Clinical Computing Systems
IT Services Help Desk:
Call or email with problems or questions
Table of Contents
Section I – Commonly used Applications
Important Websites 3
ORCA PowerChart 4
UWCores and Clinical Toolkit 6
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 –
(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
Mindscape Web Access
Clinical ToolKit https://home.mcis.washington.edu/teams/eds/toolkit.htm
Communications ToolKit http://depts.washington.edu/comtools/
Am I On http://amion.com
· Manage Logins and Passwords
· Access to UW employee site
WEB Email http://webpine.washington.edu
UW Residents http://uwresidents.com
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 email@example.com.
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 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.
· 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
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 workstations display higher resolution radiology images and support more user functionality than the web versions below.
Radiology images are also viewable from:
1. Click the Globe icon
2. No second login needed
1. Click Radiology
2. Click Centricity
3. No second login needed
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
PACS Help WebPage:
Patient Safety Net
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
· 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
· Uses CPRS, the VA electronic medical record
· Access from outside VA using above web site
Childrens 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 Childrens and is unrelated to the CIS application at HMC and UWMC
· Has mandatory education before issuing logins and passwords
Using the Organizer in ORCA
There are 3 main tools in the Organizer. They are the In-Box, Patient List and View Scheduling.
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
· With a document open use the green up and down arrows to move quickly to the next document without signing.
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 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
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
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 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
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 import frequently used data from other areas in ORCA. They are a fast way to find commonly needed information.
· 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
· Reviews Vitals (last 24 hrs), Labs (today and yesterday), Allergies, Active meds, Alerts, and Precautions
· 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 patients 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.
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
PowerNote uses templates to guide your documentation. Power notes are created in Documents Custom View and also show in Clinical Notes once signed.
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
Templates and Auto Text
Templates and Auto Text are tools to simplify note writing. They can be used in Add Documents and PowerNotes.
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
Autotext allows the user to easily add commonly used text of any length into Add Document or a PowerNote.
Section III –
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
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
Discharge Summaries – 5 Critical Cs
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
1. Date of admission
2. Date of Discharge
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
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 firstname.lastname@example.org or call the Helpdesk at 543-7012.
PDS staff will do one of the following:
· Correct the existing note (for simple notes)
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
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
Print Discharge Prescription Report
· 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.
1. Log into MINDscape
2. Select University of Washington site
3. Enter patients MRN number
4. Select Medications
5. Select VIEW/PRINT DISCHARGE PRESCRIPTION FORM
6. Click Printer icon