Pre Log In Screens back up

After discussing the issue with EPIC technical support we have decided to relaunch the pre log in screens. Days of troubleshooting uncovered absolutely nothing and no explanations have been made about why the pre login screen seemed to trigger a run-time error. We have turned them back on, as of 3pm Monday and will monitor them to see if any errors occur.

These need to be activated on a case by case basis, so if after restarting EPIC, you don't see your pre-loging screen, jot down your ETN number and let Karen/Patrick know.

thanks

Pre Log In Screens

Pre Log In Screens are still (for the most part) not activated. EPIC technical support is continuing to validate what/where/when/and why the issue occured. As you recall, nearly all of the Medical Imaging workstations experienced a run time error, which rendered the workstations inoperable. We removed the pre-login screens in order to allow the workstations to be used. It is not known if the pre-log in screens are the actual problem or if they simply exposed another issue, such as a virus or spyware. Until EPIC knows for sure what happened, we will wait to reactivate the pre-login screens.

Thank you for your patience. We will get those screens back to you as soon as it can be safely done.

ABN issue resolution

It appears we have discovered the cause of the ABN issue which was creating problems adding more than one order to a single appointment. What was occuring is that an ABN warning was firing when a user was attempting to add another order on to an appointment. The user was unable to add the order and was forced to create a new appointment. This meant that the user was forced to "begin" and "end" each seperate order. Time consuming and not a good workflow. We are continuing to monitor whether our discovery will be the ultimate fix for this issue, but in the meantime, the warning may still fire. In the event that it does, you WILL now be able to proceed through the warning and schedule your orders as needed.

Thanks

CT and Fluoro Panels now removed

All previously paneled CT and/or Fluoroscopy studies have been removed from preference lists. They have all been replaced on those lists with the study alone. All that has been removed is the associated contrast for the study. Therefore, techs will now enter orders for both Inpatients and Outpatients for any contrast to be used during the procedure.

This should lead to less confustion about when to order contrast. The answer is---> ALWAYS! Regardless of the patients IP/OP status.

Thanks!

Fluoro Panels are gone

Per your requests, all of the Fluoroscopy panels have been scrapped. This means that techs will now enter orders for contrast for both Inpatients and Outpatients.

CT panels will be removed by the end of today.

MRI panels will remain as they are today.

Thanks!

Lorna Doones and Vanilla Pudding...

In the next few days PACS director Cindy Marks will be in touch with many of you regarding a slight change in the Speech Swallow workflow. Everything will function as normal, from a technologist perspective, until you reach the End Exam Navigator. When you reach that point you will be prompted with a question. The question will ask you if you have allready sent your images to PACS and verified them. This is not a typical workflow since normally you would not verify your images in PACS until you had ended the exam in EPIC. However, for the new Swallow workflow you will be verifying your images FIRST and then ending the exam in EPIC.

Normal workflow --> End exam in EPIC--> Verify Images in PACS

New Swallow workflow --> Verify Images in PACS-->Answer End Exam Question and Accept in EPIC

Cindy will be in touch with more details.....

Thanks

Where did my Pre Log in Screen Go?

It went bye bye. But only temporarily. Many workstations were erroring out with "Run Time Errors", so as a temporary means of getting access to the workstations, the pre log in screens were deactivated. As soon as EPIC determines the cause of the error and fixes it, the PLIS will return!

Thank you for your patience.

Perinatology Issues

A few common issues have come up regarding Perinatology appointments. The first issue involves the end exam question that you are all familiar with. This question only fires if the proper visit type (5964) is attached. What happened is that, that visit type and question didnt exist at the time of cut-over so many IMG's got linked to existing appointments with old visit types. To fix this...

Go to the patients appointment desk (click appts from the scheduling menu)
Find the correct appointment and highlight it
Click "change" from the bottem toolbar
Change the visit type to 5964
Accept

Now the appointment has the correct visit type and your question should fire at end exam.

**

The second issue involves your exams not falling off of the tech work list at end exam. This is also a cutover issue. Somehow the IMG for your appointments also got linked to Dr. Davidsons schedule. In order for the order to fall off your worklist, it must be unlinked from Dr. Davidsons schedule under the appointment desk. It is unclear whether you have the ability/security to perform this function, but we are looking into it. In the mean time, Karen or Patrick will need to do the unlinking.

Thanks

Vascular Lab IP modality

The IP Vascular Lab modality has been removed from your Tech Worklists, per your requests. It has also been removed from the scheduling pools to which it was attached. This means that when you attempt to schedule an IMG with a visit type that contains a pool that used to have 400541 attached, it will not be an option.

Thanks

Daily Abdomen orders

Diagnostic techs are already seeing orders for Daily Portable Chests. The MD group has asked that we add an option for Daily KUB as well. Therefore, don't be supprised if you start seeing orders for Daily Abdomens.

Also, keep in mind that on July 8th, the MD's will be doing all of their own order entry so keep an eye out for things that might be entered incorrectly.

Logging off vs Xing out

St Marys I.T. department just sent out a memo urging people to log off correctly. The key is to actually click "Log Off" and not just "X" out.

Just a reminder!

Removing Large Comment Text

From time to time orders are being placed at area Clinics that contain huge amounts of text in the comment field. This is causing the Tech Work List to flip out and not dislay correctly. If you need to remove the text so that you can view your worklist in a more usable manner follow these steps.

Click Ancillary Orders
Find the order you want to edit
Highlight it and click
Choose "Change Order"
Remove any text from the comment section that you dont want
Accept and refresh your Tech Work List

Remember to review all of the text so that you dont remove something you later want to be able to view. Once you remove it, its gone.

Thanks

One catch with Study Notes...

Study notes is working nicely, however this is a catch. If you need to tag something on your tech work list with a message such as "this case is on hold per floor" you can do it. However, the order needs to be checked in in order for study notes to be usable. If you get an error saying that no order has been released, it means that the case is not checked in and you may not use a study note.

This tool was created by EPIC as a communication between tech and rad. We are using it as a tech to tech communication so it is not entirely taylored for what we are using it for.

Not seeing all modalities when adding on?

If you are not seeing all the modalities you expect to see when attempting to add on, try clicking the "show all modalities" box. If this doesn't display the modalities you are expecting to see, document it and call support.

Thanks

Study Note Column

Have a look at your Tech Work List. You should notice something new. 10 points if you noticed it this morning, without even checking the Tip Page! There is a new column called "Study Notes". If you see an icon in this column it means someone (most likely a fellow tech) has placed a note on this appointment. This will be your queue that you need to check out a message. To view the actual study note...

• Highlight the patient and click the "Study Note" icon on the toolbar

or

• Highlight the patient and click alt-o

Also, on the schedule orders report (right hand side of the screen) a column already exists that displays any notes that techs place on unscheduled orders.

Using Add-On at end of day

Questions are still coming in about the inability to "add-on" an exam prior to Midnight. The answer is no, you can not use "add-on" when the length of the appointment would cross over the midnight hour. Your options are either....

• Use the "schedule" function and change the length of the appointment to fit in the the current day. I.E. It is currently 11:44pm. Change your appointment length to 15 minutes so that it does not cross over midnight.
• Use the "schedule" function and schedule your appointment to begin on or after midnight.

Thanks

Canceling Orders

In the event that you need to cancel an order you may do so using the "Ancillary Order" tool. Follow this path...

1. Click the "Ancillary Orders" Icon
2. Search for your patient, click to open
3. All of the orders existing on your patients will display
4. Locate the order you wish to cancel
5. Click the cancel button on the toolbar
6. Enter required data and accept

There have been instances of users adding an order onto the Tech Worklist just so they could cancel it. This should be avoided as it assigns an accession number and creates downstream problems.

Thanks

Re Posting: Tagging items on your TWL with messages

In the event that a scheduled order is on hold you may wish to enter a message to fellow techs so they understand what is happening. This may occur when an OR case from the AM remains on the OR Tech Work List at shift change. It would be great if the tech could simply view any messages that the 1st shift tech may have entered. To do that follow these steps....

1. 
   Highlight the appointment you wish to flag with a message on your Tech Work List
2. 
   Click Study Notes from your Tool Bar
3. 
   Click "Add New Note"
4. 
   Enter a message and click Accept
5. 
   Your message is now viewable to other techs who wish to see it
6. 
   To view the message, highlight the appointment and click alt-o

Re Posting: Tagging unscheduled orders with a Message

If you need to flag some information on an order that remains on your schedule orders report, follow these steps.

1. 
   Highlight the patient on the Schedule Orders report
2. 
   Right Click and click Select
3. 
   The patients appointment desk opens
4. 
   Go to the "Orders" tab
5. 
   Highlight the order
6. 
   Click "Edit Notes"
7. 
   Enter your message and accept
8. 
   Your message is now available in the Notes column of your Schedule Orders Report

Printing Worklists (on one page)

There is some concern that when a worklist is printed, all the columns are not fitting on one page. This is easily fixed. After clicking PRINT, you have several options to taylor your print job.

In the orientation section click "Landscape" and "Fit width to page". Now your report will print in landscape fashion and will include all of the columns on your list.

Re-Ending Exams

If you forgot to enter correct begin/end times, failed to enter supporting staff or need to add a charge to an exam it is possible to re-end it.

How do I find a list of exams that were ended today you might ask? Well, we put together a new Tech Work List that will display only those exams which were ended today. The new list is called "END EXAM Report". Of course if you need to look at a list from yesterday or a previous day, simply go into the "setting" and change the Date range to reflect your search. Changing this field will only apply to your current search. The next time you log in, it will be defaulted into todays date.

Once on the list, simply highlight your patient and click "end exam".

Keep in mind that you can not and should not change orders after ending an exam.

Thanks

Printing Labels from the TWL :(

Printing labels from the Tech Worklist is not current functionality. If it was, you'd know all about it and would be doing it. The current flow to get extra labels is "cumbersome" to put it nicely. It would be possible to print more labels as a default at "check in". If everyone is interested in that, it is a change we could investigate.

It is an issue that is on EPIC's radar and a less "clicktacular" workflow is in the works.

Thanks

Viewing Pts Imaging orders from ED Trackboard

If you need to see a patients current orders from the ED trackboard you may find them in the Kardex report. The need for this could occur if the patient has multiple orders in more than one modality. If coordination between modalities needs to take place, knowing which orders have been placed on a patient is valuable.

To view the patients current orders (while viewing the ED Trackboard) follow these steps.

1. Click on the row of the patient you are interested in
2. Notice that a report opens up on the lower half of the screen
3. Change this report to the "Kardex" report
4. Scroll down to the Radiology orders

Imaging orders placed in the last 48 hours will appear here.

Now you can determine if coordination between modalities needs to take place.

Work List Colors and Font Size

There have been some tweaks to the Tech Work List and Schedule Orders Reports. Small font size was causing some people to have difficulty reading the information. Also, the row colors have been tweaked in attempt to make things as easy to read and navigate as possible.

Hope this helps!

Time Outs at Begin Exam

There were some instances of Time Out forms not displaying for certain procedures. Hopefully that issue is corrected. If you feel as if an exam that should have a Time Out attached is missing it, document it and we can make the change as needed.

Thanks.

Diagnosis Code now on OR schedule

The op time team has provided a diagnosis column to the Master Daily schedule. To view this schedule.....

Click the "Master Daily Schedule" icon on your toolbar
Select the "SMH Radiant OR Schedule" (you can make this your default if you wish)
Click Accept

The diagnosis code is now listed between the procedure and surgeon.

Thanks to the OP-Time team for that!!

User Manual IMG clarification

Let me clarify.

Currently in the printed copy of the user manual 3 items have the incorrect img# next to the name of the order.

• 
  US Upper ext right Art Doppler currently says 1432 in the book. It should read 1632...NOT 1432.
• 
  IR Perc Neph Right Stent Place currently says 1632 in the book. It should read 1633 in the book...NOT 1632.
• 
  IR Perc Neph Right currently says 1633 in the book. It should read 1634....NOT 1633.

Instead of printing 75 new pages, we were hoping to just make manual edits on those 3 items.

Make sure to Log Out!

Just a reminder.......

Make sure to log out of EPIC after you are done documenting. It is an easy thing to forget, but very important. You don't want people documenting under your user name. You can always determine who is currently logged in by looking in the lower left hand corner of the screen.

Your pre log in screen will launch after you log out, so you can continue to monitor incoming orders and view your schedule without actually being logged into the system.

6/03/08 Issues Round Up

A few items to mention.

• Using the Add-On function is not possible when the appointment would cross over midnight. It is a known EPIC issue and a fix will occur sometime in the future.
• Patients height and weight were not always pulling into your HTML fields. We think we tracked down why this wasnt always happening and have addressed the issue.
• A question came in asking if it was possible to print schedules. Yes, add all your orders to your schedules. From that point, just click Print in the upper right corner. Your workstation should have a default printer close by.
• Labels currently don't have accession number. It is being addressed and will happen in the future. The will also have appointment date and room number.
• Each department has unique end exam questions that can be answered. If they appear incorrect, report it and we can make changes. Keep in mind that the pregnancy question will not appear on Male patients OR patients over 60 years old.
• There are only 3 appropriate "priority" status' for imaging orders. STAT, ASAP or routine. If you see any others, let the floor know that they are entering those incorrectly.
• Time Out forms were not popping in for some invasive FL procedures. Should now be fixed.

We are working on many other issues as well and will update ASAP.

Orders missing Expected Exam Date

Some questions have been coming in regarding a blank Expected Imaging date column.

A little history first. This column is filled in when an order is placed on an inpatient by an MD. If the MD does nothing, todays date is defaulted in. If they choose, they can enter any date they wish.

When an order is placed somewhere within the Dean system for an outpatient to have an exam, the order does NOT populate the Schedule Orders Report. So this is not a concern. You wouldn't want to weed through every order that gets placed in the Dean system!

However, what can happen that might lead to the Expected Exam Date column being empty is this. When our front desk staff enters an order into the system from a paper order, they are not entering the order in the same way an MD would. This means that the section of the order composer that defaults in that data is bypassed. This is not really a concern due to the following reasons.

When an outpatient paper order happens, one of two things happen.

• The order is placed in EPIC prior to the patient arriving. The order should then be immediatly scheduled by the front desk staff. This removes if from the Schedule Orders Report.
• The order is placed in EPIC when the patient arrives. The front desk then contacts you and there is no confusion as to when to perform the exam.

Therefore, the only time the column should be empty is between the time the paper order is entered into EPIC and the time it is placed on a schedule.

Hope that helps clear this issue up.

Pre Log In Screen revamp

Check out your Pre Log In screens. They have been revamped in order to be more workable and less dependent on filtering. The reports are basically the same as you see once you log in, however any patient specific data will not be displayed in accordance with HIPAA guidelines.

Can't Find an Icon on your toolbar?

Make sure your screen is maximized. If you have your screen not opened to the maximum size, you may have icons hiding behind the little >> on your toolbar.

Maximize your screen and they will reappear!

If you still can't find an Icon, there might be a security issue. Call the Help desk at 5354.

Corrections to Tech User Manuals

There were 3 changes to IMG ID numbers following the publishing of the Radiant User Manual.

IR IMG1632 should be changed to 1633 in the Manual
IR IMG 1633 should be changed to 1634 in the Manual
US IMG 1432 should be changed to 1632 in the Manual

Thanks

Communicating Info on Unscheduled Orders

If you need to flag some information on an order that remains on your schedule orders report, follow these steps.

1. Highlight the patient on the Schedule Orders report
2. Right Click and click Select
3. The patients appointment desk opens
4. Go to the "Orders" tab
5. Highlight the order
6. Click "Edit Notes"
7. Enter your message and accept
8. Your message is now available in the Notes column of your Schedule Orders Report

Enjoy!

Tech to Tech Communication regarding Scheduled Orders

In the event that a scheduled order is on hold you may wish to enter a message to fellow techs so they understand what is happening. This may occur when an OR case from the AM remains on the OR Tech Work List at shift change. It would be great if the tech could simply view any messages that the 1st shift tech may have entered. To do that follow these steps....

1. Highlight the appointment you wish to flag with a message on your Tech Work List
2. Click Study Notes from your Tool Bar
3. Click "Add New Note"
4. Enter a message and click Accept
5. Your message is now viewable to other techs who wish to see it
6. To view the message, highlight the appointment and click alt-o

ENJOY!