NEXTGEN “MY PLAN” LESSON Update: October 2012

1. NEXTGEN “MY PLAN” LESSONUpdate: October 2012 This lesson introduces the use of My Plan, which heretofore has been largely dysfunctional due to technical problems. Many of these problems have been resolved, and we are now encouraging users to take advantage of some workflow enhancements available in My Plan. Most of the content here is excerpted from other lessons available at our training site. This has been prepared with EHR 5.6.5.63 and KBM 7.9.2. Subsequent updates may display cosmetic and functional changes. Use the keyboard or mouse to pause, review, and resume as necessary. There is no audio with this exercise.

2. ORDERING LABS USING “MY PLAN” Ordering many of your most common lab tests can be made easier using My Plan, accessed via the My Plan/Orders button.

3. A simple way to order lab tests is to use the My Plan tab. Here we’ve selected the Diabetes diagnosis, and picked several tests by clicking their checkboxes. When you’ve picked all the tests you need, click Place Order.

4. If necessary, select another diagnosis and add more tests. You can save the tests you commonly order for specific diagnoses as Order Sets, and you can continuously modify these on an ongoing basis. (Info on the setup of Order Sets is covered in the User Personalization lesson.) If you haven’t set up an Order Set for a particular diagnosis, you can also use the built-in Quick assessments to order tests.

5. You can also use disease management protocols to order tests here. As of this writing, we haven’t emphasized Protocols due to some technical problems. We hope to introduce the use of Protocols when these issues have been addressed.

6. After placing orders in any of these manners, note that the Lab/Diagnostics/Radiology Order Module Processing link changes color and has a solid diamond. Click on this link to open this popup. (The popup will usually appear automatically as well if you click Save and Close.) Note: Depending upon clinic-specific policies and workflow, these next steps may be performed by the nursing or front office staff.

7. If necessary, select the Labs bullet. The tests you’ve ordered will display.

8. Click in the Vendor box and select LabCorp.

9. From here you have a couple of ways to proceed. You can select each test one at a time and click the Include selected order button.

10. The test will move to the bottom list.

11. Alternately, you can select the Automatically perform… checkbox. If you do this, just clicking on the tests will move them to the bottom list.

12. To avoid sending invalid orders to LabCorp, please don’t click the Process/Submit button on sample or practice encounters. When all of the tests are on the bottom list, click Process/Submit. Your lab requisition has been sent to LabCorp, and the patient may go to have the studies done. Click Save and Close.

13. For common tests and common diagnoses, this is the easiest way to order lab studies. But sometimes you’ll need to order an infrequently-used test, or request a test related to a less common diagnosis. For this, click on the Labs tab.

14. To order labs from here, first select the diagnosis at the top, then select the test. Here, we’ll order a Uric acid level for the diagnosis of gout. Then click Place Order. Repeat this process for all tests needed, matching them up to the corresponding diagnosis.

15. You can click on any of the categories at the top to launch a popup with more studies within that category. Here the Chemistry popup has been launched. When you’ve selected all the tests you need, click Save and Close.

16. If you still haven’t been able to find the test you need, click the Other Tests link, launching the Other Labs popup.

17. Select the diagnosis, then click in the 1st Description box. A pick list appears. Say we want to order thyroid antibodies. Click anywhere in the pick list and begin to type thyr.

18. The list scrolls down. Double-click on Thyroid Antibodies.

19. Select other tests as needed. When done, click Place Order, then Save and Close. A tasking popup may appear; you can use it if necessary, or just dismiss it.

20. When you’ve placed all the orders you need, you would use the Order Module Processing popup as demonstrated above.

21. Notes about lab ordering Whenever possible, place orders via My Plan; for over 90% of your common orders this is fast and easy. If you can’t figure out how to order your lab via My Plan, try to do so via the Labs tab. Either of these methods posts the order to the Order Management template, which makes it easier to track the fact that we get results back. If you can’t figure out how to place an order via either My Plan or the Labs tab, use the Order Module. It can be an easier way to search for uncommon tests.

22. More notes about lab ordering Another consideration is tests that require AOE: Ask at Order Entry questions. We have tried to turn off the AOE requirement for most tests, since they are actually questions that would be better completed by the phlebotomist than the provider. However, a few AOE questions must still be answered by the provider. Prenatal Quad Screening is an example, since the questions include data about gestational age that the lab tech would not be privy to. Currently, AOE questions can only be easily addressed via the Order Module. Whether you place the order via templates or the Order Module, you will still need to go to the Order Module to answer the AOE questions.

23. Reviewing Lab Results Regardless of how you place the order, you will be notified about test results through your Task List. After reviewing results in the Order Module, you’ll use the Provider Test Action template to address them. To reiterate: The addition of My Plan as a lab ordering option changes nothing about how you review test results through the Order Module.

24. Ordering Follow-Up Visits Using My Plan My Plan can also be used to ask the front office to schedule follow-up visits. Clinics may wish to review their workflows and decide if this alternative is preferable to current scheduling methods.

25. Select any of today’s diagnoses, then click either the Schedule a follow-up visit checkbox or dropdown arrow.

26. Under the Follow-Up section, you can select any or all of the options for follow-up: provider, reason, time frame, or specific date. When done, click OK.

27. Make sure the checkbox is checked, then click Place Order.

28. The front office staff can see the order on the Checkout tab.

29. MY PLAN & X-RAY ORDERS “My Plan” will mostly be used to order lab work. However, it can be used to order radiographic studies, either to be performed locally (such as in the SHAC) or at one of the hospitals. Note, though, that you will still need to either print the order on paper (for in-house studies) or send a task to a staff member, such as a Referrals Clerk (for hospital studies). A brief demonstration follows.

30. Suppose we want to order a foot X-ray in a patient with gout. Select Gout as the diagnosis, then select the dropdown arrow for the next empty line under Diagnostics. (You could also just replace the Chest X-ray on line 1.)

31. The NgkbmDbp Labs Radiology popup appears. Click in the list and type foot. The list scrolls down to listings that start with “foot.” Double-click your choice.

32. The foot X-ray now appears. Click the checkbox, then click Place Order.

33. Note that the Lab/Diagnostics/Radiology Order Module Processing link changes color. You can click on this to process the order, or it will appear spontaneously when you click Save and Close. (Alternatively, some offices may employ a workflow where other staff members complete these orders.)

34. For the time being, we will not be able to place X-ray orders electronically through NextGen, so one option is to just cancel out of this popup. There is some value, however, in going ahead and processing the order from an order-tracking standpoint. Start by selecting the Radiology bullet.

35. The NgkbmDbp Orders Vendors popup appears. Scroll down and double-click USA Radiology.

36. Click on the order, then click the Include selected order arrow.

37. Click Process/Submit, then Save and Close. Again, note this does not electronically transmit the order! You must still go to the Checkout Tab to print a paper order, or send a task to a staff member, such as a Referrals Clerk, to actually get the order done.

38. Why bother to go through these steps? After you’ve saved your “My Plan” for common diagnoses, it can be a quicker way to place X-ray orders than doing it on the Diagnostics tab.

39. NEXTGEN “MY PLAN”USER PERSONALIZATIONDEMONSTRATION This demonstration reviews ways a user can personalize “My Plan” to speed up workflow.

40. In the My Plan template, NextGen provides several Quick Assessment sets of orders for common problems. These are often very useful, but if the patient’s problem is not listed, or you want to modify the plan, you may save an order set of your own. In this example, the patient has been diagnosed with migraines, but there is no Quick Assessment set for this diagnosis.

41. Let’s create an order set for migraines. First, say we often want to check a TSH on migraine patients. Click the next dropdown arrow under Lab Orders, click anywhere in the resulting popup, and type TSH.

42. When TSH appears, double-click on it.

43. In a similar fashion, we’ll add some diagnostic procedures, such as CT/MRI scans.

44. You can also remove items you don’t want. Click Clear. We don’t really want any of these injections listed, so we’ll choose to clear all.

45. As we did above, we’ll add a couple entries, choosing sumatriptan and ketorolac injections.

46. Lab orders (and to a lesser extent Diagnostics) are the two headings we’ll make the most use of.) Currently, the remaining sections aren’t really set up for use, since we have other ways in our workflow to order these items that are actually quicker and simpler. (As updates occur and we move to more specialties, we’ll continue to reevaluate use of these sections.)

47. You can also add a few brief instructions to your order set. In general, Plan Details, with the ability to save My Phrases, provides better functionality, and this is what we recommend. In addition, the setup of instructions here can be a bit confusing. However, for those users who wish to use this feature, a brief explanation follows.

48. We want to start by populating “My Instructions,” a list of instructions you frequently use. In the first Instructions line, type Keep headache diary. Click Add, and select 1 in the ensuing popup. Note that, while this is not made particularly clear, you are actually adding this to your list of “My Instructions.”

49. Delete or type over “Keep headache diary,” typing instead Take abortive med & lie down in dark, quiet room. Again click Add, and select 1 in the ensuing popup. In a similar fashion, add other lines as desired.

50. When you’re done adding items to the “My Instructions” list, click the My Instructions box. Then click in the 1st Instructions Space. When you click in this space with the My Instructions box checked, you’ll see your “My Instructions” list. Note that this includes several instructions I’ve added earlier. Double-click on Keep headache diary.