You can now make changes to Final status notes that you have created or that have been created for you. The LMR now includes a status of Amend for notes that are changed after being signed as Final. Previously, Final status notes could not be edited. For details, see Amending Final Status Notes.
Note: Due to technical limitations, notes finalized between October 8, 2006, and September 27, 2007, cannot be amended.
A new Retracted tab has been added to the Notes module. Clicking this tab displays Error status notes. Previously, these notes could not be displayed.
Practice managers can now set a practice default header (PDH) that is automatically applied to notes created by any user within that practice. For details, see Setting Default Note Headers.
Minor changes have been made to Notes view screen buttons. The Header button has been moved above the text box. Also, for View mode, buttons for Print and Print Preview are now available as icons.
For free-text notes, options to include patient information (MRN) and a signature line (Sig) have been changed from links to checkboxes. Additionally, clicking these checkboxes is not immediately reflected in the displayed version of a note. Instead, the LMR reflects these options in printed notes.
Note: Users who typically reformatted MRN information once added to a note may prefer to add information using system macros. For details, click here.
You can now activate discontinued medications from a patient note. Previously, you could only do so from the Medications module. For details, see Adding Information Using the Pt. Data Tab.
You can now choose to be notified about failed prescription transmittals via email or pager in addition to a clinical message. See Custom Preferences for details.
A tab can now be added to the Summary to display the list of nonmedications for the patient. (See Creating a Custom Summary for details.) Nonmedication information is also now available from the QuickLook menu (displayed by pressing the F8 key after a patient is selected).
The LMR now automatically updates pharmacy information in Favorites and patient profiles when pharmacy dictionary files are loaded or updated. Previously, users would have to delete and re-enter pharmacy entries to have changes take effect, resulting in incorrect information (such as bad fax numbers).
You can now select to have the Patient Med/Allergy List displayed and printed in Spanish. (This functionality is being piloted at selected Partners practices.) For details, see Printing a Med/Allergy List. The History screen indicates the number of times the Patient Med/Allergy List has been printed.
The Rx flag now displays in the Medications list screen if the medication was ever prescribed for the patient. Previously, the Rx flag only displayed if it was prescribed at the last update.
When a medication is verified, the LMR now displays "V" in the action column of the medication list to signify that the medication was verified. Previously, the LMR displayed this action as an edit by displaying an "E." The Sign and History screens have also been updated to indicate verified medications.
The Medications list screen now includes a "Reason for Discontinue" column when you click Inactive Meds to display discontinued medications. Also, "Reason for D/C" is also added to the History screen for discontinued medications, as well as to the Medication History Report.
The LMR now includes enhanced directions within notes when a medication with variable or alternative dosing is included. Previously, the LMR just included "Variable" or "Alternative" following the medication name.
The Pt. Data tab (from Notes module) now displays the number of days until expiration for medications, if applicable. Previously, this information was only displayed from the Medications module.
When adding a nonmedication for a patient, the LMR now includes the option "Take as typed" to enter uncoded entries (as is available for medications). Note that the use of uncoded entries should be avoided, as they do not make full use of the LMR's features and capabilities. Also, be sure to use the Feedback option from the Resources menu to report nonmedications that are missing from the LMR dictionary.
You can now select or update the Payor associated with the patient from the Medication lookup and detail screens (such as the Add and Edit forms). Previously, the Payor field was only available from the main Medications view.
Teaspoon conversion values now display on the medications form only for oral (PO) medications. Previously, teaspoon conversions displayed for IV, PNG, and OTIC routes.
You can now use custom paragraphs when entering medication details to save time when entering common text. (Custom paragraphs must be selected for use with medications from the Custom Paragraphs view.) Apply custom paragraphs from the Special Instructions and Comments fields by typing "." plus the custom paragraph name (such as .name).
Printed and faxed prescriptions now include the text "No Substitutions" if you had clicked the associated checkbox when adding or editing a medication. Such medications can now be faxed. Previously, you needed to manually indicate "No Substitutions" on the printed prescription, preventing the use of prescription faxing. The Sign screen has also been updated to reflect this change.
Note: For Medicaid prescriptions, practitioners must hand write "Brand name medically necessary" when the No Substitution option is used.
You can now click Renew & Sign from Medication detail screens (such as the Add and Edit forms) to go directly to the Sign view. Previously, the Renew & Sign button was available only from the main Medications view.
When adding a medication to your list of Favorites, the Add form now displays the Advanced view if your Rx Pad setting in Custom Preferences is set to Advanced. (The Advanced view is used to select medications using weight-based dosing.) Previously, the LMR used the Traditional view for adding Favorites regardless of the setting in Custom Preferences.
Selecting a single medication from your list of Favorites returns to the main Medication view, with the new medication awaiting signing. Previously, the LMR displayed the LMR Add form for the medication, resulting in an extra step to add the medication.
The Medications view has been enhanced to allow nonprescribing providers to communicate medication changes to providers in a way that makes it easy to subsequently incorporate those changes to the patient's record. For details on how medical assistants document those changes, see Requesting Medication List Changes or Renewals. For details on how providers process those change requests, see Processing Medication List Requests. This enhancement is currently being piloted at the MGH Cancer Center.
Note: A new HIS report (Outstanding Med Approval Requests) is available for practice managers and others to see all outstanding requests for a practice. To access this report, click HIS Reports from the Admin menu.
The Advance Care Planning Summary is a new module in the LMR that consolidates advance care planning information in a single location. It provides a central access point for a patient's Code Status, EOL Referral, and Advance Directive information. This module replaces the Code Status and EOL Referrals options in the Patient Chart menu. Additionally, Custom Summaries that included tabs for Code Status or EOL Referrals are replaced by the ACP Summary tab.
The EOL Referrals screen is updated to include additional Partners EOL Resources links.
You no longer need to select a DNR/DNI code option before entering comment text. Previously, the Code Status module required that you select an option before you could type into the text field.
The screen displayed when editing a note in Document Management has been significantly redesigned for consistency with the Notes module. Buttons, checkboxes, and links have been moved and reformatted. This should improve usability, and reduce the level of support and development moving forward.
Note: You can no longer correct the date of a note by clicking Correct from a Preliminary status note. Instead, correct a note date as you would make any other update, from the enhanced note edit screen. For details, see Editing a Note.
The LMR now auto-finalizes notes 21 days after the initial creation date. Previously, the LMR auto-finalized notes 21 days after the date of last edit.
You can now make changes to Final status notes that you have created or that have been created for you. The LMR now includes a status of Amend for notes that are changed after being signed as Final. Previously, Final status notes could not be edited. For details, see Amending Final Status Notes.
Note: Due to technical limitations, notes finalized between October 8, 2006, and September 27, 2007, cannot be amended.
For patients with Patient Gateway accounts, the application automatically releases Result Manager letters to the patient when you save a letter as Final status and sign it. Previously, you needed to click
. Additionally, the Results Manager queue includes
icons that indicate if the patient has viewed the associated
Result Manager letter. For additional information, see Patient Gateway
Considerations.The Results Manager now allows you to sort your queue by most recent visits. Also, if you change the sort order for your queue, the LMR retains that selection for future LMR sessions. Previously, your queue was sorted by most critical visits and could not be changed.
Results that are not associated with any visit now include the date associated with the result to the right of the "No Visit" indicator. This date is used as a sort value when you sort your queue by most recent visits.
The view of your LMR queue now includes 40 entries per page, and the patient's medical record number is included.
The Scheduled View now displays the visit time for each line. Previously, only the date was included. Additionally, columns for Visit Type and Status (indicating the arrived status) have also been added.
Multiple reports for the same test type now display as separate entries in the Result detail screen. You must now separately acknowledge each report, reducing the possibility of missed result reports.
You can now edit medications and problems directly from the Results detail screen. Do so by clicking the link for the entry name. Previously, entries could be added or viewed but not edited.
When adding an interpretation to a result (or otherwise working from the Letter tab), you can now change the subject or header used for printing. Previously, these fields were not displayed. Additionally, a Print Preview button has been added, and medications and problems display as links, allowing you to modify them by clicking them from this screen.
You can now set the default screen of your Results Manager queue to display the Scheduled View. Previously, the default screen displayed your queue of Open Visits and could not be changed. Additionally, Cancer Center users can now suppress notifications for critical results. For details, see Customizing the Results Manager.
The Results Manager is now available for CAS (Clinical Application Suite) users.
You can now add clinical-friendly terms when adding problems to a patient's list. A new column, Synonym, is now included with the table of returned results. Previously, the LMR included only the detailed problem concepts. See Adding Problems for details.
You can now look up and add list entries directly from the Summary screen. This applies to the Problems, Procedures, Medications, Nonmedications, and Physicians. See Working with Chart Lists for details.
A tab can now be added to the Summary to display the list of nonmedications for the patient. (See Creating a Custom Summary for details.) Nonmedication information is also now available from the QuickLook menu (displayed by pressing the F8 key after a patient is selected).
Pharmacy detail information can now be displayed from the Summary (applies only if the Summary includes the Pharmacies tab). Previously, the Pharmacies tab displayed only the name of the patient's pharmacies, not the phone, fax, and address. Pharmacy detail information is also now available from the QuickLook menu.
The main EOV main screen now shows all encounters for the selected patient. Previously, encounters from other clinics were hidden from the list.
Several fields have been added to the EOV header screen to capture all data needed for billing purposes.
The quantity of lab order requisitions printed is now based on the frequency you select at the Batch Frequency screen for weekly orders. Previously, EOV printed one requisition regardless of the frequency selected.
Outbound billing and lab interfaces are now available. Lab and billing departments serving practices using EOV would be candidates to take advantage of these interfaces.
You can now delete a single lab order or group of lab orders at a time by clicking the
icon. Additionally,
if you specify a frequency for lab orders, it is displayed
in the list of EOV transactions.
The Sign screen now includes all updates that you have entered but not yet signed for from previous sessions. Previously, the Sign screen only displayed information from the current session. The only exception is information you had on the Unsigned Data screen prior to this release. Unsigned data created before November 7, 2008, will continue to display only on the Unsigned Data screen until you either sign or delete it.
The Sign screen now includes the standard
icon to delete entries.
Previously, you needed to click a checkbox and then click
Remove. Note that
you are now prompted to enter your key to sign for deletions.
You can also "undo" entries that you mistakenly
remove (prior to signing) by clicking the 
.
For details, see Signing
a Session.The Sign screen no longer includes a note indicating limitations for use of faxing. Printed prescriptions now include the text "No Substitutions" if you had clicked the associated checkbox when adding or editing a medication. Such medications can now be faxed, eliminating the need for the note.
Reminders are now generated to prompt providers to reinstate prophylactic medications for certain patients who have had a recent bone marrow transplant. This only applies to DFCI patients on one of the following medications: Medpron, Bactrim, or Dapsone.
Note: Other practices, outside of DFCI, who use the BMT flowsheet and who wish to see this reminder should contact their LMR support analyst.
Reminders are also generated to remind providers to schedule an ophthalmology exam from patients on prolonged therapy of Chloroquine (Plaquenil) to check for retinal toxicity, based on certain criteria (patient age, medications, exam frequency, and so on). (This reminder will not be released until later in November.)
When batch printing reports from the Schedule, you can now have the reports sorted by medical record number (MRN). Previously, reports were sorted by appointment time, and could not be changed.
The Rx Report option has been enhanced to allow you to include only Schedule 2 medications (controlled substances). Previously, the report could only be run for all medications. Prescriptions for controlled substances need to be reviewed by an attending physician every 96 hours.
When batch printing reports from the Schedule, you can now have the reports sorted by medical record number (MRN). Previously, reports were sorted by appointment time, and could not be changed.
The Infusion Flowsheet now displays a warning message if you attempt to enter a "down" time for an IV administration that is earlier than the "up" time. Previously, no such messages were displayed, resulting in documentation errors.
The Rx Report option has been enhanced to allow you to include only Schedule 2 medications (controlled substances). Previously, the report could only be run for all medications. Prescriptions for controlled substances need to be reviewed by an attending physician every 96 hours.
A report has been added (Outstanding Med Approval Requests) to generate a list of all requested medication list changes that have not yet been processed. See Processing Review Med List Requests for details. To access this report, click HIS Reports from the Admin menu.
You can now choose to be notified about failed prescription transmittals using email or pager in addition to a clinical message. Previously, all notifications were by clinical message only.
You can now select to have the Patient Med/Allergy List displayed and printed in Spanish. For details, see Printing a Med/Allergy List. This functionality is being piloted at selected Partners practices.
You can now view the number of times this report has been printed or previewed. For details, see Overview of the Patient Med/Allergy List Report.
You can now select to have the Pediatric Asthma Action Plan printed in Spanish. For details, see Generating a Pediatric Asthma Action Plan. This functionality is being piloted at selected Partners practices.
A new item, Newborn Metabolic Screening, displays in the Children's Health Screening section for children ages 0 to 1. It includes coded responses of Normal and Abnormal.
The drop-list of batch entry options has been modified. The option "Meningococcal" has been removed, and options for "Meningococcal Polysaccharide Vaccine (MPSV4)" and "Meningococcal Conjugate Vaccine (MCV4)" have been added.