Quick Orders

Carla Guzic, PharmD

Hastings Indian Medical Center

Tahlequah, OK

Quick Orders

• Why?– Standardization– Provider ease of use when ordering– Pharmacy staff satisfaction– Accuracy– Data requirement

• Days supply, chronic vs. prn, etc

Naming Conventions

ORZ Generic and nursing text quick orders

LRZ Laboratory quick orders

RAZ Radiology quick orders

PSOZ Outpatient medication quick orders

PSJZ Inpatient medication quick orders

PSJIZ IV quick orders

FHZ Diet quick orders

GRMCZ Consult quick orders

PSOZM Pharmacy Order Menus

Naming Conventions

• Order sets– ORZSET

• To be used when mixing data elements

– LRZSET (Lab)– RAZSET (Radiology)

Naming Conventions

• Order menus– PSOZM Antibiotics/Antivirals– PSOZM Behavioral Health Meds– PSOZM Diabetes– PSOZM Quick Orders (A-B)– PSOZM Quick Orders (T-Z)

Outpatient Medication Quick Order

Outpatient Medication Quick Order

Outpatient Medication Quick Order

ALWAYS YES

Dose and Route: Setup by Pharmacy in the PDM

Special Med Quick Orders

• Clinic medications– Pick up: Clinic– Status: DONE– Not dispensed by pharmacy

• Outside Medications (ORX)

• Never Auto-accept Quick Order Medications

Quick Orders-Inpatient Medications

Quick Orders-Inpatient Medications

Unique to inpatient

Quick Orders-IV Meds

Quick Orders-IV Meds

Order Menu Setup

• Actions– Add (enter row and column)– Remove– Edit– Toggle Display (what provider sees vs. actual order)– Assign to User– Order Dialogs (can create quick orders)– Select New Menu

Creating an Order Menu

• Standard naming convention (i.e PSOZM)

• Built on the RPMS side

• Viewed on the EHR side

Order Sets

• For meds commonly used together– Albuterol and normal saline nebulized– H.pylori treatment– Multivitamins and iron

• Labs– Cardiac enzymes (CPK and Troponin)– Lipid Panel

• Can combine elements– Lab with Radiology

Quick Order Wizard

• Can create quick orders

• Cannot add to Order Menu

MAKING TEMPLATES

Carla Guzic, PharmD

Hastings Indian Medical Center

Tahlequah, OK

EHR Templates

• Create New Templates: for users with access to personal templates

• Shared Templates: for Clinical Coordinators

• Edit Template Fields: for users setup in the TIU FIELD EDITOR CLASS

Template Editor

Personal

Shared

New

Create a New Template

Type

The Boilerplate

Objects vs.Template Fields

• Template Boilerplate Panel:– Data Objects are surrounded by straight

brackets• such as |ALLERGIES| • Must be made locally• Brings information into template

– Template fields are surrounded by curly brackets

• Such as {FLD:WWH INR RESULTS}• Prompts author to input information into template

Some advice…..

• Apply: Changes will not be saved when leaving the Template Editor dialog if this button is not used

• Modify/Build Templates in your Personal Templates

• Limit access to who can modify Shared Templates and/or Template Fields

Tools Menu:

• Edit Template Fields– Edit Existing Template Fields– Use with CAUTION!! Many fields are used in various

different templates

• IMPORT/EXPORT Templates– Sites can send/receive templates to other sites– Data objects are local– Template fields can be shared– To IMPORT a template a file should be loaded on the

computer and then placed into the Template Editor

Template Fields

Old Fields

Create New

Template Fields

• EHR installation includes many template fields

• Also, made locally, PLUS• Imported into template editor whenever

any new templates are imported (national and/or other local facilities)

• Don’t modify template fields, unless certain that they are specific to only one template

Template Fields

Types of

Fields

Creating a Template Field• Click on the New Button

• Enter a Unique Template Field Name (can be up to 60 characters long)

• Select the desired Template Field Type

Creating a Template Field (continued)

• The right side of the template field editor will change depending on which template field type is specified.

Template Fields

• Edit Box: used for short responses

• Combo Box: drop-down list of choices

• Button: contains a label that changes when you click it

• Check Boxes: can fill with a check mark, may have >1 choice

• Radio Button: call fill with a mark, but only allows one choice

• Date: Contains the month and year; enter the year first followed by the month.

• Number: contains a numeric value

• Hyperlink: sends user to an on-line location

• Word Processing: used for long responses

• Text: Used for instruction; data isn’t stored in the progress note. Users cannot edit this field

Edit Box Fields

• Field length: size of the edit box in the template (up to 70 characters)

• Text length: how much text can be typed into the field (up to 240 characters)

• Default Text: what always pops up for the author

Date Field

Number Fields

Word Processing Field

Hyperlink

Text Field

• Text fields provide a mechanism for embedding predefined (non-editable) text into the dialog

• Predefined Text is entered in the Items property of the field

Common Field Properties

• Most template fields share several of the following common properties:– Inactive– Required– Indent Field– Indent Text– Notes

Required Field

REQUIRED

Finishing

Formatting Options

Template IMPORT/EXPORT Utility

• Allows templates to be shared from facility to facility

• Location of action: under TOOLS menu in the Template Editor

Template Import/Export(Continued)

• Users can EXPORT their templates into documents (with .txml extension) that can be sent to other systems/sites/users via e-mail

• Local patient data objects cannot be exported with this template import/export function

• However, template fields will be added when importing a template• Can also import the basics of a word document (not fancy

formatting, etc)

Data Objects

• Display established data already in EHR

• Only programmers may create/copy objects

• Every patch brings in more data objects

• Objects can be created for any data that exists in RPMS– Single answer (i.e. patient sex)– Group of answers (i.e. active medications)

Using Dialogs

Template Making“Words of Advice”

• EHR is a documentation tool

• Templates should………– Be customized to the user– Provide appropriate documentation

• Medical/legal necessities• Billing/coding requirements• Communicate necessary details to other providers

Template Making“Words of Advice”

• Minimize:– Clicks/keystrokes for the provider– Duplication of documentation

• Maximize:– Standardization of templates with respects to

mandatory information (i.e. similar layout)– Flexibility– Capture of needed data (i.e. data objects)– Customizability

Template Making“Words of Advice”

• Match Templates to the Workflow– Nursing/Triage– Providers

• Collecting data– Physical Exam/Review of Systems

• Recording data• Assessments• Plans

– Pharmacy Staff• DUE parameters, lab monitoring requirements, allergy

assessments, etc.

Template Making“Words of Advice”

• Provider skill level– Poor keyboarding/computer skills– Excellent keyboarding/computer skills– Using the mouse vs. using the keyboard– Voice recognition

• Style of Templates– A lot of free text vs. minimal free text with

template driven responses

• Use objects to pull in information!

New Terminology

• POE: Provider Order Entry• CAC: Clinical Applications Coordinator• GUI: Graphical User Interface (the EHR side)• OE/RR: Order Entry/Results Reporting• VueCentric: Proprietary name of the GUI that

permits data exchange with RPMS• PIMS: Patient Information Management System

(scheduling software for RPMS/EHR compatibility)

New Terminology

• TIU: Text Integration Utilities. Required on the RPMS side to provide notes in the EHR

• Vista: Veterans Health Information System & Technology Architecture. (equivalent to our RPMS)

• CPRS: Computerized Patient Record System (VA’s equivalent to our EHR)

Provider Training

• Handout given– Step 1: Select Patient– Step 2: Select Visit– Step 3: Enter New Medication Order– Complex Orders– Renew Medication Orders– Dealing with Hold Orders– Changing Medication Orders– Discontinuing Medication Orders

Provider Training

• Quick Orders– Update as necessary

• Templates– Make the templates specific for their

specialties

• Discuss CII Orders (Paper Only)

Additional Information:

• WebEX Training Center:

• https://ihs-training.webex.com/

• Click on “Recorded Sessions” under the “Attend a Session” menu on the left:

Other Resources

• List-serv: www.ihs.gov/CIO/EHR/index.cfm?module=listserv

• General Information: http://www.ihs.gov/CIO/EHR/index.cfm– EHR Clinical Overview– EHR Technical Overview– EHR National TIU Templates

• Also can be from local resources

– EHR Presentations