Horizon Expert Documentation (HED) On-line Nursing Documentation

1. Horizon Expert Documentation (HED)On-line Nursing Documentation E-training for Medical Information Services – Viewing & Printing HED Data from HED & StarPanel April, 2006

2. Using this tutorial Information included on how to access and print data charted by nurses in HED • HED Reports (available during the hospitalization) • In StarPanel Nursing Flowsheet (available in real time during and following the admission) and Reports (available post discharge)

3. Overview of HED Nursing Documentation • Nursing staff enter Vitals, I&O, Assessments, Interventions & Admission History data in HED • Data from monitors (now) and Vents (soon) downloaded into HED (nurse acceptance required) • Data saved to StarPanel in real time. Copies of completed documentation sent to StarPanel after discharge. • Others access data from HED (review screens or reports) or StarPanel (flowsheet or PDF of HED documents) • Medication administration still documented on paper MAR. Most patient teaching on paper Teaching Records. Some specialty forms still on paper.

4. 1. Viewing HED data in StarPanel Nursing Flowsheet Nursing Flowsheet From Patient View or Panel, click on “Action” & select Nursing Flowsheet *** Note -- other similar flowsheets will probably be addedover time.

5. From within an individual patient’s record, select Flows option and Nursing Flowsheet

6. Continuous is default frequency for data display. Click on Q4hrs or Q2hrs for more dense display Flowsheet will display in the Red frame

7. A small yellow box outlined in red is similar to a Post-it-Note. To see the annotation, hover over the box with your mouse and the note’s contents will appear to read. Entries in red are lab results outside the “normal’ range OR are entries flagged by the person who made the entry that are significant. For example, if pt. has an order to notify HO for temp > 101.5 and the temp is 102, the nurse should mark it as being significant so it will appear with a red colored font.

8. Default is to display only up to 48 hrs. data. Click to display all available data. Click on check mark to compress section. Section will display as single gray column. Click to re-expand. Other hyperlinks to allow more convenient navigation

9. Beige background indicates that there is either a comment or more than one value associated with the space. Hover over or click on the section to display.

10. 2-A. Changing Preferences so you can view/print HED reports in StarPanel Click on Customize from Side Bar Click on Preferences NEW Before you can see the HED Reports in StarPanel, you must first change your “Preferences” as these no longer display by default without this change to your settings.

11. Change to Yes Default setting is No

12. ALL View with HED PDF Reports Displayed 48 Hours post discharge, HED Reports will display in the All List. Blue shaded area denotes hospitalization If you do not change Preferences, these will NOT display

13. 2-B. Viewing/Printing PDFs of HED data from StarPanel. HED reports are sent to StarPanel approx. 48 hrs. post discharge (the point at which the record can no longer be altered) so look above the blue bar to see HED reports. Documents and results associated with ED and Inpt. Episodes of care have a light blue side bar by all of the dates of that encounter

14. Click on the diamond by each document to be viewed/printed. Once selected, the diamond turns red. Under Actions, click on Show to display selected documents in frame below

15. Report Name and date generated Confirms this is an HED report Click on Hyperlink to display report in next frame An Adobe Acrobat window opens to display the report in a new window

16. Header information Click print icon to print

17. “&” denotes that a comment was entered Comments text, date/time entered, ID of the person who made the entry, are displayed at the bottom of the section right before the next section. (Eg. Bottom of the Neuro Assessment and right before Cariology

18. More examples of Comments displayed At end of each section

19. To view the next document, in Action box, click on Show. The report will display in the next bx.

20. Modification/Inactivation Report shows all alterations to documentation in HED.

21. 3. Viewing/printing HED from within HED • 2. Select new Patient from Census: • From Dept. drop down list, select patient’s unit • Highlight patient name and click OK button. To access data directly from HED: 1. Click HED icon 7N Do you have HED access? If you have Wiz Order access, you should have HED access but we sometimes need to intervene to provide proper access. If you need assistance, contact the Help Desk. If you don’t have Wiz or HED access, your Security Admin will need to request for you. DOE, JOHN 7N 7024 1 VUM

22. Sample review screen. Click on “Views” to see other flowsheets. Click on “Configure” to change the way information is displayed in the review and to see cumulative I&O totals

23. Change to 30 days to see data more than 72 hrs. old Click on “12 Hour” to display cumulative I&O shift totals. Click on “24 Hour” to display cumulative 24 hour I&O totals. Click on ‘Shift” to display 8 hr. shift Totals and running cumulative totals.

24. To open Admission History, click on tab. [Note: separate Admission Histories for Peds and Subacute.]

25. Aqua blue shows items that have been completed on Admission History. • Gray items negative or not completed. 3. Click on item to open that section to view or document. 4. It will open up a data entry screen like this. Note: Longitudinal data (Medications, Allergies, Problems) can be view like this at any time. Once accepted, episodic data can be viewed ONLY from Reports or Review screens.

26. To print Admission History: • Click on Report tab. • Select Admissioin History Part 1 & Admission History Part 2 Ext. data • [Separate reports for Subacute and Peds Admission Histories]

27. To print reports, click “Send” and then “Return”

28. Names of all Reports that Can be printed from within HED at present. (Some have Not been customized for VUMC Yet).

29. Episodic data as seen on the Admission History Review. Click on a cryptic abbreviation and a pop up window with a complete word will appear.

30. Summary – ways to access data • Flowsheet in StarPanel is used by physicians and ancillaries to view data charted in HED (permanent). • Views and reports also available in HED while the patient is admitted. • 48 hrs. post discharge, PDF versions of all HED data sent to StarPanel. Can be viewed and printed from there but to see these, you must change your preferences so they are unhidden.