Important: As of June 24, 2012,
immunization entries for DTaP, Td, and Tdap are reconverted to correct
issues identified following the LMR Spring Release. These vaccines are
no longer mapped to a single DTP vaccine/row.Important: As of June 24, 2012,
immunization entries for DTaP, Td, and Tdap are reconverted to correct
issues identified following the LMR Spring Release. These vaccines are
no longer mapped to a single DTP vaccine/row.
You can now save a report in Preliminary status, allowing other staff members to contribute to the report prior to it being delivered or printed. Previously, there was no way to save a report without it being available to Patient Gateway users.
The Visit Summary Report now includes options for manually creating reports for practices for which the LMR cannot detect a previous visit. Previously, providers at practices which do not have a Scheduling system could not generate reports for their patients.
The LMR now automatically creates report and posts them to a patient's Patient Gateway account if one is not created within 3 days after a visit. This only occurs for patients with Patient Gateway accounts, and excludes teen patients.
The report now includes an option to indicate if you have provided additional patient educational materials, other than what is available from the LMR. You can also customize the list that is displayed when creating a report.
The Visit Summary report now includes a Send to PG button to allow you to make the report available to the patient (through Patient Gateway) without printing. Previously, you needed to click Print to make the report available to Patient Gateway.
The icon 
displays
on the schedule to indicate that a report has been printed
or distributed to Patient Gateway for that visit.
The Visit Summary Report module is now included as an option from the pop-up menu. This allows you to create a report while in a patient's chart.
The report now includes sections for Patient Instructions, On-going Treatment Plans, and Self Management Plans and Goals. These sections are only included if entered in Notes. The report also includes a section for immunizations given on the day of the visit (Today's Immunizations).
Changes to existing sections include the following:
Today's Prescriptions section now includes mail order pharmacy information. The status of each medication from the medication reconciliation module is also displayed.
The Conditions section now includes customized problem descriptions, if applicable. That is, if a customized problem description was entered for any problem, it is displayed with the problem name.
The Vital Signs section displays height, weight, and BMI percentiles for pediatric patients. Also, it also displays vital signs documented for the last three visits for trending the values.
The Care Reminders section now excludes immunizations that are contraindicated. Additional text is included for immunizations with precautions.
The Appointments section now includes dates in <month> <day>, <year> format.
You are no longer allowed to remove sections for Your Medication List, Your Allergy List, Your Conditions, or Your Test Results. These sections are required by Meaningful Use criteria.
The current list and reports list have been combined on a single page. The report date and report status columns have been added to the visit list to indicate that a report has been created for the visit. There will be only one report created for each visit with the previous versions displayed by clicking the History button on the report details page. The upper pane of the screen lists edit versions. Click an entry date to display details in the lower pane.
The list now includes visits for which a Visit Summary Report has been saved as preliminary, printed, or sent to Patient Gateway. It also includes any visit for the current location which does not have an associated report. Previously, users from any practice could create a Visit Summary Report from any other practice.
The report also includes
formatting changes. The patient's medical record number and
address are included in the report header. You can now change
the font size of displayed and printed reports by clicking
icons (
,
, or 
).
The LMR now uses an expanded data base when you search for a problem or condition.
When discontinuing medications, if no other medications will remain on the Medications List after signing, the LMR now displays a prompt asking "Would you like to add 'None' to the list?"
The Medications List now includes updated columns to improve usability. For the Inactive Med List, the Last Updated column is replaced by DC Date. Previously, the Last Updated column would be updated by system transactions that obscured the actual date the medication was discontinued. Likewise, the Last Updated column is replaced by Date Updated. Clicking the date in these columns displays full medication history, including system changes.
The
icon 
now displays next to the medication name on the Medications
list if comments have been entered for a medication. Move
your mouse pointer over the icon to display text of the comment.
The Pharmacy section of the banner has been modified to indicate if the patient has Specialty and LTC (Long-Term Care) pharmacies. Also, the mail order pharmacy is no longer automatically set as the patient's default if it is returned with online eligibility updates. The Patient Info link in the Eligibility section of the banner has been modified to include new benefits coordination information.
Practices can now specify that the practice fax number be added to printed or faxed prescriptions. Contact your LMR support analyst for details.
You can now move directly to the Sign page (by clicking Add New) after adding a medication from the Summary screen. Previously, the Ok & Sign button was only available when adding a medication from the Medications module.
The label "[Uncoded: will NOT be used for medication alerting]" now displays next to the medication name on the medication Add form. This label is for display purposes only, and is not included in printouts for prescriptions or reports.
The functionality to add a pharmacy has been enhanced. You can now search for a pharmacy by fax number. Also, search results now only include mail order pharmacies when appropriate. Previously, all mail order pharmacies were displayed in all search results. Additionally, when adding a pharmacy for a patient, you can now specify it to be the default (from either the Summary or the banner of the Medication module).
Drug Substitution warnings now indicate if the patient has a documented allergy to a suggested substitute. Previously, the user was not alerted until he or she started adding the medication.
The option to print the Patient Med/Allergy report in Spanish is now available to all users.
The Immunizations grid has been significantly redesigned to more closely align with the immunization layout published by the CDC.
Rows in the grid have been converted from a mix of products and vaccines to vaccines only. For example, the Immunization grid no longer includes a row for Twinrix, since this is a product and not a vaccine. Twinrix is actually associated with two vaccines (Hepatitis A and B). Products like Twinrix can now be specified as a field associated with the immunization entry. Previous entries have been converted, as applicable -- for example, a single instance of Twinrix has been converted into immunization entries for Hepatitis A and B.
The module now includes a Search field to help you find the immunization you want to document for the patient. You can search by either product or vaccine. In the case of a product that is associated with multiple vaccines (such as Twinrix), completing an entry for it results in immunization entries for each related vaccine. That is, if you were to document giving Twinrix to a patient, entries for both Hepatitis A and B display on the grid.
The Immunizations grid no longer includes links to Common, Immune Globulins and Antitoxins, and Other. These links are now displayed as expandable sections in the grid.
The Immunizations grid now includes a link for Deleted to display deleted vaccines and Inpatient to display vaccines given while this patient was an inpatient at BWH or MGH. Note that you would need to manually transcribe inpatient entries to include them in the Pediatrics or Adult Immunizations grid.
A link to Lot Maintenance has been added to the grid. Additionally, all previous entries for Lot Maintenance have been deleted. Due to the redesign of the Immunizations module, changes to fields are needed to properly document and track immunization lots. For details, see Maintaining Lots.
The Immunizations grid now
allows you to print the grid by clicking the 
. To print the Immunization report, click the
.
You are now able to specify due dates for immunizations. The LMR uses pink highlighting to indicate items that are overdue. Yellow highlighting indicates items that are due on the current day.
You can now set a flag for
immunizations to be administered (by clicking Order
Imm). These entries display in the grid with the flag
to serve as a
informal communication to other staff members.
The Select Date field has been changed. If you are not sure of the exact date, click the Approx. checkbox, and type an approximate date (you can use YY, YYYY, MM/YY, MM/YYYY, MM/DD/YY, or MM/DD/YYYY format). Otherwise, type an exact date in MM/DD/YYYY format. Previously, the LMR allowed you to type a partial date format (such as YY) without clicking the Approximate checkbox.
When documenting an immunization, you can now choose to also save that entry as a note.
The Add Multi feature has been redesigned. Minimal fields are now available for historical documentation of immunizations. Previously, all fields were available for entry of previous doses.
All previous entries for Lot Maintenance have been deleted. Due to the redesign of the Immunizations module, changes to fields are needed to properly document and track immunization lots. You can now enter more than one lot number for multi-package vaccines. Previously, if you needed to document more than one lot number for a product, you had to separate each by commas, making it difficult to track the numbers in the event of a recall.
The steps for entering lots has been modified.
Manufacturer and VIS Date can no longer be edited using Lot Maintenance (these fields are typically supplied by the LMR).
The Custom Cosign module allows authorized users to customize how the cosigning process works at your practice. The goal is to support efforts to shift data entry tasks from providers to support staff where appropriate. The cosigning process determines the acknowledgement and approval requirements for updates to patients' charts by non-providers.
Setting up (or configuring) the cosign process includes the following steps, which must be completed in the order listed:
1. Select Modules - Selecting modules that require cosign
2. Configure Cosignee Authorization - Designating users and roles that require cosign
3. Configure Cosigner Authorization - Designating users at your practice who can act as cosigners
For users that require cosigning, you can determine whether the updates they make to a patient's chart require either approval or acknowledgement. If the updates require approval, they are hidden from other users until the cosigner has signed for them. If the updates require acknowledgement, the updates can be viewed by other users even before the cosigner has signed.
Currently, the cosign process is limited to the certain LMR modules. For other modules, patient information does not currently require cosigning regardless of the user's role.
Note: Users who are set up as cosigners might also wish to add the Cosign module to their LMR Home Page. For details, see Creating a Custom Home Page.
The module is relabeled from "Pediatric Asthma Action Plan" to "Asthma Action Plan," and modified to extend its application to all age groups. Peak flow information now includes adult, gender specific information. Previously, the table only included peak flow information for pediatric patients less than 20 years old.
The medication list included with the plan has been modified. Previously, the green zone included all patient medications, and the yellow and red zones included standard recommended asthma medications that could be selected. With this release, all zones initially display asthma-specific medications from the patient's current medication list. Clicking Add Additional Asthma Meds from any zone displays a list of asthma-specific medication favorites (from your favorites and your practice's favorites) as well as standard recommended asthma medications that can be selected.
When you add a medication to the patient's green, yellow, or red zone that is not already on his or her medication list, the LMR adds that medication to the list (pending your electronic signature). Previously, when you added a medication to the yellow or red zone, those medications were listed on the Asthma Action Plan only -- they were not reflected on the patient's medication list.
You must now add your electronic signature when generating an Asthma Action Plan. Once signed, the Asthma Action Plan is available in Patient Gateway (most recent plan only). The LMR also sends a notification message to the patient's email account (if applicable).
The Provider field no longer defaults to the logged on user for non-providers. The Provider field continues to default to the logged on user's name if that user is a provider at the current location. When the current user is not a provider for that location, the Provider field displays Select Provider, and the user must use the drop-down list to pick a provider.
A Spanish checkbox displays at the top of the screen replacing the Language field at the bottom of the screen. Selecting this checkbox now prints Asthma Action Plans in both English and Spanish (previously, two plans would need to be generated to obtain copies in both languages). Also, translation now displays next to English text after selecting the checkbox.
Other fields have been repositioned and the look of the screen and printed Asthma Action Plan have been modified to improve usability.
You can now copy forward the most recent Asthma Action Plan by clicking Copy Previous AAP. This only applies to plans created after 5/18/2012.
The General section of the module now allows you to select to be prompted to select a location each time you log in. For details, see Setting Your Preferences.
If you've selected Clinic Override in the Medications section of Custom Preferences, you can now enter a fax number.
The module now includes a section for Immunizations. You can now specify the maximum age that a patient's Immunization grid defaults to the Pediatric Immunizations grid. If not set, the maximum age is set to 18 years. You can also select whether the Immunization report includes the patient's list of allergies. If not selected, the allergy list is not included.
Additional system macros are now available for patient medications, problems, allergies, vital signs, and procedures. System macros are also added for he/she and boy/girl (determined from the patient's sex), and Patient Gateway user name. For a list of new system macros, click here. For a complete list, click here.
The LMR now uses an expanded data base when you search for a diagnosis. Also, on the Past Pt. Data tab, a section for "Active Problems" displays after the Diagnosis section. Previously, the section was labeled "Search Diagnosis by Problem Name," and displayed at the bottom of the tab.
The Lab Dictionary tool has been enhanced to allow labs to identify patients by the medical record number (MRN) used at their location when the patient is being sent by an institution that uses different MRNs.
The Template Builder tool has been enhanced to allow you to use find-and-replace functionality when editing templates.
The LMR is now better integrated with the PatientKeeper application, used by some MGH and BWH practices for charge capture. The LMR now launches the correct version of PatientKeeper based on your location (BWH or MGH).
Numerous minor changes have been made for DFCI only. For details, click here.
Links between orders and dates will no longer be broken when orders are edited (except for order date changes).
HL7 messages are now sent when orders are unlinked from appointments, and when an order has a text (non-date) time frame, such as "before next appointment."
Order dates and time frames now display on the Sign screen.
A new ordering provider column is added to the encounter view tab of the main EOV screen.
Medical necessity checking
is added to the EOV. The LMR initiates checking when you click
OK & Validate.
For each order that doesn't have an appropriate diagnosis
code based on medical necessity, EOV displays the iconto the right of the order
description. If you edit the encounter to add the correct
diagnosis code, the icon 
icon replaces
the.
Note: Contact your LMR support analyst for details on enabling this feature.
You can now view results from endoscopy. The code E displays when applicable. Additionally, when working with endoscopy-based results, you have access to a new tab (Health Monit.), allowing you to assign due dates for subsequent tests.
When working with result letters, you can now include a CC list to send the note to other LMR users.
You can now add problems from your lists of favorites directly from the RM details screen.
The Results Manager is now better integrated with the BWH ANCR application. Alerts and guidelines from the ANCR application are displayed on the RM details screen.
HIS Treatment summary reports have been updated per user requirements.
The LMR now uses CTC version 4.0, as required, for all visits dated after the LMR spring release date.
The Infusion Flowsheet module now includes a field to indicate whether instructions were given to the patient following transfusions. A checkbox for Post Transfusion Instructions Given has been added to the Blood Administration section.
Oncology data is now being sent to the QDM for the following modules: premedications, chemo, take home chemo, blood products, and administration complications.
You can now display visit summary
reports associated with any visit by clicking the icon
to the right of a patient's name.
If you are set up as a cosigner and have updates to be cosigned, a banner message displays with a link to your Cosigner Queue (with the number of updates to be approved and acknowledged). For details, click here. Additionally, if you are required to approve any updates, the Sign button displays in red. (The Sign button does not display in red for updates pending acknowledgement.)
When adding the list of medications to a note, medications that you've discontinued (but not yet signed) are no longer included. Previously, medications that you've discontinued (but not yet signed) were included when you've added the Medications list to a note.
Non-DFCI practices can can now customize how non-compliance is determined for their practice. Two new options have been added to the Notes Compliance Settings screen. These options accommodate workflows at MGH and BWH practices.
No Prov Chk (No Provider Check) - If selected, compliance depends only on the note having the save service date and practice as the visit. The default is unchecked (meaning compliance depends on a match of the date, practice, and provider).
Signature Only - If selected, compliance depends only on all entered notes being signed as final. The default is unchecked (meaning compliance depends on notes being entered for each visit and finalized).
Note: Also for this release, a problem has been resolved for situations where the patient has had two visits on the same day with the same provider. The LMR now checks to be sure that there are two notes entered for the patient for that date (previously, a single note incorrectly satisfied the requirement for both visits). If No Prov Chk is set, the two notes can be written by any provider.
The list of previously saved Health Forms now includes a column for Exam Date. Columns can now be sorted by clicking a column header.
The Immunization section of the report now indicates if a positive PPD or varicella has been documented for the patient. The "Patient Had" section is redundant and has been deleted.
The report no longer includes the patient's date of birth and sex in the footer to be consistent with other LMR reports.
Access to Charts reports has been moved from Resource>LMR/PG Access Form to Tools>Charts.
Practice Managers can now grant access to Charts reports using the edit option from the Providers List. Click a name from the list to display an edit screen for the associated users. Then, set the View Charts option to Yes.
Reporting based on Charts is now based on the logged in user's practice affiliation. Additional changes to reporting includes the new reporting options as well as the option Export to File.
The LMR includes varicella and PPD in the grid based on previous documentation of these problems in the problems list. Previously, only a documented result from the lab system would cause varicella and PPD to display in the grid.
The Select Date field has been changed. If you are not sure of the exact date, click the Approx. checkbox, and type an approximate date (you can use YY, YYYY, MM/YY, MM/YYYY, MM/DD/YY, or MM/DD/YYYY format). Otherwise, type an exact date in MM/DD/YYYY format. Previously, the LMR allowed you to type a partial date format (such as YY) without clicking the Approximate checkbox.
For pilot practices only, the HM grid includes new rows for weight management fields. When applicable, patient reminders now display based on these entries.
Note: Once information is entered in these fields, they are available for viewing and editing by all LMR users.