Discharge Summaries in DEx

If you opened DEx from the CAS and there is no patient selected, or if you opened the standalone application from Partners Applications, your personal My DEx page displays automatically.
If you had already selected a patient in the CAS, the patient's DEx list displays.
To open My DEx Page (the list of patients with summaries saved by, completed for, or finalized by you) from a patient page, click in the upper left.
The default display for My DEx page is your personal DEx work list. It includes:

Preliminary Discharge Summaries awaiting completion, review, and signature
Completed Discharge Summaries awaiting your review and signature
Recently signed Discharge Summaries

The default displays for either My DEx page or the patient page include data from the last three (3) months. Click or drag the scroll bar on the right to view information that does not fit on the display. Click last month to limit the data or show all to display everything.

In the CAS: Click DEx in the CAS toolbar on the left.
Standalone: From the ÿStart menu, move the mouse pointer over the Partners Applications folder, then click DEx.

If you open DEx with the patient already selected in the CAS, the patient page opens automatically.
From My DEx page, click the patient's name to open the patient page.

If the patient is not listed on your DEx page, see the procedures for selecting a patient, next.

See Overview of DEx Pages, above, for a description of information on the patient page.

From My DEx page, click the patient's name to open the patient page.
If you are working in the CAS and the patient is not listed on your DEx page, see the procedure for selecting a patient, next.
Available only in standalone DEx: To list patients by admission date, unit, service, or team, click the link (underlined in blue). Once you select a list, the click the name to select a patient.

Click the name on the Unit Census Monitor (UCM) for Order Entry.
To reselect a patient quickly, click the drop-down arrow 6 to the right of the current patient name in the CAS, then click the patient you want to select.
Look Up By Medical Record Number
Look Up By Name
Select the Last Patient You Looked Up
Select the Last Patient List You Looked Up
Look Up On A List

Click .
Click to close the display window.

Click .
Click to close the display window.

Some providers have read only access to DEx; they cannot write, edit, or sign summaries. To change your authorization level or request access to DEx, call the Help Desk at the number posted on any MGH computer.

To open a discharge summary from My DEx Page or the patient page for unsigned summaries on current patient visits, click Start Summary or Edit Summary corresponding to the admission/discharge dates for the summary. (See above for patient's list of discharge summaries and My DEx page.)

Information from discharge orders—Fields that draw information from the Face Sheet and Discharge Order are flagged with after the heading text until the Discharge order is signed as final, and the patient is discharged via PATCOM. Changes to the discharge order are automatically carried over to DEx. These fields cannot be edited in DEx unless you break the link between DEx and the discharge order (see below, if no discharge order will be signed).
Updating information—Where applicable, click the heading or its entry. Depending on the entry, you may type or copy and paste text, or select it from data drawn from other sources, such as clinical results. See DEx Editing: Field-By-Field
Changes made to a face sheet/discharge order after discharge via PATCOM—These changes (addenda, if the discharge orders have been signed), are allowed for 36 hours after the patient has been discharged via PATCOM. The heading for the related field in DEx is flagged with . You can replace the data in the DEx entry with the new discharge order information. See individual fields, below, for details.
Field descriptions—Click Show Help or Hide Help for any field to display or hide a description of the field.
Close entry field—Click the heading. Clicking another heading to open its field also closes the current entry field.
No discharge order will be signed—Either because one will not be written, or because the order was not signed within 36 hours of the patient's discharge via PATCOM—click to break the link between DEx and the Discharge Order. See below, Write a Discharge Summary for a Patient Who Will Not Have Order Entry Face Sheet/Discharge Orders For The Visit..
Click discharge order to view information as it appears in Order Entry. Click Close to hide the display window.

To save the summary as preliminary, click Preliminary. A key signature is not required. Preliminary summaries are not listed for an MD to finalize.
Data limit warnings—If the character count of either labs and reports field indicates a length of more than 15 lines, the background of the field turns yellow. Field length greater than 21 lines turns the field red. For more information, click or hold the mouse pointer over the information icon in the upper right of the field. Clicking the icon triggers a popup message; click OK to return to the summary. Consider deleting all but the information that is relevant to the discharge.
Data limit stop—Very large discharge summaries cannot transfer to the SoftMed discharge summary repository or the CDR (Clinical Data Repository). You will not be able to successfully save a discharge summary with too much data. When you try to do so, you are notified that the summary exceeds the size limit. Click OK to acknowledge the message, then delete all information that is not significant and relevant. Size limits are defined by the MGH Executive Clinical Policy and Record Committee.

If you are an MD who is preparing your own Discharge Summary, you can go straight to the final signing. However, finalized Discharge Summaries cannot be changed; an addendum is required to include more information or corrections. See Reviewing and Signing a Discharge Summary, next.

Click Complete/Unsigned when all of the required and applicable entries are complete. Required entries are marked with an asterisk (*).
If you have completed the summary for another provider to finalize:

Click the For option.
Type the last name of the MD who will review and sign to finalize the summary. Click the here link next to to display care team information, including the name of the patient's attending MD.
Click or press ENTER.
MDs with access to DEx who match your entry are listed. Click the appropriate MD name.

Type your signing key, then click OK.

Data limit warnings—If the character count of either of the labs and reports fields indicates a length of more than 15 lines, the background of the field turns yellow. Field length greater than 21 lines turns the field red. For more information, click or hold the mouse pointer over the information icon in the upper right of the field. Clicking the icon triggers a popup message; click OK to return to the summary. Consider deleting all but the information that is relevant to the discharge.
Data limit stop—Very large discharge summaries cannot transfer to the SoftMed discharge summary repository or the CDR (Clinical Data Repository). You will not be able to successfully save a discharge summary with too much data. When you try to do so, you are notified that the summary exceeds the size limit. Click OK to acknowledge the message, then delete all information that is not significant and relevant. Size limits are defined by the MGH Executive Clinical Policy and Record Committee.

As of February 2014, an attending must review and sign to finalize the summary.

Click Sign when all of the required—marked with an asterisk (*)—and applicable entries are complete.
Type your signing key, then click OK.

Data limit warnings—If the character count of either of the labs and reports fields indicates a length of more than 15 lines, the background of the field turns yellow. Field length greater than 21 lines turns the field red. For more information, click or hold the mouse pointer over the information icon in the upper right of the field. Clicking the icon triggers a popup message; click OK to return to the summary. Consider deleting all but the information that is relevant to the discharge.
Data limit stop—Very large discharge summaries cannot transfer to the SoftMed discharge summary repository or the CDR (Clinical Data Repository). You will not be able to successfully save a discharge summary with too much data. When you try to do so, you are notified that the summary exceeds the size limit. Click OK to acknowledge the message, then delete all information that is not significant and relevant. Size limits are defined by the MGH Executive Clinical Policy and Record Committee.

Open the preview of the summary by clicking the associated .
Click .
Designate on main (To:) and one or more copy to (CC:) recipients:

To designate recipient from the Partners provider list:

Type at least three (3) letters of the provider's the last name in the To: or CC: lookup fields.
Click or press ENTER.
Providers who match your entry are listed. Click the appropriate name. See next if no matches are found.
Click to check one or both mailing options, then click <<Add Recipient.

To designate a recipient who is not on the provider lookup list:

Click .
Type the full name for the recipient.
Complete the recipient information for one or more of the available transmission methods:

To send by paper mail, type a complete postal address.
To send an electronic message, type the complete email address.
To fax, type the ten-digit (area code and number) fax number.

Click <<Add Recipient.

Recipients are displayed to the right, with the selected mailing method or methods in brackets [ ].
To remove a name, click the corresponding .

Type information for a cover sheet if desired.

Preview does not function for DEx within the CAS (Clinical Application Suite).

Click Send Document.
Click to close the summary display.

From DEx, open the preview of the summary by clicking the associated .
Click .
To default formatting option is the Standard discharge summary layout. Select Letter from the Format drop-down list to change.
Click the Use Custom Letter Head Paper checkbox if you have this in your printer. This will allow space for the letter head text.

Preview does not function for DEx within the CAS (Clinical Application Suite).

Click Print.
Click to close the summary display.

You can only delete preliminary DEx discharge summaries—those with the icon.

Erasing a preliminary summary is an option from several places:

From the patient's list of discharge summaries, click Remove to the right of the preliminary summary to be erased.
From My DEx Page or the patient's list of discharge summaries, click to display the summary preview, then click Error Out.

Click the key field and type your signing key.
Click the next field and type the reason for deleting the preliminary summary.
Click Error Out.
The Preliminary summary is removed, and the DEx list for the patient opens.

On the summary page, click Discharge Order Info.
On the patient page, hold the mouse pointer over the .

Click Add Addendum.
additional information and corrections in the Addendum field.
Click the key field, then
Type your Partners signing key.
Click Add Addendum.