The LMR includes many flags and symbols throughout the application. Click on any of the following graphics for a description.
Patient-Related - The following patient-related flags may appear to the right of the patient's name at the top of the screen:
Indicates that the patient is on precautions due to antibiotic-resistant bacteria or Enhanced Precautions. For a detailed list, click here.
Precautions may be noted for the following:
MRSA (Methicillin-Resistant Staphylococcus Aureus)
VRE (Vancomycin-Resistant Enterococci)
MDRO (Multiply Antibiotic-Resistant Gram-Negative Organisms)
C. Diff (Clostridium Difficile)
Cystic Fibrosis
Holding the mouse pointer over the P icon displays a tool tip. The tool tip shows the dates and precaution types noted for the patient. Clicking the P icon displays a PMRN tab with one or more links corresponding to each type of precaution filed. Clicking a link displays additional information, including steps for taking appropriate contact precautions and instructions for removing the patient from contact precautions (if applicable).
Indicates that the patient has enrolled to use the Patient Gateway application. This application allows patients to communicate with their primary care provider and staff for routine requests, such as medication refills and referral authorizations. It also provides them to access some medical record data.
From the Results Manager queue, moving your cursor over this flag displays either the patient's last login or indicates if the patient has never used his or her account.
Same as previous, except the pencil indicates that the patient not only has a PG account, but is enrolled with a provider in your practice. Additionally, clicking this icon starts a new Patient Gateway message to the patient.
Indicates that the patient is registered to an investigational protocol. Click the icon to display a list of protocols registered to the patient. Click an item on the list to display an online copy of the protocol documentation from the Oncpro system.
Note: Clicking the Oncpro option from the Oncology menu displays the homepage for the Oncpro web site.
Indicates that the patient is an active patient of the MGH, BWH, DFCI, or NWH anticoagulation clinic (Anticoagulation Management Services). Click the icon to access additional information, including medication information, INR range, name and phone number of the primary AMS nurse, and links for emailing and paging AMS. Additional details include time in therapeutic range, secondary indications, actual dates for a planned stop date or when the annual therapy review is due, additional thrombotics, dose instructions for induction, and manual/bridging episodes of care.
Indicates that the patient is a Complex Patient and is enrolled in the Care Management Program (CMP) at MGH, BWH, or NSMC. Holding the mouse pointer over the icon displays a tool tip indicating the program(s) in which the patient is enrolled. Click the icon to open a window displaying a tab for CMP that provides contact information for the patient's care manager or coordinator.
Clicking the icon will reveal safety information related to that individual and may provide a reference to a more extensive care plan.
Displays only if you are a user in a practice participating in the Smoking Cessation study. Indicates that this patient is identified as either a current smoker or former smoker who has quit less than one year ago (move your mouse pointer over the icon for details). Smoking information is recorded in the LMR via either an entry on either the Problem List or the Health Monitoring grid. Clicking this icon displays fields for updating this patient's smoking status on the Health Monitoring grid.
Displays only if you are a user in a practice participating in the Smoking Cessation study. Indicates that the smoking status has not been documented for this patient in the LMR (via either an entry on either the Health Monitoring grid or Problem List). Clicking this icon displays fields for updating this patient's smoking status on the Health Monitoring grid.
Indicates that the patient has an open OB Record. Click the icon to display the patient's estimated delivery date, current gestational age, gravida, and parity. Double-click the icon to go to the patient's OB Record.
Indicates that the patient is an active patient of Partners Population Health Management (PHM). Partners has implemented PHM as part of its role as an Accountable Care Organization (ACO). PHM patients are active in one of the PHS contracted health plans and may be eligible for PHM services, such as high-risk ambulatory care management or for some health plan program/requirement exemptions, such as the ACO SNF 3-day waiver). Clicking the icon indicates the patient’s PHM designation (such as Commercial, ACO, Medicaid, and so on).
User-Related - For LMR Web only, the following user-related flags may appear next to your logon initials, in the far right top of the screen:
Two numbers displays to the left of the icon to indicate the number of priority and non-priority messages waiting for you in the Clinical Messages queue.
A set of numbers display to the left of the icon to indicate the total/abnormal results in Result Manager. For example, 14/13 indicates a total of 14 results, 13 of which are abnormal.
Applies only to users with a role of MD or Admin. For MDs, indicates you have referrals with a Next Step of “Pending Authorization” or “Awaiting Ack by MD.” For Admins, indicates that your practice has referrals with a Next Step of “Draft-Staff to Complete” or “Staff to Complete.” The numbers to the left of the icon indicate the quantity of each type, if applicable. Moving the cursor over the icon displays details.
Note: When displayed next to a patient's name on the Schedule, it provides a link to the referral transaction associated with this appointment.
Two numbers display separated by a slash to the left of the icon. The first indicates the total number of draft notes, and the second indicates the total number of non-finalized (preliminary and uploaded) notes in Document Management.
A number displays to the left of the icon to indicate the number of Rx refill requests assigned to you.
Applies only to providers who use the EOV module. Indicates if you have orders requiring authentication. Click the icon to move to the Provider Authentication tab of the EOV Desktop module.
Data-Related
The following data-related symbols may appear next to the patient's name on the Schedule:
Indicates there is a Preliminary status note for this patient for the visit date specified on the schedule. Clicking the icon displays the note.
Indicates there is a Final status note for this patient for the visit date specified on the schedule. Clicking the icon displays the note.
Indicates you have created a Draft status note for this patient for the visit date specified on the schedule. Clicking the icon displays the note.
Indicates that the patient is on precautions related to antibiotic-resistant bacteria or enhanced precautions. For a detailed list, click here.
For both MGH and BWH, precautions may be noted for the following:
MRSA (Methicillin-Resistant Staphylococcus Aureus)
VRE (Vancomycin-Resistant Enterococci)
MRSA & VRE
BWH may also include precautions for:
VISA/VRSA (Vancomycin-Intermediate/Vancomycin-Resistant Staphylococcus Aureus)
Resistant Gram-Negative, including: Pseudomonas species resistant to Ceftazidime; ESBL (Extended Spectrum Beta Lactamase) producers; Carbapenem; and Enteric Gram-Negative resistant to Cefotaxime; Ceftazidime, or Ceftriaxone
MDR Acinetobacter
Enhanced Precaution
Holding the mouse pointer over the P icon displays a tool tip. The tool tip shows the sites, dates, and precaution types noted for the patient. Clicking the P icon displays a tab for each site (MGH or BWH) that has filed precautions. At the top of each tab are one or more links that correspond to each type of precaution filed by that site. Clicking a link displays additional information, including steps for taking appropriate contact precautions and instructions for removing the patient from contact precautions (if applicable).
An encounter icon
displays if the patient has an End-of-Visit (EOV) encounter.
To view a general summary of the encounter, click the icon. The encounter displays
in a separate window. This icon also is color
coded to show validation status.
Indicates the patient has unlinked orders (DFCI only).
Indicates the patient has patient entered data. Double-click the icon to display the Patient Entered Data module.
or 
Indicates that a Visit Summary report has either been printed or distributed to Patient Gateway for that visit. Displays in orange to indicate when a corresponding Clinical Summary has not been created for a Visit Summary Report. In many cases, this can be resolved by re-generating the Visit Summary Report. Do so by right-clicking the patient’s name and clicking Print Visit Summary Report.
Indicates that a Health Form report has either been printed or distributed to Patient Gateway for that visit. Click the icon to display a popup window with the Health Form report.
Note: If both
a Health Form and Visit Summary report have been printed or
distributed to Patient Gateway for that visit, only displays.
Indicates that this appointment is associated with a referral transaction. Click the icon to display a popup window with details from the referral transaction.
Patient has declined enrollment in Patient Gateway within the past year.
The following data-related symbols may appear on the Summary view as well as other patient list views (such as Medications and Problems):
Indicates there is a Preliminary status note for this patient . Clicking the icon displays the note.
Indicates there is a Final status note for this patient. Clicking the icon displays the note.
Indicates you have created a Draft status note for this patient. Clicking the icon displays the note.
When the icon displays
to the right of an entry, it indicates that a link exists
between that problem or procedure and a note. This link is
only established if you enter text in the free form or structured
note related to the problem or procedure. Clicking the icon
displays the note.
When this icon displays to the right of an entry, it indicates that a link exists between that med, problem, or allergy and a note. This link is only established if you enter text in the free form or structured note related to the med, problem, or allergy. You can click the icon to display the note.
A link to general information
on problems or medications may be provided by the icon , if applicable. Clicking
this link displays information from the MICROMEDEX or Skolar
database.
An OnCall
icon displays to the right of a diabetic problem to
allow you to access the OnCall Diabetes Monograph for the
current patient. The OnCall Diabetes Monograph is a patient-specific
”r;dashboard” of data and information related to a patient’s
diabetic condition and care. It includes vital signs, relevant
lab results, relevant medications, allergies, trend graphs
against targets for certain data elements, and result-oriented
reminders.
Note: For the MGH Rheumatology location only, you can access the Rheumatology Summary Page by adding the OnCall tab to your Summary view. See Creating a Custom Summary for more details.
Clicking this link displays general information on risk factors for the associated family history problem.
Displays only if your practice is participating in the Smoking Cessation study, and if the patient's Problem list includes an entry for "Smoking." Move your mouse pointer over this icon for additional details. Clicking this icon displays one of the following:
For current smokers, displays the Smart Form for managing the care of patients who are smokers.
For recent quitters, displays fields for updating this patient's smoking status on the Health Monitoring grid.
Displays only if your practice is participating in the Pediatric Asthma Action Plan study, and if the patient's Problem list includes an entry for "Asthma." Clicking this icon displays the Pediatric Asthma Action Plan view. For details, click here.
Applies to users in MGH primary care practices. When this icon displays next to an entry on the patient's problem list, health maintenance grid, or Summary screen, you can order an educational video or DVD for the patient by clicking the icon. You can choose to send this video as a link (via Patient Gateway) or as a DVD.
Displays next to entries on a patient's problem list (from either the Summary or Problems view) to indicate a problem-based plan has been documented. Click the icon to view the associated plan. Currently, creation of problem-based plans is limited to selected pilot users.
Displays in the Patient Letter column of a provider's Results Manager queue to indicate that the patient has not viewed the associated patient letter (via the Patient Gateway application).
Displays in the Patient Letter column of a provider's Results Manager queue to indicate that the patient has viewed the associated patient letter (via the Patient Gateway application). Move your cursor over the icon to display the date viewed.
On formulary, and preferred.
On formulary, not preferred.
Non-formulary, not reimbursable, or not covered.
Unknown; no formulary status available (currently displays for all medications for patients with MassHealth and Harvard Pilgrim).
Indicates that the patient is not taking this medication (as documented during reconciliation).
Indicates that the patient is taking this medication differently than prescribed (as documented during reconciliation).
Clicking this icon allows you to refresh the information that is displayed on your current screen.
Clicking this icon allows you to add the associated entry to your list of EOV favorites.