Health Information Systems and the Electronic Health Record
Overview
This is the second activity of the Scavenger Hunt Series. It has been developed to follow after successful completion of the Level I Scavenger Hunt: EHR Orientation. In this Scavenger Hunt, students learn basic and intermediate level skills that are essential to being successful when using an electronic health record in the classroom, lab or simulation, and at clinical. These skills will then become relevant in professional practice when usability is applied to the accuracy and proficiency in their role.
Prerequisites
Review the Neehr Perfect Student Guide
Completion of Neehr Perfect Level I Scavenger Hunt: EHR Orientation
Student instructions
If you have questions about this activity, please contact your instructor for assistance.
Document your answers directly on this document as you complete the activity. When you are finished, save this document and upload it to your Learning Management System (LMS). If you have any questions about submitting your work to your LMS, please contact your instructor.
Screen displays are provided as a guide and some data (e.g. dates and times) may vary.
Objectives
Demonstrate the technical skills necessary to access an EHR system to troubleshoot and resolve access difficulties.
Apply various filter options to select a patient chart.
Identify how to change personal preferences.
Demonstrate how to create a preferred notes list.
Evaluate examples of usability in the EHR system.
Glossary
Skill is defined as something that you learn and demonstrate competently. A skill is often a physical task and refers to the ability to use your acquired knowledge to effectively execute or complete a task. For example, when you learned how to use Microsoft Word, you acquired a new skill. Learning how to use the Neehr Perfect EHR will be a skill as well.
Usability is explained by the Agency for Healthcare Research and Quality (AHRQ) as being important in promoting the widespread adoption of EHRs and the “meaningful use” of EHRs. Usability describes how easy it is for users to accurately and efficiently accomplish a task while using a system. If an EHR is missing critical functionalities, there is poor reliability of the software. Likewise, if an EHR has an inadequate match between interface features, users’ ability to conduct their work in a concise and efficient manner will be impacted. The EHR is used by many different health care professionals, from physicians and nurses to clinical managers and administrators. To effectively accommodate different agendas, preferences can be set and modifications can be made in the EHR by the user.
The activity
In the Level I Scavenger Hunt: EHR Orientation activity, you learned about navigational tools, optimizing personal preferences and changing default settings. If you did not change the default settings as instructed in Level I, please do so now. This activity will pick up where Level I left off, adding to your knowledge of electronic health records. The following excerpt is from the Level I Scavenger Hunt; ensure you have completed the following steps to establish the appropriate user settings required for obtaining the correct answers.
User settings (from Level I Scavenger Hunt)
Go to www.neehrperfect.com and sign in to the Neehr Perfect EHR by entering your username and password in the login section.
Select the “Start Neehr Perfect EHR” button.
Select the EHR icon and enter your username and password.
Once the EHR launches, the patient selection window will appear. Search for and open Frank Stratten’s chart by starting to type the last name of the patient: Stratten. The middle name of the patient chart may include the name of your school or program. Double click on the patient name or, once the patient name is highlighted/selected, click OK to open the patient record.
Font size
The default font size for all new user accounts is 8 point. If you are accessing the EHR on a laptop or desktop computer, you may want to enlarge the font. To do so, follow the steps below.
Edit menu > Preferences > Fonts: Changing font size to 12 or 14 is recommended for desktops, PCs and Macs. An 8-point font is recommended for handheld devices and tablets. Note: after changing the font size, you may need to adjust the layout of your Cover Sheet windows so that all sections are visible.
Date ranges
Date ranges are a filter setting to allow you to view data within a specified time frame. The default setting in the EHR is two days. Change this so that historical data can easily be seen. To do so, follow the steps below.
Tools menu > Options > General tab and select Date Range Defaults: Change the inpatient and outpatient lab days to 999. Change Appointments and Visits Start date to Today – 999 and the Stop date as Today + 90. Select OK to close the Date Range Defaults on Cover Sheet window.
While still in Options, change one more default setting. Click on the Reports tab and select Set All Reports. Changing this personal setting will allow you to view items on the Reports tab of a patient chart without changing the search settings every time. Change the Start Date to 01/01/2010, leave the Stop Date at today’s date (the default date), and change the Max to 999.
Click OK and then Yes when the confirmation box appears. Click OK again to close the Options window. Go to File > Select New Patient to be brought back to the Patient Selection list.
Patient Selection
Think of the Patient Selection list as a file cabinet. When you open a file cabinet, there are paper files in alphabetical order. The patient Selection list is the same. It is a list of files, or patient charts in an electronic format, listed in alphabetical order.
This screen display is only to be used as an example. Displays may vary among different sites and you may not see the data on your monitor exactly as shown here.
The Patient Selection screen contains many options for filtering patient charts in the EHR to make it easier to locate and open the correct chart. The key filter options are:
Selecting a patient chart with a unique last name
Selecting a new patient
Selecting a patient chart with a non-unique last name
Selecting a patient chart using filters for location or social security number
Skill: Selecting and opening a patient chart with a unique last name
When you first log into the EHR, you see the list labeled (Patients) All Patients. (If you are already in a patient chart and need to get back to the Patient Selection screen, click on the File menu located in the upper left-hand corner of the screen. Click on Select New Patient.) Your patient list will contain charts of various patients with different names, and some patients with similar names or the same name.
Scroll down until you see Vivian Armand’s chart. Vivian has a unique name (a different name than any other patient in the list). Click once with your mouse on Vivian’s name to highlight and select the patient. Click OK.
Once in the chart, locate Vivian Armand’s social security number and date of birth.
Where is Vivian’s social security number and date of birth located in her chart? *Write down Vivian Armand’s social security number. It will be used in a later question.
Upper left corner
Upper right corner
Lower left corner
Lower right corner
Skill: Selecting a new patient
To select a new patient, you must go to the Patient Selection list. Open the File menu located in the upper left-hand corner of the screen. Click on Select New Patient. *TIP: Do not click on the “X” in the upper right corner of the chart. It will close the EHR completely.
What patient name is listed at the top of the patient list?
Ulfat Aftab
Vivian Armand
Frank Stratten
Evan Albertson
Skill: Selecting a patient chart with a non-unique last name (2 or more charts with the same last name)
On the Patient Selection screen, look at the list labeled (Patients) All Patients. In the search box type in Smith, for Paula Smith. All charts in your patient list with the last name of Smith will be pulled to the top. Scroll down the patient list until you find the chart of Paula Smith. Click once on the name and it will become highlighted in blue. Then click OK.
If you receive a pop-up that states “A patient has not been selected,” the EHR is wanting you to confirm that of all of the Smith charts listed, Paula Smith’s chart is the one you want to access.
Click OK to close the pop-up box if you receive one. Click and highlight Paula Smith one more time. Then click OK. You are now in Paula Smith’s chart.
What is Paula’s listed allergy?
Paula is allergic to Ampicillin
Paula is allergic to Penicillin
Paula is allergic to latex
Paula has no known allergies
Return to the Patient Selection screen. Open the File menu located in the upper left-hand corner of the screen. Click on Select New Patient.
Skill: Exploring patient chart filters by location
At the Patient Selection screen, find the Patient List filter options in the upper left-hand corner. (Note: if you are using dual monitors, please run the EHR in the primary monitor in order to view the filter options.)
Which of the following is NOT an available filtering option?
Ward
Provider
Clinic
Address
Select the option to filter patient charts by Ward. Click on the various Ward names. As you are going through each ward, locate the ward that Paula Smith is on.
Which ward did you find Paula Smith admitted to?
Emergency
NICU
Inpatient
Long Term Care
Skill: Selecting a patient using the SSN number
While on this Patient Selection screen, click on the filtering option All. In the patient search box, type the full social security number (all 9 digits without dashes) of Vivian Armand (from question #1).
What happened when you searched for the patient using the social security number?
Taken to the chart of Frank Stratten
Taken directly to Vivian Armand
Taken to the patient Paula Smith
Nothing happened
Optimizing the views in the EHR
Apply Skill: Recognizing data fields displayed on the Cover Sheet
Select Frank Stratten from the patient list and open his chart. (If you are in another chart, go to File > Select New Patient to return to the patient list). In Frank’s chart, go to the Cover Sheet tab.
The Cover Sheet is time sensitive, showing the most current information that has been entered into the patient chart. Think of it as a snapshot of what is going on with the patient, or the last time documentation was placed in the chart.
On the Cover Sheet are boxes (or sections) that correspond with the data being pulled from the various documentation areas of the chart.
Which of the following includes ALL correctly named boxes that appear on the Cover Sheet?
Active Problems, Allergies/Adverse reactions, Postings, Active Medications, Clinical Reminders, Recent Lab Results, Vitals, Appointments/Visits/Admissions.
Problems, Allergies/adverse reactions, Clinical Reminders, Vitals, Postings, Labs, Vitals, Appointments/Visits/Admissions.
Active Problems, Allergies/adverse reactions, Posting, Clinical Reminders, Vitals, Postings, Recent labs, Vital Signs/Measurements.
Problems, Allergies, Posting, Clinical Reminders, Vitals, Postings, Recent labs, Appointments.
Apply Skill: Utilizing EHR functions in an efficient manner
Everything on the Cover Sheet is important to a user in some specific way. Postings contain critical patient-related information to alert healthcare professionals. Postings are displayed in a box on the Cover Sheet. Specific notes – when they are documented on the Notes tab - can be designed to display as Postings on the Cover Sheet. The Postings button is visible on all tabs of the EHR and is always located in the upper right corner of the window.
In Frank Stratten’s chart, click on the Orders tab. Scroll down to the medication orders and locate the order for Heparin. Heparin is used to keep blood thin. Lab results related to this medication are PT, PTT and the INR. The user could go to the Labs tab, or back to the Cover Sheet, or go to the Notes tab to look up the lab values. However, the Postings button is a shortcut for the user. While still on the Orders tab, click on the Postings button in the upper right corner. Then click on the Lab Results Note v2. This is the entire lab note that is documented on the Notes tab. Scroll down the note until you locate the Coagulation Panel.
Which of the following are the correct values for the panel?
PT 10, INR 1.0, PTT 20
PT 28, INR 1.0, PTT 11
PT 11, INR 1.0, PTT 26
PT 12, INR 1.0, PTT 28
Close the note by clicking on the X in the upper right corner or clicking Close at the bottom right of the window. Then click Close again to close the Patient Postings box.
Troubleshooting tip: I don’t see the Close button. Depending on the font size you use and the size of your device’s screen, you may not see the ‘Close’ button in the bottom right of the pop-up window. Simply move the box up to see the Close button. Place your cursor on the blue bar along the top of the window. Left-click on the blue bar and hold your left button on your mouse. While holding your left mouse button, move (or drag) the window up enough so that you can see the Close button. Release the button on your mouse and click on the Close button.
Skill: Changing the “view” of the data displayed in the EHR
The “View” menu lists options the user can take to view the EHR data differently. On each tab the View menu lists different options. The EHR only lists options that are available to the user for that tab. For example, if on the Meds tab, the View options are only applicable to the actions and options available on the Meds tab.
While still on the Orders tab of Mr. Stratten’s chart, notice that the default setting for viewing the orders is all Active orders and they are listed by the Service area.
Click on the View menu at the top of the chart and then Custom Order View. You will see that there are many different ways to change the display of the orders. Select the PHARMACY category on the right-side of the window (Service/Section) and click OK.
What types of orders are listed once you select to view pharmacy only orders?
All patient orders
Infusion and Labs
Infusion, Inpatient and Outpatient meds
Infusion and Consults
Go back to the View menu and click on Return to Default View.
Skill: Resizing and moving borders in the EHR
Go to the Cover Sheet. Resize the individual data boxes on the Cover Sheet. You might think of these as vertical and horizontal dividing lines on the Cover Sheet.
To do this, hover your cursor over the box border, for example, between Active Medications and Clinical Reminders. When you see a double-sided arrow appear on the border, left-click and hold your mouse to drag the border left and right on the screen. Then place the cursor on a horizontal line, between the Active Medications and Active Problems. Click and drag the border up and down on the screen.
Which 2 boxes are side-by-side on the Cover Sheet?
Allergies and Recent Lab Results
Recent Lab Results and Vitals
Notes and Postings
Active Problems and Vitals
Stay on the Cover Sheet.
Skill: The single-click and the double-click in the EHR
To open a report and review the data while on the Cover Sheet, hover your cursor over one of the data elements (an active problem, active medication, an allergy, postings, lab, vitals, or a clinical reminder). A single click on any one of these elements will open a new window. The new window will have additional information. Try it!
In other areas of the patient chart, a double-click is required. Go to the Orders tab of Mr. Stratten’s chart. Locate the order, ‘Vital signs per protocol. ‘
Single click on the order: Vital signs per protocol. What happened?
The order was discontinued
The order was “flagged” red
The order was highlighted in blue
Nothing
On the same order, Vital signs per protocol, do a double-click. What details are you looking at? **Hint: The type of detail is identified at the top of the window.
Chart Details
Order Details
Note Details
Physician Details
Leave this window open. Do not click on Close yet.
Skill: Resizing and moving windows in the EHR
Continuing with the same window open for the vital signs, place your cursor on the blue bar along the top of the window. While holding the left mouse button, drag the window to the far left side of your screen. Close the window by clicking on the X in the upper right corner or clicking Close at the bottom right of the window. Then double click on the order to re-open the window.
Does the order window re-open on the far left-hand side of the screen and look the same as when you closed it?
Yes, it does
Yes, it does but the font is very small
No, it opened in the middle of the screen
I can’t tell
With the same window open, place your cursor along the upper left-hand corner of the window border. Once you see a double arrow, left-click on the window border and hold your left button on your mouse. Drag the window border towards the lower right side of the chart screen to make the window smaller. Then drag the window border up to the left to make the window larger.
What is the purpose of being able to make a window different sizes or being able to move it around?
To make the font (text) larger
To make the font (text) smaller
For a user’s personal preference
To make the information easier to find in the chart
Close the window.
Skill: Resizing note template windows in the EHR
Go to the Notes tab and click on New Note. If you receive a “Location for Current Activities” pop-up similar to the one below (dates/times may vary), select the most recent Family Clinic appointment under Clinic Appointment Visits and click OK.
Because this chart has a consult ordered for Physical Therapy, the system automatically places a reminder to the healthcare provider that a note is needed to resolve the consult order. The Physical Therapist has not completed the consult and written the note; therefore, the status for the physical therapy order is “pending.” The consult order will not be completed in this activity.
To continue past the consult note reminder, at ‘Progress Note Title,’ begin typing in History (for Health History). This keyword search works similar to an internet search. Searching using the word ‘History’ will bring up fewer titles than if searching using ‘Health’. All notes with ‘History’ in the title will pull to the top of the notes list. Scroll through the results and choose the note titled NURS: HEALTH HISTORY. Click on the title to highlight it.
A “Not a consult title” pop-up box will appear. Click on Yes to continue with this NURS: HEALTH HISTORY title and not complete a consult. Leave the date, time and author of the note as it appears. You will select your instructor as the co-signer. Click OK.
The template will load in a new window (called the Boilerplate text). Expand the template window to full screen by using the maximize button located in the upper right-hand corner of the template window. YOU WILL NOT BE DOCUMENTING IN THIS NOTE.
Leave the template maximized, click on Cancel to exit out of the template window. A Cancel Dialogue Processing message asking if you are sure you want to cancel without saving will pop up. Click on Yes. Notice how the note title is still listed on the left side of the screen under “New Note in Progress.” Although the note is ‘Cancelled’ it is not ‘Closed.’
Skill: A shortcut to opening a new note
From this ‘Cancelled’ state you can open a new note by selecting Change on the upper-right side of your Notes tab screen (just below the greyed out “Flag” and “Remote Data”). This is considered a short-cut for the user. Click on Change.
This time in the search field type in Accounting (for ACCOUNTING OF DISCLOSURES). Because there are fewer notes associated with the word ‘Accounting’ the ACCOUNTING OF DISCLOSURES note automatically populates the search field. Click OK. If you receive a “Not a consult title” pop-up box again, please select Yes and then OK to proceed and open the template window. Notice that this template window opened as maximized (the same size as when you closed the NURS: HEALTH HISTORY template).
The EHR system recognizes what system defaults you are replacing with your preferences. Some of these preferences you have to manually indicate, such as font size and lab dates. Other preferences are recognized by the EHR based on your user ID and interactions with the system.
Which of the following explains why the ACCOUNTING OF DISCLOSURES note opened at the same size as the note closed just before it, NURS: HEALTH HISTORY?
The EHR system made an assumption based on your history.
The EHR system only does this with certain notes.
The EHR system recognized the user preference.
The EHR system recognized the font preference.
Click on Cancel to exit out of the window. You will receive a Cancel Dialogue Processing message again asking if you are sure you want to cancel without saving. Click on Yes.
The ACCOUNTING OF DISCLOSURE note is still “open.’ The note is listed as a New Note in Progress on the left side of the screen. Remember that it is cancelled and not closed.
Troubleshooting tip: What if the note opens too small and I can’t maximize it?
Click on the Change button one more time. This time in the search field type in Surg (for NURS: MED-SURG PROGRESS NOTE). Because there are fewer notes associated with the word ‘Surg’, the NURS: MED-SURG PROGRESS NOTE will appear near the top of the list. Highlight the note and click OK. If you receive a “Not a consult title” pop-up box again, please select Yes and then OK to proceed and open the template window.
Notice that this template window opens very small in the upper left corner of the screen and you cannot access a maximize button. A few select notes in this EHR will appear like this the first time that you access it.
Place your cursor along the lower right-hand corner of the window border. Once you see a double arrow, left-click on the window border and drag the window border out to the far lower right side of the chart screen to make the window larger – you will need to do this in small increments – approximately a half inch to an inch at a time. This type of note does not have a maximize button so you will continue using this drag method until the template is opened to the size you want.
When you have completed sizing this note, click on the Finish button. The next time you open this particular note, it will open to the size you just selected. Try it out!
Skill: Using the Menus
Now return to the cancelled note, NURS: MED-SURG PROGRESS NOTE. On the left side of the screen, under New Note in Progress, click on the note to highlight it, if it’s not highlighted in blue already. Then click the Action menu and select the option to Delete Progress Note. A ‘Confirm Deletion’ box will appear. When asked to delete this progress note, click on Yes.
Many actions, or steps, can be accomplished in more than one way in the EHR. A right-click on an item within the chart will provide the same list of options as doing a single left-click on a menu. This allows users to perform actions based on their comfort level, their preference, or what is most efficient. Try it out!
Right click on one of the notes listed on the left side under “All signed notes.” Look at the options that are available for this note. Now click on the View menu. Notice that the list of options is similar. They won’t be exactly the same because of the functional design of the EHR. *Note: The options listed in each menu will vary slightly based on the chart tab you are on and the user’s security level.
Go to the Orders tab. Right-click on the first order listed. Write down the options available. Then do a single left-click on the Action menu.
Which of the following options is listed when performing a right-click on an order and a left-click on the Action menu?
Change
Flag
Unflag
Hold
The Help menu in this EHR is similar to any other program Help menu. The menu contains information and step-by-step instructions about how to use, access and locate items in the EHR, how to perform a task or complete work flow. Click on the Help menu at the top of the chart and then select Contents and click on the Index tab. In the search box (1.) type in Flag. In the lower box, labeled 2., “flag” will be highlighted. Click on the Display button. Choose the topic, Patient Record Flags Overview, and click on Display again. Read about Patient Record Flags (PRF).
Then click on the Index tab and read about ‘Flagging an Order.’ When finished with the Help menu, close the window by clicking on the X in the upper right corner or clicking Cancel at the bottom right of the window.
Select the appropriate word(s) to complete this sentence. “With CPRS, you can flag an order to draw attention to it. When an order is flagged, the order will appear on the Orders tab with a red box in the service column. The order will remain flagged until someone ___________ the order. CPRS records the name of the person who flagged the order and the date and time that it was flagged.”
Reads
Signs
Unflags
Approves
Skill: Create a “favorite” notes list
Go to the Tools menu and select Options. On the next screen, select the Notes tab and select Document Titles. In the Document Titles search box on the left, enter “Accounting” and select ACCOUNTING OF DISCLOSURES to add to your preferred list, or “favorites.” Highlight the note and click Add. This will move the selected document title to the box on the right. Repeat these steps with the notes HIPAA ACKNOWLEDGEMENT (ELECTRONIC) and CODE STATUS.
When you have completed adding the note titles, click Save Changes, then OK. Then OK again to leave the Options box. Now when you go to the Notes tab and click on New Note the notes you selected as favorites will appear at the top of the list. (Note: if you receive a “Location for Current Activities” pop-up after selecting New Note, select the most recent Family Clinic appointment under Clinic Appointment Visits and click OK.)
Skill: Editing the “favorite” notes list
Now go back and remove one of the titles you just added. Tools > Options > Notes > Document Titles. Highlight the three notes you added previously from the list on the right and click on Remove. Click on Save Changes and OK. Exit from the Options box.
Exit the chart
Open the top File menu in the upper left hand corner of the screen. Select Exit.
Submit your work
Document your answers directly on this document as you complete the activity. When you are finished, save this document and upload it to your Learning Management System (LMS). If you have any questions about submitting your work to your LMS, please contact your instructor.
References
International Organization for Standardization. Retrieved July 31, 2013 from http://www.iso.org/iso/home.html
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