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eIVF™ Patient Explorer Flowsheet • 1

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eIVF Flowsheets eIVF Flowsheets ...................................................................................................................................................1

Flowsheet ..........................................................................................................................................................2 From Patient Explorer ................................................................................................................................2 Creating a New Flowsheet .........................................................................................................................2

Creating a Cycle Order ......................................................................................................................................4 Cycle Order Tab .........................................................................................................................................4 Medical Notes and Prescription Tab ..........................................................................................................4 Ordering Prescriptions for a Cycle .............................................................................................................7 Lab Notes Tab............................................................................................................................................8 Transfer Notes Tab ....................................................................................................................................9 Alerts and Checks Tab .............................................................................................................................10

Creating an Individualized Patient Flowsheet..................................................................................................12 Advanced Customization of Patient Flowsheet ........................................................................................15 Converting a Flowsheet............................................................................................................................18 Flowsheet Icons .......................................................................................................................................19

Flowsheet Lab Management ...........................................................................................................................26 Order Blood Test ......................................................................................................................................26 Order Ultrasound......................................................................................................................................26

Flowsheet Physician Review ...........................................................................................................................28 Continuing a Medication...........................................................................................................................28 Stopping a Medication..............................................................................................................................29 Decision Taken.........................................................................................................................................29

Flowsheet Review Notification.........................................................................................................................31 Notify Patient of Results and Instructions.................................................................................................31

Flowsheet Cycle Outcomes.............................................................................................................................33



Flowsheet In eIVF, Patient Chart is often referred to as Patient Explorer.

From Patient Explorer Click on flowsheet icon. Two icons are available:

• One flowsheet icon is in the horizontal format under event notes. This icon will bring you directly to the patient’s most recent flowsheet.

• The other flowsheet icon, in vertical format on the left of the screen, will bring you to a list of all the patient’s current and past flowsheets..

Creating a New Flowsheet • In order to create a new flowsheet for a patient, the patient may not have a

cycle open. In order to add a new flowsheet you must either cancel current flowsheet or select cycle outcome.

• Click on flowsheet icon in vertical column under patient explorer.

Flowsheet icon vertical column

Flowsheet icon horizontal row



• The following screen will appear. • Click on new button to create a new flowsheet.

New

eIVF™ Patient Explorer Creating a Cycle Order • 4


Creating a Cycle Order Cycle Order Tab

• The Cycle order tab will appear first unless the patient has alerts. • Enter the planned cycle, treatment center, cycle number (ex. 1), fertility

center doctor, treatment coordinator, blood work monitoring, and ultrasound monitoring from drop down menus.

• Anesthesia consult information may also be entered on this page if desired.

• General notes section is used to import most recent cycle treatment plan. • Single click in “General Note” box and then click on icon to import most

recent treatment plan. • Treatment Plan question screen will appear. If you select “Yes”, most recent

treatment plan ordered for referenced patient will be embedded in text field. (Now you can easily complete cycle order)

• If “No” is selected, system will automatically prompt to Click N Build, so you may generate your plan.

Medical Notes and Prescription Tab

• Next, select Medical notes prescription tab. • Select treatment cycle template. All relevant Treatment Protocols and

Instructions will appear in a “folder” form in Treatment/Protocol Instruction screen. Template will vary per site according to protocols desired.

• Selection of treatment cycle will attach all relevant protocols to your flowsheet.

Cycle order tab

General Notes



• Select save when completed.

From this screen, you may also change cycle medications or flowsheet. • Cycle medications may be added (+), deleted (x), or inserted by using the

icons under Labs and Medications. • Add function will add medication to the last row under SrNo. • Insert function can be used to insert med between desired elements. For

example, in the screen above you would place your cursor on line 5 (GnRH Lupron/Antagon) to insert a medication above this line.

• Delete function will delete line your cursor is on. • Cycle medications may also be changed in regards to dosage or duration. • Double click on Drug Icon listed under Rx Signature. • The following screen will appear. Adjust medication dosage or duration as

desired from drop down menus.

Select template desired

Save Add, delete, or insert meds



Changing Flowsheet from Medical Notes and Prescription Tab

• Click once on flowsheet icon to load flowsheet screen.

• Medication dosage and duration may also be changed from the flowsheet screen.

• For example, if you wanted patient to stop birth control pills two days earlier, place cursor on desired stop date under ocp.

• Left click and then right click to bring up option to stop medication. Select stop medication.

• To change medication dosage, double click on medication and alter dosage as noted on the previous page.

Flowsheet Icon



Ordering Prescriptions for a Cycle • Once a cycle has been ordered and saved a prescription order may be

created from the Cycle Order Tab.

• Click on Prescription Tab and the following screen will appear.

• Select template name from drop down box. Template names and medications desired for treatment plan are customized per site protocol.

• Cycle Reference is a number assigned by data base and can not be changed.

Prescriptions

Select template name from drop down box

Cycle Reference

Cycle Start Date

Preferred Pharmacy

Save



• Select cycle start date from drop down menu. • Select Preferred Pharmacy from drop down menu. • When complete, select save to send prescription to pharmacy.

Lab Notes Tab Lab Notes Tab is used to capture information regarding the egg retrieval, semen source, fertilization plan, and embryo source plan. This tab is extremely crucial in

linking donor oocyte or donor sperm to a recipient.

Egg Retrieval: • Select planned retrieval procedure (VOR, LOR, GIFT). • Select oocycte source. • Select source identification. For donor egg cycles, this may be a unique code

such as J221. • Select maximum number of embryos to transfer. • Check box if plan to reduce # at UT per protocol.

Semen:

• Select semen source. • Select donor ID if applicable. • Select semen condition (fresh or frozen) • Select semen collection method.

Fertilization: • Select fertilization (Normal or ICSI). • Check appropriate box if blastocyst transfer is recommended. • Check appropriate box if assisted hatching is recommended.

Embryo:

• Select embryo source. • Select source identification of embryo if applicable. • Select frozen embryo location . • Document vial availability. • Document maximum number of embryos to transfer. • Select Save.

Lab Notes Tab Enter egg

retrieval data

Enter semen data

Enter fertilization data

Enter embryo data Save



Transfer Notes Tab Transfer Notes Tab was designed to allow documentation of mock transfer or transfer plan.

• Enter uterus size. • Enter uterus position. • Enter catheter type. • Check to indicate ultra sound and tech required. • Check to indicate stylette required. • Enter any special instructions. • Save.



Alerts and Checks Tab The alerts and checks tab was designed to encompass compliances or checklists for each type of cycle plan. Most centers have required blood tests, injection classes and consents that must be completed prior to preceding with a treatment cycle. This screen is customizable and captures those requirements.

• Alerts/Checks are noted at the top half of the screen. • Compliances are noted at the bottom half of the screen.

Alerts/Checks

Compliance



• Compliances are noted by:

1. Parameter 2. Validity 3. Duration 4. Period 5. Remarks 6. Waived 7. Waiver Comments 8. Waived Time

• Compliances that are completed or waived will appear in blue text. • Compliances that are not completed will appear in red text. • Compliances that are expired will appear in orange text. • The compliances are linked to applicable tests through eIVF. • Therefore, if a blood test or a consent is completed elsewhere in the medical

record, the compliance parameter will automatically change to blue text to indicate completion of the objective.

• To Waive a Compliance: 1. Double click on parameter desired to waive. 2. The following screen will display.

3. Check Compliance waived box. 4. Waived Date and Time will automatically populate. 5. Enter any applicable waiver comments. 6. Select Save. 7. The compliance will change from red text to blue.

Check Compliance waived

Waiver Comments

Save

eIVF™ Patient Explorer Creating an Individualized Patient Flowsheet • 12


Creating an Individualized Patient Flowsheet

• Now that a cycle plan has been ordered, a patient needs an individualized flowsheet to begin treatment.

• When a patient contacts the office to start treatment, the reference date is noted on the flowsheet.

• Reference date may also be the same as LMP if desired. • The purpose of the reference date is to indicate a start date for the

flowsheet. • Enter reference date and press tab button on keyboard to automatically

format dates on left column of screen. If tab button is not selected, the dates will not appear.

• Then enter patient’s LMP and press tab button on keyboard. LMP will appear on TE (treatment event) on flowsheet.

• For this particular example, the patient will take OCP’s first according to treatment protocol.

• Place cursor on row for date desired to start OCP. (Ex. 1/29/06) • Right click to pull up following screen. Select “Event Based Medication” and

move mouse to select “OCP”.

Reference Date

Dates autoformat according to reference date entered.



• OCP’s will appear in flow sheet for number of days specified by protocol.

• According to example protocol, patient to begin Lupron three days after last OCP. Highlight row with date desired to start Lupron and right click.

• Select “Event Based Medication” and Lupron.

Cursor on row with date desired

OCP’s per treatment protocol



• Lupron will appear in the flowsheet for days specified by protocol. • Next, the patient is to begin stimulation drugs two days after Lupron start.

• Stimulation meds will appear in the flowsheet for number of days specified by protocol. (Editing medication length and dosage will be discussed in another section)

• Stim Date will also need to be entered in field next to LMP. Press tab on keyboard. Stim dates will appear on left hand side of screen.

• The next event for this treatment cycle example would be trigger for egg retrieval.

• Place the cursor on the row for date desired to trigger and right click. • Select “Event Based Medication” and “Trigger”. • Also select “Mark Event as Trigger” (This is under the option for Event Based

Medication)

Lupron per treatment protocol

Stim meds per protocol

Enter stim date and press tab

Stim dates numbered



• This protocol is formatted to import HCG injection, retrieval date, and embryo transfer when trigger is selected.

• Next check box to select patient for retrieval and check box to select patient for transfer. This will add patient to retrieval and transfer lists under embryology tab.

This example for a treatment cycle was exactly according to the written protocol. Of course, this rarely happens and patients often need to have their drug dosage changed or length of time on a particular medication changed according to level of response.

Advanced Customization of Patient Flowsheet

Changing dose of medication: • Double click on date and medication desired. • Screen will appear to allow you to adjust that particular medication name,

strength, and identifier tab on flowsheet. • There is also the option to select prescription duration. For example, you

want to change the patients dosage of Gonal-f to 300 U for the next two days.

• Prescription duration may also include daily, every alternate day, every third day, etc.

• Click save when changes complete.

Retrieval

Embryo Transfer

HCG

Select patient for retrieval

Select patient for ET



Stopping Medication:

• Right click on medication and date desired to bring up box as demonstrated below.

• Select Stop Medication. • The option is given to delete all meds after specified day. If no is selected,

only that day’s medication will be deleted from the flowsheet.



Adding Medication:

• To add medication double click on date and medication column desired. The same screen as shown for section regarding changing dose of medication will appear. Select medication and dosage. Save.

• In order to add a medication that is not currently in a column header in the flowsheet, click on flowsheet format icon.

• Flowsheet format icon will bring you to the following screen. • Please refer back to Medical Notes and Prescriptions Tab instructions

regarding adding, deleting, or inserting medication.

Flowsheet format Icon



Converting a Flowsheet

• Converting a patient’s cycle from one type to another may occasionally be necessary.

• Highlight current cycle and select convert button. • The following screen will appear. In the example below, an IVF cycle is being

converted to an FSH/IUI cycle due to poor response. • Go to planned cycle drop down box and select IUI.

• Select Save when done. Cycle description will now read IUI.

Convert

Planned cycle



Flowsheet Icons

Lab Schedule Icon allows you to schedule labs directly from flowsheet.

• Single click on icon to bring up the following screen. • Double click on lab desired and schedule will appear.

Lab Schedule Icon



• Next, select time desired and double click on the appropriate line. • The following screen will appear.

• Blood tests may be scheduled together. • Open folder to show ordered blood tests. • Check both lab tests (estradiol and progesterone) if desired. • Select Save.

Phone Call Icon allows you to document a phone call directly from the flowsheet.

Open folder

Check both lab tests if desired

Phone Call Icon



• Single click on phone call icon to display the following screen. • Select who initiated phone call and enter message content. • Check to attach to patient chart. • Click Save when phone call documentation complete.

Flowsheet Format Icon allows you to change medications and access writing a prescription for patient’s cycle directly from flowsheet.

Attach to patient chart

Message content

Initiated by

Save

Flowsheet format Icon



• Flowsheet format icon will bring you to the following screen. • Please refer back to Medical Notes and Prescriptions Tab instructions

regarding adding, deleting, or inserting medication or writing a prescription for a patient’s cycle.

Medication Plan Icon allows you to change patient’s protocol template directly from flowsheet.

Medication Plan Icon



• The following screen will appear. • Change assignment of medications and events as desired.

Billing Icon allows you to access billing transaction directly from flowsheet.

Billing Icon



• The following billing transaction screen will appear.

Documents Icon allows you to access documents directly from flowsheet.

Documents Icon



• The following screen will appear. • Select Template Category from drop down box and Template Name

to create documentation.

eIVF™ Patient Explorer Flowsheet Lab Management • 26


Flowsheet Lab Management Cycle related labs may be ordered from a patient’s flowsheet. This is the recommended way to order labs in the system because it will ensure a link between the lab and the flowsheet. Once the lab is resulted and released, it will immediately populate the flowsheet.

Order Blood Test

1. View desired blood test column. 2. Single click to check lab (order) for date desired. 3. In this example, Estradiol and LH were ordered. 4. Select Save.

Order Ultrasound

Cycle related ultrasounds may be ordered from a patient’s flowsheet. This is the recommended way to order ultrasounds in the system because it will ensure a link between the ultrasound and the flowsheet. Once the ultrasound is resulted, the follicle sizes and endometrial lining thickness will immediately populate the flowsheet.

Check to order Lab

eIVF™ Patient Explorer Flowsheet Lab Management • 27


1. View Ultrasound column. 2. Single click to check lab (order) for date desired. 3. Select Save.

Check to order Lab

Ultrasound Column

eIVF™ Patient Explorer Flowsheet Physician Review • 28


Flowsheet Physician Review

Continuing a Medication When reviewing a flowsheet, it is not uncommon to keep a patient on the same drug regimen for several more days.

1. Single click on cell with desired med and hit enter. 2. The medication and dose listed on the previous day will appear. 3. If the drug is to be continued for several days, click on the cell with

desired med and drag down to highlight multiple lines as shown in the example below.

4. Hit enter and the following screen should appear.



Stopping a Medication

When reviewing a flowsheet, it is often necessary to stop a medication.

1. Select the cell of the desired med, on the desired date, and click on the stop medication icon.

2. The medication should not show after that date.

Decision Taken

After the physician adjusts medications and orders lab, the flowsheet needs to be marked as reviewed.

GF 225 u appears for two more days

Stop Medication



• Right click to display the following screen. • Select decision taken.

• The date, time, and user who made the decision will be documented under the flowsheet review log.

• To view this documentation, select General tab. • Click on Flowsheet Review Log. • The following screen will display.

Decision Taken

eIVF™ Patient Explorer Flowsheet Review Notification • 31


Flowsheet Review Notification

Notify Patient of Results and Instructions After the physician reviews the flowsheet the patient is contacted by the nurse to review results and instructions.

• Right click to display the following screen. • Select patient communicated.

• The date, time, and user who communicated the information will be documented under the flowsheet review log.

• To view this documentation, select General tab. • Click on Flowsheet Review Log. • The following screen will display.

Patient Communicated

eIVF™ Patient Explorer Flowsheet Review Notification • 32


eIVF™ Patient Explorer Flowsheet Cycle Outcomes • 33


Flowsheet Cycle Outcomes Upon completion of a treatment cycle, outcome needs to be documented in several stages.

This screen will assist you in easily documenting fields required by SART.

• From flowsheet, select Outcomes Tab. • The following fields are available for documentation:

1. Cycle Status 2. Cancellation Date 3. Cycle Outcome 4. Pregnancy Test 5. Pregnancy Outcome 6. Number of Gestations 7. Number of Fetal heart beats 8. Reduction 9. Reduction Date 10. Number of fetal heart rates Post Reduction 11. Number Born 12. Outcome Date 13. Birth Outcome 14. Sex 15. Weight 16. Birth Defects 17. Notes

• Select Save.

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