LutheranVista2EMR Training

Module #1: Signing in & Health Insurance Portability

And Accountability Act (HIPAA )

This session you will learn:- How to sign on- How to set your electronic signature- HIPPA Rules about passwords and EMR- Privacy Tab

Signing On to LV2

***New users: ONLY enter your access code and click ‘OK’. You will be asked to create a verify code. Leave ‘Old Verify Code’ blank. Type and confirm your verify code and click ‘OK’.

1) Find and double-click on the EMR-LV2 icon (*Icon may be different on different computers*)

2) A new screen will appear, asking for your access code and verify code.

3) Enter your access code and verify code, and click ‘OK’ or press ‘Enter’.

***Note: Your verify code must be alphanumeric with one special character and at least 8 characters in total.

Setting your Signature CodeTo create your e-signature:1) Select E-Signature from the

menu.2) A dialogue box will appear

– enter your e-signature TWICE and click ‘OK’

*Caps Lock MUST be on to SET your e-signature code, but is NOT necessary after that.

HIPAA- I

• Do not share your access and/or verify codes (login IDs) with anyone

• Your Login IDs are specific to you• It is your responsibility to log off once you

have finished with your session• To ensure a secure environment, your verify

code will reset after 90 days- - you will be prompted to change it.

HIPAA- II: Patient Privacy

Privacy Tab: If you need to walk away from your computer, make sure to click on the Privacy tab to prevent a patient’s information from being visible (HIPAA).

Module #2: Basic Navigation

This is a basic navigation session, you will learn:- Notification and processing Notifications- Setting user preferences- Overview of all major tabs (Privacy, Notification, Patient Record,

Communication, Internet, MD Dashboard) - MD Dashboard- Selecting a Patient- Patient Coversheet- Overview of all sub-tabs (Coversheet, Problem list, Medication,

Orders, Notes, consults, Discharge Summary, Labs, Reports, and Vitals)

- Patient Location Verification

Notifications I

To process a notification:Highlight one or multiple notifications and click on ‘Selected’ at the bottom right of the screen. *Clicking ‘All’ will process all notifications in succession.

LV2 will open to your Notifications Tab

*Make sure YOUR NAME appears in the blue bar at the top of the screen. If your name does not appear, SIGN OUT AND SIGN BACK IN AGAIN*

An unsigned order or note will then bring you to that patient’s chart where you can sign the outstanding item. *To sign a note, you must right click in the note and choose ‘Sign Note Now’

Note: If a notification was sent to you in error (a request for co-signature or information about someone who’s not your patient), highlight the notification and click on the ‘Forward’ button to send it to the appropriate party.

Notifications are actions which are not complete, such as:~Unsigned medications, orders, notes, and cosigned notes~Unreviewed labs, consults, or informational updates

For information-only notifications, once you have read the information, you can delete the notification.

Notifications II – Setting PreferencesTo set your preferences for which notifications you receive:

*There are five mandatory notifications that cannot be turned off:~ Critical Lab Results~ Imaging Results Amended~ Medications- Expiring- Inpt~ NPO Diet > 72 Hrs~ Order Requires Elec Signature

Click on ‘Tools’ from the Menu Bar

Click on ‘Options’Choose the ‘Notifications’ Tab

Check the box to turn notifications ‘On’

Uncheck the box to turn notifications ‘Off’

Check the Notifications you would like to receive.

Communications Tab: This tab is most frequently used by Pharmacy and the IT Department for contacting active users in Vista via a messaging system.

Other Tabs

Internet Tab: Access links to sites such as Web MD and Physician’s Portal

Dashboard The Dashboard Tab is where you can access basic information about your patients with links to their charts and create your custom census.

There are quick link buttons for:Patient Lookup, Print Census, and Physician’s Portal Patient’s Cover Sheet, Patient’s Labs, Patient’s Orders, and Patient’s Notes

Once you have found your patient(s), you can assign yourself to them to create your census. When your census is created, check the box ‘Show my Patients’ to see your customized list. You can then remove patients or share your census with another provider.

Selecting a Patient

Click on the Patient Record Tab

In both cases, a dialogue box will appear.

Once you select a patient, verify it is the correct patient via name and DOB, then click ‘OK’.

There are 3 ways to select a patient:1) Dashboard2) Patient Inquiry Button3) Patient Dropdown Menu

Click on the Patient Inquiry button in the top left cornerOR

Click on ‘Patient’ from the choices at the top and then choose ‘Select’

You can search for a patient by typing in part or all of their name or medical record number.

***A patient’s information appearing in RED means that was the last patient you accessed.*** Default the patient list by provider

or ward by clicking on the appropriate radio button and then clicking ‘Save Settings’.

Patient Cover Sheet Overview I

Clinical Reminder Clock: Used by ED and Stroke nurses for their reminders

Magnifying glass: Displays Patient Demographic Info

Signature Icon: Icon will display when there is something to be signed, ie., order, note, etc.,

Patient Inquiry: Last Name, First Name, (sex), Length of Stay (LOS), Medical Record #, DOB (age)

Height/Weight: Pulled in from Vitals

Location/Provider: Nursing Unit w Room and Bed, Account #, Provider

Care Team: Primary Care Team, Attending Physician

The patient information banner is made up of four panels located at the top of the Patient Record.

CWAD: PostingsA – Allergies/Adverse ReactionsW – MDRO noteD – Advanced Directives

VHS (Visit History Summary): Provides medication, order and documentation history from prior visits

Quick Note: Single click link to frequently used note templates

Patient Cover Sheet Overview II

Active Problem List: Displays problems as entered via Problem List tab

Allergies/Adverse Reactions: Displays allergies. *Right click in the box to add a new allergy

Patient Postings: DisplaysW – warning of MDRO’sD – Advanced DirectivesA – Allergies/Adverse Reactions*Hover to view details

Medication List: Displays Medications. *Click on medication for more details.

Clinical Reminders: Displays Clinical Reminders for ED and Stroke Education DocumentationLab Results: Displays last 72 hours of lab

results.*Click on lab for more details.

Vitals: Displays last documented vital signs*Click on specific reading for more details.

Patient Visit(s): Displays patient visit history with admitting diagnosis.

Allergies/Adverse Reactions: Displays allergies. *Right click in the box to add a new allergy

Active Problem List: Displays problems as entered via Problem List tab

Medication List: Displays Medications. *Click on medication for more details.

Patient Postings: DisplaysW – warning of MDRO’sD – Advanced DirectivesA – Allergies/Adverse Reactions*Hover to view details

Clinical Reminders: Displays Clinical Reminders for ED and Stroke Education Documentation

Lab Results: Displays last 72 hours of lab results.*Click on lab for more details.

Vitals: Displays last documented vital signs*Click on specific reading for more details.

Patient Visit(s): Displays patient visit history with admitting diagnosis.

Patient Location Verification

Under this tab, the accounts listed are outpatient and / or ambulatory encounters.

Under this tab, the accounts listed are inpatient encounters. Before placing any inpatient orders, please make sure there is a current account with the correct provider or attending physician.

Discharge Summary: Within 48 hours of a patient’s discharge from the hospital, the discharge summary should be transcribed and uploaded into this tab from Physician’s Portal.

Sub Tabs Cover Sheet: Provides summary of patient information

Problem List: Entry/display of problems along with any notes that have been added.

Medications: Entry/Display of:Discharge Medications Home Medications Inpatient Medications

*Medication Reconciliation is completed here

Orders: Entry/Display of patient orders in alternating colors

*Selection of multiple orders for signing and/or verification – use Shift or Ctrl keys

Notes: Entry/Display of Nursing Admission Databases, Provider H&P’s, ED Notes, MDRO Notes, Advanced Directive Notes, and Stroke Education Notes.

*Click on any note on the left-hand side to view details.

Consults: Displays Ancillary Department Consult status

P = PendingC = CompletedDC = Discontinued

*Select any consult from the left-hand side to view details.

Labs: Displays lab results for a patient

You can view the information in a table or graph format and you can filter the information by lab subtype, date, or test type

*You can also filter your view to include only abnormal results.

Reports: Displays multiple types of reports and radiology imaging.

* VERIFIED indicates a report is available.

Vitals: Entry/Display of vital signsLeft click once to view vitals detailsUse the table on the upper right to view cumulative vital sign entries or view the same results as a graph

Module # 3: Problem List

This session you will learn:- How to manipulate the Problem List and enter a diagnosis

Problem List Here you can add, edit, or delete diagnoses on a patient’s chart.

You can filter your view to include only active problems, only inactive problems, or both.

~ To add a problem, click on the ‘Add’ button on the upper right and a dialogue box will appear.~ To search for a diagnosis, click on the ellipsis - another box will appear where you can search for the diagnosis via text or ICD code. ~ Highlight the diagnosis you need, and click ‘OK’ to bring you back to the first screen.~ Fill in any other information as appropriate and click ‘Save’.

*Each diagnosis is given a Problem ID # – which refers to the order in which the diagnosis was entered. Thus, the first problem entered would be 1, the second would be 2, etc., You MUST fill in the Problem ID and ICD Code fields to Save the problem to the list.

*To edit a problem, highlight the problem and click ‘Edit’ on the upper right.

*To delete a problem, highlight the problem and click ‘Delete’. A new dialogue box will appear. Choose a reason for deleting the problem and click ‘OK’.

Module #4: Medication & Medication Reconciliation & Printing Prescriptions

In this session you will learn:- About the Medication Tab- How to do the Reconciliation Process: of

Home Medication, Inpatient Medication, and Discharge Medications

- How to Sign off on Medication

Medications Includes: Outpatient MedicationsHome MedicationsInpatient Medications

To take action on a medication, right click on the medication and a dropdown menu will appear:

New Medication – add a new medication to the list

Change – adjust the dosage, route, or frequency of a medication

Discontinue/Cancel – discontinue or cancel a medication

Hold – put a medication on hold* You must give a reason

Release Hold – release the hold on a medication

Transfer to Inpatient – transfer a home medication to an inpatient medication order. Do NOT transfer NF (non-formulary) drugs to inpatient unless there is no formulary alternative or the patient is bring in his/her own med.

Transfer to Outpatient – transfer an inpatient medication to a discharge medication or prescription

Medication Reconciliation I – Home to Inpatient

*Make sure you’re entering medications into the correct section by verifying text in BLUE

Medication Reconciliation begins with the RNs. It is their responsibility to D/C all home medications from previous visits and re-enter a new set for the current visit.If the RN has not D/C’ed previous home meds and entered new ones, it is YOUR responsibility to do it in order to complete the reconciliation.*To see if the home meds are up to date, double click on the medication and verify the date it was entered.

*The ONLY time you can have a home medication with an active status is if the patient is not currently on any medications and the RN entered: MISC (No home medications)

When you have reconciled all home meds, you can proceed to entering new Inpatient medications.

To do this, right click in the Inpatient pane and choose ‘New Medication’, or click the ‘New’ button. (Medication orders can also be placed from the Orders Tab.)

~ A comprehensive medication list will appear where you can search for medications by their brand and generic names. ~ Choose the dosage, route, and schedule, as appropriate – check PRN when applicable.~ When you’re ready, click ‘Accept Order.’ ~ When all medications have been entered, click ‘Quit.’~ To sign off on your medication orders, click on the hand icon in the upper right corner. *Unsigned orders appear in BLUE AND BOLD

*When you click to sign your orders, a window will appear listing everything that needs to be signed.Uncheck any orders you wish to NOT sign.Enter your electronic signature code and click.

Medication Reconciliation II – Change in Level of CareWhen a patient undergoes a Change in Level of Care, i.e., transfer to or from a critical care unit, orders MUST BE DISCONTINUED AND REWRITTEN.

*Medication orders can be re-entered from the Medications tab OR the Orders tab

Once you have accepted your order, be sure to SIGN YOUR ORDERS using the hand icon on the upper right

To re-enter an existing order, right click on the medication you wish to reorder and choose ‘Copy to New Order’

A screen will appear where you can choose to release the order immediately or delay it until the patient has been transferred to a particular unit.

Medication Reconciliation III - DischargeWhen the patient is ready to be discharged home, the final step of medication reconciliation must occur.

Once all medications have been transferred to the Discharge Meds section and signed, you can print detailed reports, summary reports, or prescriptions, as necessary.

Be sure to SIGN YOUR ORDERS usingthe hand icon on the upper right

In the Home Meds section, any medications that have been put on hold during the visit should be released or discontinued. Right click on the medication to view these options.

Medications released from hold should then be transferred to outpatient (O/P) by right clicking and choosing Transfer to O/P – bringing them to the Discharge Meds section.

Proceed to the Inpatient Meds section and highlight any inpatient medication(s) you wish to create prescriptions for. Right click on the medication and choose Transfer to O/P – bringing them to the Discharge Meds section.

Entering Discharge Medications

1. Select Medication Tab and select Discharge Medication pane.

2. Right click and select New Medication

3. Select Medication for Discharge

4. Select appropriate medication from Medication Order Dialogue box.

Prescription PrintingTo print prescriptions for a patient:

Highlight the medication(s) you wish to print prescriptions for.

Click the ‘Print’ button at the top.

A dialogue box will appear. Choose ‘Prescription’ and ‘Print.’

Prescriptions will then print to the nearest prescription printer. *Remember to sign your prescriptions.

Module #5: Orders

In this session you will learn:- How to enter an order- How to use order sets and Why.- How to use “a la carte” menu to place orders- How to sign an order- How to create a delayed order

Remember the Patient Location Verification- this is important!The process for inpatient orders is different from outpatitent ordersEMERGENCY DEPARTMENT is an outpatient locationEDH (ED HOLD) is an inpatient location. Make certain the patient is in EDH before placing inpatient orders.

Orders I - OverviewStep 1. Click on the “Orders” Tab.

To view current patient’s orders: You can sort your orders by the column headers – Service, Order, Start/Stop Date, Provider, Nurse, Clerk, Chart, Status, or Location by clicking on the respective column header.

Step 2. Placing medication orders: Order Sets MUST BE USED AS THE FIRST COURSE OF ACTION for placing patient orders. As a matter of fact, some drugs can ONLY be ordered through order set, e.g. anticoagulant, PCAs, and restricted antibiotics. Commonly prescribed IV fluids, Labs, Cultures, food, etc. are on the Order set. There are more items available if you scroll down to the column of the category and click on “Other IV fluids”, Other Lab Tests” etc.

You can find order sets by department on the left hand side of the Orders tab screen.

Should you NOT able to find a medication on the Orders Set, it can be ordered from the “A La Carte menus” (Meds. Inpatient).You can find the a la carte order menus on the left hand side of the Orders tab screen below the Order Sets.

Orders II – Order SetsFor example, choosing the Chest Pain Low Risk Order Set:

Order sets, as part of evidence-based medicine, are an important piece of effective patient care.

Order sets walk you through a step-by-step process - diminishing the possibility of omitting something when assessing a patient’s care needs.

In the Medicine Daily Orders, click on ‘Chest Pain Low Risk Admission’ A series of windows will pop up taking you through the order set starting with the ‘Reason for Request: ADMIT’

Fill in the Admitting Location, Admitting Physician, and Admitting Diagnosis.

*If the patient has other pertinent diagnoses, be sure to include them.

Click ‘OK’

Accept your Order.

The next window to appear is Allergy Entry.

Search for allergies typing all or part of the word and clicking ‘Search’.

If your patient has no known allergies, be sure to check ‘No Known Allergies’

The next several screens will offer menus for :

Nursing OrdersLab Orders VTE ProphylaxisGI ProphylaxisMedication OrdersRad/Diagnostic/Consults

Choose whatever orders are appropriate for your patient and click ‘Next’ to proceed to the next screen.

You will be brought back to the main Medicine Daily Orders Screen.Click ‘Done’ to return to the main Orders screen and review your orders.

Note: Selected orders will appear in blue

Unsigned orders appear in blue and bold – REMEMBER TO SIGN YOUR ORDERS USING THE SIGNATURE ICON

Orders III – Delayed OrdersWhen a patient has a change in level of care, existing orders will automatically D/C and new orders need to be written.

To ensure that the patient is receiving the proper care in a timely fashion, use the Delayed Orders Order Set to write orders in anticipation of their transfer.

Choose the unit where you wish to transfer your patient

Confirm where you wish to transfer the patient Accept the order for Transfer

A window with your current orders will appear where you can select orders to copy to delayed release.

Finally, the receiving department’s Order Sets page will appear, where you can order any other items the patient will need upon transfer.

Click on ‘Delayed Orders’ on the left and a window will appear.

*Remember to hold down ‘Ctrl’ to individually select orders you wish to copy. OR

* Hold down ‘Shift’ and select the first and last item to highlight a block.

Remember to sign your orders

For non-medication orders such as DME’s, go to the Discharge Order Sets menu.Orders IVChoose Non Medication Discharge Orders (DME/Supplies)

Choose whatever supplies or miscellaneous orders you need

Module #6: Notes

In this session you will learn: - How to view notes- How to create a MD Admission H&P- How to edit note/ append boilerplate text

concept- How to sign off on a note- How to create an addendum- How to delete unsigned notes

NotesNotes are grouped by whether they are:

Signed/UnsignedInpatient/Outpatient VisitSpecific Visit – with most recent note at the top

To view a note, simply click on the title on the left hand side, and the right side will preview all the details of a note.

The sequence for each note is the same – Date Written, Title of the Note, Unit/Location, Author

In the Notes tab, you can view and author notes written for a patient.

Notes II – Authoring a NoteWhen authoring a note, remember the ‘Action’ menu – every action you’ll need to take is there.

There are two ways to open a new note:New Progress Note from the dropdown menu OR‘New Note’ button on the bottom left

A dialogue box will appear where you can choose the note you wish to write, for example, MD: Inpatient H&P

*Note: You can search for notes by all or part of their title or by Department/Role Prefix, i.e., MD: = ProvidersED: = Emergency DepartmentBlood = any notes regarding blood transfusion

A template will appear.

Highlight the note you wish to write and click ‘OK’

The gray area on top is where you will be filling in patient information.

The two white fields on the bottom are auto-populated by what you’re entering above in gray.*Minimize them to maximize template space.

Check the section you wish to complete and fill out and complete it accordingly.

Fields with a single asterisk are MANDATORY and MUST be addressed or you will NOT be allowed to finish your document.

Radio buttons have a ‘one or the other’ functionality.*Be sure to respond to any follow up fields that open when clicking a radio button.

Allergies and Medications are automatically pulled in from the patient’s coversheet and CANNOT BE EDITED in the note.*Make sure Allergies and Medications are up-to-date BEFORE you open a note.

Check boxes are optional and multiple boxes can be checked off if applicable.

*When ticking a checkbox, be sure to fill in any follow up fields

*If you finish all sections of the note in one session, click ‘Finish’ when you have completed the last section.

At the end of a section, you can:

Continue filling out the other sections OR

Finish this piece of the note, and come back later to finish the rest.

At the end of a section, you can:

Continue filling out the other sections OR

Finish this piece of the note, and come back later to finish the rest.

If you have filled in all the appropriate fields, the next screen to appear will ask you to identify the Primary Provider for the patient – which should be YOU. Click ‘Yes’

* If the name shown is NOT the Primary Provider, click ‘Select Primary’ and choose the correct provider.

You will be brought back to the main screen with a preview of your note appearing in the right pane.

*If you have not completed the note, go to ‘Action’ and choose ‘Save without Signature’

Notes III – Appending a BoilerplateWhen you are ready to finish your note, highlight the note you wish to complete and put it in ‘Edit Mode’ (Go to ‘Action’ and choose ‘Edit Progress Note’)

Go to the ‘Action’ Dropdown menu and choose ‘Reload Boilerplate Text’

A new dialogue box will appear:ALWAYS CHOOSE ‘Append the boilerplate text to the text in the note’Then, click ‘OK’

* DO NOT redo the section(s) you already completed, or your original entries will be overridden.

The template will reappear, allowing you to continue where you left off.

*Remember, once you finish your note to SIGN YOUR NOTE, using the signature icon

Notes IV – Deleting/Editing a Note vs. Making Addenda

*BEFORE your note has been signed, you have the option to Edit or Delete it.

To Edit or Delete a note, you can:~Right click anywhere on the note ~Click ‘Action’ from the menu bar

Once your note has been signed, you CANNOT edit or delete it. You CAN make an addendum to include additional information and/or clarify a discrepancy, such as entering information into the incorrect patient chart.

To make an Addendum, you can:~Right click anywhere on the note~ Click ‘Action’ from the menu bar

*Be sure to sign your addendum using the signature iconso that others can view the information.

Module #7: Consults and Results

In this session you will learn:- How to view consults- How to create/order consults- How to complete/ enter results in consults- How to set your preferences to receive consult

notifications

Consults I – Ordering Consults

You can find Consults under two menus in the Orders Tab:Procedures/Department Consults

ORPhysician Consults

A menu of available consults will appear. Choose the one you need, e.g., Internal Medicine

A window will pop up, reminding you to call the consulting physician or service.

Fill out the consult order accordingly and click ‘Accept Order’

You will return to the home Orders screen.*Remember to SIGN YOUR ORDERS.

Consults II – Completing ConsultsTo complete a consult:

In the Consults tab, highlight the consult you wish to complete.

Click on ‘Action’ > ‘Consult Results’ >‘Complete/Update Results’

The note dialogue box will appear. Choose the appropriate note and click ‘OK’.

Complete the consults results, filling out all information and click ‘OK’

*Remember to sign your note when you’re finished, using

*A (p) before the consult type indicates that the consult is pending and has not yet been done.

*A (c) before the consult type indicates that the consult has been completed.

*A (dc) before the consult type indicates that the consult has been discontinued.

*A (pr) before the consult type indicates that the consult has partial results – meaning the note has been started, but not completed.

Consults III – Setting Preferences To set your preferences for which consult notifications you will receive:

Go to ‘Tools’

Click the ‘Notification’ tab

Click ‘Options’

Select all Consult Request options and click ‘OK’

Module #8: Labs & Radiology Reports

In this session you will learn:- How to view and graph labs- How to view radiology reports and images

Labs To view lab results, particularly those older than 72 hours (which are not viewable from the Coversheet) go to the Labs Tab.

To view the results for a specific test, click ‘Worksheet’ from the left menu.

Choose the test you wish to see

Click ‘Add’

Test should appear in the right column. Click ‘OK’

Your lab results will appear.

You can change your view with the options above.

You can also view lab results in graph form – and can view two items simultaneously, using the Split View function.

Click on ‘Graph’ from the left menu.

*To view two graphs, be sure ‘Split View’ is checked.

Choose the items you wish to see in graph form.

Right click on the report of the image you wish to see

To view an image:

Reports

Choose ‘View Image’ from the dropdown menu

The results and images from radiology reports are available here once the procedure has been done.

To find out if a report is viewable, check the ‘Report Status’ column for a ‘Verified’ status.

If the status is verified, select the report and the results will appear in the pane below.

A new window will open in Internet Explorer with the corresponding image

Click ‘Images (local only)’ to see a list of radiology and imaging reports.

You have reached the end of the presentation.

Please print out and complete the quiz.

You MUST bring this quiz to your validation training. Failure to comply may impact your eligibility for EMR access.