iknowmed software release notes... · the icd10 codes display as rows in the flowsheet within the...

Copyright © 2014 McKesson Specialty Health. All rights reserved.

iKnowMed Software Release

Version 6.5.1

December 2013

2 Copyright © 2014 McKesson Specialty Health. All rights reserved.

iKnowMed Software Release

Version 6.5.1

December 2013

Release at a Glance (Table of Contents)

1. Overview .......................................................................................................................................................................... 4

2. ICD-10 and the Problem List Tool ................................................................................................................................. 4

2.1 Mark Problem Reviewed ........................................................................................................................................ 4

2.2 ICD10 Codes in the Problem List Tool .................................................................................................................. 5

2.3 Edit ICD10 Codes .................................................................................................................................................... 5

2.4 Search by ICD10 Code or Description ................................................................................................................... 6

2.5 ICD10 Codes in the Flowsheet ............................................................................................................................... 6

2.6 ICD10 Codes in Progress Notes ..............................................................................................................................7

2.7 ICD10 Codes on the Charge Capture Report ..........................................................................................................7

2.8 Other Charge Capture Changes ...............................................................................................................................7

3. ARRA Meaningful Use Stage 2 Preparation .................................................................................................................. 8

3.1 Demographics: Multi-select Race .......................................................................................................................... 8

3.2 Treatment View: Searchable Encounter Notes ..................................................................................................... 9

3.3 Viewed Attachments Cleared from Temporary File Cache .................................................................................. 9

4. Attachment Review: Sign All Items Behavior Corrected .............................................................................................. 9

5. Attachments: Attending Required to Attach, Web Site Printing Not Supported ...................................................... 10


6. Medications ................................................................................................................................................................... 10

6.1 Prescriptions: Added Patient Address, eRx Disabled for Controlled Drugs ..................................................... 10

6.2 Regimens: Better Explanation When Adding Cycles, Cycle Day Admin Fix ..................................................... 10

6.3 Added Gehan & George BSA Formula ................................................................................................................. 10

7. Results: Renamed Lab Report, Added Next Appt to Result Review, and more ........................................................ 10

8. Encounter Note: Added Bone Health Agent, Fixed Assisted By Nurse Display ......................................................... 11

9. Improved Flowsheet View, Interface Monitor, Saving Dictations, OET Display and Timeout Behavior ................. 11

10. Patch Release Addendums............................................................................................................................................. 11

10.1 Version 6.5.1 b64 (December 13, 2013) ................................................................................................................ 11

10.2 Version 6.5.1 b84 (January 7, 2014) ..................................................................................................................... 11

10.3 Version 6.5.1 b91 (January 15, 2014) .................................................................................................................... 12

10.4 Version 6.5.1 b98 (January 24, 2014) ................................................................................................................... 12

10.5 Version 6.5.1 b99 (February 5, 2014) ................................................................................................................... 12


1. Overview

iKnowMed version 6.5.1 prepares iKnowMed for the transition to the ICD10 billing code system and increases

iKnowMed’s compliance to Meaningful Use Stage 2 regulations. Important changes include adding/editing ICD10

codes in the Problem List Tool, allowing multiple selections for a patient’s race, providing a way to search an

encounter note, improving the removal of PHI from the workstation, fixing Attachment Review problems, adding the

patient’s address to the Prescription editor, adding the Gehan & George BSA formula, renaming Lab Report to Result

Report, and making the Log In page appear after a timeout.

2. ICD-10 and the Problem List Tool

The entire ICD10 code set is loaded into iKnowMed. Billing of ICD10 codes begins on 10/01/2014, however we

encourage providers to select ICD10 codes well before 10/01/2014 to minimize billing disruptions after that date.

Before then, both ICD9 and ICD10 codes are captured, but ICD10 codes will not display on the Charge Capture Report

until 10/01/2014.

iKnowMed’s ICD10 code lists are being refined, and will improve over the coming months.

2.1 Mark Problem Reviewed

With this release, we hope many users will transition from using the Progress Notes’ Problems row to using the

Problem List Tool for charting problems.

To facilitate that transition, problems can be marked as reviewed in the current visit by checking the new checkbox

next to the problem.

Right-click a problem’s name to see the available options for: adding detail, inactivating a problem and removing a

problem.

As with the existing behavior, changes that will be charted display in blue. In the example above, the ICD10 code

“D70.1” was matched with the existing “Neutropenia” problem, so only the ICD10 code will saved to the chart, so only

the code is blue.


2.2 ICD10 Codes in the Problem List Tool

ICD10 codes display in a new column in the Problem List Tool.

ICD9 codes do not display in the Problem List Tool.

Multiple ICD10 codes may be associated with a problem.

A green checkmark next to the ICD10 column indicates a specific code is selected, and no further code editing is

necessary. In some cases, the default code is specific enough for billing purposes that the green checkmark

appears. In other cases, the default code is not specific, other more appropriate codes are available, and the green

checkmark does not appear.

Sometimes, no default code is associated with a problem, in which case “Select code” appears.

If no code is linked with a problem “No available code” appears.

ICD10 codes that are not associated with any problem display on their own row.

Clicking the checkbox next to a loose ICD10 concept (which has “No problem selected”) shows as “Capture code”

in the flowsheet. Hover on the ICD10 code to see the ICD10 description.

Right-click a row in the ICD10 column to see the available options for adding, editing and removing codes.

Editing an ICD10 code does not mark a problem as reviewed.

ICD10 codes do not appear in the Inactive Problems area.

2.3 Edit ICD10 Codes

Progress Notes derive the specific ICD10 code for a small subset of primary diagnoses, so this tool will primarily be

used to assign specific ICD codes to the remaining primary diagnoses and general problems.

To add, edit, or remove an ICD10 code, left-click the ICD10 cell associated with the problem. A window appears

listing the codes associated with the problem. Check and uncheck codes as desired. Codes are only pre-checked if

they were manually checked in the current editing session. If you click Save (to save changes to the Problem List) or

click Cancel (to forego making a change to the Problem List), any selection will not be selected the next time you open

the Problem List.


2.4 Search by ICD10 Code or Description

The search area allows for searching on problems, ICD10 codes and ICD10 descriptions. Searching by ICD9 codes in

the Problem List Tool is not supported. Choose the “Billing codes” search option below the “Problem / Code Search”

field to search for ICD10 codes and descriptions.

2.5 ICD10 Codes in the Flowsheet

The ICD10 codes display as rows in the flowsheet within the category ICD10, as shown below. Flowsheet Views can be

customized to hide these services or even the new ICD10 Code Category from view. (Contact the iKnowMed Help

Desk for help modifying Flowsheet Views)

The value “Capture code” indicates that the code will display on the Charge Capture Report. If the code should no

longer be captured, the value “N/A” displays.

Additionally, the specific ICD10 code displays when hovering on a problem, as shown below. The ICD9 code will

continue to display until some period after 10/1/2014.


2.6 ICD10 Codes in Progress Notes

Progress Notes automatically capture the specific ICD10 code for a small subset of diagnoses. If not enough

information is available to capture a specific code, an alert displays in the knowmed. ICD10 codes for primary

diagnoses captured in Progress Notes generate the same services in the flowsheet as the Problem List Tool. By placing

the Problem List toolbar button to the right of the toolbar, the Problem List Tool can be accessed with the Progress

Note knowmed open.

2.7 ICD10 Codes on the Charge Capture Report

ICD10 codes will display on the Charge Capture Report and will be transmitted via the charge interface

beginning10/01/2014. Charges prior to 10/01/2014 will report ICD9 codes.

The Charge Capture Report no longer displays the text “Missing code” for problems without codes. Instead, “No code

selected” or “No code defined” display. In the example below, no code was selected for Essential hypertension, and no

code was available for “Fear of medical personnel”.

2.8 Other Charge Capture Changes

The Capture Charges section of the Charge Capture Report displays dose amount exactly as the Medication

Administration section displays it. This corrects a problem in which the doses were displayed with different precision

(decimal places).

The Charge Capture Interface now sends the first Attending found at any practice when there is no provider at the

practice under which billable services were charted.


3. ARRA Meaningful Use Stage 2 Preparation

3.1 Demographics: Multi-select Race

iKnowMed fully meets Meaningful Use requirements for the Demographics § 170.314(a)(3) objective. The objective

requires the Race to support multiple values, and requires any value not equal to one of the five OMB defined values

(i.e., American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or Other Pacific Islander

and White) to be aggregated into one of the five. By keeping races already charted, and aggregating them to the OMB

values, most practices will be in a good place for meeting this measure’s 80% Stage 2 threshold.

Race, in the Patient Demographics window, is completely redesigned.

The previous drop-down list is replaced with a “No Race

specified…” link. Click the link to update the patient’s

Race.

The new Modify Patient’s Race dialog appears. The five OMB defined races are represented as Categories. Other

races available in iKnowMed display under Races. Selecting a Race also selects the Race’s Category, but selecting a

Category does not select a Race. Clicking Declined or Unknown deselects all other selections, and selecting a race

or category deselects Declined and Unknown.

Click Declined or Unknown to clear all other selections.

The OK button is only enabled after making changes.

Races received by interface are handled just like manual updates. Races not represented in the dialog can be

mapped to an existing value, or the new value can be requested from the iKnowMed Help Desk.


3.2 Treatment View: Searchable Encounter Notes

To meet Meaningful Use requirements for the Electronic Notes § 170.314(a)(9) objective, you can now search for text

in an encounter note by way of the Treatment View. To view encounter notes via Treatment View, click the View

menu’s Treatment View option, and click an icon on the same row as the diagnosis. Use the Find feature at the

bottom of the window to search for a word or phrase in the currently selected note.

3.3 Viewed Attachments Cleared from Temporary File Cache

To better meet HIPAA regulations and the Meaningful Use End-user Device Encryption § 170.314(d)(7) objective,

viewed attachments are cleared from the Temporary File Cache when navigating to a different page of iKnowMed. To

take advantage of this functionality, be sure your local IT has installed the latest ActiveX controls.

4. Attachment Review: Sign All Items Behavior Corrected

When signing an entire page of attachments in Attachment Review, prior to the release, subsequent pages of

attachments did not function properly. This release changes the behavior so that when the user signs all of the items

on page one the following occurs: 1) the item count does not change, 2) The page of items are signed, the list is

advanced to the next page and the first item is selected. 3) The first page of attachments can still be accessed.

In the initial release there are two problems that will be corrected in a later patch release:

When there are no items in the queue three flashing squares display on the left side, implying something is

loading, but nothing ever loads. Hover on the To Do List button to determine if items should appear in the queue,

or Customize the list for a different queue.

When signing all items in the queue, the items may remain in the queue after clicking Refresh. In this case, click

the To Do List button’s Attachment Review option to refresh the page.


5. Attachments: Attending Required to Attach, Web Site Printing Not Supported

Each chart must have an attending physician selected in the demographics for any charting to occur, and now, this

includes attachments. When attaching, if a chart is not assigned an attending and no provider is selected in the

Signature Required field, then an error appears and the document cannot be attached.

When attempting to print a web site linked to a chart in Attachment Review, a message appears indicating that this

type of document is not supported in iKnowMed. To print this kind of attachment, display and print it using the

associated application, which, in nearly all cases, will be using Internet Explorer's Print capability.

6. Medications

6.1 Prescriptions: Added Patient Address, eRx Disabled for Controlled Drugs

The patient's address now appears on the Add/Edit Order window. This was done to make it easy to provide

pharmacies with the patient's address when creating/editing Prescriptions, but it also appears for Admixtures and

other orders.

For controlled drugs, the disabled e-Prescribe option is more easily seen as disabled.

6.2 Regimens: Better Explanation When Adding Cycles, Cycle Day Admin Fix

When changing number of cycles in a regimen, the dialog now explains, "New cycles are copied from the last cycle.

Held and Discontinued orders in the last cycle are not copied to new cycles. After adding new cycles, you can add and

modify the orders." Prior to this change, it was not clear that held and discontinued orders in the last cycle would not

be propagated to new cycles.

When loading the Cycle Day Administration window, a "Loading" message appears, preventing clicks from occurring

in the window and thereby preventing other, downstream errors.

6.3 Added Gehan & George BSA Formula

The Gehan & George BSA formula is added to iKnowMed. It can be chosen in the Regimen Order Editor or by editing

the Body Surface area (BSA) service directly.

7. Results: Renamed Lab Report, Added Next Appt to Result Review, and more

The Lab Report is now named Result Report because results displayed on the report are not always labs.

The patient's next appointment (at any location at the customer) displays when reviewing results in the Result Review

Queue.

In the printed Lab Trend Report, text results are truncated at 25 characters to correct a problem that caused other

results to be hidden.

A result's requeue option is disabled if the practice does not use the Result Review Queue.


8. Encounter Note: Added Bone Health Agent, Fixed Assisted By Nurse Display

On the encounter notes, "Bone health agent" appears in Completed Treatment Details.

When more than one person is selected in the "Bone Marrow biopsy/aspiration procedure note" > "Assisted by Nurse"

the encounter note now shows the names of those selected rather than a string of numbers.

9. Improved Flowsheet View, Interface Monitor, Saving Dictations, OET Display

and Timeout Behavior

This release corrects a problem that prevented Flowsheet View hide/zip preferences from affecting child services.

Error messages in the Interface Monitor are more simply worded for easier troubleshooting.

This release improves saving dictations in progress notes.

This release improves the display of the Order Entry Tool (OET) so that the OK and Cancel buttons are not partially or

fully hidden.

When a session times out, instead of closing the window, the login page appears with a message indicating the timeout

occurred.

10. Patch Release Addendums

10.1 Version 6.5.1 b64 (December 13, 2013)

In the initial release, a problem was introduced causing the attachment list to be populated with many repeating

attachments after signing the entire first page of attachments. This patch release corrects that behavior.

In fixing the behavior mentioned above, a problem is introduced. If you select one or more attachments and move

to another page of attachments, then the previous selections are lost. Until this problem can be addressed in an

upcoming release, we recommend signing or transferring selected attachments on the current page before viewing

another page.

An occasional problem preventing the creation of new patients received by interface is fixed.

10.2 Version 6.5.1 b84 (January 7, 2014)

This patch release corrects behavior introduced in the previous patch (see bullet #2 in section 10.1). If you select

one or more attachments and move to another page of attachments, then the previous selections are now retained.

This patch release also corrects a problem that showed new regimen orders as if they were part of the original

regimen order.

A configuration issue no longer generates errors when attempting to “Save Chart to File”.



Hour glassing in Attachment Review is fixed.

The Race “Filipino” was incorrectly categorized as “Native Hawaiian or Other Pacific Islander”. It is now correctly

categorized as “Asian”.

A problem which prevented a new cycle from being added to a regimen is fixed.

Searching an encounter note for a phrase, through the Treatment View, now finds the whole phrase instead of

finding each word in the phrase separately.

Accessing the Home page no longer clears the cache – a feature introduced in 6.5.1 as a back-up precaution to

protect patient health information (PHI). Removing the cache clearing from the Home page cuts the Home page

load time by half. PHI is still protected by clearing the cache after viewing attachments.

Interface message errors, in the Interface Monitor, are clearer and use less jargon, making troubleshooting

interface messages easier.


Attachments: Fixed a problem that caused the Duplicate Check feature not to recognize already attached

documents as duplicates.

Problem List: Fixed a problem in which reviewed problems did not always save properly in the chart.

10.5 Version 6.5.1 b99 (February 5, 2014)

Interface Monitor: The message error “[Test identifier] received more than once in panel…” now shows in the

Interface Monitor.

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