BETH ISRAEL DEACONESS MEDICAL CENTER

0

Volume

1

eScription – User Guide

Practice Admin

Training Manual

1

Table of Contents

Daily eScription Tasks for the Practice Administrator................2Daily tasks for the Practice Administrator..................................2Support......................................................................................3Support Channels......................................................................4Common Problems / Issues.......................................................6

Changing a Dictation Status and Sending to OMR..........................6Correcting Patient Name and MRN errors in eMon.........................8Procedure for Listening to a Dictation from eMon............................9

Working the Pended List............................................................9Using the Dictation Tab to access the pended dictation list...........10Using the Messages Tab to access the pended dictation list........10Blank Dictation...............................................................................13Blank in a Note...............................................................................13ID Unknown...................................................................................13Wrong Entity Code entered............................................................13Speaker enters wrong ID...............................................................13Service Date not Dictated..............................................................13Multiple Dictations or Addendums on one eScription ID................13Check Addressee or CC data........................................................13Wrong Worktype............................................................................13

OMR Exception Report Overview............................................14Procedure for Running the OMR Exception Report.......................14

Clinician Information................................................................16Maintenance of Active Speaker Lists for your Entity......................16eScription General Guidelines for Dictation...................................17Phone Instructions.........................................................................18

Play Record/overwrite Rewind 5 seconds.....................18Appendix..................................................................................19Practice Administrators eScription Questions and Answers....19eScription Hardware and Software Specifications...................20

Daily eScription Tasks for the Practice AdministratorAs the Practice Administrator you’ll be the primary support for eScription in your practice/department. If the issue cannot be resolved internally, please email esupport@bidmc.harvard.edu and someone from the eScription team will contact you.

here are several tasks that must be done daily by the Practice Administrator to ensure the smooth running and timely upload of transcriptions to OMR.T

Daily tasks for the Practice Administrator1. Serve as the primary contact for all eScription issues for your practice. The eScription team will be there to serve as your back up.

2. Log into eMon every day to review the pended dictations. These dictations can be viewed under the Message and the Dictation tabs.

3. Take appropriate action on all “Pend to BIDMC” dictations to ensure that they have successfully transferred to OMR. If you are having problems resolving the “Pend to BIDMC” dictations, please email internal support at esupport@bidmc.harvard.edu.

4. Run OMR Exception Report weekly to resolve dictations that did not successfully move to OMR. This report must be run for each practice.

3

Support The eScription project team offers secondary support once the implementation is complete. The team will act as a liaison between the

Practice Administrators and eScription. Currently the eScription application is supported Monday through Friday during regular business hours.

General Information: The eScription support team will notify all users of scheduled downtime.

Please use the eScription support Outlook email address for any questions that can not be resolved within your department: esupport@bidmc.harvard.edu.

For all questions related to hardware problems, please contact BIDMC Desktop Support.

We do not support handheld devices or cell phones for dictators. We do not support software or hardware for employees who work from home. We will answer questions relating to the pended queue or other routine support problems.

Emergency support after business hours is available by paging 31446. Please only use this resource for system failures and/or lost STAT dictations. Business hours are M-F 8-5.

4

Support Channels Below are examples of issues that should be sent to BIDMC eScription Team support mail box, e support@bidmc.harvard.edu .1. System Access Issues: All access problems should be reported to BIDMC eScription Team mailbox. This includes dictation access for providers and eMon access for practice representatives.2. Adding New Providers/eMon Users: Please send new providers/eMon users access requests to the BIDMC eScription Team mailbox.3. Missing Dictations: After the initial practice investigation, missing dictations requests should be sent to the BIDMC eScription Team mailbox.4. Audit Trail Questions: All audit trail questions should be sent to the support mailbox.5. Training: Request for provider and eMon user training should be sent to the support mailbox. Below are examples of issues that should be sent to directly to you from the transcription company.1. Dictation Practice Questions: All questions specific to provider dictation practices will be directly addressed to the practice for resolution.2. Alerts for Pended Dictations: All STAT and other pended dictation messages from the transcription company should be sent directly to the practice. Please continue to use standard pended comments. Below are examples of issues that should be sent to directly to your Transcription Company / representative.1. Formatting: All formatting questions can be sent directly to the transcription companies for processing.2. Quality Problems: Please send all quality issues (spelling, grammar, turn-around time, date of service questions) to your transcription representative.

Below are examples of issues that will be sent to Support mailbox from the Transcription Company / representative.

5

eMon User → BIDMC SupportTranscription Company → eMon User

eMon User →Transcription Company Transcription Company → BIDMC Support

1.AD HOC Weekly Status reports: A weekly status report should be sent to the BIDMC eScription Team mailbox that outlines the issues/requests made by the practices.2. AD HOC Weekly Conferences Calls: An ongoing weekly conference call is established between the BIDMC eScription Team and the transcription companies’ representatives to discuss open issues.3. Audit Reports: Audit reports are sent to the BIDMC eScription Team mailbox for review. We require that the total percentage and number of dictations be included in the report. In addition, we require that it contain a summary of the error percentages. We no longer require that the specifics of reviewed documents be included on a regular basis. We do, however, require that the transcription vendor maintain the information in the event that it is needed for reference/audit at a later date. We also request that the document accuracy report be cumulative and sent on a weekly basis.4. Adding New eMon Users: Currently, requests for addition of new eMon users should be sent to the BIDMC eScription Team mailbox.5. Formatting Request that require system changes: Formatting request that will have a global impact must first go through BIDMC eScription Team. This includes formatting changes that will require programming changes, as well as all template requests. If there is any doubt, please email the support mailbox for confirmation prior to implementing any changes.

6

Common Problems / IssuesChanging a Dictation Status and Sending to OMRFollow this procedure if you have already addressed the reason why a dictation is pended to your practice. The following steps will walk you thorough the process of changing a dictation status from “Pended” to “Transcribed” and how to send that dictation to OMR.

Note:

This process requires eMon Version 7 or higher.

FIGURE 1: To get to this screen, you will need to log into eMon. Go to the Dictation tab > Select the correct dictation > select properties.

1. Double Click on the Dictation you wish to edit. The Properties screen will be displayed. Above is an example of a Properties screen.

7

2. Assuming you have made all the edits you need to make, are ready to change the status to “Transcribed”, and then to send it along to OMR, follow these steps:

a. Change the Status of the dictation to “Transcribed” and click on the box at the bottom of the Properties screen that says “Save/Distribute”. This will produce the screen below.

b. Click on the first box (Distribute transcription to institution) as shown.

FIGURE 2: You will get to this screen when you select save/distribute from the properties screen.

c. Finally, click “OK” - This completes the process for changing a status of a dictation to “Transcribed” within eMon and subsequently sending that dictation on to OMR.

Note:

Please do not hesitate to contact the BIDMC eScription Team if you have any questions about these work instructions.

8

Correcting Patient Name and MRN errors in eMonOccasionally, the Practice Administrator must correct an error related to a patient name or MRN within eMon. This could happen for a number of reasons; a simple spelling error by a transcriptionist, or perhaps a clinician incorrectly entered an MRN. These edits are easily and quickly made within eMon and then the record is sent to OMR manually by the practice administrator to signature by the provider. It is important to note that manually sending the dictation is a very important step, in that otherwise, the dictation will not be submitted to OMR.Error Notification: Notification of these errors will most likely appear in your pended list. An example of how these might appear is show in the extracted “Pended Note” below

9

In the above screen-shot, the Practice Administrator is being told by the transcriptionist that the patient demographic registration data was not available to identify the patient by MRN .Always turn to the dictation first to see if you can gather this data from the clinician first-hand. The procedure below walks you through the process for listening to a dictation from eMon.

Note:

Headphones are required for this process.

Procedure for Listening to a Dictation from eMon1 . Log on to eMon.2 . Access the dictation from the “Dictation” tab by searching for it using one

of several parameters – by speaker, by dictation number, etc. depending on what data is currently known about the dictation. To do this, simply enter in the data known and click “Search”.

10

3. Double-Click on the dictation to reveal the “Properties” screen.4. Click on the “Edit Document” button at the bottom of this screen.

5. The text of the note will appear. Finally, click the “Audio-play” button. The button looks like an audio speaker. Note: There will be a slight delay as the audio dictation is accessed.

6. Listen to the audio and document correct patient name and/or number if possible.

7 . Note: When the audio is playing, you can use the “Audio Slide” to access specific portions of the audio dictation. This can save you time if you need something towards the end of an audio dictation.

If you were able to get the information you were looking for, continue with the procedure below, which outlines searching for the patient within eMon and making the necessary edits. If you are still unable to determine the correct medical record number or identify the patient (i.e. patient info was not dictated or it was too difficult to hear), please refer to the document section entitled “Advanced Trouble-Shooting within eMon and CCC”.

P R O C E D U R E F O R F I N D I N G A N D C O R R E C T I N G T H E P A T I E N T I N E M O N

1. Log on to eMon.2. Access the dictation in question using Step#2 above as a guideline.3. Double-Click on the dictation to reveal the “Properties” screen.4. Click on the “Advanced” button to the right of the Patient Name. 5. Select “Select an Existing Patient to Assign to this Dictation”.6. Enter MRN, in “Medical Record Number” field and select search.7. Highlight the record by clicking on it.8. Select “Save” and “Finish”.9. This will bring you back to the Properties screen.10. Change the Status from “Pending” to “Transcribed” using the drop down

box.11. Click Save and Distribute.12. Click Distribute to Institution.

Working the Pended List The primary role of the Practice Administrator is to manage the Pended List for his/her assigned practice and/or eScription speakers. The pended dictations should be reviewed at least once daily to ensure that dictated notes are making it into OMR in a timely fashion.There are two ways that the list of pended dictations can be displayed to the practice administrator. This is through the “Dictation” tab and through the “Messages” tab in eMon. The locations of these tabs are shown below:

11

Using the Dictation Tab to access the pended dictation list1. Click on the Dictation Tab2. If previously entered search data is on the screen, click the “Clear” button. 3. Enter the dictating clinician name or Speaker Code.4. After the search criteria have been entered, click on the “Search” button to

start the search. The search results will be displayed in the bottom half of the screen.

Using the Messages Tab to access the pended dictation list1.Click on the “Messages” Tab2.The Screen automatically shows you all BIDMC pended dictations. Notice at the bottom of the screen there is a field called “Business Entity” Filter.3.Find the appropriate practice in the breakout listings and click on “Refresh”. This will produce a list of the pended dictations for only that chosen practice. Note: Only one practice may be selected.4.There is also an Owner Filter. Click the drop down button and Select BIDMC. You will only see dictations that you need to process.

12

3. Highlight a dictation and double-click to open the “Properties” screen. 4. A pended dictation is one that requires your input to send it to OMR. When

a dictation is “Pended”, the practice administrator should look to the “Pending Note” field to identify the reason the dictation is pended. The location of this field is shown below:

13

For the most part, the “Pended Note” is manually entered by a transcriptionist. The pending note should clearly point out the issue causing this dictation to pend. In the example above, the dictation was pended because it had one blank word in the note.

IMPORTANT: Edit dictations that have pending notes prefaced with “Pend to BIDMC” only. Do not edit notes that have pending notes prefaced with Pend to NTS.The table below shows the most likely reasons why a dictation may become pended. Further, included is a general set of steps needed to fix them. Most pended dictations fall into one of five categories; Blank Dictation, Service Date not Dictated, Blanks in dictation, CC not known, or HL-7 Unknown.More detailed procedures on how to fix some of the issues below are available from the BIDMC eScription Team if required.

14

Pended Reason How to Fix / CommentsBlank Dictation(entire note is blank)

Listen to the dictation to make sure it is blank. Change Status from Pending to Transcribed and click Save. Do not Delete.

Blank in a Note (just a word or 3)

Often there is a word that was not understood properly by the voice recognition system or by the transcriptionists. Practices differ in their approach to these. Some options include:1. Listen to the dictation from eMon and try to determine the blank word. Depending on the relationship between the Admin and the Clinician, make the correction in Emon . Then change the status to “Transcribed” and “Save/Distribute” it.2. Most common: Send the dictation to OMR with the blanks and let the clinicians correct the note for themselves prior to signing the note. You can send up to 3 blanks.

ID Unknown The practice admin should listen to the dictation and see if the clinician says the number or name of the patient in the dictation. If the clinician does not state the name or MRN, look at the dictation by clicking Edit Document, obtain any pertinent information from the note, i.e., gender, age etc. Then look at the clinician’s schedule in OMR to try to match the information with a MRN.

Wrong Entity Code entered If the speaker enters an incorrect entity (practice) code into the phone, it will have to be corrected. Listen to the note and change the entity code to the correct value. Change the dictation status from “Pended” to “Transcribed”, and then “Save/Distribute” it.

Speaker enters wrong ID If the speaker enters an incorrect speaker code, it will have to be corrected. Listen to the note and change the speaker code, by selecting the correct clinician from the drop down menu. Then “Save/Distribute” it.

Service Date not Dictated Determine the correct service date for this patient in OMR. Then enter the value in the “Service Date Field” on the properties window. The easiest way is to review the provider's schedule around the time of the dictation. Send dictation to OMR.

Multiple Dictations or Addendums on one eScription ID

Send the dictation job id to the transcription account manager to have the dictation split into two jobs.

Check Addressee or CC data Verify address data in eMon.If addressee is not in Emon then listen to the dictation to get the name of the referring clinician. Go to the Portal and look up the name and address in Find A Doc. Add the new clinician in the CC field. Change the status to “Transcribed”, then “Save/Distribute" it.

Wrong Worktype If a speaker enters an incorrect worktype, correct the worktype from the drop down menu, change the status to “Transcribed”, then “Save/Distribute” it. Note: Because the worktype has an impact on the dictation depending upon the associated template, consult the BIDMC eScription Team for Support.

OMR Exception Report Overview Transcriptions sent from eMon to OMR that do not successfully transfer into OMR are listed in the “OMR Exceptions Report.” This report should be run weekly so that the failed dictations transfer can be corrected. Even though eMon might show that a dictation was sent to OMR, there still may be reasons why the dictation did not make it into the patient’s medical record. The goal

15

of this task is to be able to run the OMR Exception Report and have no records listed.

Procedure for Running the OMR Exception Report1. Enter your CCC key to access the Clinical Information System (AKA

CCC/OMR).2. Select OMR option. (If you have the screen labeled “Transcription Options”

when you enter OMR, choose Option 8.)3. The screen will ask you if you want to continue with a previous patient,

press return to enter past this prompt.4. Choose “Option 3, Management Options”5. Choose “Option 10, eScription Processing”6. Choose “Option 3, Reports”7. Enter “from date”. Typically, you will choose a date that includes the

previous month. Date shortcuts are available. (i.e. 14 days ago = “T-14)8. Enter “thru date”. Enter “T” for today or use date shortcuts as shown

above.9. Enter “E” for the error report. (Note: Choosing anything other than “E”

here, will result in a very long report – essentially showing everything that gets sent to OMR from eScription from the very beginning.)

10. Enter “4” to select sort by service/location.11. Enter “Y” at the “Specify service/location option.12. A list of all the services appears on the screen. Enter the number

corresponding to your practice (i.e. “13” for General Medicine / Primary Care).

13. A list of all the practices with those services appears. Select your site or department from the list and press “Enter”.

14. Enter “Y” to print the report. (This makes it easier to work with in EMON).

16

Errors: This section of the report will tell you ‘why’ the eScription record was rejected by OMR. These errors are explained in more detail below.The most useful fields in the report are the MRN, Date of Dictation and the dictating clinician.Please confirm all values in Emon before changes are made.

Common Errors on the OMR Exception Report and how to fix them

1. NAME MISMATCH – This error occurs when the name coming over from the eScription side doesn’t match the name associated to the MRN within CCC. Resolution – Log into CCC. Enter the MRN and pull up the patient’s name. Go to Emon, pull up the dictation and click on Properties. Click Edit Data. This will open up the place where you will copy and paste The name from CCC to Emon. Copy and paste the last name and first Name separately. Click Save and Distribute.

Contact esupport for the following errors:

2. UNIT# NOT FOUND – This happens when the wrong MRN is entered or the patient’s information was not sent to eScription to be matched to the dictation. This most commonly happens when a letter is sent to a patient who either did not have an appointment or hasn’t been seen in some time. Resolution - Find the patient in OMR and enter the correct name and the medical record

number in the eMon patient record, then save and distribute the dictation to OMR.

3. DUP DOC – (Duplicate Document Number) This error will be seen when a file is sent more than once to OMR. This usually happens when a change is made in eMon and then the file is over to OMR. If OMR is still detecting an error then the file will remain on the report and this message will appear.

4. NOT AUTH OMR – If you see this error on the OMR Exceptions Report, it means that there is an OMR technical setup issue for an eScription speaker. Resolution - Please consult with the BIDMC eScription Team for assistance if you run

into any of these.5. PROV NOT FOUND - If you see this error on the OMR Exceptions Report, it means that

there is an OMR technical setup issue for an eScription speaker. Resolution - Please consult with the BIDMC eScription Team for assistance if you run

into any of these.

Clinician InformationMaintenance of Active Speaker Lists for your EntityTo start each implementation, we ask the practice to provide us with a complete listing of clinicians who will dictate. This includes, when

17

appropriate, Doctors, RNs, residents, etc. This comprehensive speaker list is loaded into the system and each clinician is “Activated”.

As new clinicians join or leave your practice - after Go-Live, the need will arise when a speaker must be added to the list and be “Activated” within the eScription system.

We require that we are given a two week notice on new additions to your speaker population. Understandably, we know that sometimes this can not be given so we will work to get your additional speakers in as quickly as possible in the event of a last minute addition or change needed. We ask that all such requests are emailed to esupport@caregroup.hardvard.edu for review. These requests must include the following:

New Speaker Request1. First Name:2. (Middle Initial):3. Last Name:4. Suffix (i.e. MD, NP, etc):5. Resident, Fellow or Attending:6. Pager number if Resident or Fellow:7. BIDMC CCC provider code:8. Specialty:9. Business Entity (Location):

18

eScription General Guidelines for Dictation

1. Use your own code when you dictate, even if you are dictating for someone else. The system is tailored carefully to each speaker’s

voice, so it needs to know who is speaking.

2. Say your full name at the beginning of each dictation. It is not necessary to spell your name or say the address of your clinic. The system already has this information.

3. Restrict each dictation to a single encounter with a single patient. Please use the number 5

key on your telephone keypad to indicate that you are moving on to another dictation. You may

also hang up if you are finished dictating.

4. Use verbal punctuations. Especially “comma” and “period”.

5. Say section headings. For example, “Medications” or “History+Physical”.

6. Say important formatting directives. For example, “New Paragraph”.

7. Say “number” when enumerating lists. For example, “Number One” or “Next Number”.

8. Dictate reports sections in the order they are to be typed.

9. When you pause, press the “pause” key or remain silent.

10. It is best to use the same telephone channel (handset and phone line) for all dictations. Using a cell phone is prohibited because of voice clarity and call drop-out.

19

Phone InstructionseScription Dictation System

<Site Name>

1. Dial (617) 632-8580 (Internal:120) to access the dictation systemAudible prompts will guide you through the following steps:

2. Enter the three digit clinic ID# for your dictation location:

<Site Name> : <Code>3. Enter your five digit provider ID#

________________4. Enter the 2 digit work type corresponding to the

dictation: 10: Progress Note 11: Initial Note 91: Telephone Note 92: Patient Correspondence 93: Other Correspondence (to a referring

Doctor)5. Enter the seven digit patient medical record

number.If you make a mistake, press “*” to re-enter the number, or “**” to return to the beginning of the dialogue.

Start by providing the following header information.

o Your nameo Clinic nameo Patient nameo Patient Medical Record Number

o Date of visit Record your dictation after the tone starting

with the Date of Service End your dictation by saying ‘End of

Dictation’ There is NO need to SPELL PATIENT NAMES

Play Record/overwrite Rewind 5 seconds

Pause Begin new Dictation Record from End

Forward 5 Rewind to Disconnect Seconds Beginning

Change Help n/a Priority

1 2 3

4 5 6

9

#* 0

87

To dictate multiple reports, press “5” and re-enter the work type and next medical record number. (Re-routes to Step#4 above)

At the end of dictation, hang up or press “9” to confirm your dictation was recorded.

To Mark a Dictation as STAT, hit the “*” key prior to starting the dictation.

Appendix

Practice Administrators eScription Questions and AnswersAdvanced Troubleshooting

Q1: Dr. Smith cannot find a note for his patient. I have looked in eMon and there is nothing pending for him or any of my doctors. Where is this note and how do I locate it for him?

A1: This can be a tricky issue to address because although it is unlikely, there is a possibility that Dr. Smith never dictated this note. This is a common error for a busy clinician. If you are certain that is was dictated, be sure to run your OMR Exceptions Report in this instance to make sure that the note wasn’t rejected for some reason on the OMR side. If you still can’t find the note, lastly search for all notes that Dr. Smith did for the same approx. date range and look for an MRN that is close to the one of the patient in question as this might be related to a mistaken keyed MRN on the part of the clinician.

Q2: Dr. Jones asks for the volume of his overall dictations. He wants to know in hours and minutes, how much he has dictated in the past 2 weeks.

A2: This data is very easy to provide for the doctor. Go to the “Dictation” tab in eMon and enter in the search criteria as defined; his/her name, dictated from the date range in question. The search result screen will show you the elapsed time the “Search” and “Clear” buttons, as shown below.

(In the example above, 9 notes were entered, adding up to 53 minutes and 38 seconds.)

Q3: Dr. Hughes realized AFTER he hung the phone up that he forgot to enter a note as a STAT note – using the “*” key. He quickly called me and asked if I could do it after the fact? I went into eMon and saw that the status of the note was already in "Checked out for Editing” status. Is it too late to mark it STAT?

A3: Yes. These types of changes can only be made before the note has actually been “Checked out for editing” or “Checked out for transcription”. You may contact esupport for assistance with this problem.

Q4: I have always been confused as to the difference between the statuses of “Checked out for Editing” and “Checked out for Transcription”. Can you please explain the differences?

A4: Whether or note a note goes into “Checked out for editing” vs. “Checked out for transcription” is based on whether or not the speaker entering the note is qualified on the voice recognizer. A new speaker on eScription (not qualified) dictates notes that are sent directly to a transcriptionist to type up. Hence, the status of these notes will be “Checked out for transcription”. However, notes from a speaker that has been using eScription for some time (i.e. qualified) will go into the voice recognition system and the software will generate a draft document. This draft note will have to be sent to a transcriptionist as well, but this time it will only need to be edited. Hence the status of these notes will be “Checked out for editing”.

eScription Hardware and Software SpecificationsVersion: 9

Emon and Handiscript Only