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1 eclinicalworks Clinician Training Guide Outline I. Login II. Office Visit Screen III. Prepping for a Patient a. Patient Dashboard i. Viewing Past Appointments ii. Looking at Test Results b. Right Chart Panel (medical summary and patient histories) IV. Charting Workflow for Typical Appointment a. Overview of Progress Note Navigation b. Clinician HPI c. Review and Revise sections (Histories, Current Rx etc.) d. Examination e. Assessment f. Treatment i. Medication ii. Labs iii. Diagnostic Imaging iv. Referrals g. Immunizations h. Check-Out Sheet i. Next Appointment j. Locking Progress Note V. Looking Up a Patient Part I. Login Logging into eclinicalworks (ecw) Look for the ecw icon and double click to open the application Login with personal volunteer credentials Change Password: Go to File>Change Password My ecw username: My ecw Password: **Please contact Sarah Labriny if you have questions or concerns regarding eclinicalworks at CrossOver Healthcare Ministry: Sarah Labriny, EHR Coordinator slabriny@crossoverministry.org, x.124 Page 1 of 40
2 Part II. Office Visit Screen (Clinician Schedule) When clinicians login to eclinicalworks, it will open to the Office Visit Screen, which displays the clinician s appointment schedule for the day: [#1] Select the P radio button on the top left. [#2] Select your name from the drop down list of clinicians. Make sure that the Facility and Appt. time are set appropriately or nothing will appear in your schedule. Status [#6] Order of statuses: NUR, Ready for, SV (clinician), Done (clinician) Ready = patient is ready to be seen by clinician Change Status to SV (Start Visit) **NOTE: Clinicians can also access this Office Visit Screen by clicking on the S Jellybean located on the top right of the screen (the jellybean is the circle to the right of the S). This will be helpful when navigating back and forth between appointments: Visit types [#3] New Patients (NP), Physical (PHYS), Established Patient (ESTPT) Reason [#4] A general reason for the appointment that loads the template into the progress notes (e.g. PHYSICAL, PRIMARY CARE, WELL WOMAN EXAM). [#8] Double Click on the patient s name to enter the patient s chart. Visit status [#5] = Patient has arrived. = Patient checked out at front desk. = Patient has not checked in for appointment yet. [#7] Indicates that the nurse has taken vitals. Page 2 of 40
3 Part III. Prepping for a Patient Section A. Patient Dashboard Patient Language: Identify if patient needs a translator. If a translator is needed, please ask front office for an interpreter or use the language line (number found at Nurses Station). Labs: View Lab orders and results. See pg. 5 DI: View DI orders and results. See pg. 6 Encounters: View past progress notes. See pg. 4 Patient Docs: contains scans of hospitalization records, discharge papers, external test results etc. See pg. 6 Page 3 of 40
4 Viewing Past Appointments Click on Encounters in the Patient Dashboard (or the Encounters button in the Patient Hub). View the Progress Notes from past appointments by double clicking into the row of the appointment. View the locked progress note: Page 4 of 40
5 Finding Test Results Test results are generally in one of three places: 1. Labs 2. DI 3. Patient Documents You can access these sections through the Patient Dashboard in the Progress Note or through the Patient Hub (see Part V. of this guide). 1 Labs In Labs, a paperclip indicates that a result is present. Click on the paperclip to open up the results window. Received: Indicates whether we have received the lab result. Reviewed: Indicates whether the result has been reviewed by a staff clinician. View In-House Lab results by double clicking on the lab order and viewing the yellow row in the center of the screen. Find In-House Lab results recorded in the yellow Last Updated on line 2/18/19 (that is by the Sarah line that Labriny corresponds to that order). Page 5 of 40
6 2 DI (Diagnostic Imaging) The DI window functions the same as the Labs window. View results by clicking on the paperclips. However, oftentimes, DI results are scanned into our system and can be found in Patient Documents. 3 Patient Docs Patient Docs contains any documents pertaining to the patient that have been scanned into ecw (Hospitalization records, Discharge papers, Cardiology test results etc.). Check Patient Docs if you cannot find a test result in Labs or DI. Use arrows to navigate through pages. If there is a document in the folder, it will appear as a branch of that folder. Click on the document and it will appear in the viewer to the right. Use the scroll bar to view the rest of the results. Page 6 of 40
7 Section B. Right Chart Panel Right Chart Panel: Overview Tab Located in the Right Chart Panel (on the right side of the patient progress notes) is the Overview tab, which includes the patient s problem list, current medications, allergies, immunizations, and therapeutic injections. This tab is a useful and efficient way to view patient information without leaving the progress notes. Click on Overview in the Right Chart Panel The Problem List contains the patient s chronic conditions that have already been diagnosed. Click on Blue arrows to move problem list diagnosis over into today s progress notes. Scroll down to view Current Medication, Allergies, Immunizations, and Therapeutic Injections sections. Click on plus sign to display more details about the immunization. A minus Last sign Updated will appear on 2/18/19 by Sarah Labriny with bullet points detailing the date of the vaccine and which dose it was in the series. Page 7 of 40
8 Right Chart Panel: DRTLA Tab Located in the Right Chart Panel (on the right side of the patient progress notes) is the DRTLA tab, which stands for Documents, Referrals, Telephone Encounters, Labs, and Actions. This tab is a useful and efficient way to view both orders and results of patient labs, diagnostic images, and referrals without leaving the progress notes. Click on DRTLA in the Right Chart Panel Use the drop-down menu to select how far back you would like to view labs, diagnostic images, referrals etc. Date of lab order Pink paper clips mean that an electronic result has been received. Click on the pink paper clip to view lab results. (Same for Diagnostic Images) Scroll down to view Referrals section. Date referral was made in eclinicalworks Click on the reason for the referral to view the Outgoing Referral Window, where you will see a specialty field indicating what kind of specialist the patient has been referred to. Page 8 of 40
9 Right Chart Panel: History Tab Located in the Right Chart Panel (on the right side of the patient progress notes) is the History tab, which includes the Review medical, gynecological, surgical, family, and social histories. This tab is a useful and efficient way to view patient information without leaving the progress notes. Click on History in the Right Chart Panel Scroll down to view Social History. (Gyn History will appear as a separate section for female patients.) Page 9 of 40
10 Part IV. Charting Workflow for a Typical Appointment 1. Chief Complaint 2. HPI: Nurse Interview 3. Current Medication 4. Medical History 5. Allergies 6. *GYN History 7. *Surgical History 8. *Hospitalization History 9. *Family History 10. *Social History (2 folders) : Social History, General TOB/OB/Drugs 2. HPI: -Clinician HPI [if new patient then also fill out: -PHQ-2 -Sexual History] Review & Revise these sections 11. Vitals 14. (Treatment: Nurses place standing orders only) 15. Immunizations: Administer immunizations (Nurses only place the standing order immunization: flu shot.) 12. Examination 13. Assessment 14. Treatment 15. Immunizations: Order Immunizations * = only necessary to fill out for New Patient appointment 16. Next Appointment Page 10 of 40
11 Section A: Overview of Progress Note Navigation Definition: Progress Notes are the equivalent of a patient s paper chart for that appointment. 1. To enter the Progress Notes for a particular patient, double click on the patient s name from the Office Visit Screen (S Jellybean). 2. To open a section of the Progress Note, click on the corresponding blue hyperlink. The first Progress Note section that clinicians fill out (according to the What Do I Fill Out? chart above) is in HPI. 3. Page 11 of 40
12 Section B: HPI (History of Present Illness) 1. Click on the Notes box that corresponds to Complaint 1. * If no mini-template appears on the progress note, navigate to Clinician HPI on the left side of the screen and fill in those questions 2. This will open up a dialogue box in which you can free-text the Subjective of the SOAP note Free-text notes here Page 12 of 40
13 3. If the HPI question contains structured data, a new window with questions will appear. Click into the value field until a drop-down menu appears. Make your selection from the drop-down menu. Click into the Notes field to free-text additional notes about that question Section C: Review and Revise Sections While the nurse completes the following sections, the clinician is responsible for reviewing and revising them as necessary: Current Medication Medical History and Allergies GYN History Surgical History & Hospitalization Family History Social History Vitals Click on the blue hyperlinks on the Progress Notes to access these sections. Page 13 of 40
14 Once you open a hyperlink, you can access other sections of the Progress Note by clicking on the picture icons located at the top of the hyperlinked screens. Hover over the picture icons to see which sections they represent: Medical History & Allergies Current Medication Vitals Family History Social History Surgical History & Hospitalization 1 Current Medication (Review and Revise as needed) This section contains all medication the patient is supposed to be taking according to what was prescribed during their last visit. The nurse conducts medication reconciliation prior to the clinician interview with the patient. Page 14 of 40
15 Note: medication adherence questions are answered in the Nurse Interview in the Adherence area. Page 15 of 40
16 2 Medical History & Allergies (Review and Revise as needed) Add Medical History and Allergies as needed. To add an allergy, click the Add button. Then, free-text allergies into Agent/Substance field, and f in the type of reaction, type of allergy, and always mark the allergy as Active Check off NKDA if no known drug allergies. 3 GYN History (Review and Revise as needed) Use the blue hyperlink to access this section. Page 16 of 40
17 4 Surgical History & Hospitalization History Add Surgical and Hospitalization History as needed. Use the Add button to add a new field. 5 Family History (Review and Revise as needed) Use the blue hyperlink to access this section. 6 Social History (Review and Revise as needed) Use the blue hyperlink to access this section. Page 17 of 40
18 7 Vitals (Review and Revise as needed) Use the blue hyperlink to access this section. Page 18 of 40
19 Section D: Examination 1. Click the green arrows to populate the default setting for a normal observation into the Observation field or click directly into the Observation field to free-text notes. Page 19 of 40
20 Section E: Assessments Every part of the treatment plan in eclinicalworks must be associated with a diagnosis code. The purpose of the Assessments screen is to pull up diagnosis ICD-10 codes so that treatment can be attached to the diagnoses. Use this screen to 1. Pull-up existing diagnoses 2. Put in new Diagnosis codes 1 Pulling-Up Existing Diagnoses #1 Click on Previous Assessments radio button. *Note: To select an Assessment/Dx code from the (chronic) Problem List, click the Problem List button. #2 Select the diagnosis (single click). The Diagnosis will move into the Selected Assessments section outlined below. Page 20 of 40
21 2 Putting-In New Diagnoses #1 To search for a new assessment, ensure that you are assigning ICD-10 codes by checking the Use ICD10 box and type into the box on the left by wording of the assessment or by the code itself. Hit Enter on your keyboard. (DO NOT check the Real Time box.) #2 Select the diagnosis (single click). The Diagnosis will move into the Selected Assessments box outlined below. *Note: Clicking on blue diagnoses will open up a new window of questions about the diagnosis in order to narrow it down to the most specific ICD- 10 code. Problem List: Check off the box next to the ICD-10 code to add it to the Problem List (chronic conditions). NOTE: the box does NOT need to be checked off in order for the diagnosis to appear in today s notes. (Optional): Remove an assessment selected at this encounter by first clicking on the diagnosis in Selected Assessments and then the Remove button (Optional): Manage the patient s Problem List by clicking the Problem List button. Problems can be added or removed and added to Medical Hx from the Problem List window. If you see an ICD-9 code on a patient s problem list, YOU MUST UPDATE IT TO AN ICD-10 CODE! Add the ICD-10 code and then delete the ICD-9 code. Click X to save and exit back to the Progress Note. Page 21 of 40
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23 Section F: Treatment The Treatment screen is the main ordering hub for clinicians. From this screen, clinicians take treatment notes, order medication, labs, DI, and referrals. They also make notes about their treatment plan for the patient. eclinicalworks ties every order and note to a diagnosis (assessment). Therefore, it is important that you pay attention to the Assessment tabs. 1 Medication See separate handout Ordering Medication and e-prescribing. TYPE TREATMENT NOTES HERE Record treatment plan notes in the Clinical Notes section. Make sure you are on the correct Assessment tab before you start taking notes. 1 Medication [see separate guide on Ordering and eprescribing Medication in ecw ] Page 23 of 40
24 2 Ordering Labs (from the Treatment Screen) Lab Ordering Policy: ALL labs should be ordered as FUTURE ORDERS (even if the hope is that they can be done same day). The exception to this is that In-house orders that are being performed the same day should be put in as same day. 1. Click the Browse button next to Labs. 2. Select Future Orders Page 24 of 40
25 3. ***IMPORTANT: Check off the box next to the Assessment/Dx code for which you are ordering. 4. Change the search criteria from Starts with to Contains (this makes the lab easier to find). Page 25 of 40
26 5. Type the name of the lab into the Lookup field. Select the lab by clicking on it. Select the In- House option if one exists, otherwise: If you are at the Henrico Clinic: choose the Quioccasin option. If you are at the Cowardin Clinic: choose the Cowardin option. If both an In-House and location option exist, choose the In-House option. This will add the lab under Future Orders. Page 26 of 40
27 6. The ICD-CPT Association box will appear. Check off the box next to the ICD-10 code for which you are placing the order. (If applicable, check off more than one.) Then, press Ok. NOTE: You will only get this pop-up window when you place an In-House order. 7. Next, click on the date in the order date column and then use the calendar to select when you would like the patient to come back in for their lab. Check off the checkboxes next to the lab order to indicate: S for Stat; F for fasting. Page 27 of 40
28 8. Click Ok at the bottom to return to the Treatment screen. Page 28 of 40
29 3 Ordering Diagnostic Imaging 1. Click the Browse button next to Diagnostic Imaging. 2. ***IMPORTANT: Check off the box next to the Assessment/Dx code for which you are ordering. Page 29 of 40
30 3. Change the search criteria from Starts with to Contains (this makes the order easier to find). 4. Type the name of the DI into the Lookup field. All DI orders start with one of the following: Ultrasound, CT, MRI, X ray. Select the DI by clicking it: If you are at the Henrico Clinic: choose the Bon Secours option. If you are at the Cowardin Clinic: choose the HCA option. (The only In-House DI is Bladder Scan.) This will add the DI under Today s Orders. Page 30 of 40
31 5. Check off the box next to the ICD-10 code for which you are placing the order. (If applicable, check off more than one.) Then, press Ok. NOTE: The ICD CPT Association window below will pop up every time an order is placed that has a CPT code associated with it. Only In-House orders (labs, DI, procedures, and possibly immunizations/therapeutic injections) will have a CPT code associated with them. This means that you will only get this pop-up window when you place an In-House order. 6. Click Ok at the bottom to return to the Treatment screen. Page 31 of 40
32 4 Making Referrals 1. Fill out the back of the Check-Out Sheet as follows: If the referral is a Routine Check-Up for Ophthalmology, Dental, or Well Woman exam: DO NOT enter referral in eclinicalworks. Simply mark next to the corresponding Routine Check-Up on the Check-Out sheet. Otherwise: It must be entered in eclinicalworks (as seen below) AND marked on the check-out sheet. Use the CrossOver In- House and Outside Referral Availability document to determine whether the referral is CrossOver (In-House) or Access Now. This document will automatically load as the last tab in Internet Explorer From within the Treatment window, click Assessment/Diagnosis tab for which you are writing a referral. 3. Then click the Outgoing Referral button. (Note: Although the button is called Outgoing Referral, it is used to make both In-House CrossOver referrals and Access Now referrals.) Page 32 of 40
33 (*Fill out the Outgoing Referral form according to the red asterisks) Select the Specialty to which you are referring. 5. Select either Referrals, Cowardin or Referrals, Henrico in the Assigned To field according to the clinic at which you are serving. 6. Select the Priority of the referral in the corresponding field Under the Diagnosis/Reason tab, click the Add button and free-type the reason for referral and any special instructions. If your explanation is too long for the first dialog box, use the add button (7) to add more dialog boxes and finish your explanation in the next box(es). Otherwise, your description will get cut-off and the next provider will not be able to read your reason for the referral. 8. Click Structured Data button Double click in the Value column next to Referral System and a drop-down menu will appear. Select either In House Specialty at CrossOver OR Access Now. (Do not select bottom three options unless instructed to do so.) 10. Click the OK button. DO NOT CLICK SEND REFERRAL! 10. Page 33 of 40
34 Section G: Immunizations/Therapeutic Injections Ordering an Immunization is 2-step Process: Step 1 Check Immunization Hx to make sure that the patient has not already received the immunization. Step 2 Ordering Immunization 1 Checking immunization History Click Immunization on the Patient Dashboard to view the patient s Immunization History. **DO NOT ORDER IMMUNIZATIONS FROM THIS SCREEN.** 2 Ordering Immunizations and Therapeutic Injections 1. After you have checked the patient s Immunization/Th. Inj. History, Click the Immunizations or Therapeutic Injections link on the Progress Note under Plan : 2. Click Add next to Immunizations or Therapeutic Injections to add an order Page 34 of 40
35 3. Search for the order on the left side of the screen and select it 4. Select whether or not vaccination has been given in the past. 5. Associate it with an Assessment. 6. Press Ok. (The person who administers it will fill in the rest.) Section H: Check-Out Sheet Nurse visit: short min visit with the nursing team for BP check, INR, DEPO, etc. Indicate when you would like the patient to return for a follow-up. Lab visit: short min visit with the nursing team to drawn lab. *Indicate whether or not it is a fasting lab. Page 35 of 40
36 Section I: Next Appointment Enter the follow-up time frame in the Follow Up field or check the Follow N/A box if no follow up is needed. IMPORTANT: Scribes and Medical Students must enter the appropriate signature in the Follow Up field: Scribe signature: <Time Frame>, <Progress Note documented by scribe <First Name, Last Name>> Example: 2 weeks, Progress Note documented by scribe Sarah Labriny Medical Student signature: <Time Frame>, <Seen and Examined by First Name, Last Name> Example: 2 weeks, Seen and Examined by Sarah Labriny Residents: See How to Co-Sign and Lock Progress Notes guide to for finalizing Progress Notes Click Close Page 36 of 40
37 Section J: Locking the Progress Note Click the caret next to Lock. Then select Modern I Style. This will lock the note, closing editing capabilities. Documentation completed? Return to the schedule by clicking S jellybean Change Floor Status by clicking into Status field and selecting ALL DONE End of Shift The Provider must lock their progress notes! You may do this either at the end of your shift for all appointments (recommended) or as you finish with each patient 1. At the bottom of the Progress Note, select the arrow next to the Lock button 2. Select Lock Modern I Style 3. Upon prompt, click Yes to lock encounter 4. Return to S jellybean and repeat for each progress note Page 37 of 40
38 Part V. Looking up a Patient 1. Lookup Patient using Sherlock Allows user to search for a patient by last name, first name or by DOB Clicking here will take you to the Patient Hub 2. This will take you to the Patient Hub. In the Patient Hub, users can acces the same medical information they would find in the progress note including labs, DI, referrals, Patient Docs, Immunizations, Allergies and other sections described in the above guide in pages 3-6. (This is a secondary way to access those sections.) Page 38 of 40
39 Logout of ecw To logout of eclinicalworks, click the X in the top right corner of the eclinicalworks window. When prompted, click Yes to close the application. When you are finished with your shift, please close all applications and SHUT DOWN your computer! Thank you Page 39 of 40
40 Computer Usage Guidelines 1. Sign computers in and out. 2. Do NOT remove the chargers from the charging stations. If the computer is low on battery, use an extra charger located on the bottom of the computer rack. 3. Do not leave your computer unattended with eclinicalworks open. Log out of eclinicalworks if you walk away from your computer. 4. Position computer so that patients cannot see your screen. It is a HIPAA violation for patients to be able to see the eclinicalworks application. 5. After shift: Close all applications and SHUT DOWN computer. (see how to guide on shutting down comp.) PLUG COMPUTER INTO ITS ASSIGNED CHARGING STATION. (ex: PM2 PM2) Page 40 of 40
