Obstetrician 100 Exercise Booklet Web view©2014 Epic Systems Corporation. Confidential. This material should be stored securely and may not be distributed publicly. EpicUUID: 2EC9D01E-AD96

OBSTETRICIAN 100, 200, 300 EXERCISE BOOKLET

Finding My Patients for Today...............................................................................................................................4

Reviewing Patient Information From the Multi-Provider Schedule...................................................................4

Viewing Another Provider's Schedule............................................................................................................... 5

If You Have Time: Reviewing Today's Patients..................................................................................................5

Investigating Patient Information..........................................................................................................................7

Reviewing Reason for Visit and Vitals................................................................................................................7

Reviewing and Updating Allergies.....................................................................................................................7

Reviewing and Updating Medications...............................................................................................................7

Using Chart Review Filters.................................................................................................................................8

If You Have Time: Reviewing Trends in Chart Review........................................................................................9

If You Have Time: Reviewing a Medication Order Report...............................................................................10

Updating Patient History..................................................................................................................................... 11

Viewing History Section as Read-Only.............................................................................................................11

Documenting Additional Medical History........................................................................................................11

Exploring Family History..................................................................................................................................12

Exploring the Social History.............................................................................................................................12

If You Have Time: Adding a Family Member....................................................................................................13

Managing Medications........................................................................................................................................ 14

Updating Current Medications........................................................................................................................14

Taking Actions on Medication Orders............................................................................................................. 14

If You Have Time: Editing the Columns in the Meds & Orders Section............................................................15

Documenting the Encounter............................................................................................................................... 17

Updating the Problem List...............................................................................................................................17

Adding Visit Diagnoses.................................................................................................................................... 17

Associating Diagnoses With Orders.................................................................................................................18

If You Have Time: Ordering From the Problem List.........................................................................................19

Placing Orders - Basics.........................................................................................................................................20

Ordering Using a Preference List.....................................................................................................................20

Adding An Order To Your Preference List........................................................................................................211

If You Have Time: Adding Another Version Of An Order To Your Preference List...........................................22

Placing Orders - Advanced...................................................................................................................................23

Ordering Within A SmartSet............................................................................................................................23

Signing An Order and Beyond..........................................................................................................................24

If You Have Time: Edit Multiple Orders Simultaneously..................................................................................25

Using NoteWriter................................................................................................................................................ 27

Opening NoteWriter........................................................................................................................................27

Documenting in NoteWriter............................................................................................................................28

Viewing Your Note...........................................................................................................................................28

Manually Entering a Complaint in NoteWriter................................................................................................29

Adding Comments in NoteWriter....................................................................................................................29

If You Have Time: Creating a Macro................................................................................................................30

Using SmartTools.................................................................................................................................................32

Using SmartTexts and SmartLists.................................................................................................................... 32

Using SmartPhrases.........................................................................................................................................32

Create a SmartPhrase from Scratch.............................................................................................................33

Use the SmartPhrase Butler........................................................................................................................ 34

If You Have Time: Creating Patient Instructions..............................................................................................34

Obstetrics Documentation.................................................................................................................................. 36

Documenting an Initial Prenatal Visit: Part 1...................................................................................................36

Creating an Episode of Care........................................................................................................................ 36

Documenting Tobacco Use..........................................................................................................................36

Documenting a Previous Pregnancy............................................................................................................37

Documenting Dating and Working EDD.......................................................................................................37

Documenting an Initial Prenatal Visit: Part 2...................................................................................................37

Queuing Up Prenatal Lab Orders.................................................................................................................38

Documenting Prenatal Vitals and a Note.....................................................................................................38

Documenting the Prenatal Physical Exam...................................................................................................39

Using the Pregnancy Checklist.....................................................................................................................39

If You Have Time: Using the Problem List....................................................................................................39

If You Have Time: Signing Orders................................................................................................................ 39

Documenting Procedures....................................................................................................................................41

Documenting a Suture Removal......................................................................................................................41

If You Have Time: Documenting a Foreign Body Removal via ProcDoc...........................................................43

Annotating Images.............................................................................................................................................. 44

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Acquiring and Annotating an Image................................................................................................................44

Annotating an Image from the Database........................................................................................................45

If You Have Time: Continuing Your Annotation...............................................................................................46

Writing a Letter................................................................................................................................................... 48

Writing a Letter to a Provider..........................................................................................................................48

Sending a Letter to a Patient........................................................................................................................... 48

If You Have Time: Communicating with Specialists.........................................................................................49

Check Your Work............................................................................................................................................. 50

Wrapping Up....................................................................................................................................................... 51

Wrapping Up an Encounter.............................................................................................................................51

If You Have Time: Create an Addendum..........................................................................................................52

Managing In Basket............................................................................................................................................. 53

Following Up on Result Messages................................................................................................................... 53

Following Up on Rx Request Messages........................................................................................................... 54

Following Up on Patient Communication Messages.......................................................................................55

Following Up on Outstanding Visit Messages..................................................................................................56

Following Up on Cosign Messages...................................................................................................................57

If You Have Time: Creating a QuickAction.......................................................................................................58

Answer Key.......................................................................................................................................................... 60

Finding My Patients for Today.........................................................................................................................60

Investigating Patient Information....................................................................................................................60

Updating Patient History................................................................................................................................. 61

Managing Medications.................................................................................................................................... 61

Documenting the Assessment.........................................................................................................................62

Placing Orders - Basics.....................................................................................................................................62

Placing Orders - Advanced...............................................................................................................................63

Using SmartTools.............................................................................................................................................63

Writing a Note in SmartSet..............................................................................................................................64

Documenting Procedures................................................................................................................................64

Annotating Images.......................................................................................................................................... 65

Wrapping Up................................................................................................................................................... 65

Managing In Basket......................................................................................................................................... 65

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FINDING MY PATIENTS FOR TODAYThe screen shots are provided for reference only. Choose any medications that would apply. If you get stuck and the hints don't provide enough assistance, consult your learning dashboard or ask your instructor.

REVIEWING PATIENT INFORMATION FROM THE MULTI-PROVIDER SCHEDULEIn this exercise you will practice reviewing patient information from the schedule activity.

PATIENT: 9:00 Appointment

TIME: 5 minutes

SCENARIO:

Your 9:00 appointment is here for a check-up. You want to review her history and the rooming information entered by the nurse before you enter the exam room.

TRY IT OUT:

Access the Multi-Provider Schedule activity.

Use the Schedule Glance link of your home screen.

Select your 9:00 appointment.

Review the SnapShot report in the pane below.

Determine the following for your patient.

What medications is the patient taking?

What diagnoses are on the patient's Problem List?

Is the patient due for any vaccines?

View the rooming information entered by the nurse.

Use the selection button to choose the Rooming Report.

Why is the patient here today?

How is the patient's blood pressure?

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Make a commonly used report a button on the toolbar to decrease clicks.

Click the wrench on the report toolbar.

Select the AMB Rooming Report.

Update the Display Name if you want.

Click Accept.

VIEWING ANOTHER PROVIDER'S SCHEDULEIn this exercise you will practice viewing another provider's schedule in the schedule activity.


TIME: 2 minutes

SCENARIO:

You want to send your patient to another specialist for additional treatment. You want to take a look at her upcoming schedule.

TRY IT OUT:

Change the department whose schedule you are looking at.

Click the selection button in the Dept field in the schedule tree.

Find the specialist's department.

Expand the department folder.

View the upcoming two weeks of schedules for the providers listed in this department.

Select a physician in the tree.

Use the calendar to view different days.

Return to your schedule for today when you are done exploring.

IF YOU HAVE TIME: REVIEWING TODAY'S PATIENTS5

In this exercise you will practice reviewing patient information for the patients listed on today's schedule.


SCENARIO:

You have a few extra minutes before you see your next patient, so you decide to review some of the other patients that you will be seeing today.

TRY IT OUT:

Select your 9:00 appointment from the schedule and answer the following questions about the report options.

Is the Rooming Report still a button in your toolbar?

Can you view the AVS from the schedule?

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INVESTIGATING PATIENT INFORMATIONThe screen shots are provided for reference only. Choose any medications that would apply. If you get stuck and the hints don't provide enough assistance, consult your learning dashboard or ask your instructor.

REVIEWING REASON FOR VISIT AND VITALSIn this exercise you will learn how to review information entered by your clinical support staff.


TIME: 2 minutes

SCENARIO:

You are about to start an office visit with your 9:00 appointment, and you want to review the reason for visit and patient vitals.

TRY IT OUT:

Open your 9:00 appointment from your schedule.

Review the patient's reason for visit and vitals entered by the clinical support staff.

REVIEWING AND UPDATING ALLERGIESThis exercise provides guidance regarding how to update allergies for a patient.


TIME: 2 minutes

SCENARIO:

After reviewing the information entered by your clinical support staff, you are ready to review your patient's allergies with her. She informs you that she is sensitive to latex, which is not currently documented in her chart.

TRY IT OUT:

Document the patient's latex intolerance.

True or False: Allergies are the only items that can be documented in the Allergies/Contraindications section of the visit navigator.

Mark the Allergies/Contraindications section as reviewed.

REVIEWING AND UPDATING MEDICATIONSIn this exercise, you will update a patient's medication list.

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TIME: 3 minutes

SCENARIO:

After reviewing allergies with your patient, you want to make sure her medication list is accurate and up-to-date. During the review, she remembers another medication she has been taking that she forgot to mention to your clinical support staff.

TRY IT OUT:

Open the Medications section.

Medications that are prescribed automatically update the medication list. What types of medications should be added in the Medications section?

Add a medication.

When adding a patient-reported medication, can you edit the default dose, route and frequency information that pulls in for a medication?

Use a quick button to select a dose for the medication.

Enter a starting date in the past.

When you've finished entering the medication, mark the Medications section as reviewed

USING CHART REVIEW FILTERSThe following exercise provides guidance on how to sort through historical patient information.


TIME: 3 minutes

SCENARIO:

You would now like to review your patient's previous glucose test results.

TRY IT OUT:

In Chart Review, apply a filter to view only POCT glucose results.

Hint: Select the Labs tab and click Filters

Hint: Here is an example POCT glucose filter.

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Click on one of the listed results to review the result report in the right hand pane.

SCENARIO:

You realize that you often filter on one type of test, and you would like to create a Quick Filter so you can easily narrow down a patient's lab test results with one easy click.

TRY IT OUT:

Save your filter.

Locate your filter's checkbox on the tab.

True or False: After creating a Quick Filter on one tab, it will be available on all tabs in Chart Review.

Remove the filter.

IF YOU HAVE TIME: REVIEWING TRENDS IN CHART REVIEWThis exercise walks through one way to review trends in a patient's chart.


SCENARIO:

In the previous exercise, you used a Quick Filter to narrow down the list of lab results visible in Chart Review. You now wish to compile the results to look for trends in your patient's test results.

TRY IT OUT:

On the Labs tab, create a filter to view only one type of lab result.

Open several results in a flowsheet.

Hint: To select multiple lab results at once, click the first lab result row, press and hold the Shift key, and click the last lab result row.

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Hint: Click Lab Flowsheets.

Graph the values.

Hint: Select the component row and then click Graph Region.

IF YOU HAVE TIME: REVIEWING A MEDICATION ORDER REPORTThis exercise provides steps on how to review the details of a medication order.


SCENARIO:

In a previous exercise, you indicated that the patient was still taking a medication on her medication list. You are curious when the medication was added to the patient's medication list.

TRY IT OUT:

In the Medications section, select the clipboard icon next to one of the medications to review the order report.

Review the original order details.

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UPDATING PATIENT HISTORYThe screen shots are provided for reference only. Choose any medications that would apply. If you get stuck and the hints don't provide enough assistance, consult your learning dashboard or ask your instructor.

VIEWING HISTORY SECTION AS READ-ONLYIn this exercise you will practice reviewing patient history that is already documented.


TIME: 2 minutes

SCENARIO:

Your nurse has already roomed the patient. After reviewing the patient's vital signs, allergies, and current medications, you want to see what is documented in the patient's history.

TRY IT OUT:

Open your patient's chart for today's appointment.

View the History section as read-only.

Hint: Click the blue arrow next to History in your navigator.

Indicate that you have reviewed the history section.

Hint: Click the Mark As Reviewed button.

DOCUMENTING ADDITIONAL MEDICAL HISTORYIn this exercise you will practice updating items in the History section and adding items that do not appear on the forms in the History section.


TIME: 3 minutes

SCENARIO:

During the encounter with the patient, she informs you that she was diagnosed with hypertension in 2009 and had gastric bypass surgery in December of 2011. You will add this information to the patient's chart.

TRY IT OUT:

Open your patient's appointment for today.

Navigate to the History section.

Update the items to match the scenario.

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Add Hypertension to the patient's history.

Add Gastric Bypass to the patient's history.

Hint: Use the Add field.

Indicate that you have reviewed and updated the history for the patient.

GUIDED QUESTIONS:

What action do you take to view a read-only view of the patient's history?

How do you open the History section to update or document the information?

How do I add a date of onset or date of surgery to a patient's history?

EXPLORING FAMILY HISTORYIn this exercise you will practice documenting and updating a patient's family history.


TIME: 3 minutes

SCENARIO:

While reviewing the patient's history with the patient, she informs you that her mother, Sophia, died of congestive heart failure at the age of 74. Also, her brother George has diabetes. You will add this information to the patient's chart.

TRY IT OUT:

Locate the patient's family history.

Document that the patient's mother had heart disease.

If heart failure is not listed in the table, click the green plus sign in the Add Problem column to search for it.

Add names for the mother and brother.

Update the mother's status and note the reason and age of death.

Document that her brother George has diabetes.

EXPLORING THE SOCIAL HISTORYIn this exercise you will practice documenting and updating a patient's social history


TIME: 2 minutes

SCENARIO:

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The patient needs to have her social history updated. While discussing the patient's social history, you find out the following:

She drinks 1 glass of wine a week.

She is a former smoker who smoked 1 pack/day for 15 years.

She does not use illicit drugs.

TRY IT OUT:

Document the patient's social history.

Indicate that you have updated and reviewed the patient's social history

IF YOU HAVE TIME: ADDING A FAMILY MEMBERIn this exercise you will practice adding new family members to the patient's history.


SCENARIO:

Your patient explains that her sisters, Emily and Julie, have been diagnosed with asthma and her father, has hypertension and hyperthyroidism.

TRY IT OUT:

Navigate to the Family History section

Add Emily and Julie to the table.

Hint: Use the Add Family Member button to insert another row for the second sister.

Use the table to document the history for each family member.

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MANAGING MEDICATIONSThe screen shots are provided for reference only. Choose any medications that would apply. If you get stuck and the hints don't provide enough assistance, consult your learning dashboard or ask your instructor.

UPDATING CURRENT MEDICATIONSIn this exercise you will practice updating current medications and add an additional patient-reported medication to the patient's chart.


TIME: 5 minutes

SCENARIO:

Your patient started feeling ill 3 days ago and her symptoms have been gradually worsening. The patient reports to you that she has been taking Tylenol and Nyquil for her symptoms for 3 days in addition to all her other current medications.

TRY IT OUT:

Open the patient's encounter.

Hint: Use the Schedule Glance section of your home screen.

Navigate to the Rooming activity.

Navigate to the Medications section.

Update the current medications based on the scenario.

Add the new patient-reported medications.

Hint: Use date conventions to record the appropriate start dates.

GUIDED QUESTIONS:

What button can you click to mark all the medications as taking?

What icon denotes a medication is marked as long-term?

TAKING ACTIONS ON MEDICATION ORDERS14

In this exercise you will explore display options and actions you can take on medication orders.


TIME: 4 minutes

SCENARIO:

You want to make changes to the medication regimen your patient is currently taking.

TRY IT OUT:

Open your patient's encounter from the schedule.


Navigate to the Meds and Orders section.

Discontinue one of the current medications.

Reorder a historical medication.

Hint: Click Options.

Update the medication details as necessary.

Hint: Click the Summary Sentence (blue link) to edit the details of the order.

Note: The details copy over from the original prescription. You can modify them as desired.

Hint: When you are finished with your edits, click Accept.

Mark the medication as Long-term.

Hint: Expand the medication details.

Sign your order.

GUIDED QUESTIONS:

If Change/Modify has not been added as a column in the Meds & Orders section, how do you access the change button?

How do you display both current and historical medications in the Meds & Orders section?

IF YOU HAVE TIME: EDITING THE COLUMNS IN THE MEDS & ORDERS SECTIONIn this exercise you will customize the columns and display in the Meds & Orders section.


TIME: 3 minutes

SCENARIO:

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You want to be able to change the details of a current medication and to see a summary of the order without expanding the medication.

TRY IT OUT:

Open the patient's encounter from the schedule.

Navigate to the Meds & Orders section.

Add Change as a column.

Hint: Click Options if it is not already expanded.

Add the medication summary to your view.

GUIDED QUESTIONS:

What are four additional column options available in the Meds & Orders section?

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DOCUMENTING THE ENCOUNTERChoose any problems, diagnoses, medications, etc. that would apply to your specialty. If you get stuck and the hints don't provide enough assistance, consult your learning dashboard or ask your instructor.

UPDATING THE PROBLEM LISTIn this activity, you will practice updating the problem list by adding new problems, changing the priority of problems, and adding a goal for a problem.


TIME: 7 minutes

SCENARIO:

Your nurse has already roomed the patient. You need to update her problem list and copy some of the problems over as visit diagnoses.

TRY IT OUT:

Open your patient's appointment.


Add a medium priority problem to your patient's problem list.

Hint: Open the details of the problem.

Add a high priority problem to their problem list and mark it as chronic.

Hint: Open the details of the problem.

GUIDED QUESTIONS:

How could you tell if your patient had a chronic problem?

Sort the problems by priority.

Hint: Click the Options button

Add an item from the problem list as a visit diagnosis.

Hint: Click .

GUIDED QUESTIONS:

How do you add a problem-specific goal?

Add a goal to one of the problems that you added.

Hint: Click More Detailed View.

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ADDING VISIT DIAGNOSESIn this exercise, you will practice adding visit diagnoses to the patient's chart for an encounter.


TIME: 4 minutes

SCENARIO:

Your patient complains of new symptoms that are not recurring problems. In this visit, you won't be dealing with one of the problems they told you about earlier .

TRY IT OUT:

Add a visit diagnosis using a common diagnosis.

Add a visit diagnosis from a previous encounter.

Display your options as buttons, instead of a list.

Return the options to a list if you prefer a list.

Hint: Hover over the buttons in the Visit Diagnoses section to see what they do.

Add a visit diagnosis from the problem list without leaving the Visit Diagnoses section.

Add a visit diagnosis that is not currently on the Problem List to the Problem List.

Hint: Click .

Remove one of the visit diagnoses that you previously copied over from the problem list.

Hint: Click The X.

GUIDED QUESTIONS:

How do you add an item from the Problem List as a visit diagnosis if you are in the Visit Diagnoses section?

ASSOCIATING DIAGNOSES WITH ORDERSIn this exercise you will practice associating orders with diagnoses.


TIME: 4 minutes

SCENARIO:

You decide to order tests and medications for your patient's diagnoses.

Order what makes sense for your specialty and the new diagnoses you assigned (that were not carried over from the problem list).

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TRY IT OUT:

In the Plan activity, locate the Medications and Orders section.

Place orders for appropriate medications and procedures for the visit diagnoses you selected in the previous exercise.

Completion match on medication or procedure name in the New order field.

Choose Select & Stay to search for more items.

Click Accept when you are finished selecting orders.

Click Associate.

In the Associate Orders grid, click in the empty boxes to associate each order with the appropriate diagnosis.

If a diagnosis is not on the grid, use the Diagnosis field to search for and add it.

GUIDED QUESTIONS:

While associating your orders to the corresponding diagnoses, you notice that you forgot to enter a diagnosis for this visit. What is the quickest way to add another diagnosis?

Sign your orders.

IF YOU HAVE TIME: ORDERING FROM THE PROBLEM LISTYou will complete an order related to one of the entries on the Problem List.


SCENARIO:

You want to take appropriate action on the high priority problem you added in the previous exercise.

TRY IT OUT:

In the Problem List section of the Plan activity, locate your high priority problem.

Open the More Detailed View of the problem.

Order an appropriate medication or procedure for the problem.

Hint: Completion match in the New order field in the Relevant Medications and Unsigned Orders section.

GUIDED QUESTIONS:

Do you need to associate orders placed from the Problem List section with a diagnosis? Why or why not?

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PLACING ORDERS - BASICSThe screen shots are provided for reference only. Choose any medications that would apply. If you get stuck and the hints don't provide enough assistance, consult your learning dashboard or ask your instructor.

ORDERING USING A PREFERENCE LISTIn this exercise you will practice placing orders from a preference list.


TIME: 6 minutes

SCENARIO:

Your patient is here today for a check-up, current issues are noted in the Visit Information section of the chart.

TRY IT OUT:

Select your patient's encounter.


Navigate to the Plan activity.


Click New Order.

From the preference list, choose some appropriate medications for the patient.

Expand the Medications list.

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Check the corresponding box for a medication you'd like to order.

Click Accept to leave the Preference List Browser.

Edit the details of the medication.

Click the Summary Sentence (blue link) to open the Order Composer.

Change the details of the prescription as desired.

Click Accept.

Update the remaining orders as needed.

Hint: Use buttons and lists to make your selections.

Sign your orders.

GUIDED QUESTIONS:

How do you access your preference lists?

You want to change the details of an order, how do you open the Order Composer?

ADDING AN ORDER TO YOUR PREFERENCE LISTIn this exercise you will practice adding items to your personal preference list.


TIME: 6 minutes

SCENARIO:

Refer to the Visit Information section of your patient's chart to determine why she is here today.

TRY IT OUT:



Order an appropriate medication.

In the order field, type the first 3 letters of the medication to look it up.

Select the appropriate medication from the resulting list.

Click Accept.

Add this medication to your personal preference list.

Click the star.

Give the medication a unique display name.

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Modify the details as appropriate.

Change the Dose, Route, and/or Frequency fields to meet your needs.

Add any additional medications to your preference list as desired.

Sign your orders.

GUIDED QUESTIONS:

You are with a patient and ordering Amoxicillin for the third time in one day. While ordering it, you realize you are repeatedly updating the same fields with the same information. To prevent this unnecessary work in the future, you decide to add it to your preference list after updating the details. How do you do this?

IF YOU HAVE TIME: ADDING ANOTHER VERSION OF AN ORDER TO YOUR PREFERENCE LISTIn this exercise you will practice adding different versions of an order to your preference list.


SCENARIO:

Imagine that your patient is a child here for the same reason as the patient in the previous scenario.

TRY IT OUT:

Open your patient's visit from the schedule.


Open your personal preference list.

Hint: Click New Order.

Hint: Check the Only Favorites box.

Order the medication on your preference list from the previous exercise.

Update the medication details to reflect a pediatric dose and other fields as needed.

Hint: Click the Summary Sentence to edit the details of the order.

Add the new version of the medication to your preference list.

Sign the order.

GUIDED QUESTIONS:

If you add multiple versions of a medication to your preference list, it is important to change what field for each version?

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PLACING ORDERS - ADVANCEDThe screen shots are provided for reference only. Choose any medications that would apply. If you get stuck and the hints don't provide enough assistance, consult your learning dashboard or ask your instructor.

ORDERING WITHIN A SMARTSETIn this exercise you will practice how to place orders using a SmartSet.


TIME: 7 minutes

SCENARIO:

Your patient is here today for a check-up, current issues are noted in the Visit Information section of the patient chart.

TRY IT OUT:

Select your patient's encounter.

Use the Schedule Glance section of your home screen.

Navigate to the Plan activity.

Navigate to the SmartSets section.

Open a SmartSet.

Hint: Use a suggested SmartSet, use completion matching, or click the Add button to see a list of available SmartSets.

Select and edit a few orders in the SmartSet.

Expand the subsections and check the corresponding boxes.

Hint: Click the Summary Sentence (blue link) to open the Order Composer.

Add an order that is not part of the SmartSet.

Hint: Click the Add Order button in the Additional SmartSet Orders section.

Associate the orders with appropriate diagnoses.

Hint: Choose diagnoses in the SmartSet and click Associate or click New Dx and search for the appropriate diagnosis.

Assign a pharmacy if necessary.

Sign your SmartSet.

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GUIDED QUESTIONS:

How do you edit an order within the SmartSet?

After selecting orders in SmartSet, what other actions must you take before you sign the SmartSet?

Orders have been released to their destinations. Did you sign or pend the SmartSet?

SIGNING AN ORDER AND BEYONDIn this exercise you will practice ordering medications that are administered in clinic and how to change the status of an order.


TIME: 8 minutes

SCENARIO:


TRY IT OUT:



Order the appropriate tests and medications for the next year to monitor her progress.

Hint: Click New Order and select from the preference list.

Change the status to future/standing when appropriate.

Order a medication that will be administered in the clinic.

Hint: Select Clinic Administered Meds.

Associate each order with the appropriate diagnosis.

Hint: Click the Associate button, search for diagnosis, and use the grid.

Verify that at least one of the orders has a status of future or standing.

Hint: Purple square or green circle next to the associated rings.

If not, edit at least one of the orders.

Sign your orders.

Cancel one of the medications and one procedure.

Note: Make sure it's not the future/standing order if you only have one.

Hint: Medication = Discontinue, Procedure = Cancel.

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Release a future/standing order.

Hint: Open the Order Review activity under More Activities.

Highlight the procedure. Click Release in the toolbar.

OR

Hint: Click the Order Entry link.

Select Open Orders in the toolbar.

Highlight the procedure.

Click Release in the toolbar.

GUIDED QUESTIONS:

What is the purpose of the Order Review activity?

You order a blood test and want it to be released to the lab two weeks from today. How can you make this happen?

IF YOU HAVE TIME: EDIT MULTIPLE ORDERS SIMULTANEOUSLYIn this exercise you will practice editing the details of multiple orders simultaneously.

PATIENT: 3:00 appointment

SCENARIO:


TRY IT OUT:

Open your patient's encounter.

Navigate to the SmartSets section.

Open an appropriate SmartSet.

Use completion matching in the Search field.

Select appropriate orders (do not edit them).

Associate orders with diagnoses.

Pend the SmartSet.

Edit multiple orders simultaneously in the Meds & Orders section.

Hint: Click Edit Multiple in the Meds & Orders section.

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Select the orders you want to edit.

Assign appropriate order details to the selected orders.

Sign the orders.

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USING NOTEWRITERThe screen shots are provided for reference only. Choose any medications, diagnoses, problems, etc. that would apply. If you get stuck and the hints don't provide enough assistance, consult your learning dashboard or ask your instructor.


TIME: 20 minutes

OPENING NOTEWRITERIn this exercise you will practice opening NoteWriter, moving NoteWriter, and opening the forms available within NoteWriter.

SCENARIO:

Refer to the Visit Information section of your patient's chart to determine why she is here today. You will use NoteWriter to document the visit.

TRY IT OUT:

Navigate to the Notes activity.

Open a new NoteWriter note.

Hint: Select Standard Visit Note.

If prompted, click Create New Note.

You will see that information was generated in your note automatically, including the patient name and age, and there are headings for the different parts of the note.

Also notice that there is a new activity tab on the left for NoteWriter.

Move NoteWriter to the Sidebar.

Hint: Click Move in the top left corner of the Notes activity.

Move the note back to the left pane.

Hint: Click the arrow on the Notes tab.

Open the HPI form.

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Hint: Click the HPI button.

Tip: If you do not see an HPI form for the patient's reason for visit, you can add one manually.

Hint: In the Add HPI form field in the top right corner of the activity search for the patient's reason for visit.

DOCUMENTING IN NOTEWRITERIn this exercise you will document in NoteWriter using a form that is available based on the patient's reason for visit.

SCENARIO:

Compose your note in NoteWriter using the HPI, ROS and Physical Exam tabs.

TRY IT OUT:

Work through the form documenting information about the problem.

Document any information on the form you choose.

You can select and unselect the rectangular buttons by clicking them. You can document the presence or absence of symptoms using the plus and minus signs on the symptom buttons.

When you have finished documenting the HPI, navigate to the ROS tab and document your patient's symptoms.

Mark at least one entire section as negative.

Hint: Select .

Document a physical exam. Include at least one image.

Hint: Explore the different forms on the Physical Exam tab.

VIEWING YOUR NOTEIn this exercise you will practice moving your note, so you can work in NoteWriter while viewing your note.

SCENARIO:

After working through the multiple available forms in NoteWriter, you will review the automatically generated text of your note.

TRY IT OUT:

Open your note in the Notes activity.

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Tip: The text should correspond to the buttons you selected on the NoteWriter forms.

Move your note to the Sidebar.

While NoteWriter is open in the left pane of your window, your note can remain open in the Sidebar. You can make changes in NoteWriter, or other places in the patient's chart, and see the immediate effects.

MANUALLY ENTERING A COMPLAINT IN NOTEWRITERThis exercise will take you through the process of manually opening a NoteWriter form.

SCENARIO:

While you are working in NoteWriter, the patient also mentions that she has been experiencing shoulder pain. You can document this issue without going back to the Visit Information section of the Rooming activity.

TRY IT OUT:

Add a new HPI form to NoteWriter to document the patient's shoulder pain.

Hint: Search in the Add HPI form field in the top right corner of the activity.

Fill out the form as you like.

Beyond the Basics: Instead of clicking the plus and minus icons on the symptom buttons, try using left-click and right-click to document positive and negative values.

If a chief complaint of "shoulder pain" had been entered in the Rooming activity, the HPI would have been pre-populated with the Shoulder Pain HPI form. By adding the complaint manually you can easily open the HPI without leaving NoteWriter. This won't, however, be automatically updated in the Reason for Visit field of the Rooming activity.

ADDING COMMENTS IN NOTEWRITERIn this exercise you will customize the text in automatically generated by NoteWriter by adding comments within the form.

SCENARIO:

While you documented the basics of the shoulder pain using NoteWriter, you need to add more detail to the note.

TRY IT OUT:

If you are not already there, navigate back to the reason for visit HPI form.

Mark that the patient is experiencing ear pain and enter a comment of "right ear."

Hint: Hover over the Ear Pain button and begin typing.

After you have finished typing your comment press Enter.

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If you successfully entered a comment, the name of the button is now underlined. You can also see your comment in the note.

Add comments to other positive/negative buttons within the form.

Add a comment to an entire section.

Hint: Click .

If you successfully entered a comment, the paper now has lines ( ).

IF YOU HAVE TIME: CREATING A MACROIn this exercise you will practice creating a macro to document a set of normal finding with the click of one button.


SCENARIO:

The patient is here for a checkup. During the visit everything you observed is what you would consider normal. To speed up documentation in the future for similar visits and similar examinations you will create a macro.

TRY IT OUT:

Open your 1:00 appointment from your schedule.

Navigate to the Notes activity.

Open NoteWriter.

Open the ROS tab.

Hint: Click the ROS button at the top of the note.

On the ROS tab, document pertinent negatives and/or positives for a typical exam you may complete.

Tip: Add comments as necessary.

With the ROS complete, open the Manage Macros menu.

Hint: Click the arrow next to the Manage Macros button.

Select Save as macro.

Tip: This option will allow you to name the macro using documentation currently in your workspace.

Tip: This option will often not allow you to define the age and sex restrictions.

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Click Cancel to exit the macro editor.

In the Manage Macros menu, select Create new macro.

Name your macro and define the restrictions.

Tip: Name the macro something that easily identifies what information it includes.

Tip: You must restrict the macro by age.

Tip: Restricting a macro to a gender is not required.

Click Accept. In the Macro Editor, make selections and add comments as you would in NoteWriter.

Open the Owners/Users tab.

You, as the macro creator can share the macro with other users. By sharing the macro you are allowing others to use it. If you do not share it, you will be the only person able to use it.

Click Accept.

Back in NoteWriter, apply the macro you just created.

Hint: Click Apply Macro.

Tip: If you have multiple macros, you will need to click the small arrow next to the Apply Macro button to select which macro should be applied.

Tip: After applying the macro, you are still able to make changes to the form.

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USING SMARTTOOLSScreen shots are provided for reference only. Choose any diagnoses, medications, etc. that apply to your specialty. If you get stuck and the hints don't provide enough assistance, consult your Learning Home Dashboard or quick start guide, or ask your instructor.

USING SMARTTEXTS AND SMARTLISTSIn this exercise you will practice using SmartTexts and SmartLists to complete documentation in Epic.


TIME: 10 minutes

SCENARIO:

You are finishing up your appointment with your 9:00 patient and you want to write a progress note using a SmartText.

TRY IT OUT:

Open your 9:00 appointment from the schedule.

Create a progress note.

Hint: Open the Notes activity.

Tip: The Notes activity may be in the Sidebar.

Select a SmartText to use in the note.

Hint: Use the Insert SmartText field to perform a search.

Tip: If it isn't obvious what a SmartText includes, click Show Preview in the SmartText Selection window.

Complete the required fields.

Hint: Use F2 to identify and navigate to outstanding SmartLists.

Hint: Remember to follow the rhyme "left-click to pick, right-click to stick."

USING SMARTPHRASESIn this exercise you will practice creating a SmartPhrase on-the-fly and creating a SmartPhrase using the editor.


TIME: 15 minutes32

SCENARIO:

While creating your note you realize you are writing information you would write for many patients. You decide to create a SmartPhrase to save time in the future.

TRY IT OUT:

If you aren't already in it, open the progress note for your patient.

Select text in the progress note that you would frequently use in your notes for patients.

With the text selected, click .

Give the SmartPhrase a meaningful display name.

Tip: Using your initials can help you locate your SmartPhrases quickly.

Tip: In the name, give some type of description of the phrase, making it easily identifiable.

Make any adjustments needed to the phrase.

Tip: You may want to remove the patient's name, or the word "patient." You can replace information with wild cards or SmartLinks.

Save the SmartPhrase.

Use your new SmartPhrase in your note.

Hint: Summon the SmartPhrase by typing ".<displayname>" and pressing Enter.

GUIDED QUESTIONS:

What are the differences between SmartTexts, SmartLinks, SmartPhrases, and SmartLists?

CREATE A SMARTPHRASE FROM SCRATCH Create a SmartPhrase.

Hint: Click .

Enter your desired text.

Tip: Consider adding SmartLists to your SmartPhrase.

Tip: Consider using wild cards to insert a placeholder for information you would update each time.

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Share your SmartPhrase with another user.

Hint: Navigate to the Owners & Users tab.

Tip: Use the selection button to find users, or share the SmartPhrase with your neighbor.

GUIDED QUESTIONS:

What are the two types of SmartPhrases, and what is the key difference between them?

USE THE SMARTPHRASE BUTLER Use the Butler to look up all SmartPhrases and SmartLinks.

Hint: Type ".?" and press Enter to open the butler, or simply click .

Find an existing system SmartPhrase and add it to your note.

Hint: Use the filter options on the right side to narrow down the SmartPhrases you see.

IF YOU HAVE TIME: CREATING PATIENT INSTRUCTIONSIn this exercise you will use SmartTools to document patient instructions.


SCENARIO:

Using the SmartTools you practiced with in these exercises, create patient instructions for your 9:00 appointment to take home.

TRY IT OUT:

Open the Patient Instructions section of the patient workspace.

Hint: Within the patient's encounter, navigate to the Wrap-Up activity.

Complete the patient instructions for Harold using a SmartText and a SmartPhrase.

Create a custom SmartPhrase from the text in the instructions.

GUIDED QUESTIONS:

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What is F2 used for?

What is ***? And what is its purpose?

How can you access the SmartPhrases you created?

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OBSTETRICS DOCUMENTATIONDOCUMENTING AN INITIAL PRENATAL VISIT: PART 1In this exercise, you will practice creating an episode, documenting tobacco use and previous pregnancies, entering dating information, and choosing a working EDD.

PATIENT: Cynthia

TIME: 5 minutes

CREATING AN EPISODE OF CARE SCENARIO:

Your patient's PCP confirmed her pregnancy. She is in her first trimester and has an appointment in your department to establish prenatal care. You are with her in the exam room.

TRY IT OUT:

Log in as your obstetrician.

Open the initial prenatal visit with your patient.

Hint: Double-click the appointment slot.

Because this is the first visit, create a new pregnancy episode. Note that while your nurse sees a New Pregnancy Episode button, you might only see a New Episode button. Use the button available to you to create a new pregnancy episode.

Tip: Usually, this is a task your nurse does during rooming, but it's important that you also know how to do this. Certain sections, such as Dating, will only open if the encounter is linked to an active pregnancy episode.

CHECK YOUR WORK:

You should see the new episode listed in the Episodes section.

DOCUMENTING TOBACCO USE SCENARIO:

Your patient smokes a few cigarettes each day. She is not ready to quit smoking, and you counsel her about the importance of quitting while she is pregnant.

TRY IT OUT:

In the History section, scroll down to the Social History subsection.

Update the tobacco use details as needed.

Document that she is not ready to quit and that counseling was given.

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Hint: Use the buttons.

DOCUMENTING A PREVIOUS PREGNANCY SCENARIO:

Your patient was pregnant once before, and her baby was born full term. The baby was delivered at an unaffiliated hospital in another state.

TRY IT OUT:

Stay in the History section and scroll down to the OB History subsection.

Add a previous pregnancy.

In the details form, document the outcome as full-term.

Hint: Use the Term button.

Document a few more details.

Accept the details.

If you have satisfied your organization's policy on when to click Mark as Reviewed, mark the History section as reviewed.

CHECK YOUR WORK:

After accepting this historical information, the various counts automatically update in the grid at the top of the OB History subsection.

DOCUMENTING DATING AND WORKING EDD SCENARIO:

Your patient's last period was 10 weeks ago.

TRY IT OUT:

Use the Dating section to enter an LMP of ten weeks ago (try using a date convention).

If you want, also enter a date for another basis.

Choose a working EDD.

CHECK YOUR WORK:

After entering a working EDD, the patient header should display information for EDD and GA.

DOCUMENTING AN INITIAL PRENATAL VISIT: PART 2In this exercise, you will practice selecting some pregnancy-related lab orders, entering prenatal vitals and a note, documenting the prenatal physical exam, and using the pregnancy checklist.

PATIENT: Cynthia

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TIME: 8 minutes

QUEUING UP PRENATAL LAB ORDERS SCENARIO:

You want to prep standard prenatal lab orders to sign later.

TRY IT OUT:

Use the Results Console section to select all the first trimester orders.

Tip: Although the buttons are named Order, you're just selecting orders, not signing them.

Hint: There is a way to select all orders in a group with only one click.

CHECK YOUR WORK:

In the Result Console's first trimester group, the Order buttons should be grayed out. (Some of the buttons in the other groups might also be grayed out.)

DOCUMENTING PRENATAL VITALS AND A NOTE SCENARIO:

Your patient's urine is negative for albumin and glucose. Her current weight is 140 lb, and she says her pre-pregnancy weight was 138 lb.

TRY IT OUT:

Normally, your nurse will enter basic vitals. For practice navigating, use the Prenatal Vitals and Notes section to enter a blood pressure of 104/68.

Hint: It's faster if you enter a space instead of a slash.

Hint: To quickly go from field to field, press Tab.

Next, enter a weight of "140lb".

For urine albumin and glucose, enter "negative".

Hint: These fields have lists, so you can completion match "n" for negative.

Because this visit is early in the pregnancy, many of the fields for prenatal vitals are not relevant. However, feel free to navigate to them and use them.

In the text box below the vitals grid, look up the <OB PREGNANCY INITIAL VISIT> SmartText.

Hint: Use the Insert SmartText field in the text box toolbar, and completion match <"ob ini">.

Tip for in the clinic: You are not forced to use a SmartText for your note. You can compose your own note, or convert a SmartText into a hand-tailored user SmartPhrase.

For the sake of time, move on now. If you have time later, come back to this section and complete the note's SmartLists.

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CHECK YOUR WORK:

You should see the data you entered in the vitals table as well as your note in the text box.

DOCUMENTING THE PRENATAL PHYSICAL EXAM SCENARIO:

For the general exam, everything is normal, except that your patient has tenderness in both breasts. For the pelvic exam, everything is normal.

TRY IT OUT:

Use the Prenatal Physical section to document your findings, adding a comment about breast tenderness.

CHECK YOUR WORK:

Close the section (press F9 on your keyboard). You should see a table with your documentation, including your comment.

USING THE PREGNANCY CHECKLIST SCENARIO:

You review with your patient all of the patient education for weeks 6-8, but only a few of the education items for weeks 10-12.

TRY IT OUT:

In the Pregnancy Checklist section, mark all the 6-8 weeks items as completed.

Hint: You can do this with one click.

Mark just a couple of the 10-12 weeks items as completed.

Hint: To expand a group, click the arrow next to its name.

Add a comment to one of the items.

Hint: Click the name of the item.

CHECK YOUR WORK:

Today's date should be listed for all the 6-8 weeks items and the 10-12 weeks items you selected.

IF YOU HAVE TIME: USING THE PROBLEM LIST Add a pregnancy-related diagnosis to the patient's problem list.

Link the new problem to the episode.

After accepting the new problem, use the diagnosis calculator that appears to add a more specific diagnosis as today's visit (encounter) diagnosis.

IF YOU HAVE TIME: SIGNING ORDERS 39

Go to the Meds & Orders section and look up any additional orders you want.

Associate the unsigned orders (which include the orders you selected via the Results Console) with a diagnosis.

Sign the orders.

If you still have time, re-explore any navigator sections covered in this exercise series or go to the Chart Review activity and read the episode report on the Episodes tab. (Obviously, this report's information will be limited because only one encounter is linked to this episode.)

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DOCUMENTING PROCEDURESThe screen shots are provided for reference only. Choose any medications that would apply. If you get stuck and the hints don't provide enough assistance, consult your learning dashboard or ask your instructor.

DOCUMENTING A SUTURE REMOVALIn this exercise you will practice using ProcDoc to document the visit.


TIME: 13 minutes

SCENARIO:

Your 1:00 appointment is a patient who required sutures in her eyebrow after falling on the edge of a coffee table. She is back in the office to get the sutures removed. You will use ProcDoc to order, document and write a note about the procedure.

TRY IT OUT:

Access the patient from your schedule

Hint: Use the schedule link in your startup activity.

Access the Notes activity.

In Notes, open the procedure note template.

Click the drop down next to the Create Note button and choose Procedure Note.

Select Create New Note.

You could free text a note or use SmartTools to document your note. Instead, you will use ProcDoc.

Click the Procedures button.

NoteWriter opens in a separate activity tab.

Select Suture Removal.

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The Suture Removal SmartForm opens for you to document the details of the procedure.

Associate a diagnosis with this procedure for ordering purposes.

Click Dx Association.

Add a diagnosis of Visit for suture removal.

Associate the diagnosis.

Click Accept.

Document the details of the suture removal.

Choose a Body area of head/neck.

What happens?

Indicate that this is her left eyebrow.

The wound is clean and pink.

Document that it is only mildly tender.

You removed seven sutures and zero staples.

Afterwards you applied antibiotic ointment.

Indicate that the patient had the initial procedure at your clinic, and she tolerated the procedure well.

Document that you spoke with the patient's mom and advised her to continue to watch the area.

View the note that you just documented.

Click Edit Note.

Note that if your note is in the sidebar, you do not need to click Edit Note to view the note. If it is not in the sidebar, you need to click that button to return to the note.

Everything that you documented with the buttons pulls into the note.

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Can you edit the note text here?

SCENARIO:

You realize that you took eight sutures out, not seven.

TRY IT OUT:

Edit the details of the procedure documentation.

Click Procedures.

If your note is in the sidebar, you do not need to click Procedures to return to the documentation. If the note is in the sidebar, just return to the Notewriter tab.

Change the number of sutures removed to eight.

Return to your note.

Sign your note.

Normally you would sign the note upon closing the encounter so that you can make edits without creating an addendum, however for the purposes of this lesson you will sign the note now. This allows you to see details of the procedure in a report in Chart Review. These details do not display until the note is signed.

In the lower left, change the option from 'Sign at close encounter' to 'Sign on saving note.'

Click Accept.

View the details of this procedure in the patient's chart.

Open Chart Review.

Go to the Procedures tab.

Single-click the Suture Removal.

Is there a narrative for your procedure?

Was an order signed when you did this documentation?

Can a user tell that this was documented via ProcDoc?

IF YOU HAVE TIME: DOCUMENTING A FOREIGN BODY REMOVAL VIA PROCDOCIn this exercise you will practice using ProcDoc to document a procedural visit.


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SCENARIO:

Your 2:00 appointment is a patient who has a marble stuck in her right nostril. After consulting with an Otolaryngologist, you decide to remove it during the visit.

TRY IT OUT:

Access your patient's encounter.

Use ProcDoc to document the removal of the marble from her nostril.

Remember for the purposes of training, change the note to Sign on saving note.

Review the procedure documentation.

ANNOTATING IMAGESThe screen shots are provided for reference only. Choose any medications that would apply. If you get stuck and the hints don't provide enough assistance, consult your learning dashboard or ask your instructor.

ACQUIRING AND ANNOTATING AN IMAGEIn this exercise you will practice annotating an image.


TIME: 5 minutes

SCENARIO:

Your 9:00 appointment has an office visit for a skin rash. You take a picture of their problem so you can annotate it and compare progress at a future appointment.

Imagine for our scenario that images from the exam room camera upload to the network location used in class.

TRY IT OUT:

Import an image into Hyperspace (Note: The image is already saved in a location you can access.)

Epic> Patient Care> Media Manager> choose patient

Click Import button

Navigate to <<location of image not yet determined>> and double-click on the image to select it

Doc Type is required. Choose Other or All Files.

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Note: By default, this image is added to the patient level. If you want it saved to a specific encounter, you have to select the Enc... button, and choose the appropriate encounter.

Open your patient's appointment and navigate to the Images activity.

Hint: More Activities> Additional Tools> Images

Find and select the image you acquired in step 1.

Hint: Click

Add an annotation to your image.

Hint: Click

Draw a free-text shape around part of your image.

Hint: Click

Select the free-text object you just drew and move it.

Hint: Click

Leave the Image activity open

GUIDED QUESTION:

If you access the Images activity (under More Activities) often, how could you add it to your favorites?

ANNOTATING AN IMAGE FROM THE DATABASEIn cases where you don't have the ability to take a picture, the patient hasn't supplied one, or you want a general image, you might want to annotate a generic image from the database. In this exercise you will annotate an image from the database.


TIME: 5 minutes

SCENARIO:

You are in the middle of the patient's appointment when you notice something unusual.

TRY IT OUT:

Navigate to the Images activity

o Epic> Patient Care> Media Manager> choose patient

In the Images activity, pick an image that relates to your specialty from the database of images.

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Hint: Click

GUIDED QUESTION:

How do database images differ from patient or physician-supplied images?

Annotate on the image using the skills you learned above (make sure you add an annotation and a drawing)

Pull this image into a progress note

Hint: Go to Notes and use the .annimg SmartLink to pull in annotated images from this encounter

GUIDED QUESTION:

Where do the annotations that you completed on the image show up in the note?

IF YOU HAVE TIME: CONTINUING YOUR ANNOTATIONIn this exercise you will explore more options available within the Images activity.

Time: 5 minutes

SCENARIO:

You would like to add additional items to your annotated image.

TRY IT OUT:

Go back to the Images activity and your original image (not the database image)

GUIDED QUESTION:

What options are available when you right-click on the image?

Draw a shape in the image and flip it

Hint: Click the shape of your choice , , , , , , , , or

Hint: Click

Add a shape to your image with different fore and fill colors.

Hint: Left-click for the fore (outside) color, right-click for the fill (inside)

Explore additional icons as time permits

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WRITING A LETTERMedical information and screen shots are provided for reference only. Choose any medications that would apply. If you get stuck and the hints don't provide enough assistance, consult your learning dashboard or ask your instructor.

WRITING A LETTER TO A PROVIDERIn this exercise you will practice writing a letter to another provider


TIME: 5 minutes

SCENARIO:

The patient came in to your office today for her quarterly diabetic check-up. You need to send a letter to a provider about the visit.

TRY IT OUT:

Open your 10:00 appointment.

Open the Communications activity.

Hint: Click the Communications activity tab.

Create a new communication and specify a recipient.

Hint: Click New Communication.

Select a letter template.

Edit your letter as appropriate.

Preview you letter to make sure everything is correct.

Hint: Click Preview at the bottom of the activity.

Close the preview.

Route the message to support staff for clean-up.

Hint: Select the Route to support staff and the Clean up letter check boxes.

SENDING A LETTER TO A PATIENTIn this exercise you will send a letter to a patient. You will use the same activity, but practice using different recipients and templates.


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TIME: 5 minutes

SCENARIO:

The patient also asks you for a letter regarding her back pain to take to her employer.

TRY IT OUT:

If you are not already in it, open the patient's scheduled appointment.

Navigate to the Communications activity and create a new letter.

Select a recipient.

Hint: This letter is being sent to the patient.

Select a letter template.

Complete any outstanding documentation in the letter and then send it (don't actually print it now).

Hint: Press F2 to open any SmartLists and navigate to any wild cards in the letter.

IF YOU HAVE TIME: COMMUNICATING WITH SPECIALISTSIn this exercise you will be sending a letter to a patient's PCP and another physician.


SCENARIO:

The patient came into your office today for a follow-up visit. As a specialist, you want to share information from this encounter with other providers.

Your tasks:

Complete visit documentation.

Write a letter to the patient's PCP.

CC the encounter to a colleague.

Route a chart review report to a colleague.

TRY IT OUT:

Open your 10:00 appointment and complete visit documentation.

Hint: Use diagnoses, orders, etc. that apply to your specialty and patient.

Navigate to the Communications activity and create a new letter.

Hint: You are sending this letter to the PCP.

Navigate to the Follow-up section of the Wrap-Up activity.

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Hint: Select the Wrap-Up activity tab.

In the Send Chart Upon Closing Workspace portion of the activity, choose a recipient to receive the chart.

Tip: Use the selection button and choose a recipient from the list.

Tip: If you want to add comments for the provider to see in his In Basket, enter those in the Comments field.

Route the chart.

Hint: Close the workspace.

Tip: You can also send an encounter report from Chart Review using the Route button.

CHECK YOUR WORK Go to the Letters tab in Chart Review.

If you printed/sent the letter, it should have a status of Sent.

If you routed the letter to support staff or pended the letter, it should have a status of Open.

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WRAPPING UPThe screen shots are provided for reference only. Choose any medications that would apply. If you get stuck and the hints don't provide enough assistance, consult your learning dashboard or ask your instructor.

WRAPPING UP AN ENCOUNTERIn this exercise you will practice wrapping up a visit.


TIME: 15 minutes

SCENARIO:

You have been working with the patient in an office visit but have not yet completed all necessary documentation. After documenting a reason for visit, writing a note, and entering a visit diagnosis, you decide that the patient needs instructions for dealing with her constipation. You can add these to her After Visit Summary.

TRY IT OUT:

In the Wrap-Up activity, use a SmartPhrase to insert patient instructions for the patient's constipation.

Hint: enter ".inconstip" and press Enter.

Note: It is also possible to insert a SmartText into the Patient Instructions field. (Refer to your SmartTools module for more information).

SCENARIO:

The patient is an established patient who received Level II service during today's visit.

TRY IT OUT:

Use a quick button to document the LOS for this visit.

Hint: EST2.

SCENARIO:

After documenting the LOS and patient instructions for the patient, you need to print off her AVS. (To save paper, you won't actually print it right now.

TRY IT OUT:

Preview the After Visit Summary

What information is included in the AVS?

Close the After Visit Summary

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SCENARIO:

You have completed all of your documentation for the patient and are finished charting.

TRY IT OUT:

Sign the Visit

Hint: If any required documentation is incomplete, a warning box will appear with blue links. Click on any of the links to open that section of the chart and complete the missing documentation.

IF YOU HAVE TIME: CREATE AN ADDENDUMIn this exercise you will create an addendum to a visit.


TIME: 15 minutes

SCENARIO:

You have already signed the visit, but you realize that you forgot to document that the patient has also been having minor headaches and has been taking Tylenol as needed for the last 2 weeks.

TRY IT OUT:

Create an addendum to the encounter.

Hint: Click the closed appointment from your schedule.

Document that the patient has been having headaches for 2 weeks.

Hint: enter a reason for visit in the Rooming activity.

Document the patient's medication for her headaches.

Sign the addendum.

Beyond the Basics: Route your addendum to other providers when you sign it.

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MANAGING IN BASKETThe screen shots are provided for reference only. Choose any diagnoses, medications, etc. that would apply to your specialty. If you get stuck and the hints don't provide enough assistance, consult your Quick Start Guide or ask your instructor.

FOLLOWING UP ON RESULT MESSAGESIn this exercise you will practice processing result messages.

PATIENTS: Chandler and Monica

TIME: 6 minutes

SCENARIO:

You have results in your In Basket that you would like to take a look at before going to lunch.

TRY IT OUT:

Log in to Hyperspace.

Open the Results folder in your In Basket.

Hint: Use the In Basket Glance section of your dashboard.

Open the message for your Monica patient.

Hint: Single-click the message.

View more information about the results in the report pane.

Hint: The bottom portion of your screen is the report pane, and presents information about the message without leaving In Basket.

Write a result note asking a nurse to communicate the results to the patient.

Hint: Click Rslt Note.

Route the note to the nurse.

Hint: Enter your nurse's name in the Recipient field.

Close the result note.

Hint: Click Accept.

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Indicate that you reviewed the results and remove them from your folder.

Hint: After marking the message as Reviewed, click Refresh.

Open the result message for Chandler.

Place an appropriate reflex order for this patient based on the results.

Hint: With the result message selected, click Reflex.

Once in Order Entry, place the order.

Hint: Search for an order in the New Order field and sign it.

Close the patient workspace.

GUIDED QUESTIONS:

How can you tell if results are abnormal?

What actions can be taken on Result messages?

FOLLOWING UP ON RX REQUEST MESSAGES PATIENTS: Chandler and Rachel

TIME: 6 minutes

SCENARIO:

One of the nurses in your office answered the phone when Chandler called, asking for a refill for his medication. The nurse pended the medication and sent it to you to be signed. The nurse also sent a pended medication to you from a refill request received from MyChart.

TRY IT OUT:

If you are not in it already, open your In Basket.

Open the Rx Request folder.

Open the message for your Chandler patient.

Review the information available to you regarding the request.

Hint: Look at the Requested Medications section of the Message report (default report) to view information about the request.

Approve the medication.

Hint: Click Approve All on the folder toolbar.

Open the message for your Rachel patient.

Review the information regarding the refill request.

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Tip: Click the links in the Requested Medications section of the Message report to view more information about the order and the visit when the order was placed.

Refuse the refill.

Hint: Click Refuse All/Rt on the folder toolbar.

Write a note about why you are refusing the refill.

Tip: The information you add in the Notes section of the form will be saved in the patient's chart.

Send the note back to the nurse so she can contact the patient about the refused refill.

Hint: Click Add Sender.

Write a message to the nurse to inform her of the follow-up required.

Sign and send the message back to the nurse.

Click Sign and Route.

Choose an appropriate reason for refusal from the list.

Hint: To see all of the available options, click the selection button (the magnifying glass).

Refresh your In Basket folder to make the messages disappear.

GUIDED QUESTIONS:

What are two sources of Rx Request messages?

FOLLOWING UP ON PATIENT COMMUNICATION MESSAGES PATIENTS: Rachel and Ross

TIME: 6 minutes

SCENARIO:

You have two types of messages in your In Basket involving patient communication that you need to take care of.

Rachel send you a message through MyChart asking a non-urgent medical question.

Ross called the office about a rash he developed over the weekend.

TRY IT OUT:

Open your Pt Advice Request folder in In Basket.

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Select the message from Rachel.

View the information available to you.

Tip: In the report pane you will see the message from the patient.

Tip: You have more reports available to you about past visits, labs, medications, problems, and your last progress note for the patient.

Reply to the patient.

Hint: Click Reply to pt.

Tip: You have options available while replying to the patient, such as Notify me if not read by, Allow reply directly to me, and Deliver to patient on.

Send the message.

The status of the message should now be Done. Remove the message from your folder.

Hint: Click Refresh.

Navigate to the Patient Calls folder.

Open the message for your Ross patient.

View the call documentation.

You would like the patient to come in for an appointment. Let the nurse know this.

Hint: Click QuickNote.

Route the QuickNote back to the nurse.

Hint: Click Route to Sender.

Indicate you have finished working with the message.

Hint: Click Complete.

Tip: Do not close the encounter. The nurse will continue documenting in the same encounter when she calls the patient back to make an appointment.

GUIDED QUESTIONS:

What are sources of patient communication messages?

What can a provider do with a medical advice request message?

What can a provider do with a patient call message?

FOLLOWING UP ON OUTSTANDING VISIT MESSAGES PATIENTS: Chandler and Monica

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TIME: 6 minutes

SCENARIO:

You have been very this week and have outstanding chart and encounter messages in your In Basket.

TRY IT OUT:

Open your My Open Charts folder in In Basket.


Review the information about the visit.

Close the encounter.

Hint: Click Close Enc.

Hint: If there is any additional information required to close the encounter, you will be prompted to enter it by following the links provided.

Once all of the required items are complete, you are able to close the encounter and the message will disappear from your folder.

Navigate to you My Open Encounters folder.

Select the message for Chandler's encounter.

Review the information available to you.

Close the encounter.

Tip: Similar to the My Open Charts message, if necessary information has not been entered, you will be prompted to complete it.

Refresh the folder.

Hint: The message should no longer be in the folder.

FOLLOWING UP ON COSIGN MESSAGES PATIENTS: Monica and Ross

TIME: 6 minutes

SCENARIO:

You are a supervising provider and responsible for co-signing charts that residents complete and orders that they place.

TRY IT OUT:

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Navigate to the Cosign - Chart folder in In Basket.

Find and open the message for your Ross patient.

View the information regarding the visit in the report pane.

Open the encounter to complete more detailed review.

Hint: Click Enc.

Hint: If an encounter is closed, you will not be able to make changes without creating an addendum.

After reviewing everything you wanted to check, sign the chart.

Hint: Click Sign.

Back in In Basket, your message should be done. Refresh your In Basket for the message to disappear.

Navigate to the Cosign - Clinic Orders folder.


Open the encounter from which these orders were placed.

Hint: Click Jump To.

If you attest to the orders, sign the orders. If not, decline the orders.

Hint: To sign the orders, click Sign.

Hint: To decline the orders, click Decline.

After signing or declining the orders and refreshing the folder, the message will disappear.

GUIDED QUESTIONS:

Can an encounter be closed before a physician cosigns the chart?

IF YOU HAVE TIME: CREATING A QUICKACTIONSCENARIO:

You need to write a Result Note asking your nurse to call the patient. You will be sending these In Basket messages frequently, and to do this efficiently in the future, you will create a QuickAction

TRY IT OUT:

Click Manage QuickActions.

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Create a Result Note QuickAction.

Hint: Choose Result Note.

Tip: You can create QuickActions for different tasks.

Choose a name and recipient for your QuickAction.

Hint: Enter Button Name and Recipient.

Enter your message in the text box on the right.

Save your QuickAction.

Hint: Click Accept.

Use your new QuickAction to send a result note.

Tip: If you don't have result messages, create a different type of QuickAction to be used on another message.

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ANSWER KEYFINDING MY PATIENTS FOR TODAYREVIEWING PATIENT INFORMATION FROM THE MULTI-PROVIDER SCHEDULE

What medications is your patient taking?

<Update with your patient's data>

What diagnoses are on the patient's Problem List?


Is the patient due for any vaccinations?


Why is the patient here today?


How is the patient's blood pressure?


REVIEWING TODAY'S PATIENTS

Is the Rooming Report still a button in your toolbar?

Yes

Can you view the AVS from the schedule?

Yes

INVESTIGATING PATIENT INFORMATIONREVIEW AND UPDATE ALLERGIES

True or False: Allergies are the only items that can be documented in the Allergies/Contraindications section of the visit navigator.

False. You can also document intolerances, contraindications and unspecified reactions.

REVIEW AND UPDATE MEDICATIONS

Medications that are prescribed automatically update the medication list. What types of medications should be added in the Medications section?

Only patient-reported medications should be added in the Medications section.

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When adding a patient-reported medication, can you edit the default dose, route and frequency information that pulls in for a medication?

Yes. You can use quick buttons or click the magnifying glass icon to see the entire selection list for the field.

USING CHART REVIEW FILTERS

True or False: After creating a quick filter on the Labs tab, the quick filter will be available on all tabs in Chart Review.

False. The quick filter only applies to the tab on which it was created.

UPDATING PATIENT HISTORYDOCUMENT ADDITIONAL MEDICAL HISTORY

What action do you take to view a read-only view of the patient's history?

Select the blue arrow next to the History section

How do you open the History section to update or document the information?

Select the section from the table of contents

How do I add a date of onset or date of surgery to a patient's history?

Select the paper icon

EXPLORE FAMILY HISTORY

Are you required to include family members' names and statuses?

No. The fields are not required.

MANAGING MEDICATIONSUPDATING CURRENT MEDICATIONS

What button can you click to mark all the medications as taking?

Mark All Taking

What icon denotes a medication is marked as long-term?

Red push pin

ACTING ON MEDICATION ORDERS

If Change/Modify has not been added as a column in the Meds & Orders section, how do you access the change button?

Expand the medication by clicking the blue triangle to the left of the name.

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How do you display both current and historical medications in the Meds & Orders section?

Select the Med History check box under the Options button

EDITING THE COLUMNS IN THE MEDS & ORDERS SECTION

What are four additional column options available in the Meds & Orders section?

Dose/Frequency, Dispense as Written, Patient Sig, Start, End, Ord/Sold, Ordered on, Authorized by, Discontinued on, DC Reason, Dispense, Refills, Last Dispense, Pharmacy, Dx Associated, Order Report Link, Med Note, Last Administered

DOCUMENTING THE ASSESSMENTUPDATING PROBLEM LIST WITH PRIORITIES AND GOALS ANSWERS

How could you tell if your patient had a chronic problem?

Red push pin selected to the left of the problem.

How do you add a problem-specific goal?

Click the More Detailed View link.

ADDING VISIT DIAGNOSES

How do you add an item from the Problem List as a visit diagnosis if you are in the Visit Diagnoses section?

Use the Problem menu/buttons.

ASSOCIATING DIAGNOSES WITH ORDERS

While associating your orders to the corresponding diagnoses, you notice that you forgot to enter a diagnosis for this visit. What is the quickest way to add another diagnosis?

Search for it in the Diagnosis field in the Associate Orders grid.

IF YOU HAVE TIME: ORDERING FROM THE PROBLEM LIST

Do you need to associate orders placed from the Problem List section with a diagnosis? Why or why not?

No. Orders in the Problem List are automatically associated with the problem/diagnosis under which they were ordered.

PLACING ORDERS - BASICSORDER FROM A PREFERENCE LIST

How do you access your preference lists?

Click the New Order button.

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You want to change the details of an order, how do you open the order composer?

Click the Summary Sentence (blue link).

ADD AN ORDER TO YOU PREFERENCE LIST

You are with a patient and ordering Amoxicillin for the third time in one day. While ordering it, you realize you are repeatedly updating the same fields with the same information. To prevent this unnecessary work in the future, you decide to add it to your preference list after updating the details. How do you do this?

After accepting the details in the Order Composer, click the star and assign it an appropriate display name.

ADD ANOTHER VERSION OF AN ORDER TO YOUR PREFERENCE LIST

If you add multiple versions of a medication to your preference list, it is important to change what field for each version?

The display name for the preference list item.

PLACING ORDERS - ADVANCEDORDERING WITHIN A SMARTSET

How do you edit an order within the SmartSet?

Click the Summary Sentence (blue link) to open the Order Composer.

After selecting orders in SmartSet, what other actions must be taken before you sign the SmartSet?

Complete required fields in the order composer, associate orders with diagnoses, and select a pharmacy if outpatient medications are ordered.

Orders have been released to their destinations. Did you sign or pend the SmartSet?

Sign

SIGNING AN ORDER AND BEYOND

What is the purpose of the Order Review activity?

To release a future/standing order so that it can be resulted in Epic.

You order a blood test and want it to be released to the lab two weeks from today. How can you make this happen?

Change the status to Future.

USING SMARTTOOLSUSING SMARTPHRASES

What are the differences between SmartTexts, SmartLinks, SmartPhrases, and SmartLists?

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SmartLinks pull in information from the patient chart, such as patient name or age.

SmartLists are lists of choices for you to choose from.

SmartPhrases are text that can be created by administrators or users and can contain SmartLinks and SmartLists.

SmartTexts are text that are created by administrators and can contain SmartLinks and SmartLists

What are the two types of SmartPhrases, and what is the key difference between them?

There are system SmartPhrases and user SmartPhrases. The key difference is who created and can edit them.

IF YOU HAVE TIME: CREATING PATIENT INSTRUCTIONS

What is F2 used for?

To navigate to and open any outstanding variables, such as wild cards and SmartLists.

What is ***? And what is its purpose?

It is a wild card. It can be replaced with anything, and is therefore used for custom documentation.

How can you access the SmartPhrases you created?

Use the SmartPhrase butler or summon it by typing ".<SmartPhrase name>"

WRITING A NOTE IN SMARTSETEDIT THE SMARTSET NOTE

True or False: You cannot edit a SmartText note opened via SmartSet.

False. You can edit a SmartText note opened via a SmartSet by completing SmartTools, adding additional SmartTools, and adding free text information.

DOCUMENTING PROCEDURESDOCUMENTING A SUTURE REMOVAL

Choose a Body area of head/neck. What happens?

It opens more fields to document the location of the sutures.

Can you edit the note text here?

No, you must go back to the SmartForm to make any edits.

IF YOU HAVE TIME: DOCUMENT ANOTHER PROCEDURE VIA PROCDOC

Is there a narrative for your procedure?

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Yes

Was an order signed when you did this documentation?

Yes

Can a user tell that this was documented via ProcDoc?

Yes. Under the Comments header in the report it lists 'This order was created via Procedure Documentation.'

ANNOTATING IMAGESACQUIRING AND ANNOTATING AN IMAGE

If you access the Images activity (under More Activities) often, how could you add it to your favorites?

Click the star to the right of Images while accessing it under More Activities.

ANNOTATING AN IMAGE FROM THE DATABASE

How do database images differ from patient or physician-supplied images?

More generic images (outlines, not patient-specific)

Where do the annotations that you completed on the image show up in the note?

Under the image (listed by number).

IF YOU HAVE TIME: CONTINUING YOUR ANNOTATION

What options are available when you right-click on the image?

The same options available from the More button.

WRAPPING UPWRAPPING UP AN ENCOUNTER

What information is included in the AVS?

It contains information about a patient's visit and any follow-up action that should be taken.

MANAGING IN BASKETFOLLOWING UP ON RESULT MESSAGES

How can you tell if results are abnormal?

The yellow bar and exclamation points alert you of abnormal results.

What actions can be taken on Result messages?

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Write a result note, mark it as reviewed, place a reflex order, forward the results to a different user, or release the results to MyChart.

FOLLOWING UP ON RX REQUEST MESSAGES

What are two sources of Rx Request messages?

A patient requesting a prescription through MyChart and a nurse creating a refill encounter and routing it to the physician to be signed.

FOLLOWING UP ON PATIENT COMMUNICATION MESSAGES

What are sources of patient communication messages?

MyChart medical advice request messages and patient call messages.

What can a provider do with a medical advice request message?

Respond to the patient through MyChart.

What can a provider do with a patient call message?

Close the encounter, route the message to a different user, or open the encounter to continue documentation.

FOLLOWING UP ON COSIGN MESSAGES

Can an encounter be closed before a physician cosigns the chart?

Yes. The user responsible for cosigning the chart is attesting to the information, and the encounter can be closed without a cosignature.

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© 2014 Epic Systems Corporation. All rights reserved. Certain information contained herein is confidential and must be treated accordingly. After Visit Summary, Analyst, ASAP, Beaker, BedTime, Break-the-Glass, Breeze, Cadence, Canto, Care Elsewhere, Care Everywhere, Charge Router, Chronicles, Clarity, Cogito ergo sum, Cohort, Colleague, Comfort, Community Connect, Country Connect, Cupid, Epic, EpicCare, EpicCare Link, Epicenter, Epic Earth, EpicLink, EpicOnHand, EpicWeb, Haiku, Healthy Planet, Hyperspace, Identity, IntraConnect, Kaleidoscope, Light Mode, Lucy, MyChart, MyEpic, OpTime, OutReach, Patients Like Mine, Phoenix, Powered by Epic, Prelude, Radar, RedAlert, Region Connect, Resolute, Revenue Guardian, Rover, SmartForms, Sonnet, Stork, Tapestry, Trove, Trusted Partners, Welcome, Willow, Wisdom, With the Patient at Heart and World Connect are registered trademarks, trademarks or service marks of Epic Systems Corporation in the United States and/or in other countries. Other product or company names referenced herein may be trademarks of their respective owners. U.S. and international patents issued and pending.

This guide is based on Epic 2014.

Documents

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