Overview of DEx Discharge Express

 

What is DEx?—DEx, the Discharge Express application, integrates existing Discharge Orders and Instructions from Provider Order Entry and results from the Clinical Data Repository (CDR) into the Discharge Summary. Providers no longer have to enter Discharge Orders into Order Entry, then duplicate the information for the Discharge Summary.

Can I dictate the Discharge Summary?—DEx requires that the remaining documentation for the Discharge Summary be entered by the provider—Dictaphone information will not be transcribed into DEx in this phase.

Dictaphone services are still available to create Discharge Summaries without using DEx, but Discharge Orders and relevant results must also be dictated, just as they have been prior to the availability of DEx.

Can I use the information From other electronic data sources in DEx? You can copy and paste text from the Longitudinal Medical Record (LMR), PEN Notes, and your personal electronic documents into the Discharge Summary in DEx. See Copying and Pasting Text for time-saving tips. In addition, you can call information from reports in the Clinical Data Repository directly through DEx, select any part of the report, and pull to into the Discharge Summary.

Who can write discharge summaries in DEx?—Providers who can use DEx to write discharge summaries include Physicians, Nurse Practitioners, Physician Assistants, and Certified Nurse Midwives. These providers can also complete the Face Sheet and write Discharge Orders in Order Entry. An MD must review and sign off the Discharge Summary to finalize the note. Other providers have access  to read the discharge summary in DEx without being able to edit or sign it. Call the Help desk—the number is posted on every computer—if you need access or a change in authorization.

How can nurses use DEx?— Nurses are able to view and print the discharge summary in DEx. See Viewing and Printing a Discharge Summary in DEx.

How does DEx work?—DEx pulls completed results from the CDR together with signed Discharge Orders and Instructions from Order Entry into a single Discharge Summary document. For obstetrical patients, information is also pulled from the OB-EMR. There is one Discharge Summary for every patient visit. In DEx, you can then select which results you want to include in the Discharge Summary, add or change the information from the Discharge Orders and Instructions, and enter additional summary information. Changes made to the information from Order Entry exist only within the DEx summary—these changes do not affect the information in Order Entry.

When can I start the Discharge Summary?—You can begin the Discharge Summary for a visit as soon as the patient is admitted, even before starting the Discharge Orders.

What's the basic DEx process?—After calling up the summary in DEx, authorized clinicians can update the information as available, then save the summary as Preliminary. Once the summary is Complete, a provider who has prepared the summary for an MD to review and finalize can sign it as "Prepared by" and assign the completed summary to the MD who will sign off. MDs preparing their own summaries can also sign them as completed rather than signing off, if the discharge process is not complete.

As of February 2014, to comply with requirements from the Centers for Medicare & Medicaid to demonstrate the meaningful use of electronic health records (EHRs), an attending physician must review and sign off to finalize the summary. The records for discharged patients are checked automatically to ensure that their discharge summaries in DEx have been signed as complete. Residents, House Officers, NPs, PAs, and CNMs can save DEx notes as Complete/Unsigned, and assign an attending physician for the final review and signature. In addition, any notes written by an attending are assigned to the author automatically. Every week, attendings receive an email listing all discharged patients with a DEx note that is assigned to them for final signature. Note that only patients who have been discharged from PATCOM whose summaries are not finalized are included in the email reminder.

Signed Discharge Summaries cannot be changed; an addendum is required to include more information or corrections. See Writing a Discharge Summary in DEx.

Can I erase a summary?—You can error out a summary until it is signed as complete or finalized.

Can I write a summary when there is no discharge order in Order Entry?—There are limited situations when you might need a discharge summary for a patient who will have no electronic discharge orders. You can do this if you provide a reason for doing so. Required information that would be carried from the Order Entry discharge order must be typed into DEx. If a discharge order is written later, the information in the order is not carried over automatically to DEx.

Can I complete a summary when the discharge order in Order Entry hasn't been signed?—Discharge Orders can be signed up to 24 hours after the patient has been discharged via the PATCOM admissions system. If a discharge order exists, you should sign it or get it signed if possible, before signing the discharge summary as completed or final. Once the summary is signed, it can no longer be updated with discharge order data if the discharge order is signed later. However, if it is too late to get a signed discharge order in Order Entry, you can override the need for signature.