The Advance Care Planning module has been enhanced to streamline documentation for advanced care planning conversations. Text has been updated and superfluous questions have been removed.
The LMR now prompts you to add "NKA" (No Known Allergies) to the patient's chart when all allergies are inactivated. Previously, you would need to manually add NKA to the patient's chart.
This new module in the LMR allows you to document care plans for the associated patient. Care plans allow you to document goals to improve the health of the associated patient. They can help you track completion of goals relative to a diagnosis on the patient’s problem list. This can range from losing weight or stopping smoking, to managing a patient’s asthma or high blood pressure. Care plans can guide in the ongoing delivery of care and assist in the evaluation of that care.
Note: The Care Plan module can also be accessed from the Pop-up Menu as well as from the Notes module.
All messages from LMR and Patient Gateway are now available from the Clinical Messages module. Previously, Patient Requests and messages from patients using Patient Gateway were only available using the Mail Center module in Practice Portal. Tabs are added to both the Clinical Messages module in LMR and the Mail Center module in Practice Portal to allow all messages to be accessible from either application.
Note:
- A Patient Requests tab displays in Clinical Messages only if you are assigned to any of the “desks” that receive patient requests. By default, this tab displays requests from all of your authorized locations (practices), but you can change it (for details, click here).
- The LMR "remembers" your most recent selection (of the Clinical Messages or Patient Requests tab) for subsequent sessions.
You can select a patient as a recipient when creating a new message. This only applies if a patient is associated with the message and the patient has a Patient Gateway account. Previously, the list of available recipients included only Partners providers.
When working with Patient Requests, you now have access to all capabilities previously limited to Clinical Messages. These include formatting options (including spell check, bold, underline, italics), custom subjects and paragraphs, and voice recognition. You can also add a read receipt to these messages, recall them, and save them as To Do items.
You can now specify the email address you want to be used for notification messages about Patient Requests received from patients using Patient Gateway. Do so using a new preference "Send email notifications to" in the General section of the Preference module. Previously, this email address could only be specified in the Practice Gateway application by users with special authorization (such as Practice Managers).
Important:
Although the Mail Center in Practice Gateway included a Saved
folder, the Patient Requests tab does not. Messages that you previously
saved to this folder are available as follows:
- if the message was sent to a patient or if a patient was attached, it is available from the Active queue of the Patient Requests tab if within the last 60 days or within the Patient View with no time limit.
- if the message was not associated with a patient, the message is available from the Active queue of the Clinical Messages tab if within the last 30 days.
To meet Meaningful use and certification requirements, a field for LOINC has been added to the EOV Lab dictionary to allow future lab orders to be coded in LOINC (Logical Observation Identifiers Names and Codes). The code appears under Admin > Tools > EOV > CPT Add Tool, CPT Add Map Tool, CPT Add Map Tool (edit screen) and CPT Lab Panels. In the future, a mapping service will be used to map CPT codes to LOINC.
You can now enter multiple encounters per day for the same subset. Previously, you were only allowed to enter a single encounter per patient, per date, per subset location. In order to user this feature, your practice must be configured in the ADO system (new LMENC field must be set to Yes). Contact your support analyst for details.
Printed requisitions can now include the lab client ID as well as printed bar codes (for the patient's medical record number and lab client ID). This should reduce the risk of errors and save time.
Note: To use this feature, changes must be made using EOV Tools from the Admin menu. Contact your support analyst for additional information.
Additional fields are available for you to include, as required, when updating EOV headers. Additional fields include insurance information from the EMPI. For a list of new data fields that have been added to the EOV Header Builder so that they can be printed on the requisition form, click here.
- Ins company address - IN1.05
- Ins group number - IN1.09
- Ins responsible party name (subscriber) - IN1.16
- Ins relationship of insured to patient - IN1.17
- Ins billing type (coverage type) - IN1.47
- Ins guarantor name - GT1.03
- Ins guarantor address - GT1.05
- Ins guarantor phone number - GT1.06
- Lab Client ID without Bar Code
- Lab Client ID with Bar Code
- Patient MRN with Bar Code
The initial screen now includes items from your custom family history list or from the Enterprise FH list, and not currently recorded for the patient. This saves time when adding common family history items.
Additional filter options from the main screen allow you to display views for Positives (only items and relatives with a “positive” history for the item) and Quick Entry.
The Enter and Edit screens have been changed to improve usability. Previously, you could not specify that some family members had a positive family history while others had a negative family history.
The LMR now includes an Enterprise FH List that is used as a starting point for adding family history items. Previously, if you had not created a default Custom Family History grid, the process of adding even common family history items required additional steps.
The Risk Assessment now considers additional data such as the patient's tests, image studies, and medication data. Previously, the assessment only considered the patient's problem list and family history.
Adding a family history item not contained in the grid to a patient's family history now uses standard problem lookup functionality for consistency.
You can now add a section for Family History to a visit form or previsit form (using Custom > Visit Forms). If sent to a patient using Patient Gateway, that patient can send return updates to you via the Patient Entered Queue.
A field for Comments is now available for every family member and family history item. Previously, a single comment applied to all family members. During the conversion, comments entered prior to this release are duplicated for all family members.
To meet Meaningful use and certification requirements, the Height field has been relabelled "Height/Length."
To meet Meaningful use and certification requirements, additional options have been added for documenting smoking status. You can now qualify patients as heavy or light tobacco smokers.
The Inpatient folder tab has been renamed Repository. It now includes all immunizations documented for other Partners applications (such as MGH and BWH Order Entry), as well as within the LMR.
You can now indicate if a patient does not want to allow his or her vaccine information to be shared outside of his or her care providers. A button Consent Info has been added to the main Immunizations page.
You can now indicate if a child is eligible for federally funded childhood vaccinations under the VFC (Vaccines For Children) program. Clicking VFC Status allows you to document if the patient meets the associated criteria (including on MassHealth/Medicaid, no health insurance, or of American Indian or Alaska Native descent).
Immunizations without coded responses are coded with "Done (Historical Entry).
The LMR now allows you to indicate if a medication or therapy was given to the patient while in the office. This new check box is added to the Medication entry form to meet Meaningful use and certification requirements.
The LMR now automatically completes the Strength & Form field when you perform a look up for a medication for which only a single form is available. Additionally, if you do not complete this field for any medication, the LMR now displays the message "Strength & Form is required for ePrescribing." This enhancement should help increase ePrescribing rates (prescriptions missing Strength & Form information default to fax and cannot be ePrescribed).
The LMR now includes a red formulary indicator for medications that are excluded according to the formulary status from Surescripts.
To meet Meaningful use and certification requirements, alerts for drug-allergy and drug-drug interactions now include the icon
. Clicking this link to learn more
about the source of the alert being triggered within the patient's
record.A 'dose warning' no longer displays when ordering insulin products. For other medications, these warnings let you know when you are ordering a different number of units than is supplied by service. However, due to the custom nature of prescribing insulin products, this warning does not apply.
Prescriptions now include the SIG and special instructions on the same line. Special instructions, if applicable, display in brackets. This applies to all printed and faxed prescriptions.
A Type column has been added to the list of Pharmacies on the Summary 2 screen. This field distinguishes between Retail, Long-term, and Specialty pharmacies.
The Medications section of the Preferences module now includes a new preference "Default Rx Transmission." This preference allows you to select a default option for sending or printing prescriptions. Your selection here determines which option is selected by default after you sign medication updates that include prescriptions. You can choose to override this default.
Note: To maintain current LMR behavior for sending or printing prescriptions, you can either leave this option as is or select the Last Selected option.
To meet Meaningful use and certification requirements, changes have been made to the steps for working with lists for patients with active reminders. The Reminders tab now uses Patient List Query reports from Reports Central instead of Patient Reminder Provider Panel reports. Additionally, an option to allow patients to opt out of receiving notification of reminders has been added.
Note: The user running the Patient List Query in Reports Central must be the actual provider. A staff member cannot generate this list on the behalf of a provider.
The LMR now displays a message when you sign for an addendum associated with a Final note that has been errored out. Upon signing, both notes display in the Retracted tab.
You are no longer allowed to close an OB record with a date earlier than the opening date of the record.
Problems entered later than the end date of the pregnancy are not included in individual patient reports Previously, problems were included in the Problems list section of the individual patient report regardless of the date entered.
The Infusion Flowsheet has been updated to allow you to type a free text location when you add any of the following routes: Central Implant, Central Tunnel, Central PICC, IP Implanted, and Tenckhoff. To type a free text location, select the Other option. Previously, you had to select from a limited list of locations for all routes.
The Patient Assessment section of the Infusion Flowsheet has been updated to include a History button to view previous comments for the Risk for Falls section.
When you add a tumor type using the Oncology Staging module, the LMR now prompts you to also add that tumor to the patient's problem list if not already done. Previously, you would need to go to the Problems module to add it manually.
A consistent feature set is applied to all Patient Gateway practices to ensure all patients have a consistent user experience. Previously, the types of requests available to patients under the request menu and the types of clinical information available to them under the Health Record menu were suppressed by some practices.
- With this release, a consistent set of desks is enabled. This includes message desk, medications desk, appointment desk, enrollment desk, and registration desk. Research and referral will remain optional, and there will no longer be a miscellaneous desk.
- Additionally, the display of information including immunizations, lab results, and radiology reports is also made consistent across all practices.
Additional reports are available to patients using Patient Gateway. These include Discharge Instructions, Pathology, and Microbiology reports.
All messages from LMR and Patient Gateway are now available from the Mail Center module. Previously, Clinical Messages from the LMR were only available from the Clinical Messages module in the LMR. For details, see entries for changes to Clinical Messages above.
Patients are now allowed to request multiple medication renewals in a single request. Previously, only one renewal could be included in a request.
Functionality from Practice Portal and Supportal are now available from the LMR. New options under the PG menu item now include Staff Edit, Practice Edit, Pt Create/Manage, Pt Search/Details, and Pt Count Report.
The Medications Preferences section now includes a new preference "Default Rx Transmission." This preference allows you to select a default option for sending or printing prescriptions. Your selection here determines which option is selected by default after you sign medication updates that include prescriptions. You can choose to override this default.
Note: To maintain current LMR behavior for sending or printing prescriptions, you can either leave this option as is or select the Last Selected option.
The General section now includes a new preference "Send email notifications to." Use this setting to specify the email address you want to be used for notification messages about Patient Requests and messages received from patients using Patient Gateway. For Patient Requests, you receive only notifications for the types of requests and providers to which you are assigned.
The General section now also includes a new preference "Patient Request Default View." This setting determines whether the default view of Patient Requests (via the Clinical Messages module) shows requests for your current location or for all locations. The default is "All locations."
The preference "Do Not Show Family History on Problem List" (listed under General > Other Settings) has been removed. It is replaced by a new preference in a new Family History category. The new preference "Display Family History on problem list if identified as" includes check boxes for Positive and Negative. With this release, the LMR sets the default for this new preference based on your previous setting for "Do Not Show Family History on Problem List."
- If you had selected this option, then neither the Positive nor Negative check boxes are selected by default with this release.
- If you had not selected this option, then the Positive option is selected by default with this release. In this case, all positive family history items are included in the problem list for your patients, but negative family history is not. Previously, if you had left the option "Do Not Show Family History on Problem List" unselected, all family history items (negative and positive) would be included in the problem list for your patients.
The LMR now prompts you to add "None" to the patient's chart when all problems are inactivated. Previously, you would need to manually add "None" to the patient's chart.
When adding a problem, you can now specify that the item should be added to the patient's list of family history problems (and not to his or her personal problem list). Do so by clicking Family History. This button is added to the problem selection screen (displayed after you search for an entry).
You can now add a specialist to your Favorites list while creating a referral. Do so by clicking the Add New... option from the Name drop-down list while selecting a Source of “Favorites” and the associated specialty.
When adding a new referral, check boxes for “Medications/Allergies” and “Problems/Procedures” have been removed. For internal referrals, it is no longer necessary to include clinical information in the specialist letter since specialists now have access to the LMR and the patient’s chart.
Additionally, when creating a new referral, a new check box has been added for “Clinical Summary.” The LMR automatically selects this check box if the specialist is not an LMR user. This option creates a referral summary to meet Meaningful use and certification criteria.
When sending a new referral, the option “Other” is re-labeled “Print.” Additionally, when you select the “E-mail” option for sending a referral, if the recipient is not a Partners specialist, the LMR sends the letter and attachment via the "Send Secure" method.