Prescribing medications in the EMR

It has taken me several months to figure out the best way to prescribe medications in the treatment section of a progress note: ie. so they will correctly populate the ongoing medication list. 
For most of us it is easier to be shown  how to do this when you are in the clinic, but let me give you the main concepts and if you need one of us to show you when you are next in the clinic please ask!

1)Current medication Section:
When you are in a progress note and  you are seeing a patient for whom medications have already been entered these will show up in the "Current med" section. You can update  this section if the patient is taking different medications.(for example a consultant prescribed a medication that the patient is now taking--or if the patient never started the medication you prescribed 3 months ago and has decided not to take it).  However (and this is important )--adding a medication here does not Link it to a diagnosis, but that's okay because you will be do it later in the Treatment section which I'm going to decribe to you

2) Assessment Section
You need to assess any problem that you assessed at the visit for which you plan to prescribe or change a medication. And for clarity, for now ,it is useful to assess all the problems for which the patient is taking a medication so you can get it linked to the diagnosis and show that you want the patient to continue it.

3) Treatment Section:
click on treatment and you will see a screen that lists the diagnoses that you have assessed. If the medications that are in the current med list have ever been linked to a diagnosis you will see them listed as you tab across the diagnoses. If you see the medication you can prescribe and/or change from this screen--click under the word  "Comments"-and a list will come up --that says start, decrease, increase etc.. click the appropriate action and the prescribing screen will appear; make your changes in this screen.

However, and for now because the meds are mostly NOT linked,  this is the usual way it goes:

 If the medication that is listed in current meds has never been linked to the diagnosis you won't see it--and you need to take one more step before you change it. You need to go to the Current med screen--and go through all the medications--linking them to a diagnosis--and clicking the C (for continue) button. You can link a med that has no diagnosis to "other" (this should be rare, but might be useful for a multivitamin).

After you have closed this screen you are back to the main treatment screen and you can make changes as reviewed  above. This is preferable to Stopping a medication --and Represcribing it at a new dose or sig-from the current med screen -because if you stop and represcribe it from the from this screen, the ongoing med list will not populate correctly and it won't be clear that you just changed a dose or sig.

Messsaging within the EMR: 

AKA "don't use the message jellybean" for messaging for clinical care.
All messages directly concerning patient care are most efficiently done within the patient’s chart through “Telephone Encounter”.The title “Telephone Encounter” is very confusing;  Think --”Messaging “ not just telephone encounters. (It took me several months to figure this out).

From the patient “HUB”, select  “new telephone encounter”. From this window you can do many things such as:

1) Document an actual telephone encounter with a consultant, or the patient or patient’s family member.

2) Send a message to staff to call the patient to make an appt, or ask staff to add a lab order, or to contact the patient to ask them to pick an order etc.

3) Send a message to another provider to coordinate care of a problem.

4) Document  orders for a new prescriptions either to Nova Scripts  , or print a new prescription for a patient to pick up. This is useful whenever a medication change is made outside of a patient visit. These  messages should be addressed to Lilian unless she specifically tells you to mark it addressed because she’s already taken care of her part of the issue.

Mark the encounter as “Addressed” if no other action is needed; otherwise leave it “Open” and send it to the member of the staff whom you want to see it by clicking “okay”.

Other interoffice messages can be sent with the “M” jellybean at the top of the screen.
This will become more useful as we all get used to checking for these messages when we log into the EMR. Message sent this way will not be connected to a patient chart so it makes it awkward for patient care messages. Staff will not be seeing these except on days that they are at JSFC--so your  regular email might work better for most kinds of messages now.

As always--if you want someone to show you this feature--ask Margaret, Lilian or a provider colleague who is using this function.

Let's try a Blog for learning to use the EMR

I'm hoping this Blog will help  providers at JS Free Clinic as we learn to use the EMR.  We'll be able to post questions for each other to answer and help each other learn!

Here are some initial notes:

Margaret  and Lilian  can answer questions about  how to use eClinical works. Providers can help each other during patient care sessions--so ask your colleague questions. We are finding that we each learn some new thing each week. 

Margaret has ask us to  to lock our notes at the end of the visit, but only after the patient checks out. You can tell if the patient checks out by looking at the schedule. 

Be sure that the medication list is up to date at the end of every visit, so that medication ordering and refills can be done correctly when you are not around.  It seems that the med list in eCW does not always reflect the list as previously ordered—so until we know this is functioning properly, be sure to read the plan in the last provider’s note carefully.

All referrals to outside providers, including eye exams, should be done through the eCW. Send them to Lilian .  By clicking on “referrals” you can view what referrals have been done.

Prescriptions for the patient to take to a pharmacy can be written and printed through the EMR saving you the extra step of handwriting the prescription.

Start entering an ALERT —with dates for future needed diagnostics ( Mammograms, needed follow up exams, Dexascans).  Ask if you aren’t sure how to do this. Grace Hipona is good at it!

Past immunizations can be entered into the immunization section.