (Other Alarm) cannot be blank. m) S6202 (Number of Admissions with Overnight Stay in Last 90 Days) cannot be greater than 90. n) S6212 (Number of Observation Stays) cannot be greater than 90. 2) Warnings: a) S0113 (Resident Living Situation Prior to Admission) should not be blank. b) S0114 (Resident Has One or More Support Persons) should not be blank. c) S0153 (Resident Identifier) should not be blank. d) S0185 (Discharge Against Opinion of Nursing Home) should not be blank. e) S0505 (Reason for Admission) should not be blank. f) S0521 (Primary Reason for Admission) should not be blank when A0310A (OBRA Reason for Assessment) is 1. g) S2040 (Behavior Modification Program) should not be blank. h) S6202 (Number of Admissions with Overnight Stay in Last 90 Days) should not be blank. i) S6212 (Number of Observation Stays) should not be blank. j) S6500 (Has the Resident Received Comfort Care) should not be blank. k) S8015 (MMIS Identification Number) should not be blank. l) S8015 (MMIS Identification Number) should contain an 8-digit number, or a single dash. m) S9085A (Is the Resident Enrolled in CHC) should not be blank. n) S9085B (CHC Effective Date) should not be blank when S9085 (Is the Resident Enrolled in CHC) is 1. o) S9085C (CHC Product Name) should not be blank when S9085 (Is the Resident Enrolled in CHC) is 1. p) S9085D (CHC Member ID) should not be blank when S9085 (Is the Resident Enrolled in CHC) is 1. d. New skip patterns: 1) If N0450A=[0], then all active items from N0450B through N0450E must be equal to [^]. 2) If N0450B=[0], then N0450C must be equal to [^]. 3) If N0450D=[0], then N0450E must be equal to [^]. 4) If A0310A!=[01], then S0521 must be equal to [^]. 5) If S9085A=[0], then all active items from S9085B through S9085D must be equal to [^]. e. Report Changes: 1) Corresponding report changes have been made for All UI changes listed above (where appropriate). f. Changes to formatting rules for Medicare Number (A0600B): The formatting rules for A0600B 5
have been expanded to support the coming "Medicare Beneficiary Identifier" (MBI) format, while simultaneously still supporting the legacy "Medicare Number" format. To accommodate this, the following changes have been made (NOTE: All changes are applied retroactively to all ARDs): 1) The following previously enforced validations have been REMOVED: 2) A0600B (Medicare or Railroad Insurance Number) can only contain alpha-numeric characters (0 thru 9 or a thru Z)." 3) "A0600B (Medicare or Railroad Insurance Number): If first character is numeric (0 thru 9), then the first nine characters must all be numeric (0 thru 9)." 4) "A0600B (Medicare or Railroad Insurance Number): If the first character is alphabetic, then there must be 1, 2, or 3 alphabetic characters followed by 6 or 9 numbers." 5) A new general validation has been added (exact verbiage listed). This new error is triggered if the entered value does not meet the formatting rules for EITHER the Medicare Number or the Medicare Beneficiary Identifier. a) "Incorrect Medicare Number or Medicare Beneficiary Identifier (MBI). See item help for details." b) The item Help (right-click menu) for A0600A and A0600B has changed. Formerly, the two controls shared a single help display, that covered both items. These have now been separated. The A0600A instructions are unchanged. The A0600B instructions have been expanded to include the formatting rules for both Medicare Number and MBI entry (copied from the CMS edit verbiage). g. State-specific section S changes: (all effective as of 10/1/17 and not retroactive, unless otherwise noted) 1) California: The following existing fields have been modified: a) S9040A: A new response option of "2. In Process" has been added. This will only appear for assessments with ARDs on or after 10/1/17. b) S9040E: Label changed to "CA - POLST Section D - Signature of Physician, Nurse Practitioner or Physician Assistant". NOTE: APPLIED RETROACTIVELY. 2) Connecticut: The State of Connecticut has terminated the use of ALL SECTION S ITEMS, effective 10/1/17. 3) New York: a) The following existing fields have been modified: i. S0160: A new response option of "09. Neurodegenerative" has been added. This will only appear for assessments with ARDs on or after 10/1/17. b) The following new fields have been added: i. S0185 (If this is a discharge assessment (A0310F = 10 or 11) and the resident is being discharged to an acute hospital (A2100 = 03), is the discharge to hospital due to the request of the resident s healthcare proxy, and against the opinion of the nursing home?) ii. S6500 (In the last 14 days, has the resident received comfort care?) iii. S8015 (MMIS Identification Number) 6
4) Pennsylvania: The following new fields have been added: a) S0113 (Resident Living Situation Prior to Admission) b) S0114 (Resident Has One or More Support Persons) c) S0521 (Primary Reason for Admission) d) S9085A (Is the Resident Enrolled in CHC) e) S9085B (CHC Effective Date) f) S9085C (CHC Product Name) g) S9085D (CHC Member ID) 5) Virginia: a) The following existing fields have been modified: S9100A: i. Response option 2 changed to "2. Virginia Commonwealth Coordinated Care (CCC) Plus". ii. Response option 3 changed to "3. Other reimbursement source". iii. Response option 4 was removed. b) The following new fields have been added: i. S0101 (Admitted from community) (Note existing skip pattern (A1800)) ii. S0153 (Resident Identifier) iii. S0180 (Discharged to community) (Note existing skip pattern (A2100)) iv. S0505 (Level of Care) v. S0520 (Primary reason for assessment) vi. S1210A (Mental Health Diagnoses: Schizophrenia) vii. S1210B (Mental Health Diagnoses: Delusional disorder) viii. S1210C (Mental Health Diagnoses: Schizoaffective disorder) ix. S1210D (Mental Health Diagnoses: Psychotic disorder not otherwise specified) x. S1210E (Mental Health Diagnoses: Bipolar I mixed, manic, and depressed) xi. S1210F (Mental Health Diagnoses: Bipolar disorder II) xii. S1210G (Mental Health Diagnoses: Cyclothymic disorder) xiii. S1210H (Mental Health Diagnoses: Bipolar disorder not otherwise specified) xiv. S1210I (Mental Health Diagnoses: Major depression, recurrent) xv. S1210Z (Mental Health Diagnoses: None of the above) xvi. S2040 (Resident was Provided a Behavior Modification Program) xvii. S6202 (Number of Admissions with Overnight Stay in Last 90 Days) xviii. S6212 (ER visits w/o overnight stay in last 90 days). TR449618 2. MDS Section GG, Functional Abilities and Goals: If documented on Day 1 of the resident stay in the Adm/Gen Observation, and the MDS ARD was Day 8 of the stay, we used a 7-day lookback and the information did not flow to the MDS. We have corrected this so that if Functional Abilities and Goals are documented on Day 1, the information will flow to MDS Section GG Functional Abilities and Goals when the Assessment Reference Date used is Day 8. 9122-4620653, TR454046 7
3. Section N, Medications: The look-back period for the MDS 3.0 items (Medication/Orders Days) N0300, N0350 (A,B), and N0410 (A-H) has been changed. If a discharge/re-admit took place during the 7-day lookback, we now look back only as far as the re-admit date. 9122-4620635, TR451883 4. ADT history and MDS: The look-back period for the MDS 3.0 items listed below has been changed. If a discharge/re-admit took place during the 7-day lookback, we now look back only as far as the readmit date. Affected items include O0400A(1,2,3,3A,4,5, 6), O0400B(1,2,3,3A,4,5, 6), O0400C(1,2,3,3A,4,5, 6), O0400D(1,2), O0400E(1,2), O0400F(1,2), and O0420. NOTE: The therapy start and end date (O0400*5 and O0400*6) calculation did not require any changes, and the query looks for orders that were created prior to the ARD. The change to the Section O calculation algorithms will also correct the same issue for the MDS Worksheet module. 9122-4619983, TR 445037 5. We corrected an issue with the logic relating to "Impaired Cognition" section of the RUG-III calculations (any state using RUG-III regardless of the grouper). The B2A (RUG IV=C0700), B4 (RUG IV=C1000) and C4 (RUG IV=B0700) trigger values should ONLY be considered if ALL THREE values contain a valid answer OTHER THAN "- UTD". Previously, if one was blank, the other two could still be considered, which is contrary to the RAI manual instructions. 9122-4612809, TR 440626 6. S6051A-D controls were not being properly disabled during the UI form load, when S6050 was not set to 'Yes'. TR 440441 ORDERS and emar/etar 1. Staff Signoff Queue: When the user is prompted to select a new start date because the previous start date has passed, the user must now select the next med pass time for the medication. 9122-4618926, TR 43622 2. PO (Physician Order) signing: an enhancement has been added for facilities electronically signing orders to differentiate prescribers who want to view and sign New Orders with a variety of scenarios. Depending on the user type logged into the MD New Queue, different radio buttons for sorting will be seen. a. MD New Queue for Physician Users: 1) Where I am the prescribing or attending physician 2) Where I am assigned to the resident 3) Where I am the prescribing physician (this should be selected if the prescriber wants to sign only the orders prescribed by themselves). 4) Orders with or without implied signatures will display for physicians based on the Allow Electronic Signature setting in the Physician library. There is no change in this functionality. b. MD New Queue for NP/PA users: 1) Where the selected physician is the prescribing or attending 2) Where the selected physician is assigned to the resident 3) Where I am the prescriber (this should be selected if the prescriber wants to sign only the orders prescribed by themselves). All orders where the NP/PA is the prescriber will display 8
with this radio button regardless of the physician selected when the NP/PA enters the MD New Queue. 4) For the NP/PA s, the 3 rd radio button will show unsigned orders with and without implied signatures where they are the prescriber with order dates within 30 days prior to the release. if you would like to have the timeframe adjusted for the 30 days, please contact Optimus Support. 9122-4618835, TR 436903 REPORTS 1. Effective November 28, 2017, the State Operations Manual Appendix PP requires Long Term Care Facilities to develop a Baseline Care Plan for the resident within 48 hours of admission, provide a baseline care plan summary to the resident/representative, and that the resident has the right to sign the care plan after significant changes to the plan of care. The summary of the baseline care plan includes but is not limited to: initial goals, summary of medications and dietary instructions, list of any services and treatments to be administered by personnel of the facility/on the facility s behalf, and notification of updated information based on the details of the comprehensive care plan as necessary. a. To assist with meeting these requirements, a new report located in Reports>Administrative> Care Plan>Care Plan and Orders Summary has been added. 1) The report includes the Care Plan items and Orders that were active as of the START DATE selected. This report is intended to represent a snapshot of the care plan and orders for the individual date selected. The report should be run just prior to the meeting with the resident and representatives for the latest information to be included. 2) The bottom page of the report includes a Comments field for hand written notes by the resident, representative, or staff and signature lines for handwritten ink signatures. 3) The signed report may be maintained in the paper chart or uploaded through echart>document/image Storage 4) This new report may be used in conjunction with the Care Plan Library/Templates to meet the requirements for the Baseline Care Plan for the resident within 48 hours of admission. The Optimus Care Plan Library/Template may be used by your community to setup a Baseline Care Plan Template with the items you would like. For assistance with customizing the Care Plan Library/Templates, see the Care Plan resources on Optimus University or contact Support. Add the report permissions through Tools>Staff and Security>Group Permissions>Reporting>Administrative Reports>Care Plan Reports> Care Plan and Orders Summary. TR457662 2. Medication Regimen Review e-signing Summary: A new report has been added to monitor key information including the resident, unit/room, medical record number, current primary physician, date and time, and user entering the Medication Regimen Review Progress Notes for the date range has been added. It is located in Reports>Administrative Reports>Progress Notes>Medication Regimen Review e-signing Summary. Add the report permissions through Tools>Staff and Security>Group Permissions>Reporting> Administrative Reports>Progress Notes>Medication Regimen Review e-signing Summary. TR459930 9
3. Skin and Wound Reports: The following changes have been made to the Reports>Clinical Data>Skin and Wound Reports> a. Removed the Skin Checked-No Deficits entries from the Skin and Wound Log-By Site and Skin and Wound Log-Inactivated for Date Range Reports, and b. Added Skin Checked-No Deficits to the Skin Conditions with Images, Skin Conditions without Images, and Skin Condition/Wound Progression, Skin Condition-No Wound Reports. 9122-4590035 TR 436902 4. We corrected an issue with an exception error in the Administrative Reports>Electronic Medical Record (EMR Report)>General Observation 3 Report. 9122-438631, TR 438631 INTERFACES 1. OmniCare Pharmacy Interface/SCRIPT: a. The inbound message processing logic for the SCRIPT Pharmacy Interface has been changed to ignore pharmacy rejection messages for DCd/cancelled order. When a pharmacy interface is active and the order has been discontinued in Optimus, any future messages will be logged and NOT processed regardless of message type. This will ensure all emar reports going forward will be correct from the point of the order discontinuation regardless of any future messages received from the pharmacy. When such a message is received, we now log the information audit message below, and take no further action. The related order itself is completely unaffected. Message: "Pharmacy Rejection Message received for cancelled order. Message not processed." b. When a pharmacy interface is active, we will block the ability of the user to add end dates in an order while the order is in the Staff Signoff queue. The user workflow will be to approve the order and then end date or DC in the Resident Orders screen. 9122-4620869, TR 455527 10