Transcript NEXTGEN PRENATAL INTAKE VISIT DEMONSTRATION

NEXTGEN KBM 7.9 WORKFLOW DEMONSTRATION
Sick Child Visit
(Pediatric Template Set)
This demonstration works through a sample sick child visit
(asthma exacerbation) in KBM 7.9, introducing the new user to
the general workflow. While it uses the Pediatric Template Set,
use of the Family Medicine Template Set would present very few
differences.
This has been prepared with EHR 5.6.x and KBM 7.9.x.
Subsequent updates may display cosmetic and functional changes.
Slides are updated if the changes are pertinent to the points
being illustrated.
Use the keyboard or mouse to pause, review, and resume as
necessary.
There is no audio with this exercise.
The nurse begins by right-clicking on the patient from her
provider’s appointment list, and selecting Go to Patient’s
chart. (Alternately you can just double-click.)
Our patient is 10 year-old male, established in the practice,
brought in for an asthma flare-up.
If this is the first encounter in NextGen, you may see
an alert like this. Click OK.
The chart opens to the nurse’s default template; in
Family Medicine and Pediatrics, this will be the IntakeOV template. (If the patient has had a previous
encounter in NextGen, the chart may open directly to
this template.)
Patient
Location
Provider
Date
Perform the 4-Point check.
If necessary, select New vs Established Patient. In
this example, our patient is Established.
Enter Template set, Visit type, and Historian.
In this example, we’ll use Pediatrics, Office Visit, and
Mother, respectively. (We could also choose Family
Practice for the Template set.)
Glance at the Alert
button. If there were
any alerts on this
patient, the button
would change shape and
turn red.
Also look at the Sticky
Note link. Since the
diamond is solid, there is
something entered here,
so click on this link.
Review the notes. When done click
Save and Close or Cancel.
Now click Add to
add Vital Signs.
Enter Vital Signs. (Details are
reviewed in a separate exercise.)
Data used in this example:
Ht 53.5 inches, measured today.
Wt 69 lbs, dressed without shoes.
T 98.2, ear. BP 102/60 sitting, right arm.
HR 98, regular. Resp 20.
Pulse Ox 90%, pre-treatment.
If desired, click the Standard to Metric button to
perform this conversion. (Make entries using all English
or all Metric units before clicking the appropriate
conversion button.)
BMI and the Height, Weight, and BMI percentiles
are automatically calculated.
When done click Save and Close.
The patient’s asthma is a known chronic problem.
To add that, click Add Problem.
There are multiple ways to search for problems.
For this example, click All to search for this diagnosis.
The familiar search popup appears. Using the method of
your choice, search for asthma. In this example, we’ll
select Asthma 493.90. Double-click on that line.
The diagnosis is displayed.
Enter Date of onset and Additional
information to the extent known/pertinent.
Asthma was first diagnosed about age 5;
we’ll approximate as 1/1/2006.
Click Save and Add New if you
have other diagnoses to add.
That’s the only chronic problem we
have to enter, so click Save and Close.
A Note About Date of Onset
NextGen sometimes makes this a required field. However,
there are many times when you will be entering data such as
this, but won’t know the Date of Onset, and may not have the
patient available to ask. Our recommended workaround is to
enter the date 11/11/1111.
Click in the Date of onset box.
This brings up the Calendar
popup. Click the X to close it.
The cursor will still be in the Date of onset box. Just
type 11111111, then save your entry as described above.
Enter medications. You can
open the Medication Module by
double-clicking on the
Medication Grid.
If you display the History Bar, you can
also bring up the Med Module in a tab
by clicking on the Med Module here.
A detailed discussion of the Medication Module is
included in another lesson.
In this example, our patient is taking:
Albuterol HFA inhaler 2 puffs every 4 hours as needed.
Flovent-44 HFA inhaler 2 puffs twice daily.
Add these medications, then close the Med Module.
Review allergies. He has
problems with beets, so doubleclick on the Allergies grid.
Add the patient’s moderately severe vomiting when
confronted with beets. (A detailed discussion of the
Allergy Module is covered in a separate exercise.)
When done, click the X to close the Allergy Module.
Beets now display in the Allergies
grid.
Since this was just added, click
the Allergies added today bullet.
Now we’ll add some chief
complaints. Click in the
1st Reasons for Visit box.
Select asthma.
Depending upon office policy, the
nurse may document some components
of the HPI.
Click HPI Detail.
A suggestion is for the nurses to document the details in
the blue shaded area at the top, and any other information
that is volunteered while rooming the patient.
The father states this asthma attack started 3 days ago;
albuterol has helped, but the attack is moderately severe
and worsening. He’s been having a lot of cough; OTC cough
meds haven’t helped.
When done click Save and Close.
The nurse can add other comments
by clicking Intake Comments.
Type comments as desired, then click Save and Close.
Now move to the Histories tab.
The diamond by Intake Comments becomes solid,
indicating that something has been entered.
The nurse reviews/enters Past Medical/Surgical
history. Episodic historical items should be entered
here. Since asthma was entered in the Chronic
Problem List, it doesn’t need to be added again here.
He’s had no surgery or other major incidents, so click
No relevant past medical/surgical history.
To enter the Family History, click the Update button.
(Double-clicking the grid would give you an alternate
method of entry.)
His mother has asthma.
Click the Mother bullet, then
the Asthma Yes bullet.
Click Save.
In a similar fashion, add
that the sister also has a
history of asthma.
When done click Save and
Close.
Some Social history can be added here.
We’ll add that the parents are married, they speak
English, there is no smoke exposure, and he is in the
4th grade.
To add further details, click Update.
Add further details.
He lives in a suburban house with both parents. He has a
younger sister. There are no concerns about how he gets
along with family and other children. He’s in the 4th
grade. He always wears seat belts. They have smoke and
carbon monoxide detectors in the home.
The patient is ready for the provider.
Hover the mouse over the Navigation Bar
area, and click the Tracking icon.
In the Room box, enter Exam 2.
In the Status box, enter waiting for provider.
Click Save and Close.
Patient
Location
Provider
Date
The provider then opens the chart from the
appointment list and performs the 4-point
check, as previously demonstrated.
The Summary tab is NextGen’s recommended starting
point for the provider (though the provider can set
preferences to begin on another tab as desired).
Chronic problems, vital signs, meds, allergies,
and growth charts can be reviewed here.
Begin by taking note of any Alerts, Sticky Notes, or
Intake Comments that have been entered. The solid
diamonds indicate that there are Sticky Notes and an
Intake Comments added.
Click on these to review; dismiss the popups when done.
Click in the Order view
box. Note that while it
initially displays vital
signs, several other items
can be displayed here.
You will also want to
review the Histories tab.
Review/update Past Medical/Surgical, Family, and Social
Histories, selecting the appropriate review bullets.
When done, move to the SOAP tab.
Review the Reasons for Visit.
With the asthma bullet selected, click HPI Detail.
Review the details entered by the nurse, and add further
details obtained from the patient and father.
The father states this asthma attack started 3 days ago,
after spending the night with a friend who has a cat.
Albuterol has helped, but the attack is moderately severe
and worsening. He’s been having a lot of cough; OTC cough
meds haven’t helped. There has been no fever. He’s also
having a lot of sneezing, runny nose, and watery/puffy
eyes. In fact, he has these symptoms a lot. The school
says he has to use his albuterol almost every day now, and
he’s missed PE several times in recent weeks.
When done, click Save and Close.
These details display.
Now click Update to address the Review of Systems.
Some items that have been previously entered through
the HPI may appear here. Add other items as per your
normal practice and as dictated by the visit.
Here we’ll add that there has been no vomiting, diarrhea,
or rash.
When done, click Save and Close.
Next, click Physical Exam.
Here you can document most common ageappropriate exam items on all systems.
You can click on the link for each individual
system, to go to a more detailed exam popup
for that system.
Here we’ve documented several exam findings:
He is in mild distress. There is clear eye,
nasal, and postnasal drainage. He displays
moderate, diffuse wheezing and slightly
labored breathing. Exam otherwise normal.
You can also save and recall personalized exam
presets, which can save you time on future
encounters. (A review of this is included in
another lesson.)
When done, click Save and Close.
We’ll give the patient an albuterol
treatment. Click Procedures and choose
Nebulizer treatment in the ensuing popup.
Click in the Indication Description box and choose
Asthma Exacerbation 493.92 in the ensuing popup.
Select Albuterol premixed 2.5 mg.
Then click Save and Close.
Ask your nurse to do the albuterol
treatment. After the treatment is done,
return to the Nebulizer treatment popup.
You examine the patient and note a good
response. Document this.
Click Submit to Superbill, then
Save and Close.
Add today’s assessments. There are
several ways to go about this. In this
example, click the Update button and
select Specialty.
Click Asthma, exacerbation.
It is also likely the patient has
Allergic rhinitis, so select this too.
When done, click Save and Close.
These diagnoses now display. Since Allergic rhinitis
belongs on the chronic problem list, we’ll add it there.
Click in one of the Assessment boxes.
Note that this popup gives you a different way to add
diagnoses. We don’t need to select any more diagnoses,
but click the Chronic List Add button next to Allergic
rhinitis to add it to the Chronic Problem List.
When done, click Save and Close.
Now we’ll document our plans.
Click My Plan/Orders.
Plans, instructions, lab orders, diagnostic study orders,
referrals, and office services/procedures are available in
a tabbed format, though the main tabs we use here are
Plan Details, Diagnostics, and Referrals, and to a limited
extent, My Plan.
Detailed reviews of these tabs are provided in other
lessons. A few simple examples will be shown for the
purposes of this exercise.
On the Plan Details tab you can enter
plans and instructions here via typing,
Common Phrases, or My Phrases. Here
we’ve added some instructions and plans
for asthma, including the addition of
Singulair.
Details on the use of the My Plan and Plan
Details templates are covered in another
exercise.
When done, go back
to the My Plan tab.
Highlight one of the
Asthma diagnoses.
Click in the He is to schedule
a follow-up visit box, and
choose 4 weeks in the
Timeframe box, then OK.
Finally, click Place Order
then Save and Close.
He needs refills on albuterol and Flovent, and we
added Singulair and loratadine, so click Meds.
A detailed review of the Medication Module is provided in
another exercise.
Here we’ll renew Albuterol and Flovent, and prescribe
Singulair. Even though we recommended getting loratadine
OTC, we’ll add that here as well.
When done, close the
Medication Module.
For an actual patient, we would highlight Albuterol,
Flovent, and Singulair, then click ERx to electronically
prescribe them.
(That can’t be performed in these exercises.)
The patient needs a school excuse.
Click Document Library.
There are links to several document types.
Click Work/school excuse brief.
We’ll excuse him for 3 days, and
keep him out of PE for the next 5
days.
When done, click Save and Close.
When done, close the document by clicking the X.
The school excuse document displays.
You may further edit the text as
desired, then click the Printer Icon to
print the excuse.
We don’t need to generate anything
else from here, so close the Document
Library by clicking the X.
The final Comments box is a good place to
add notes about discussions with attending,
or the participation of medical students.
One of the Meaningful Use criteria
requires patients to receive a summary
of their visit. Click Patient Plan.
A visit summary is
produced (our
letterhead will be
added). Edit the
text if desired,
print, then close the
document.
Now move to the Finalize OV tab.
E&M coding is reviewed in another
lesson. Here we’ll select Moderate
complexity and click Calculate Code.
If the calculated code is acceptable
to you, click Submit Code(s).
Residents will need to click
Submit to supervising physician
for review.
Select your attending, then click Add User(s).
Then click OK.
A resident also needs to view
encounter properties to set the
Supervising Physician for billing
purposes.
Right-click on the encounter
folder and select Properties.
The resident doctor clicks
the Supervisor dropdown
arrow, and selects the
attending.
In this example, we’ll use
Dr. Duffy.
Click OK to close the popup.
Now generate today’s visit note.
One way to do this would be to click Chart Note.
Your visit note displays.
However, this will generate the note in
real time, which can tie up your computer
for several seconds, or even minutes.
So you’ll probably want to generate the
note offline. To do this, hover the mouse
over Navigation.
When the Navigation Bar
displays, click Offline.
The provider’s work is complete, and the
patient can be sent to checkout, or
further work can be completed by the
staff as necessary.
The Checkout tab may be utilized by office staff to
document completion of various orders, referrals,
appointments, etc. The degree and manner of its use will
be individualized to the workflow of each clinic.
This concludes the NextGen
Sick Child Visit demonstration.
Why does a round pizza come in a square box?
This concludes the NextGen
Sick Child Visit demonstration.
Why does a round pizza come in a square box?