Clinical Computing Systems

Resident Survival Guide

June 2008

 

IT Services Help Desk:

206-543-7012 or

mcsos@u.washington.edu

Call or email with problems or questions

 

 

 

 

 

Table of Contents

 

Section I – Commonly used Applications

     Important Websites                …………………… 3

     ORCA PowerChart                …………………… 4  

     Mindscape                             …………………… 5

     UWCores and Clinical Toolkit   …………………… 6

     PACS                                              …………………… 7

     Patient Safety Net/UW Residents…………………… 8

     Web Email/My UW                 …………………… 8

     Other Clinical Assignment Sites            …….…………….. 9 

 

Section II – ORCA Instructions        

     In-Box                                  ………………….. 10

     Patient List                            ………………….. 12

     View Scheduling                    ………………….. 14

     Finding Patient Data in ORCA ………………….. 15

     Writing Notes                         ………………….. 18

     Add Document                      ………………….. 19

     PowerNotes                                      ………………….. 20

     Creating Personal Doc List       ………………….. 23

     Templates and Auto Text        ………………….. 24

 

Section III – Documentation Guidelines

    Dictation                               ……………….… 26

     Discharge Summaries             ……………….… 27

    Errors in Notes                      ……………..….. 29

    PDS/Transcription Resources   ……………..….. 30

     Printing Discharge Prescription Reports ….……. 31

Section 1 –

Commonly Used Applications

(See following pages for more details on these sites.)

 

Important Web Sites      

Multiple applications are used to manage clinical and non-clinical tasks.  The most used sites are;

 

ORCA PowerChart Web Access

http://orca.medical.washington.edu

Mindscape Web Access

http://mindscape.mcis.washington.edu

UWCores

https://cores.medical.washington.edu

Clinical ToolKit https://home.mcis.washington.edu/teams/eds/toolkit.htm

Communications ToolKit http://depts.washington.edu/comtools/

Am I On http://amion.com

My UW http://www.myuw.washington.edu

·       Manage Logins and Passwords

·       Access to UW employee site

WEB Email http://webpine.washington.edu

UW Residents http://uwresidents.com

VA CPRS

https://vhav20csecure.v20.med.va.gov/citrix/metaframeXP/

ORCA PowerChart

http://orca.medical.washington.edu

Note:  When using web access, click the text “ORCA Powerchart users can bypass…” in the red box to avoid multiple logins.

·       ORCA (Online Record of Clinical Activity) is the main charting system at HMC, UWMC and SCCA for both inpatient and outpatient services. 

·       The ED and OR do not currently use ORCA but all of their charting is scanned into the system.

·       All disciplines document in ORCA and it is the primary site for viewing clinical data of all kinds.

 

Section II of this booklet provides detailed instructions on how to find and enter data in ORCA.  Further information and training is also available online at http://www.orcaed.washington.edu.

 

For immediate assistance using ORCA call the Helpdesk at 206 543-7012.  If you do not require an immediate response, email mcsos@u.washington.edu.

 

 

 

 

MINDscape

http://mindscape.mcis.washington.edu

Mindscape is a read only application which imports data from other systems (primarily ORCA) and organizes it differently.    It has patient information from HMC, UWMC and SCCA. 

Most information in Mindscape can be easily found in ORCA.  You will need to use Mindscape to quickly find;

·       Echocardiogram results

1.     Search patient

2.     Click Cardiology

3.     Click Echocardiography

4.     The report will be scanned into ORCA – usually within 24 hours.

·       Vascular lab reports

1.     Search patient

2.     At HMC: Click Vascular

3.     At UWMC: Click Radiology

§  Look for “US Ext ART” or “US Ext DPLR”

·       Outpatient medications only if they are filled at the HMC pharmacy (HMC only)

 

 

 

 

 

 

UWCores

https://cores.medical.washington.edu

UWCores is a web-based system used to manage patient lists and sign out, store entered diagnoses, problem lists, medications and other information.  Information entered in CORES does not become part of the medical record.  Vitals & labs are updated automatically, but medications, antibiotics & plans must be manually updated by you.

Helpful Hints:

·       Generates sign out sheets and rounding lists

·       Click MRN in patient screen to open MINDscape without second login

·       Can copy and paste between ORCA and CORES

·       Remember to click Save after entering data

 

Clinical Toolkit

https://home.mcis.washington.edu/teams/eds/toolkit.htm

The Clinical Toolkit is available on all medical center desktops.  It provides quick links to clinical applications, Patient Safety Net, reference materials and other helpful websites for managing employee and student information. 

•       HINT: Place the Clinical Toolkit as a shortcut on your home computer for when you are on call

 

 

 

PACS

PACS workstations display higher resolution radiology images and support more user functionality than the web versions below.

Radiology images are also viewable from:

ORCA

1.     Click the Globe icon

2.     No second login needed

MINDscape:

1.     Click Radiology

2.     Click Centricity

3.     No second login needed

Clinical Toolkit 

1.     Click HMC or UWMC GE PACS

2.     Enter login and password

 

24 Hour PACS Workstation and Account Support:

IT Services Help Desk:  206 543-7012 or

mcsos@u.washington.edu

PACS Help WebPage:

http://depts.washington.edu/pacshelp

PACS HMC https://hmcradweb30.medical.washington.edu/ami/html
PACS UWMC https://uwradweb21.medical.washington.edu/ami/html

 

 

 

Patient Safety Net

https://psn.medical.washington.edu

The Patient Safety Net icon is available on all medical center desktops.  It provides access to the institutional incident reporting system for anonymous notification of safety slips, gaps, errors and suggestions for improvement

 

UW Residents http://uwresidents.com

UW House Staff Association site for UW Residents and Fellows

·       Main page shows date/time/location of next meeting

·       Links to many clinical and non-clinical websites

 

WEB Email http://webpine.washington.edu

·       Available on all medical center desktops

·       There are multiple ways to access email (web-based, secure shell based, desktop email clients)

·       Check out www.washington.edu/computing for a good starting point

 

MyUW http://myuw.washington.edu

·       Provides access to many student and employee services including managing benefits, passwords, and email vacation settings. Links to UW and community services, news, weather, etc.

·       Login and password used are the same as email (UWNetID)

 

Other Clinical Assignment Sites

 

Seattle Veterans Administration Medical Center

https://vhav20csecure.v20.med.va.gov/citrix/metaframeXP/

·       Uses CPRS, the VA electronic medical record

·       Access from outside VA using above web site

 

Children’s Hospital and Regional Medical Center

·       Uses Cerner PowerChart for documentation and order entry.  Not linked to UWMC and HMC ORCA PowerChart (also Cerner)

·       PowerChart is called “The CIS” at Children’s and is unrelated to the “CIS” application at HMC and UWMC

·       Has mandatory education before issuing logins and passwords

Section II – ORCA Instructions

 

Using the Organizer in ORCA

There are 3 main tools in the Organizer.  They are the In-Box, Patient List and View Scheduling.

 

In-Box

Sign or review documents

1.     Double click documents to sign or review

2.     Click OK or OK and next to add your electronic signature

3.     Click  to refresh screen

Refuse notes from In-Box

1.     Double click document

2.     On bottom left, click Refuse

3.     Forward to hmcfix or uwmcfix for Review

4.     Click OK

Complete saved notes (Add Document type)

1.     Double click to open note

1.     Right click in document and select Modify

2.     Complete note

3.     Add names for review/signature

4.     Click Submit

5.     Close note pane

Note: Saved PowerNotes can only be found in PowerNote under the Existing Tab

 

Results to Endorse

1.     Lab results associated with your name will appear in Results to Endorse

2.     Once you have viewed the result, click OK or OK and Next.

 

Other Useful In-Box Features

Arrows

·       With a document open use the green up and down arrows to move quickly to the next document without signing.

Preview Window

1.     Select Inbox from menu

2.     Select View

3.     Click Preview Pane to preview note in bottom half of screen

4.     Note can be modified from preview screen by right clicking and selecting Modify

 

 

Patient List

Patient Lists can be created based on Service (eg Cardiology) or Location (eg 4E, 4SE). These lists are particularly useful for inpatient providers.

Users can also create a custom list, from which patients can be added or removed.

Users can add up to 19 active lists.

 

To Add Lists

1.     Click on Patient List

2.     Click List Maintenance icon (wrench)

3.     Click New in the Modify Patient List window

4.     Select the type of list you want and click Next

For Medical Service Lists

5.     Follow steps 1-3 above selecting Medical Service

6.     Select desired service

7.     Click Next

8.     Set the desired filters (generally Not Discharged and Inpatient, Limited Stay and Observation)

9.     To include Pre-Admits select None and None

Change Filters on Lists

1.     With list showing click

2.     Change desired filters

3.     OK

 

Create Custom Lists

Custom lists are created and maintained by the user and are viewable only by the creator of the list unless you proxy it to another user.

1.     Click on Patient List

2.     Click List Maintenance icon (wrench)

3.     Select Custom List and click Next

4.     Name your list

5.     Set the filters you want

6.     Click Finish

7.     Select the new list in the Available List Pane

8.     Click the blue arrow to place it in Active Lists

9.     Click OK

 

Add Patient to the Custom List

1. Click Add Person icon (person with yellow star)

2. Search and select correct patient

3. Click OK

Or

1. Select the patient from another list (eg service, location)

2. Right click and select Add to a Patient List

3. Click your own list

4. Click  to refresh screen if you do not see patient

Remove Patients from the Custom List

1. Select the patient

2. Click Remove Patient icon (person with red star)

View Scheduling

View Scheduling is especially useful for those working in outpatient clinics. 

 

View the Clinic, Provider or Resource schedule

1.     In Resource box enter the provider or clinic name,  typing  HMC or UW before clinic name (eg HMC Adult Medicine)

2.     Hit Enter or click binoculars

3.     Select the desired Resource and click OK

Set a Default Resource

1.     In the menu, click Schedule

2.     Select Preferences

3.     Select the Generic tab

4.     In the Default Resource search for provider or clinic name as above

5.     Select desired name and click OK

Note: Default settings will not be effective until you have logged out of program and logged back in.

To View Weekly or Monthly schedule

1.     From menu click Schedule

2.     Select View and choose day, week or month view

Note: Long views of large clinics can be very slow to load

Other useful tools in View Scheduling

  1. Change the date on the left to view other days
  2. Click Recent to select the most recently viewed schedules

Finding Patient Data in ORCA

 

Search for Patient

     

1.     Enter MRN or Name and hit Enter or click binoculars

2.     Select the correct patient in top half of window and correct encounter in bottom half of window

3.     Click OK and chart opens

View Recent Charts

1.     Click Recent to see 5 most recently viewed charts

 

Clinical Notes Tab – All narrative style notes

·       Document sort can be changed.  Use radio buttons on bottom left of screen to sort by Type, Date or Performed by, etc.

·       Move quickly from note to note using the green arrows below the sort types

·       View more documents by clicking the right facing arrow to the right side of the horizontal, blue bar

 

 

72hr Quick View, All Results and Lab

Data entered in ORCA flows to these tabs for easy viewing. 

·       Data can be viewed differently by clicking the radio buttons above the blue bar.  The default is the Table view.  Use Group view to see trends, or List view to read longer pieces of information

·       See 500 more results by clicking the right arrow on blue bar

·       Change search range by right clicking in the blue bar

·       Search for a specific value

1.      Click ....

2.     Type the name of the parameter (can be a med, vital, lab etc)

3.     Hit Enter on keyboard (not OK)

4.     Select the desired value and click OK

·       Graph values

1.     Click in gray box next to parameter(s) you wish to graph

2.     Click the graph icon.

 

 

 

 

Summary Tabs

Summary tabs import frequently used data from other areas in ORCA.  They are a fast way to find commonly needed information.

eMAR Sum

·       To change search range, Right click in blue bar to Change Properties (temporary) or Defaults

·       To view specific medications by Time View or Therapeutic Class View, click

Pt Plan Sum

·       Discharge planning info from Rehab Therapies, Social Work, Nutrition, Spiritual Care and Nursing

Pt Status Sum

·       Reason for admission, PMH, PSH, LNOK, Precautions, Diet, Psych alerts and privilege levels, Current reason for restraints, Substance abuse history, Event/Procedure history

MD Sum

·       Reviews Vitals (last 24 hrs), Labs (today and yesterday), Allergies, Active meds, Alerts, and Precautions

IO Review

·       Daily intake, output, net and daily weight

·       24 hour (0600 of the prior day to 0559 of the date listed), 10 day, 30 day, and length of stay totals

·       IO Review tab is not a reliable tool for tracking medications. It records fluid volumes, not dose history

Writing Notes in ORCA

There are two ways to write notes in ORCA.  One is referred to as Add Document and the other is PowerNote.  Regardless of which tool is used to create the note it must be attached to the correct encounter.

 

Selecting the Correct Encounter

It is very important to write your note on the correct encounter for billing and so others can find it.

·       If the patient’s chart is opened directly from a Location or Service List (inpatient) or from View Scheduling (outpatient) it should be in the correct encounter.

·       Confirm that chart is opened to correct encounter;

1.     Check Location: in colored Demographic Banner to assure chart is opened to desired encounter

2.     If encounter needs to be changed, click Location: and double click the desired encounter

 

Selecting the Correct Note Type

It is important to select the correct Note Type so the document is filed correctly and can be easily found.

When signing either kind of note you will be directed to choose a note type.  Preferences can be set.

 

Add Document

 

Write a note in Add Document

1.     Start in Clinical Notes

2.     Right click in center screen, select Add

3.     Select the correct Document Type using down arrow (The document type determines where a note is filed. You can customize your list of document types*)

4.     Add a subject line

5.     Click  to add names for signature or review

6.     Add text

7.     Submit or Save (Saved Add Documents go to InBox)

*Create Note Type List: ClinicalNotes>Documents>Options

 

Modify Add Documents

Once signed there are limited ways to modify a note created with Add Document.

1.     Right click inside the note and select Modify

2.     Select text and click  Strike Through text.  (Strike through will show in final document)

3.     Write an Addendum at the end of note

4.     Additional providers can be copied

 

 

 

 

 

PowerNotes

PowerNote uses templates to guide your documentation.  Power notes are created in Documents Custom View and also show in Clinical Notes once signed.

 

Start/Find PowerNote

  1. Go to Documents Custom View
  2. Click + Add
  3. Enter *Type and Title and check Date and Time for accuracy
  4. In Encounter Pathway tab, search for the desired note
  5. To see all notes leave Search: blank and click binoculars
  6. To add to Favorites select note and click Add to Favorites.  Notes are now under Favorites tab
  7. Saved notes are under the Existing tab (not In-Box) and show as Active
  8. Double click the note you wish to use

 

Write a PowerNote

1.     The navigator on the left shows the note sections

2.     When <Hide Structure> is showing, there is text which can be selected and added to the note

3.     Selected text is bold and will show in note

4.     If clicked again it unbolds and is removed

Note: In some cases a 2nd click may put a line through symptom. Final note will then read “denies symptom.”  3rd click clears text.

5.     If there is no pre-formatted structure under a heading, click below it to add free text

6.     If you do not want to use the template, click <Hide Structure> and click under heading to enter free text

7.     To preview note click  at top of right scroll bar

8.     To continue charting, click  again to show template

9.     Click OTHER to get a text box

10.   Enter text in box and click OK or hit Enter on keyboard

Hint:  if text seems to disappear, click Edit from dropdown menu and choose Undo.

 

Sign or Save a PowerNote

1.     Click Save or Save & Close to save note for later completion

2.     Click Sign or

3.     Check  to forward for co-sign or review

4.     Click under the word Endorser to search names

5.     Click under the word Type to select sign or review

6.     Click OK to sign

 

Find a Saved PowerNote

1.     Go to Documents Custom View in correct patient chart

2.     Click + Add

3.     Click Existing tab

4.     Limit by clicking Unsigned notes only or My notes only (Unsigned notes will have Active status)

5.     Double click note to open for completion

 

Correct a signed PowerNote

1.     Open the note that needs correction in Clinical Notes

2.     Right Click in the note

3.     Select Correct – Documentation window opens

(Modify in PowerNote only allows an addendum to be added)

4.     Click Show Structure to work in note

5.     Correct note as needed

6.     Click sign icon  or Documentation>Sign

7.     Close documentation box with X in right corner

Note: Signed notes can also be Corrected from the Existing tab.  Select note and click Make Correction

 

 

 

 

 

Create a Personal Document Type List

  1. Open a PowerNote
  2. Click on the menu item View at the top of the screen
  3. Select Customize… from the drop down list
  4. Select the Document Types tab
  5. Uncheck Display last document type used as default
  6. Default Note Type: should be <None>
  7. Default List Type: should be Personal Note Type List
  8. Select desired Document Types from the All Available Document Types list on the left side of the window
  9. Move it to the Personal Document Type List by clicking the single arrow in the middle of the window
  10. Continue with all needed Document Types
  11. Click OK

Templates and Auto Text

Templates and Auto Text are tools to simplify note writing.  They can be used in Add Documents and PowerNotes.

 

Using Templates

1.     From within an Add Document or PowerNote click the rubber stamp icon

2.     A list of available templates comes up.  Smart templates are preceded by an * and import data directly from other parts of ORCA

3.     Selected note type determines which templates show as Associated Templates

4.     There are many templates for notes, procedures, etc.

5.     Use F3 to move easily from underscore to underscore to enter text

6.     Multiple templates can be entered in the same note

 

 

 

 

 

 

 

Create Autotext

Autotext allows the user to easily add commonly used text of any length into Add Document or a PowerNote.

  1. Click the Manage Auto Text icon
  2. Create an abbreviation which will be recognizable to you.  Start all abbreviations with the same infrequently used character (eg. zsig for signature or zintro for introduction)
  3. Enter a description
  4. Click Add Text…
  5. Enter text in Formatted Text Entry box exactly as you would like it to appear in your document and click OK
  6. You can use the underscore _ in places where you will enter patient specific information later (using F3 function)
  7. Click Create and Close
  8. When “z” is typed in document a dropdown list of autotext choices appears
  9. Double click the desired auto text to insert in note

 

 

 

 

 

 

Section III –

Documentation Guidelines

 

Dictation

There is an institution wide mandate to decrease dictation costs.  Please follow these guidelines:

·       OK to dictate Complex Discharge Summaries and Operative Reports

·       Use ORCA Powerchart note entry for all notes on non-complicated patients

·       Clear, concise dictation is appreciated

·       Minimize background noise

Note: Loud noises such as coughing can be painful to the person transcribing

 

Note Writing Guidelines

Co-signature Requirements

Requirements may differ from service to service – check with the attending

1.     At HMC:  Discharge Summaries, Operative Reports

2.     At UWMC:  Clinic Notes, Discharge Summaries and Operative Reports

 

 

 

 

 

Abbreviations policy

·       HMC https://hmcweb.washington.edu/ADMIN/APOP/PatientDataServices/APPROPRIATE+ABBREVIATIONS.htm

·       UWMC https://departments.medical.washington.edu/uwmcpcs/apop/100/100_34.html

 

 

Discharge Summaries – 5 Critical C’s

1.     Correct Encounter and Service Date – the chart is not complete if the discharge summary is not attached to the specific encounter.

2.     Correct Document Type – always use Discharge Summary.

3.     Co-Signature – Add the appropriate Attending as a co-signer on the document.

4.     CC Recipients – Called Reviewers in ORCA.  Always add the referring physician as a Reviewer.

5.     Complete – Discharge summaries as soon as possible.  Unsigned discharge summaries cannot be viewed by other providers.

 

Consequences if not followed:

·       Attending will receive Anticipated Document notices in ORCA In-box stating that he/she has incomplete patient records

·       Billing and release of information may be delayed

Required Elements of the Discharge Summary

1.     Date of admission

2.     Date of Discharge

3.     Service

4.     Admission Diagnosis (no abbreviations)

5.     Final & Secondary Diagnoses (no abbreviations )

6.     List Consults requested

7.     Operation/Surgeries or procedures

8.     Reason for admission and brief history

9.     Admission medications

10.   Allergies

11.   Past Medical History

12.   Family History

13.   Social History

14.   Physical Exam

15.   Labs at discharge

16.   Radiology studies

17.   Hospital course by problem

18.   Disposition and/or follow-up required

19.   Medications at discharge

20.   Action Plan

21.   Copies to referring providers

 

Note: Interim Summaries must be copied and pasted into a Discharge Summary note and updated.

 

Errors in Notes

 

The ITS Help Desk should be contacted for critical note errors such as the ones listed below:

·       on the incorrect patient

·       on the incorrect encounter

·       with the incorrect service date

·       with the incorrect document type

 

Send detailed information (e.g. patient name, MRN #, date of service, specific nature of problem) to hmc-trans-support@u.washington.edu or call the Helpdesk at 543-7012.

 

PDS staff will do one of the following:

·   Correct the existing note (for simple notes)

·   In-error the note and re-enter it correctly
(for PowerNotes) In-errored notes are marked in ORCA with an IN ERROR status, and are not removed/deleted from the chart

·   Contact and work with the user if further steps are needed           

 

 

 

 

 

ITS Help Desk Contact Information

Phone: 543-7012

E-mail: mcsos@u.washington.edu

 

PDS and Transcription Resources

For corrections, un-charting and in-erroring of documents, please call IT Services Help Desk at   543-7012 and ask for a CR Ticket directed to PDS.

 

HMC Transcription Contacts

Main Desk                                     206-744-9009

Grace Bergo, Transcription Supervisor  206-744-9031

Denise Bendickson, PDS Analyst      206-744-9033

Greg Hammock, Manager                            206-744-9032

 

UWMC & SCCA Transcription Services Contacts

Main Desk                                      206-598-6175

Jeanne Miele, Transcription Supervisor  206-598-1922

Kathy Wong, Manager                       206-598-1929

Erick Blandin, PDS Analyst                            206-598-3590

Print Discharge Prescription Report

 

HMC

·   Can be accessed from any ORCA PowerChart screen

·   Can NOT print from ORCA on the web or via Mindscape

1.     Click Discern Explorer icon from icon toolbar

2.     Double click the Main Menu folder

3.     Double click Pharm Discharge Med Profile

4.     Default printer MINE is set to the nursing unit/clinic where you are located

5.     Type the MRN into the box

6.     Click Execute – the report will display on the screen

7.     Click Printer icon at the top of the Report Output screen and click OK

Note: DO NOT CLOSE the output screen before the document is finished printing or the document will not print completely.  The report has the words “Report End” at the bottom of the page.

                                   

UWMC

1.     Log into MINDscape

2.     Select University of Washington site

3. Enter patient’s MRN number

4.     Select Medications

5.     Select VIEW/PRINT DISCHARGE PRESCRIPTION FORM

6.     Click Printer icon