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It has been a very busy week for the MEDITECH and IT teams and there are a number of topics to discuss:

Medical Records Deficiencies

Health Information Management (HIM, Medical Records) is completing the transition from paper to electronic as we move along with Covenant Health's implementation of the MEDITECH EHR. There are a number of steps to take now and in the future in order to ensure timely completion of our medical records.

  1. All electronic documents dictated/generated in MEDITECH (H&Ps, Consultations, Operative notes and Discharge Summaries) need to be signed in MEDITECH.
  2. Anything that is in HPF for signature needs to be signed there as well.
  3. Incomplete records that remain in HPF need to be completed and signed in HPF.
  4. Paper documents (office H&Ps, scanned orders and documents, etc.) will continue to be signed in HPF.
  5. Any transcribed reports that appear in MEDITECH need to be edited and signed in MEDITECH.
  6. Any dictation pending at the time of discharge needs to be completed in HPF.
  7. Documents that are not created in MEDITECH (for example, Provation and ProSolve) need to be completed in that application.

HIM will start sending deficiency notices that include MEDITECH as well as HPF tasks in the near future.

In order to access and complete signatures in MEDITECH: (Screen Shot Below)

  1. In the Desktop in MEDITECH, click on the "Sign" button in the lower right corner to access you signature queue.
  2. Sign your deficiencies.
  3. Enter your PIN.

ED Admit Order

In order to enter orders on a patient in the ED who is being admitted to inpatient, observation or outpatient status (SDC in the order sets) the patient must be placed in an inpatient bed. This is done by entering an "ED Admit to" order. At times there have been delays while the Patient Placement Center changes the patient's registration out of the ED. This has been understandably frustrating to our physicians.

Starting on November 20 (yesterday) this process has been automated. If the order is entered correctly, the patient's registration status should update in less than a minute. There were some initial adjustments that needed to be made to the software, although the MEDITECH team was working to have them resolved by November 21. See below for instructions about how to enter the ED Admit To order.

In the MEDITECH Order Entry module, search for and select the "ED Admit To" order, as shown below:

This will bring up the ED Admit order screen, as shown below:

The dropdown menu lists all of the ED beds at both CMC and CWC. In order to quickly narrow the search type in the following for the different ED areas:

Medical Center ED Virtual Beds

TCMEDA = Pod A Beds

TCMEDB = Pod B Beds

TCMEDC = Pod C Beds

TCMEDTR =Treat & Release

Children's ED Virtual Beds

TPMEDP = Children's ED Beds

If the registration status in the right upper corner of the screen does not update within a minute, the order has been rejected. The ordering physician needs to notify the ED Unit Secretary or charge nurse immediately so they can alert Bed Management and the process can be completed manually.

More detailed instructions are available on the CovenantEHR.org website.

Prescriptions that must be written:

Four medications have been identified to date that cannot ePrescribed or printed. This is due to a definition problem in the EHR. MEDITECH is aware of the problem and is working to correct it. They have not yet given us a completion date.

The medications (and their generics) are:

-Bactrim (trimethoprim/sulfamethoxazole)

-Keppra (levetiracetam)

-Decadron (dexamethasone)

-Flexeril (cyclobenzaprine)

If you need to prescribe one of these medications to a patient at the time of discharge, you need to hand write the prescription(s). We will inform you as soon as this is corrected.

Attestation

Attending physicians who work with Midlevels or Residents need to attest that they have seen and provided input to a patient's care whenever we countersign one of their notes. A specific field will be added to Progress Notes in MEDITECH the week of November 25th that specifically addresses this requirement.

In the preview document view and in printed documents, the attestation will appear at the top of the note.

The screen shots below outline this process.

As always, please feel free to call me at 725-0265 if you have any questions.

Lawrence Martinelli, MD, FACP, FIDSA
Chief Medical Informatics Officer
Medical Director, Case Management/Utilization Review