What's New in this Release jun09

What's New in this Release - June 2009

Clinical Messages

New messages are now displayed in bold text enabling you to more easily distinguish between new and read messages.
Once you have read a message, you can now mark it as ”r;New.”
New action icons now display to denote that a message has been replied to ( ) or forwarded ().
You can now flag a message, and you have the option of adding comments. For more information, see Working with Message Flags.
The AutoFilter option is now available to filter the list of messages. For more information, see Using AutoFilter.
Using the Patient View option, you will now be able to look up a patient and view all of your practice's clinical messages for that patient. For more information, see Using the Patient View.
You now have the ability to recall a message that you sent. For more information, see Recalling a Sent Message.
The out of office option has been expanded to include reply messages. Previously, an out of office message was only sent out when a user received a new or forwarded message.
GE Centricity users from authorized Partners practices will now receive out of office messages from LMR users.
The status of a clinical message no longer changes to Read if it has been opened by the author via his or her Sent queue.
The Sent messages list has been modified to display the most recent message at the top of the list to be consistent with all other Clinical Messages lists.
Now when you reply to all, you are excluded from receiving the message. This new functionality mimics Microsoft Outlook.
There is a new preference enabling you to be prompted with a warning message if you send a clinical message without a patient attached. You can also set a preference to be e-mailed when you receive a new Clinical Message. For more information, see Setting Your Preferences.
You can now save a clinical message as a draft allowing you to continue working on messages you are not ready to send. For more information, see Working With Draft Messages.
Similar to the Notes module, you now can view patient data and update a patient's chart from a clinical message using the Pt. Data and Quicklook tabs. With this enhancement, you no longer have the ability to add multiple patients to a message.
The HTML text editor used in the Notes module is now available in Clinical Messages. This includes the ability to perform spell check.
You can now print multiple messages at the same time. For more information, see Printing Messages.
There is a new ”r;Request Read Receipt” checkbox that allows you to request a read receipt for a clinical message.
When you save a clinical message as a note, you have the option to modify the subject and date, and you can add comments to the note text.
When you save a clinical message as a To Do item, you have the option to modify the start and end dates.
You can now send a note via clinical message from the Notes module. This functionality is similar to e-mailing a note. For more information, see Sending a Note via Clinical Message.
You can now send a clinical message from a shortcut menu that is available when you right-click any underlined patient's name in the LMR. For more information, see Using the Right-Click Shortcut Menu.

Medications

You can now prescribe certain oral chemotherapies based on auto-calculated BSA- or weight-based dosing guidelines for adult patients. Previously, only fixed dosing was available. For details, see Adding Medications. Additionally, the Rx pad now allows you to pull in the primary Diagnosis from the Infusion Flowsheet and the Indication from the COE application. The LMR also displays warnings if the daily or weekly dose limits are exceeded.
An alert screen now displays to let you know if the patient has been recently discharged from BWH or MGH and has medications to reconcile. Clicking Ok brings you directly to the Medication Reconciliation module to reconcile medications.
The pharmacy location is now automatically set to "DFCI-Outpatient Pharmacy" for DFCI Boston locations.

Notes

You can now save a note with a Draft status. A Draft note can only be viewed by the author of the note, and it is not part of the patient’s record until it is saved as Preliminary or Final status. This allows you to save a note that is not ready to be viewed by other users.
The save button options have been changed to accommodate the Draft status enhancement. The Ok and Ok-Final buttons have been replaced by the Draft, Prelim, and Final buttons.
The spell check functionality has been enhanced to highlight the word that is spelled incorrectly in the note.
Now faxed HTML notes retain all of the original note content including formatting, inserted images, and annotated diagrams.
A practice default header can now contain patient information. For more information, see Setting the Default Custom Header.

Document Management

You can now save a note with a Draft status, and there is a new Draft note queue in Document Management enabling you to manage your draft notes. A draft note can only be viewed by the author of the note, and it is not part of the patient’s record until it is saved as Preliminary or Final status. This allows you to save a note that is not ready to be viewed by other users.
The save button options have been changed to accommodate the Draft status enhancement. The Ok and Ok/Next buttons have been replaced by the Prelim and Prelim/Next buttons, and the Final button has been added.

Results Manager

The Results Manager module can now be accessed from the Patient Chart menu, allowing providers to see a patient-centric list of Results Manager visits across all providers (regardless of location). However, only members of the ordering provider's practice can acknowledge or close results.
A tab can now be added to the Summary to display up to 20 open Results Manager visits for the patient. Results Manager information is also now available from the QuickLook menu (displayed by pressing the F8 key after a patient is selected).
For pilot users only, the LMR displays Results Manager reminders based on the presence of certain abnormal test results. For details, click here.

Flowsheets

The LMR automatically calculates pediatric blood pressure percentiles when the blood pressure and height are updated for a pediatric patient. The new field, Blood Pressure (%), displays in the format xx / yy, where xx is equal to the patient's systolic blood pressure percentile, and yy is equal to her or his diastolic percentile.

Note: Due to problems with the calculation for low percentile blood pressures, this calculation is temporarily turned off.

End of Visit (EOV)

A new EOV History screen has been added to enable users to simply and quickly view a listing of changes that have been made to an encounter.
There is a new Provider Authentication screen in the EOV Desktop to enable batch order approval. For more information, see Reviewing and Approve Orders.
For DFCI only, there is now a link between a group of lab orders for a patient and a scheduled patient visit with a physician. Now when a visit is rescheduled, the LMR maintains the link so the lab orders are also rescheduled. For more information, see Working with Order/Visit Linking.

My Patient List

The My Patient Lists module has been redesigned. The initial screen now includes tabs on the left for My Lists and Practice lists. This enables you to select a list and view the patients on the list at the same time.
The patient search function has been updated. You can chose to search for patients from within either your current lists or the whole EMPI, and you can add patients from your search results to any of your lists.
You can now move and copy patients to other lists without having to delete and re-add them.
Deceased patients now display a Deceased flag notifying you that the patient can be removed from your lists.
You can now add a patient to your list from the schedule using the Add to List button.
There is a new shortcut menu that can be accessed when you right-click any underlined patient’s name in the LMR. From the shortcut menu, you can view that patient’s last visit note or last practice note. You can also send a clinical message or add that patient to a patient list. For more information, see Using the Right Click Shortcut Menu.

Oncology

The LMR now includes a Treatment History module. This new option from the Oncology menu provides a summary of the oncology treatments that have been recorded for the patient across Partners institutions. It also provides a location for recording treatment history for non-Partners sites. For additional information, see Treatment History.
The Patient Assessment functionality in the Infusion Flowsheet is now embedded into the flowsheet for easier accessibility. Prior to this release, you had to click the Patient Assessment button to access that information. Now the information can be viewed and edited directly from the flowsheet.
The BMT Flowsheet module has been enhanced, as follows:

- Now you have the ability to add additional transplants to the BMT Flowsheet. Previously, you only had the option to add two. You can do this via the Add Transplant button in the BMT Flowsheet header.

- The Oa and Ob fields have been reorganized for ease of use.

- A new Add Donor button has been added to each transplant section. Clicking the button adds a donor section to a specific transplant. Additionally, HLA fields have been added to each donor and transplant section.

- Now the GVHD scoring section has two sections for Acute and Chronic.

Notes Compliance Reporting has been enhanced to better align with the workflow of the MGH Cancer Center, as follows:

- When run for the MGH Cancer Center, the Notes Compliance report now suppresses reporting of notes with a status of P (Preliminary) or OS (Overdue Signature). Additionally, notes with these statuses are no longer included in the Incomplete/Overdue queue in the Document Manager module when the clinic is set to an MGH Cancer Center location. (The Incomplete/Overdue queue displays only for Notes Compliance users.)

- A new option, Notes Comp Mgt Settings, has been added. This option allows each clinic to determine the report parameters that are used for all Notes Compliance Management reports. If not used, reports run as they do today.

- HIS authorized users can now update the status of multiple notes compliance records at a time. A Change Status button has been added to the Notes Compliance Detail screen (displayed after selecting a provider from the Notes Compliance report). Additionally, HIS authorized users can also forward one or more reports to another user's queue.

Note: Notes Compliance is an HIS-based feature of the LMR, currently used only by DFCI and the MGH Cancer Center. For details about Notes Compliance workflow, click here.

You can now prescribe certain oral chemotherapies based on auto-calculated BSA- or weight-based dosing guidelines for adult patients. Previously, only fixed dosing was available. For details, see Adding Medications. Additionally, the Rx pad now allows you to pull in the primary Diagnosis from the Infusion Flowsheet and the Indication from the COE application. The LMR also displays warnings if the daily or weekly dose limits are exceeded.
The pharmacy location is now automatically set to "DFCI-Outpatient Pharmacy" for DFCI Boston locations.

Oncology Staging

The Oncology Staging module has been enhanced to include several new tumor types. For a complete listing, click here.

A new diagnosis group, GI, has been added, with the following tumor types:

Anal canal
Extrahepatic bile ducts
Gall bladder
Ampulla of vater
Colon
Esophagus (moved from Digestive group)
Liver
Pancreas
Rectum
Small intestine
Stomach (moved from Digestive group)

Also, a new diagnosis group, GU, has been added with the following tumor types:

Penis
Adrenal
Kidney
Prostate
Renal Pelvis and Ureter
Testis
Urethra
Urinary bladder

Treatment History

This new option from the Oncology menu provides a summary of the oncology treatments that have been recorded for the patient across Partners institutions. It also provides a location for recording treatment history for non-Partners sites. For additional information, see Treatment History.

BMT Flowsheet

Now you have the ability to add additional transplants to the BMT Flowsheet. Previously, you only had the option to add two. You can do this via the Add Transplant button in the BMT Flowsheet header.
The Oa and Ob fields have been reorganized for ease of use.
A new Add Donor button has been added to each transplant section. Clicking the button adds a donor section to a specific transplant. Additionally, HLA fields have been added to each donor and transplant section.
Now the GVHD scoring section has two sections for Acute and Chronic.

Notes Compliance

Notes Compliance Reporting has been enhanced to better align with the workflow of the MGH Cancer Center, as follows:

When run for the MGH Cancer Center, the Notes Compliance report now suppresses reporting of notes with a status of P (Preliminary) or OS (Overdue Signature). Additionally, notes with these statuses are no longer included in the Incomplete/Overdue queue in the Document Manager module when the clinic is set to an MGH Cancer Center location. (The Incomplete/Overdue queue displays only for Notes Compliance users.)
A new option, Notes Comp Mgt Settings, has been added. This option allows each clinic to determine the report parameters that are used for all Notes Compliance Management reports. If not used, reports run as they do today.
HIS authorized users can now update the status of multiple notes compliance records at a time. A Change Status button has been added to the Notes Compliance Detail screen (displayed after selecting a provider from the Notes Compliance report). Additionally, HIS authorized users can also forward one or more reports to another user's queue.

Note: Notes Compliance is an HIS-based feature of the LMR, currently used only by DFCI and the MGH Cancer Center. For details about Notes Compliance workflow, click here.

Custom Preferences

A new preference (Show Oncology Info) has been added to include additional information for chemotherapy medications. When you add a chemo med, the Add screen includes fields for Diagnosis and Indication. This LMR automatically selects this setting for the MGH Cancer Center, DFCI, and the North Shore Cancer Center.
You can now set a preference to have the LMR prompt you with a warning message if you send a clinical message without a patient attached.
A new preference has been created to send a message to your Partners Outlook account when you have any of the following: new uploaded transcriptions in Document Management, new clinical messages, or new Rx renewal requests/tasks.

Sticky Notes

The location of Sticky Notes has been moved to the right side of the To Do module (from the Patient Chart menu). Only the first line of text is initially visible. To display the entire Sticky Note, move your mouse pointer over the Sticky Note area or click View All/Edit. To add or update text, click View All/Edit.

Visit Summary Report

This new report, accessed from the Reports menu, allows you to provide a report to the patient of actions were taken during his or her visit (such as medication list updates, prescriptions generated, order entered, and so on). There is also a section at the bottom of the report for you to type in comments prior to printing. It is intended to be printed immediately after the patient's visit to facilitate effective patient/provider communication. (This report can also be printed from the Schedule module.)

Note:

For Patient Gateway users, an online copy of the Visit Summary is added to the patient's Patient Gateway account when this report is printed from the Reports menu.
If you have problems seeing this report option, the problem may be related to Custom Menus. Go to the Custom > Custom Menu and click Reset to default.

Schedule

The Visit Summary Report can be printed from the Schedule module. This option allows you to provide a report to the patient of actions taken during his or her visit (including medication list updates, prescriptions generated, orders generated, and so on). For detail, see Printing Visit Summary Reports from the Schedule.
You can now add a patient to one of your patient lists from the schedule. For more information, see Adding a Scheduled Patient to a Patient List.
There is a new shortcut menu that can be accessed any patient’s name link in the LMR. From the shortcut menu, you can view that patient’s last visit note or last practice note. You can also send a clinical message or add that patient to a patient list. For more information, see Using the Right-Click Shortcut Menu.

OB Record

You can now reopen a pregnancy that was closed in error. If a patient does not have an open pregnancy, there is a link available on the most recent closed pregnancy that allows you to reopen the pregnancy. For more information, see Reopening a Pregnancy Closed in Error.
If you have multiple babies entered for a pregnancy, you can now remove babies that were entered in error. For more information, see Removing a Baby Entered in Error.
Now you can change the pregnancy start date by entering it in the Initial prenatal visit field. For more information, see Changing the Start Date of a Pregnancy.
Now the patient’s estimated delivery date (EDD) is displayed with either an ”r;(I)” for initial or an ”r;(F)” for final. This displays when you click the OB stork icon and when you view the OB Record Header from the OB Pregnancy Summary screen.
The OB Header has been consolidated to display with only two lines of information. Research Protocol information has been removed.
Reminders have been removed from the Open Pregnancy Summary screen and OB Reports.
All Open Pregnancy Summary tabs are now expanded by default.
The labs have been reordered on the OB Labs tab.
Changes to OB Flowsheet include the following:

- The Weight Change and Preterm Labor fields have been removed.

- The Return to Office (RTO field has been added.

- The Prepregnancy Weight field has been moved up to be more accessible in the flowsheet.

The following changes have been made to OB Forms:

- Demographics - You can now change the start day of a pregnancy by entering it in the Initial prenatal visit field.

- Pregnancy Dating – The Initial Exam and associated fields have been removed.

- Menstrual History – The Interval field has been added to eliminate confusion when entering menstrual duration information.

- Genetics History, Bedrest, Research Protocol, and Current Pregnancy Outcome – Certain unnecessary Ok Next and Ok Previous buttons have been removed so you are not automatically brought to the optional Bed Rest and Research Protocol forms.

- Current Pregnancy Outcome and Add Past Pregnancy – The Delivering OB/Midwife field has been added. The VBAC selection has been moved up higher in list Delivery type options. The Add Baby button been renamed to Add Baby – multiple gestation to reduce errors.