OpenDoorDocs.org

Urban Ministries of Wake County

Open Door Clinic

Support & Guidance for EMR

AllScripts’ MyWay, active 7/9/2012

Updated: July, 2012
Gary Greenberg, MD
(email )

Background

Demos & Learning Videos

Interactive Lessons

Reference guides

Background

    It’s an interesting question as to why we embarked on this challenging task to initiate an electronic medical There are several steps.

    1) Blue Cross & Blue Shield of NC initiated a program, ("North Carolina Program to Advance Technology for Health" or NCPATH) to update documentation at all unaffiliated clinics throughout the state.

    The partnership also engaged AllScripts, who contributed a huge discount of the licensing and implementation costs.  

    A press conference in announcing the program was widely covered including a special promotional video. The ‘poster child’ of the grateful doctor was Gary Greenberg, MD from the Open Door Clinic.

    The plan for these clinics is to relieve them of 85% of these costs, in order to qualify them for Federal bonuses for "Meaningful Use" credits, provided to each participating doctor.

    2) The BCBSNC Foundation recognized that the Free Clinics of NC would be unable to participate without supplemental support, and have supplemented their longstanding support of the state-wide Association of Free Clinics for years, and awarded the necessary funding to cover the residual 15% of the fees.

    3) The Association knew that even with full license subsidies, that most Free Clinics would be unable to manage the necessary infrastructure for its installation. In late May, a grant for more than $10k for each participating clinic was announced.

    4) The Open Door Clinic program began a bold timeline in May, leading to a Go-Live date of 7/9/12. During the steps leading to the activation of the software, hundreds of process & clinical modifications were required to free up the time, manpower and equipment to begin the process.

    5) During the week of July 9-13, the clinic began full-time (though only half-volume), entirely electronic use of the new system. AllScripts MyWay support team included up to 3 professionals throughout the week.and  

    6) Updates of the progress can be expected to show mixed success, and occasional reports will be made here.

 

 

Demos & Learning Videos

    The AllScripts MyWay is demo’d for promotional services at You-Tube and the infommercial is quite useful to see as an overview:

    If you don’t interrupt it (I DO recommend doing so, including viewing it at full magnification) it’ll last at least 14.5 minutes. Since the last third is all about billing, you can legitimately quit at 10 minutes.

    Since the initial sentence is that it’s fine-tuned to tablet / "pen-based" use, i need to specify that we aren’t doing that process. We have a whole corral of desktops & laptops ready for all to use, and they’re a vast improvement on what we’ve previously relied upon.

    Don’t be discouraged that the demo process moves too quickly to ever hope to learn. It does present a great (if overly enthusiastic!) view of the documentation process.

    If you want a less rushed approach, there’s this other video, with similar content, that’s 13+ minutes, and is almost entirely about provider charting:

    While you’re watching, let me remind you that we’re *NOT* (yet) having our notes audited or scored for CPT reliability, and we’re *NOT* expecting our visit notes to use the multi-click approach for recording history or physical elements.

    In fact, so far, ALL we’re using is JUST the uppermost free-text data entry field ("Notes"). You can see this appear in HPI (but it isn’t ever used) at minute 5:32 during the promotional video.

    There’s a similar "Notes" area in each tab ("Hx", "PE", "Dx", "Rx" & "Plan"). It’s there that we’re collecting the note from your visit.

    We don’t want to freeze anybody from learning or using the point-&-click documentation options, but these can be supplemental frustration until you learn the system’s flow. Trust me, it’s enough to get used to as is.

    Also, the section of the chart called "Hx" is actually Significant Past History (not the current note). The quick-talking demo-guy mentions that it’ll hopefully be completed in advance (from prior visits) and this is also true for us, since we’re trying to enter ANYthing that’s pertinent from our prior "Pink Sheet" which is also photographically scanned into the new record for your review.

    So, "Hx" will include a whole harvest from the prior document:

    • Active chronic problems (but not episodes of sore-throat, etc)
    • Significant prior hospitalizations (usually coded as inactive history or surgical)
    • Previously listed allergies (environmental or meds)
    • Significant family & social history
    • Most recent vaccines
    • (soon!) most recent cancer screenings

    "Dx" does require matching your impressions to the provided list, and selection of a diagnosis from the categories provided. We’ll show you how to search for other items that seem unavailable.

    It’s here that users first begin to admire the "adaptive" nature of the program (at least on their 2nd use!)… since the easiest diagnoses to find are:

    • the ones that YOU most frequently select as a provider
    • the most recent ones that were assigned to the particular patient you’re seeing.

    Unfortunately, there’s no most-frequent ANYthing when you’re 1st starting, so the frustration of searching is more striking while you’re still a raw newbie.

    Missing from the video are some important tools we’ll need to master (and you’ll work on at your supervised initial clinical sessions):

    • initiating referrals (including radiology)
    • ordering in-house activities (in the "SP" = "Services Provided" tab)
    • triggering send-out ("SO" or Services Ordered) lab requests
    • managing incoming messages, aimed to the provider seeing a patient, eg when new lab results arrives before a visit.

    Also, our use of the "Rx" tab is essentially nil. It took only a brief analysis to recognize that we were more effective, accurate and efficient in our present method of having each provider evaluate & approve (or modify) the "Medication Profile" generated from the Pharmacy’s own records. We will continue to hand in that document (yes, on PAPER!) to the pharmacy each visit, and then scan it into the electronic record for review. Remember, there’ll be a new one generated at the next visit, so the scanning if mainly for posterity & between-visit review.

    "Plan" is perhaps the most complex tab, and will need to be reviewed at your hands-on lesson at your next clinic assignment.

 

 

Interactive Lessons:

    As part of our staff’s learning the system, we were given access to the AllScripts Academy, a rather dull, but systematic introduction to many aspects of the program’s function.

    After repeated requests to specify how many other training logins we were allowed to assign to volunteers, it became clear that they have no actual policy, but don’t object to "reuse" of the logins we’ve already used.

    For the providers who wish to go through the step by step process of how the program wants data to be entered (for all of the tabs in a Progress Note), I’d welcome your request to share my (or Angela’s) login to AllScripts Academy. Please simply email me so we can share the logins we’ve been using.

    Topics I would recommend:

    • Provider Train Program (this is the category of lessons for clinicians)
      • Navigate and Use General Features of Allscripts MyWay (5 min)
      • Create a Message (5 min)
      • Navigate the Full Note Composer (FNC) (46 min)
      • Chart a Patient Note Session I (31 min)
      • Chart a Patient Note Session II (52 min)
      • Chart a Patient Note Session III (1 hr 10 min)
      • Chart a Patient Note Session IV (48 min)
      • Chart a Patient Note Session V (59 min)
      • Chart a Patient Note Session VI (17 min)

     

 

 

Reference Guides

 

 

During the training, several of our 2-hour conference calls were recorded, and the recordings were made available for re-play and reference. Java is required, and they are presented only in real-time.

  • Clinician Training Call (2h 3 min): Download/ play from here

Additionally, when we’d accomplished the implementation for a particular process, the software commands and instructive fields were combined into several composite reference sheets or short PowerPoints. These are all linked and described below.

  • How to join the Client Connect, AllScripts’ User Group for questions: an Acrobat File: MyWay Self Help tool chart.pdf
  • Quick reference guide for call messages, a PowerPoint document: Creating a call message.pptx
  • Vaccine Administration: step by step guide for logging vaccine administration and their inventory information, a PowerPoint document: Vaccine QRG.pptx
  • A quick reference guide for document generation (like mail-merged letters and instructions) quick reference guide for document generation, a PowerPoint document: Doc Gen QRG.pptx
  • A guide for the provider to enter a patient referral from the plan tab in Full Note Composer: an Acrobat File: Entering Patient Referral from FNC.pdf
  • A workflow guide for nurses, showing the details of their “clicks” from arrival to handing off the note to the provider: an Acrobat File: Nurse Workflow.pdf