manage workflow - munsonhealthcare.org

Manage Workflow for Providers

Cerner PowerChart EDUCATION

Clinical EHR Education, Sept. 17, 2021 KE and CD 1 of 17

Summary: For the Hospital Optimization project, the Manage (Specialty) Workflow MPage will have significant updates to improve provider efficiency. Dynamic Documentation will be expanded to include common Dolbey dictated notes that result in real time documentation. When: Sept. 14, 2021 Support: Help Desk at 231-935-6053

Table of Contents

Manage Workflow Overview .................................................................................................................................................. 2

Allergies ................................................................................................................................................................................... 3

Assessment and Plan .............................................................................................................................................................. 4

Care Team ............................................................................................................................................................................... 4

Chief Complaint ....................................................................................................................................................................... 4

Diagnostics .............................................................................................................................................................................. 5

Documents .............................................................................................................................................................................. 5

Focus Notes (Last 24 Hours) ................................................................................................................................................... 6

Histories .................................................................................................................................................................................. 6

Home Medications .................................................................................................................................................................. 6

Hospital Course ....................................................................................................................................................................... 7

Immunizations......................................................................................................................................................................... 7

Implant History ....................................................................................................................................................................... 8

Intake and Output ................................................................................................................................................................... 8

Labs ......................................................................................................................................................................................... 9

Lines/Tubes/Drains ................................................................................................................................................................. 9

MAPS ..................................................................................................................................................................................... 10

Medication Timeline ............................................................................................................................................................. 10

Microbiology ......................................................................................................................................................................... 11

New Order Entry ................................................................................................................................................................... 11

Notes/Reminders/Queries .................................................................................................................................................... 12

Objective/Physical Exam ....................................................................................................................................................... 13

Orders Profile ........................................................................................................................................................................ 13

Pathology/Misc ..................................................................................................................................................................... 14

Problem List .......................................................................................................................................................................... 14

Procedure/Surgical History ................................................................................................................................................... 14

Quick Links ............................................................................................................................................................................ 15

Review of Systems ................................................................................................................................................................ 15

Scales and Assessments ........................................................................................................................................................ 15

Subjective .............................................................................................................................................................................. 16

Visits ...................................................................................................................................................................................... 16

Vital Signs .............................................................................................................................................................................. 16




Manage Workflow Overview Manage Workflow is recommended for providers to review patient information, place orders, and create the Dynamic Documentation note while allowing for better decision making without having to access multiple areas of the electronic health record (EHR).

1. When PowerChart is opened, access Provider View via the left Menu. This is the area where providers can find

the Manage Workflow MPage. Once located, providers should unpin the Menu by clicking the pushpin icon. 2. Manage (Specialty) Workflow is one of the tabs across the top. These tabs are called MPages and they can be

customized to each provider’s preference.

a. MPages can be added using the +. Please review all available MPages.

b. MPages can be deleted using the x. c. MPages can be rearranged by left clicking and dragging.

3. Within the Manage Workflow MPage, there are Components with pertinent patient information to be reviewed or used by the provider. Note: Some headers are hyperlinked to the Menu.

a. Components can be rearranged by left clicking and dragging. 4. Components in the Manage Workflow MPage can be added or hidden using the Page Menu (3 lines). The only

Component that cannot be removed is Notes/Reminders/Queries, as this is a billing requirement. a. Hover over Components. b. Check to display or uncheck to hide the Components.

5. While reviewing the Components of the Manage Workflow MPage, there are look backs (how far the system is looking back for data) available that will differ between Components.




6. Contextual View is a feature that allows side by side viewing of patient

information (left) and portions of your note (right). To enable Contextual View, click on the small gray arrow on the right of each free text Component.

7. Auto Text can be utilized in free text Components including Assessment and Plan, Hospital Course, Objective/Physical Exam, Review of Systems, Procedure/Surgical History, Reason for Consultation, and Subjective. To view more information on this topic, see the Cerner Auto Text document.

8. Providers can Tag information that they want to carry into their note. There are two ways to Tag information.

a. Left click and highlight the information to Tag. Release the left click and a Tag button will appear. Clicking the Tag button will place it into the Tagged Items area to indicate there is saved information ready to place in your note.

b. With Contextual View on, highlight the information then drag and drop the information into the intended free text Component.

Allergies The Allergies Component will allow the provider to review the patient’s allergies.

Note: Features like Contextual View, Auto Text, and Tagging will allow the provider to create notes more efficiently.




Assessment and Plan The Assessment and Plan Component is a free text Component that will pull into the provider’s note. Problems designated as This Visit and prioritized in the Problem List Component will populate here. As with most free text Components, providers can type, use Dragon Medical One, use Tagging, or use Cerner Auto Texts.

Care Team The Care Team Component allows the provider to view a patient's most recent care team assignments for an encounter. A care team can be a medical provider, a provider team, or medical service. Providers can also use this Component to assign a provider, team, or medical service to a patient; and add and remove care team assignments.

1. To assign, click on the plus sign on the right side and select the desired action (Assign Myself, etc.).

2. To remove, single click on the assignment and then select remove after the options appears on the right side.

3. To change the provider’s role, click Modify.

Chief Complaint The Chief Complaint Component allows the provider to document the chief complaint of the patient that will pull into the Admission H & P.

1. Click in the Chief Complaint field. a. If no Chief Complaint has been entered, free text the chief complaint. b. If the Chief Complaint has been entered by nursing, review and modify as needed.

2. Click Sign.

Note: Nurses can’t

assign themselves or

view Care Team.




Diagnostics The Diagnostics Component allows the provider to view diagnostic reports and images.

1. When the desired diagnostic test is double clicked,

the report will open in a new window. 2. Providers can Tag information in the diagnostic

report. 3. If there is an image associated with the report, the

provider can click on the View Image icon at the top of the screen.

Documents The Documents Component allows the provider to view a variety of documentation including Admission H & P, Consult notes, Progress notes, Operative/Procedure notes, Hospital Summaries, and multidisciplinary documentation. One type of documentation that is not found here is nursing documentation (Focus Notes).

1. To open the note, single click and it displays on the right. a. Note: Double clicking just opens and closes the note on the right.

2. To view the note in a new window, click View Document on the left upper section of the note. 3. Providers can also check Enable Continuous Scrolling to scroll through all notes at once. 4. Providers can choose to Tag information in the note.

Note: Diagnostics in the last 24 hours will

automatically pull into the Admission H & P

and Consult notes.




Focus Notes (Last 24 Hours) The Focus Notes Component allows the provider to view nursing focus notes and shift summaries.

1. Click on the note header to view the Focus Note form in another window.

Histories The Histories Component allows the provider to view the patient’s history including Problems, Procedures, Family, Social, and Pregnancy.

Home Medications The Home Medications Component allows the provider to view the patient’s home medications and perform the admission or transfer medication reconciliation.

1. A green check mark indicates that the Meds History is complete. 2. The list of medications will be displayed on the left side of the Component. 3. There is a Compliance column where the provider can review any comments. 4. The provider can also use the status bar area to perform the Admission or Transfer Medication Reconciliation.




Hospital Course The Hospital Course Component is a free text Component that will pull into the provider’s note. Providers can type, use Dragon Medical One, use Tagging, or use Cerner Auto Texts. This Component is multi-contributor that allows multiple users to add content that will save for everyone. This Component should be completed by the attending provider group.

Immunizations The Immunizations Component allows the provider to obtain immunization information for the patient. This data populates from a variety of sources including hospital encounters, primary care offices, and MCIR (Michigan Care Improvement Registry).




Implant History The Implant History Component allows the provider to view implanted devices (i.e. Scanned or manually entered surgical implants).

Intake and Output The Intake and Output Component allows the provider to view 24 hour balances of intake, output, and counts.

1. The Intake and Output Component in the Workflow only shows 24-hour balances. 2. There are drop-downs for details related to those 24-hour balances. 3. To view Intake and Output in Interactive View, click on the Intake and Output Component header in the

Workflow. Interactive View is where nursing records their documentation. It displays hourly reporting, shift balances, yesterday and today’s balances at the top.




Labs The Labs Component allows the provider to view and Tag lab values to pull into their note.

1. The Lab header links to Results Review.

2. Certain labs automatically populate into the note.

• Most recent in the last 24 hours.

• Varies per specialty. 3. The provider can click on the lab to

view a trending graph. 4. The provider can Tag a single lab or

multiple labs. a. To Tag multiple

labs, hold down the Ctrl key and select any desired lab value (s).

b. Click the Tag button.

Lines/Tubes/Drains This Lines/Tubes/Drains Component displays the following for active or discontinued items:

• Type

• Location

• Insertion date and time When each individual line, tube, or drain is selected, the most recent clinical documentation correlated with that site is displayed in a side panel providing full visibility to the site status, assessment, need for reassessment, and replacement or renewal.




MAPS The MAPS (Michigan Automated Prescription System) Component allows the provider to view MAPS data related to controlled substances for the patient.

1. This Component displays the Michigan only MAPS score for the last 2 years. 2. Providers can click View Drug Report to view more details. 3. To search MI Only prior to previous two years, log into the full MAPS site in the Resources link in the toolbar.

Medications Timeline The Medications Timeline Component allows the provider to view medications that are Scheduled, Unscheduled, PRN, Continuous Infusions, or Inactive.

1. View Menu: Allows you to select the view you want to see. 2. Icon Legend: Displays the Icon Legend. 3. Medication Profile: Orders are displayed below their corresponding headings. 4. Time Frame: There are a few ways to change the timeframe in Medication Timeline.

• Click the timeline and drag it into a new time frame.

• Click the forward button (>) to move to a later time frame or click the back button (<) to move to an earlier time frame.

• From the Time Interval menu above the time frame on the right, select the time interval you want to use.

• Click Today to return to the time frame that was displayed when Medication Timeline was initially accessed or refreshed.

• Click the Zoom In button or double-click the timeline or Component to move to the next lowest time interval.

• Click the Zoom Out button or press CTRL and double-click in the timeline or Component to move to the next highest time interval.

5. Pop-Up Boxes: Click a cell that contains an icon to view corresponding information in a pop-up box. Click the View link to display more details, such as rate changes and important medication action details.




Microbiology The Microbiology Component allows the provider to view microbiology results.

1. In the Susceptibility column, click on the pill icon to open the

susceptibility report. 2. Click on individual test to see further details.

New Order Entry The New Order Entry Component allows the provider to enter orders from the Workflow.

1. There is a simple search functionality. 2. Select from the following tabs: Home, Mine (your favorites), Public or Shared. Public allows the provider to

search location and specialty. Your home tab should be already set to this. Shared allows the provider to search another provider and use their favorites.

3. Click the Orders for Signature button in the upper right to modify and sign orders.

Note: Providers are unable to Tag items in this Component. Must use Ctrl-C to copy and then Ctrl-V to paste into the note.




Notes/Reminders/Queries Notes/Reminders/Queries allows the provider to address documentation queries. It also allows the providers to address non-urgent communication from clinical staff. Documentation Queries Documentation Queries are created if a current diagnosis needs to be specified further or if the provider has documented a diagnosis that has not been added to the problem list. Providers only need to address the queries for their group/specialty.

1. To address the Query, click on the query (blue link).

2. Review the query. a. If the provider agrees with the

query: Then the provider would sign the query and immediately go add/change the diagnosis in the Problem List Component.

b. If the provider disagrees with the query: There is a Provider Comments section at the top of the query to mark their comments and click Sign.

Provider Communication This is only for non-urgent communication from clinical staff. To address this communication, click on the message which is a link. The link leads to the Communication to Provider form. Clinical staff have completed the top portion, and the provider completes the bottom section.

3. Select the appropriate answer. 4. To sign the form, click the green check mark

in the upper left corner.




Objective/Physical Exam The Objective/Physical Exam Component is a free text Component that will pull into the provider’s note. Providers can type, use Dragon Medical One, use Tagging, or use Cerner Auto Texts.

Orders Profile The Orders Profile Component allows the provider to view orders, Cancel/DC orders, and Cancel and Reorder orders.

1. The Orders Profile header links to the Orders in the Menu. ▪ It is difficult from this view in Workflow to see what PowerPlans are ordered, which can be seen using

the hyperlink to Orders in the Menu. 2. The Component will default to display All Active Orders – users can change display by selecting another option in

the View filter/drop-down. 3. Providers can Cancel/DC or Cancel and Reorder from here:

▪ Single click on an order, then click the appropriate button at the top, then click on the Orders for Signature button in the upper right corner.

▪ Providers can sign, save, modify, or cancel the order. If an error is made, it can be removed by clicking Remove next to the order.

▪ When used before signing, clicking Clear will reset the Cancel/DC or Cancel and Reorder buttons. o If selecting Cancel and Reorder, make sure to modify the details as necessary.




Pathology/Misc The Pathology/Misc Component allows the provider to view or Tag any pathology reports and view send out lab information. Send out labs come from Mayo Clinic, Spectrum, and other sources.

1. To view the report, click on the blue hyperlink. Providers can Tag the report if needed.

Problem List The Problem List Component allows the provider to view, add, review, and change This Visit and Chronic problems. Munson Healthcare policy requires all providers to participate in managing this Problem List Component.

1. Providers can search for and add problems in the upper left search field. The problem chosen will add as the selected option in the drop-down to the left of the search field (This Visit, This Visit and Chronic, or Chronic).

2. Providers can use the This Visit and Chronic buttons as appropriate on each diagnosis. 3. Providers can individually prioritize problems without affecting any other provider’s order. This Visit active

problems will automatically populate the Assessment and Plan part of your note, in the ranking that you assigned.

4. Diagnosis Assistant is available by clicking on the exclamation point. This allows you to pick a more specific diagnosis that meets ICD-10 requirements.

▪ Then can narrow the results available by selecting the appropriate choices in any column and click save. 5. Be careful when resolving problems because this is a shared list across the system. If the provider who is

currently logged in resolves a problem, it resolves it for all other providers.

Important Information for Managing the Problem List – For Consultants

• Consultants do not need to prioritize all the problems contained on the Problem List, only the

specific problems that they are managing.

• Only the problems that are prioritized flow into the Assessment/Plan of the note. Any problem

which is not prioritized will be left out.

• Consultants should not delete a problem from the Problem List unless it is a problem that they are

managing. The Problem List is a single, shared list used by all providers care for the patient. When a

problem is resolved that problem is then unavailable for other providers taking care of the patient,

who need it to be available for their notes.




Procedure/Surgical History The Procedure/Surgical is a free text Component that will populate the note. Providers can type, use Dragon Medical One, use Tagging, or use Cerner Auto Texts.

Quick Links The Quick Links Component allows the provider to view Focus Notes and other basic patient information regarding Code Status-AMD (Advanced Medical Directives). This varies per specialty, for example: Cardiologist have a Quick Link called LVEF Results where they can view patient’s ejection fraction information.

1. Focus Notes leads to Results Review in the Menu 2. Code Status-AMD leads to Code Status-AMD in the Menu. Beside seeing Code Status and Advanced Medical

Directive information here, the provider can also find Emergency Contact information. 3. MyPatient Views leads to myPatient Views in the Menu where SmartWeb can be utilized, and Blood Transfusion

information can be viewed.

Review of Systems The Review of Systems is a free text Component that will pull into the provider’s note. Providers can type, use Dragon Medical One, use Tagging, or use Cerner Auto Texts.




Scales and Assessments The Scales and Assessment Component allows the provider to view patient information such as pain scale, CIWA, PCA

dosing, Broset score, Glasgow, and CHA2DS2-VASc Screening. The specific information available to view in this

Component varies per specialty.

Subjective The Subjective Component is a free text Component that will pull into the provider’s note. Providers can type, use Dragon Medical One, use Tagging, or use Cerner Auto Texts.

Visits The Visits Component allows providers to view details about a patient's current, future, and previous visits. Providers

can view additional details about a visit by positioning their pointer over a visit row. The current, open patient encounter

is indicated with the Currently Viewing label.

1. The Visits Component displays information about a patient's visits in the Today, Future, and Previous sections.

You can view the Reason for Visit, Location, Type, and Date columns for additional visit details.




Vital Signs The Vital Signs Component allows the provider to view the latest and previous vital signs for the patient. The most recent set of Vital Signs with max temp will auto populate the note.

1. The latest set of vital signs displays first. 2. Condense the view by clicking on the right side of the (book-like) icon. 3. Click on the vital headers (i.e. Temp, HR, BP, etc.) to view a trending graph.