Happy Halloween to all! Those of us who have young children (or who are young at heart) know how exciting today is for the little ones.
There have been some concerns raised about the Clinical Documentation Improvement (CDI) queries that are now showing up in our Sign Queues in MEDITECH. The CDI Department did not place any queries to the physicians during September after the MEDITECH Go-live. CDI started placing queries on October 1st. The queries serve two purposes: to allow Covenant Health to assure the accuracy of its coding and also to ensure that our treating physicians get credit for the severity of the patients that we treat.
There are two types of queries, concurrent and retrospective. The concurrent queries are placed while a patient is in the hospital and the CDI needs a clarification in order to code correctly. These queries are treated as an unsigned portion of the medical record, show up in your sign queue and ultimately as a medical record deficiency if they are not completed. If you have questions on how to navigate this process or complete the queries in MEDITECH, please call Jacque Smith at 725-0676.
There have been problems recently with the use of "range orders" in MEDITECH order entry. MEDITECH does not handle "range orders" and what we think we are ordering is not what we end up with, to the potential detriment of our patients.
For example, if a physician or midlevel orders:
Norco 1-2 tablets, the order shows up as Norco
Morphine 2-5mg, the order shows up as Morphine 25mg
Both of these medications and dosing ranges are available in the Pain Medication order set.
If a physician or midlevel orders:
Norco 7.5, with 7.5 being entered into the dose field, the order shows 7.5 tablets
This is because the Norco dose is based on tablets, and the system interprets a dose of 7.5 as tablets, not milligrams. To place an order for Norco 7.5, in the Order Entry Module, select Norco 7.5. To order a one or two tablet dosing range, you must select both the one and two tablet dose. The following two screen shots show this:
This will be correctly interpreted by the EHR so that the patient has both Norco 7.5 one or two tablets every 6 hours available for them.
There have been questions about "What happened to Up-to-Date?"
Up-to-Date remains available for our use at Covenant Health. The Up-to-Date icon is no longer available on the desktop, however. In order to access Up-to-Date:
- Open Internet Explorer on the Covenant Desktop.
- Select Favorites in the upper left corner. (See screen shot below).
- Select Up-to-Date from the list of applications.
In the next few days we are going to be adding a new feature to physician documentation in MEDITECH. This is known as "Normals".
When you are documenting either the Subjective or Objective portion of a progress note, clicking on the "N" will bring up prepopulated Normal values for either the Review of Systems or the Physical Exam. This can be done system by system or for the entire exam. Individual items can be edited by adding a comment to an element, deselecting it or changing it to from a positive to a negative (or negative to a positive).
Although this is a convenient feature, it should be used with caution, since by using this feature and signing the note, you are attesting that you have reviewed or done all of the indicated elements and that the note is correct.
Time stamp issue
Some of you may have noticed that when we are working in the Preview version of a Pdoc note the time stamp will show Pacific Time (2 hours earlier than Texas time). Although there may be a bit of a lag, when the note is finalized and filed, the correct time is displayed in the record.
One of the most frequent requests that we are receiving is for more training. The MEDITECH Team is currently developing a plan to provide more classroom training as well as more "live" support to help us use MEDITECH more efficiently and effectively. We are also working on making more support available in our patient care areas. As soon as more details are available we will make them available to you.
Covenant Health and Saint Joseph Health are in the process of improving our password management and reset process. Over the next few weeks you will receive a message directing you to a Website. There, you can provide answers to a series of "challenge" questions. (You may be familiar with this process, many commercial websites do this.) Once we complete this process we will be able to reset our passwords without having to go through the Help Desk. More details will be forthcoming as we finalize the implementation plans.
Lawrence Martinelli, MD, FACP, FIDSA
Chief Medical Informatics Officer
Medical Director, Case Management/Utilization Review
3615 19th Street
Lubbock, Texas 79410