Guide To

Core CPRS GUI

For the HUI

October 2002

Contents

1. Introduction to Core CPRS

2. Starting CPRS

1. 1. In the Patient Selection screen, select a category in the Patient List box by clicking the radio button in front of the category (Providers, Teams, Specialties, Clinics, Wards, or All).

4. 1. You can also enter the patient’s name in any of the traditional VISTA formats (e.g., type the last initial and first four digits of the SSN).
   2. Verify that you have selected the correct patient and click on OK. If the patient displayed is not the correct patient, repeat either step 3 or 4 until you find the right patient and then click OK.

Starting CPRS, cont’d

Opening Another Patient Record

From within one patient’s record, you can easily switch to another patient’s record.

Click on File | Select New Patient. The Patient Selection dialog window will appear.

Note: If you have created or changed any orders or documents that are unsigned, a pop up window will appear and request that you review and/or sign the additions or changes.

Refreshing a Patient Record

You can refresh a patient’s information so that recent changes will be reflected. To refresh a patient’s records, click File | Refresh Patient Information. This option will refresh the information of the currently selected patient in the same manner that changing patients looks for the latest information. Refreshing a patient’s information will result in notes in progress being saved, and the review/sign changes screen will appear if changes are pending

Starting CPRS, cont’d

Notifications

Clinical Notifications are displayed at the bottom of the Patient Selection screen. You will only see notifications for your patients. You can set personal preferences to determine the type of notifications you receive.

1. Double-click on a displayed notification to review it.

2. To take action on one or more notifications:

• • Click the Process Info button to delete Information Only notifications (items preceded by an "I").
  • Click the Process All button. Each notification will be presented to you sequentially for you to review and take action on.
  • Hold the Ctrl key and click on one or more notifications. Then click on the Process Selected button. You will process each of the selected notifications sequentially.

3. Click the Next button on the status bar to move to the next notification.

3. Features Available from Any Tab

In the CPRS GUI, the tabs are intended to mimic the paper chart. Chart tabs divide functionality. The menu items on the View and Action menus change depending on which tab is selected.

However some features are available regardless of which tab is active:

• • Patient Inquiry

• • Current Activities (Encounter Provider and Location)

• • Primary Care

• • Postings (CWAD)

• • Patient Name
  • Social Security Number
  • Date of Birth
  • Age

1. 1. Click on the Visit/Encounter button.
   2. Locate and click the provider for this encounter in the list box.
   3. Click the tab of the correct encounter category for this visit:

• • Clinic Appointments
  • Hospital Admissions
  • New Visit

1. 1. Select a location for the visit from the choices.
   2. If you are creating a New Visit, enter the date and time of the visit (the default is NOW).
   3. When you have the correct provider and location, click OK.

• • Primary Care provider assigned.

• • Associate provider assigned.

• • The attending physician’s name and contact information.

• • Crisis Notes (C) – Cautionary information about critical behavior or health of a patient. Example: Suicidal attempts or threats.

• • Warnings (W) – Information about a patient of which medical center personnel need to be aware. Example: Patient can be violent.

• • Adverse Reactions/Allergies (A) – Posting that tells staff about medications, foods, and other conditions to which the patient is allergic or may have an adverse reaction.

• • Directives (D) – Also called Advanced Directives, Directives are recorded agreements that a patient and/or family have made with the clinical staff. Example: DNR directive on file.

1. 1. Click the Postings button. A dialog containing all postings for the selected patient appears.
   2. 
   3. Click a posting to see a detailed explanation. A new window will appear with the full text of the posting.

4. Electronic Signature

• • Select File | Review/Sign Changes – to see the orders you have entered for this patient in this session.

• • Select File | Select New Patient – to close this record and open a new record.

• • Select File | Refresh Patient Information – to refresh the patient chart so that new changes will be reflected.

• • Select File | Exit or click the close button.

The Review/Sign Changes dialog box shown below will appear. After signature, orders are released to the services for action. If the electronic signature code is not entered, or is entered incorrectly, the orders are not released to the services for action, but are held in an unreleased/unsigned status.

Note: Whenever possible it is best to enter all orders and sign them all at once. Each time you enter your signature code, the order(s) just signed will automatically print at the printer designated for the patient’s location.

Electronic signature, cont’d

The following Review/Sign Changes dialog box will be presented if the patient has outpatient medication orders that need to be signed and certain copayment conditions are met. The upper left corner box lists all service connected conditions and rated disabilities. The box to the right lists those conditions exempt from copayment requirements. All unsigned medication orders will display in the lower white box, along with a check block grid.

A question mark in a checkbox indicates that the user needs to identify whether that medication order is related to the condition in that column. (SC = Service Connected Condition, AO=Agent Orange Exposure, IR=Ionizing Radiation Exposure, EC=Environmental Contaminants, MST=Military Sexual Trauma, and HNC=Head or Neck Cancer). If you place a check in a box, you are indicating that a medication order is related to the condition in that column. If you create an empty box, you are indicating that the medication order is not related to the condition in that column. Note also that only those exemptions as they apply to the veteran are highlighted and selectable.

You can toggle the checkboxes by:

• • Clicking an individual checkbox.
    This will toggle the box between checked and unchecked.
  • Pressing the appropriate Copay button
    ( or )
    This will toggle all the check boxes in that column.

• • Pressing the button.
    This will toggle all the check boxes on the screen.

• • If a patient is a veteran and 50% service connected or greater then
    the Copay buttons will not be displayed on the Review / Sign Changes dialog.
    

• • If a patient is a veteran and less than 50% service connected and the patient is exempt from copay then the Copay buttons will not be displayed.
    If a patient is a veteran and less than 50% service connected, and the patient is not exempt from copay then the Pharmacy package checks to see if the drug specified in the medication order is marked as supply or investigational. If the drug is marked as supply or investigational, the Copay buttons will not appear.
    

• • Clinicians may enter, electronically sign and release orders. Orders automatically print at the patient location (clinic or nursing unit), and appropriate receiving services are notified electronically.
  • RNs may enter and release orders, such as telephone and/or verbal orders. The orders print at the patient location and receiving services are notified electronically. These orders require electronic signature by the ordering clinician. The clinician is alerted to sign these orders at their next log on.
  • LVNs and Clerks may enter orders and mark them as written, signed on chart orders. These orders will not print out, as it has been indicated that the hand-written order is already on the chart.

1. 1. Type TBOX at any menu option prompt in VistA.
   2. Select Electronic Signature Code Edit.
   3. Edit or enter information at the prompts presented. The information typed in Signature Block Printed Name and Signature Block Title will be what prints on progress notes and orders that you sign electronically. Please include your Baylor ID number in your Signature Block Title.
   4. If you enter a pager number it will also print on your signed documents.
   5. Your signature code must be at least 6 characters long and less than 20. It can contain any combination of letters or numbers. When you create a new code you must type it in all caps.

Example:

If you are prompted for your Current Electronic Signature Code and you do not know what it is, you need to contact your ADPAC or go to the IRM Help Desk. They will clear your old electronic signature code and you will then be able to create a new one.

5. Printing from within CPRS

6. Tools within CPRS

• • Clinical Drug Information – link to Micromedex web site

• • CPRS Home Page – link to the Houston CPRS home page where you can find the latest information on CPRS.

7. Personal Preferences

You can change many of the settings that control the way CPRS works for you. The Options menu on the Tools menu contains dialogs that may allow you to change which notifications and order checking messages you get, manage team and personal lists, assign your default patient selection settings, and modify your default tab preferences. To access the Personal Preferences settings, click Tools | Options from any CPRS tab.

The Options dialog consists of a number of tabs, each of which allows access to a category or type of preference settings.

Personal Preferences, cont’d

General tab

The General tab includes options for setting and changing Date Range defaults, Clinical Reminders, and other parameters involving the initial chart tab on startup and imaging reports.

Personal Preferences, cont’d

Date Range Defaults…

Click on Date Range Defaults… to set how long lab results and appointments and visits will be displayed on the Cover Sheet. Click on the Use Defaults button to set to the system defaults.

Personal Preferences, cont’d

Other Parameters…

To set chart tab preferences click Other Parameters. This option also allows you to set restrictions on the number of image reports you want to display.

Chart tabs

Click on the drop-down button and select the chart tab with which CPRS should open. Click on the check box if you want CPRS to remain on the last selected tab when you change patients.

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Personal Preferences, cont’d

Notifications Tab

This tab allows you to change your notification options.

Surrogate Settings…

To set a surrogate, click on Surrogate Settings… From the Surrogate Settings dialog, select a surrogate from the drop-down list. When saved, the surrogate information is displayed on the Notifications tab.

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To set a surrogate date range, click on Surrogate Date Range… From the Date Range dialog, click on the ellipsis buttons and select a start date and a stop date. You may also select a start time and a stop time for the surrogate. When saved, the Surrogate Date Range information is displayed on the Surrogate for Notifications dialog.

Personal Preferences, cont’d

Remove Pending Notifications…

Click on Remove Pending Notifications and then on Yes on the Warning dialog to clear all of your current pending notifications. This button is enabled only if you are authorized to use it.

Display Sort

Click on the drop-down button to select the sort method for your notifications. Choices include Patient, Type, and Urgency.

Notifications list

Click the check box next to any Notification to enable or disable it. Notifications with "Mandatory" in the Comment column cannot be turned off or disabled. Click the heading to sort Notifications so that you can see which are turned on and which are turned off.

Order Checks tab

Click the check box next to any Order Check to enable or disable it. Order Checks with "Mandatory" in the Comment column cannot be turned off or disabled. Click the heading to sort Order Checks so that you can see which are turned on and which are turned off.

Personal Preferences, cont’d

Patient Selection Defaults

Click on Patient Selection Defaults… to change your defaults for selecting patients. Click a radio button in the List Source group. Combination uses the criteria defined using Source Combinations. After selecting a List Source, click the appropriate drop-down button and select the criteria for that source. If you select Clinic or if Clinic is one of the sources in your combination of sources, you will need to select a clinic for each applicable day of the week. If you do not work in any clinic on a particular day, leave the field for that day empty.

Click a radio button in the Sort Order group to determine the sort order for the patients. If an item is dimmed, it is not available with the List Source(s) you have selected. Alphabetic is the default.

To display patients who have clinic appointments within a specific date range, click the selection buttons. The Start and Stop fields denote the number of days before or after today that appointments should be displayed.

The defaults that are set here are used when you select patients from the Patient Selection dialog in the CPRS chart.

Personal Preferences, cont’d

Personal Lists…

This option allows you to edit a personal list of patients or combinations of wards, clinics, providers, specialties or lists.

Click Personal Lists... to edit or create list of patients. To create a list, click New List... and type in a name for your list. Click a radio button in Select patients by group to select a method for defining patients on your list. The selection box below the Select patients by group lists the available choices for the selection method. The Patients to add field lists all of the patients that can be added from the particular selection method. With the desired patients in the Patients to add field, click Add (which adds the highlighted patient or patients) or Add All to copy the patients to Patients on personal list. Click Save Changes if you plan to make other changes on the Personal List dialog such as creating one or more additional Personal Lists. Click OK when you have finished making all desired changes and additions to this dialog.

You maintain these lists by using this dialog. Patients are not updated automatically on personal lists. You can select from these lists by selecting the Teams choice on the Patient Selection dialog.

Personal Preferences, cont’d

Source Combinations…

Click Source Combinations… to edit or create a list of sources from which your patients can be selected. You can change your combinations by adding or removing specific wards, clinics, providers, specialties, or lists.

To create a source combination:

1. Click on a radio button in the Select source by group.

2. Click an entry in the selection field below the Select source by group.

3. Click Add.

4. Repeat steps 1 through 3 for each desired source.

5. When all desired entries are in the Combinations field, click OK.

You can create only one combination list. The Combination list can be set as your default using the Patient Selection dialog.

Personal Preferences, cont’d

Notes Tab

Notes…

This option on the Notes tab allows you to configure defaults for editing and saving notes. Click on the selection arrows to change the number of seconds between auto save intervals for notes. You may also assign a default cosigner for notes by clicking on the drop-down button and selecting a provider. You may also click on the either of the two check boxes, if you wish to be prompted for a subject for progress notes and if you wish to verify note titles. If the verify note title is NOT checked, your default title will load automatically.

Personal Preferences, cont’d

Document Titles…

You may select a personal list of document titles to be displayed for several different types of documents. Click on the drop-down button on the Document class field and select the class of document for which you would like to create a list. When you have selected a document class, the Document titles field is automatically populated with all available choices. Highlight one and click on Add. Hold down the Control key to select more than one title at a time. To select a title from your list as your default, highlight it and click on Set as Default. Click on Save Changes if you will be making more changes on this dialog before you click OK.

Reports Tab

Use the Reports tab to change the default date range and occurrence limit for all reports or individual reports on the Reports Tab in CPRS.

8. Cover Sheet

1. 1. Click on a value in the Cover Sheet Vitals area. The Vitals dialog appears.
   2. In the upper left of the dialog box, click on a time period that you want to view. (Today, All Results, Date Range, etc).
   3. Click the vital category you want to view on the lower left of the dialog box.
   4. Adjust the graph features as desired:
   5. • Click Zoom and enlarge a part of the graph by clicking and dragging from above and left of the area to below and right of it.
      • Click 3D to make the graph into a three-dimensional representation.
      • Click Values to show the numerical value of each graph point.
      • Click on a point in the graph to get a list of all vitals for the same date/time.
      • Click in the graph heading to get a listing of all entries displayed in the graph.
   

   9. Problems

   `

   The Problem List is used to document and track a patient’s problems. It provides a current and historical view of the patient’s health care problems across clinical specialties. It allows each identified problem to be traceable through the VISTA system in terms of treatment, test results, and outcome.

   When you select the Problem tab, the patient’s active problems are listed in the right-hand box. You can display inactive problems only, both active and inactive problems, and problems for a selected service or provider by changing your view through the View menu. Click Action to see a selection of action items. You can add, change, inactivate, remove, verify, or annotate problems.

   Problems, cont’d

   To add a new problem to a patient's problem list:

   1. 1. Click on the New Problem button.
      2. Click on the Other Problem button.
      3. Type in a key word to describe the problem and click on Search.
      4. Highlight the diagnosis and click on OK.
      5. 

         Problems, cont’d

      6. Enter information about the problem in the dialog box that appears.
   6. Click on OK when you have completed all items in the dialog box. The problem will be added to the problem list.

   Details

   To view details about a problem, double click on the problem you want to view.

   Verifying a Problem

   An unverified problem will have a (u) in the status column.

   To verify a problem:

   1. 1. Click on the problem in the problem list.
      2. Select Action | Verify or right-click the problem and click Verify on the shortcut menu.
   Problems, cont’d

   Changing a Problem

   CPRS allows you to change existing problems.

   To change a problem:

   1. 1. Click on the problem that you want to change in the problem list.
      2. Select Action | Change or right-click the problem and click Change on the shortcut menu.
      3. Enter the desired changes in the dialog box.
      4. Click OK.
   Inactivate a Problem

   You will inactivate a problem when it has been resolved.

   1. 1. Click on the problem you want to inactivate in the problem list.
      2. Select Action | Inactivate or right-click the problem and click Inactivate on the shortcut menu.
   Removing a Problem

   You will use the action to Remove a problem if it has been entered in error. Problems cannot be deleted from the database but they will not display on any reports or lists if they have been removed.

   To remove a problem:

   1. 1. Click on the problem you want to remove in the problem list.
      2. Select Action | Remove or right-click the problem and click Remove on the shortcut menu.
   10. Meds

   On the Meds tab, you can review both Outpatient and Inpatient Medications. The expiration date and refills remaining are shown for Outpatient Medications. You can also get a more detailed display of each order by double-clicking on the medication in the list. To take other actions, such as discontinue, refill, or change, use the Action menu or right-click on a medication. You can order new medications by selecting New Medication from the Action menu or by going to the Orders tab.

   

   The default order in which meds are displayed is by status, with active orders shown first.

   Meds, cont’d

   Ordering Medications

   Medications can be ordered from either the Meds tab or the Orders tab.

   See Chapter 11 for details on ordering inpatient and outpatient medications.

   Changing Medication Orders

   Use the Change action to start a new dosage or schedule of a medication. When you change an active medication, you will get a new order with the changes and the original order will be discontinued.

   To change a medication:

   1. 1. Highlight the order(s) you want to change.
      2. Select Action | Change or right-click on the order and click Change on the shortcut menu.
      3. Complete the changes as appropriate in the dialog box. Click Accept.
      4. You may sign the order later when you have completed all orders.
   Renewing Medications

   Active orders may be renewed. In addition, inpatient medication orders that have expired in the last four days and outpatient medication orders that have expired in the last 120 days may be renewed. The default Start Date/Time for a renewal order is NOW.

   After the new (renewal) order is accepted, the Start Date/Time for the new order becomes the Stop Date/Time for the original (renewed) order. The original order’s status is changed to RENEWED. The renewal and renewed orders are linked and may be viewed using the History Log function. Once an order has been renewed it may not be renewed again or edited.

   Meds, cont’d

   To renew medication orders:

   1. 1. Highlight the order(s) you want to renew from the list on the Meds tab.
      2. Click on Action | Renew or right-click on the order and click on Renew in the shortcut menu.
      3. From the dialog box shown below, highlight the medications that you want to change and click on the Change… button.
   4. Only number of refills and pick-up can be edited on a renewal. Make changes and click on OK.

   

   5. Click on OK to accept renewal orders. They will be displayed in blue on the Meds tab and will need to be signed when you have completed placing orders.

   Meds, cont’d

   Discontinuing Medication Orders

   When an order is discontinued, the order’s Stop Date/Time is changed to the date/time the action is taken. An entry is placed in the order’s Activity Log recording who discontinued the order and when the action was taken. Pending and Non-verified orders are deleted when discontinued and will no longer appear on the patient’s profile.

   To discontinue a medication order:

   1. 1. Highlight the order(s) you want to discontinue.
      2. Select Action | Discontinue/Cancel or right-click on the order and click on Discontinue.
      3. Click on a Reason to Discontinue.
   4. Click on OK.

   11. Orders

   On the Orders tab, you can write new orders and view existing orders.

   Orders, Cont’d

   Viewing Orders

   In CPRS you can choose from several methods of sorting the orders that are displayed. Changing the view of the Orders tab allows you to focus the list of orders on one of several criteria. Focusing the list will speed up the selection process. All of these options are under the View menu.

   You can also save a view as your default order view by clicking on View | Save As Default View.

   When you view orders, you can quickly get information such as what services the orders are for, the start and stop dates for each order, the name of the provider that entered the order, and the status of the order. Double-click on an order to get more details.

   Orders, Cont’d

   Custom Order View

   If you choose Custom Order List…, you can make the list of orders very specific. You may choose to display orders by any combination of Order Status, Service/Section, and date range. For example, you can view just pharmacy orders. When the Orders tab is displaying only some of the orders, an icon appears below the Postings button on the right side of the dialog. The icon is a pair of hands covering a sheet of paper and indicates that the user is not seeing all of the orders for the selected patient.

   

   If both the Reverse Chronological Sequence and Group Order by Service boxes are checked, the display of orders will be in reverse chronological sequence within each defined service/section. To have orders displayed by reverse chronological sequence only, remove the checkmark from Group Orders by Service. Once you leave the Custom Order List dialog box you may want to save the new display order as a default view. Click on View | Save as Default View.

   Orders, Cont’d

   Writing Orders

   In the Write Orders box on the left are names of services or categories you may order. Select a service and a box will open with a more detailed list of items for that service. When you select an item from the list, an ordering dialog box appears for you to complete the order information.

   

   The order menu will contain quick orders and order sets to make ordering items easier for the clinician.

   Orders, Cont’d

   Quick Orders

   Some commonly ordered items have been set up so that you don’t have to fill in any details or conditions about the order; you simply click on the order name and it is automatically completed for you. An arrow to the left of the order text designates those orders that are quick orders. The purpose is to minimize the number of prompts to be answered when entering orders.

   Note: CPRS allows you to create your own quick orders. After entering an order in the usual manner and before accepting the order, click on Options | Save as Quick Order. You must save it as a Quick Order before accepting/signing the order.

   Order Sets

   Order sets are comprised of a group of pre-defined, related orders which are used frequently, such as standard admission or pre-op orders. A single selection from the menu may automatically place a number of orders.

   Order Checking

   Order checks are performed on all orders when you click Accept Order and before you sign the order to identify duplicate orders, order contraindications, and for other conditions.. If the order checks find any of these conditions, you can review them and decide whether to continue placing the order, change it, or cancel it. Some critical order checks require a justification if you continue to place the order.

   Signing Orders

   When you exit the patient chart, you are prompted to sign your orders. You may also choose to sign orders before you leave the chart by selecting Action | Sign or File | Review/Sign Changes.

   Orders, Cont’d

   Allergies

   You may enter allergies from the Orders tab when entering other patient orders.

   You can review a patient’s current allergies in several places:

   • • On the Cover Sheet, in the box labeled Allergies/Adverse Reactions
   • • On any tab of CPRS, click the Postings button if it shows the letter "A"
   • • On the Enter Allergy Information dialog, click the Current button.
   To enter an allergy:

   1. On the Orders tab, in the Write Orders list, click on Allergy/Adverse Reaction.

   2. In the dialog that appears, select the causative agent. You may type the word or part of the word (a minimum of three characters is required) you are searching for and click Search. In the list that appears, click the causative agent and click OK. The search for a causative agent includes a breakdown of the different files where a match was found, and encourages the user to select from the most preferable source first. The list of matches is returned as a treeview grouped by file. There is a checkbox for No Known Allergies on this dialog box.

   

   Orders, Cont’d

   3. In the dialog that appears, select the reaction type.

   4. Select whether this is an Observed or Historical allergy or reaction. An observed reaction requires both a Reaction Date/Time and a Severity.

   5. Select the applicable Signs/Symptoms from the list. If this is an Observed reaction, click on the Date/Time button to record when it was observed.

   6. Click on OK.

   7. The Enter Allergy Information dialog box remains open for additional allergy entries. Click on the … button for Causative agent to select another allergy or click on Quit.

   

   Note: There is a clinical reminder which is due if neither an allergy or No Known Allergies (NKA) has been entered for the patient. You can also enter allergies through the clinical reminder dialog on the Notes tab.

   Orders, Cont’d

   Orders, Cont’d

   Diets

   To order diets:

   1. Click on Diets in the Write Orders list.

   2. You will get a list of common diets and quick orders (shown below). Click on the diet you want to order and complete the order dialog box.

   3. Click on Accept Order.

   

   If the diet you want to order is not in the list, click on Other Diet Orders.

   The Diet Order dialog shown below has five tabs that offer different types of diet orders. The information you enter on each tab will create a separate order.

   

   Orders, Cont’d

   Tips on Ordering Diets

   • • A diet order becomes effective for the next meal if it is ordered after the cut off time. If a diet is ordered after the cut off time the user will be prompted to order a late tray for that meal.
   • • A diet called an Admission Diet is automatically ordered for a patient as soon as an admission is entered. The admission diet is fat, sodium, and carbohydrate controlled diet so that it is appropriate for almost all patients. Patients will receive the admission diet until a diet order has been entered. The following nursing units do not get an admission diet: 5K (SICU), 3LCC (CCU), and 3LMI (MICU).
   • • A late tray is automatically ordered when a patient is admitted between 4:00pm and 7:00pm.
   • • A diet order can consist of a maximum of five diet components, such as soft, 2 gram sodium, 40 gram protein, 2 gram potassium, and 1800 cal diabetic.
   • • It is not possible to order conflicting diets, such as "no added salt, 2 gram sodium".
   • • You cannot combine a Regular diet with any other diet components.
   • • If a diet with several restrictions needs to be changed you must reorder the whole diet. You cannot cancel one portion of the diet order.
   • • If the diet ordered is unusual and is not listed, enter the diet order as Special. Then enter the diet on the Additional Order tab of the Diet Order dialog box.
   • • If a diet is ordered for someone on a tube feeding, you will be asked if the tube feeding should be canceled.
   • • Consult the unit dietitian for assistance when ordering tubefeeding.
   • • Diet orders will change chronologically, based on future orders. For instance, if a clear liquid diet has an expiration date, when it expires the patient’s diet will revert back to the previous order.
   • • All future diet orders are displayed with the Diet Order dialog box. If you order a diet without an expiration date you will cancel any future diet orders. It is easy to unintentionally cancel NPOs or other future orders.
   Orders, Cont’d
   Labs

   Order Inpatient Labs

   1. Select Lab Orders, Inpatient from the Write Orders list.

   

   2. Select the collection method (ward draw/time or lab draw).

   3. A menu listing common lab tests will open. Click on the lab test needed. Control (ctrl) click to select more than one test. (At the same time press the ctrl key on the keyboard and click the left mouse button.) The tests with an arrow in front of them are quick orders. These are one-time orders, with predefined collection type and urgency. When you use a quick order you will not be prompted for additional information.

   Orders, cont’d

   Other Lab Orders

   1. 1. If you need to order tests that are not listed as quick orders, click on Other Lab Orders on the Lab Orders menu.
      2. Type the test name in the Available Lab Tests box or scroll through and select from the displayed list.
   1. 1. Tab to the Collect Sample box. Tab again to accept the sample type as defined by Laboratory Service.
      2. Enter the Collection Type. Tab to accept the default value, or select from the drop down list.
      3. Enter the Collection Date/Time.
      4. Tab to the How Often box. For repeated tests, click on the arrow to see the available choices, such as QD or MO-WE-FR. Select the desired frequency and indicate the number of days desired.
      5. Click on the Accept Order button.
   NOTE: If you select multiple times for a test under How Often, a + will appear in front of this test on the Orders screen.

   Orders, cont’d

   Order Outpatient Labs

   1. Select Lab Orders, Outpatient from the Write Orders list.

   

   2. A menu listing common lab tests will open. Click on the lab test needed. Control (ctrl) click to select more than one test. (At the same time press the ctrl key on the keyboard and click the left mouse button.) The tests with an arrow in front of them are quick orders. These are orders for collection today. When you use a quick order you will not be prompted for additional information.
   1. 1. Use Other Lab Orders to order tests not listed.
      2. You may order future lab tests if you know the future date for collection. If you do not know what date in the future that the sample/specimen will be collected, write your orders in the progress note.
   Orders, cont’d

   Medications

   You can order Medications either through the Orders tab or the Meds tab.

   If you want to renew, discontiue, refill, or change active medications, it is easier to use the Meds tab. If you want to create your own personal quick orders, you must be on the Orders tab.

   Outpatient Medications

   To order an outpatient medication quick order:

   1. 1. From the Orders tab, select Medications, Outpatient from the Write Orders box.
      2. You will see a dialog box with a list of medication categories. Click on the type of medication you want to order.
      3. The next screen will be a listing of medications, dosages, and schedules. Click on the medication you want to order. Control (Ctrl) click will allow you to select more than one. (At the same time press the ctrl key on the keyboard and click the left mouse button.)
      4. A dialog box will appear for each medication you order with all fields completed. Edit as needed. When everything is correct, click on Accept Order. Your completed medication orders will be listed on the order sheet.
      5. You will be prompted to sign when you exit the patient chart.
    

   

   Orders, cont’d

   To order an outpatient medication without a quick order:

   1. 1. 1. 1. From the Orders tab, select Medications, Outpatient from the Write Orders box.
            2. Click on Outpatient Medications.
            3. A dialog box will appear for the selection of the medication name. Non-formulary drugs are identified with the letters NF. (See Methantheline Tab)
            4. Personal quick orders will be listed in the middle selection list.
            5. Select the appropriate form and click on OK.
            6. 

               Orders, cont’d

            7. The medication order dialog box will appear.
   
   1. 1. Some drugs have associated pre-set guidelines. This information is displayed by clicking on the underlined text Display Restrictions/Guidelines.
      2. Select a dosage from the list. If the desired dosage is not included in the list of dosages, then type a new one in the dosage field. It is important to use the same format as the selection list uses. (i.e. 75MG)
      3. Select a schedule. A standard schedule should be selected from the schedule list whenever possible. In the future, this will enable order checks to be done for dosages (i.e. alert the provider of a possible overdose). Non-standard schedules should be avoided if at all possible.
      4. Check the PRN checkbox to order As Needed.
      5. Use the Comments field for indications or additional instructions. The pharmacist will be prompted with a yes/no question as to whether the comments should be added to the sig.
      6. Some drugs have a pre-set indication (ex. For blood pressure) which appears as a check box near the bottom of the order dialog screen. If this box is checked, the indication will be automatically added to the end of the sig.
      7. Days Supply is automatically completed. Edit if necessary.
      8. Quantity is calculated automatically based on the Days Supply and Schedule, as well as the number of dispense units per dose.
      9. Enter the number of refills.
      10. Click on the appropriate button for Pick Up.
      11. Always review the completed order text in the box at the bottom of the order dialog screen. Click on Accept Order when all entries are completed.
      12. Orders, cont’d

          Topicals

          1. 1. 1. Most non-oral dosage forms will list as a dosage and the strength/properties of the item. In the example there are two different strengths, 20% and 40%.
                2. If a dosage other than what is listed is needed, then the free text should also include strength or other distinguishing information. For example, THIN FILM OF 20%.
                3. The route field CAN be left blank if not needed for the sig.
                4. The Qty field is not calculated. Input the amount based on the Quantity Dispensed information displayed above the field. In this example, the quantity should be dispensed as grams in multiplies of 70. The Qty field would then contain 70, 140, 210, etc.
                5. 

                   Orders, cont’d

                   Oral Liquids

                   1. 1. 1. The strength is the same on both choices, but the quantity changes from 1 teaspoon to 2 teaspoons.
                         2. The Qty should be completed per the instructions. In this example, the quantity should be in MLs in multiples of 120. Enter 120, 240, 360, etc.
   

   Orders, cont’d

   Complex Doses
   1. 1. This process is used for orders that have two or more distinct parts.
      2. Select the medication.
      3. Click on the Complex tab.
      4. Fill out the table with dosage, route, schedule, and duration information. The duration prompt should only be used when the drug is to be taken for a designated period of time and stopped.
      5. Days Supply and Quantity fields will calculate as the table is completed.
      6. Enter the Number of Refills and Pick Up method.
      7. Review the completed order and click on Accept Order.
   

   Orders, cont’d

   Notes about the outpatient medication dialog:

   • • If you are going to prescribe medications for a patient who is not here, or who is here without a scheduled visit/appointment, you should first click on the Encounter button on the button bar, enter a new visit, and check the "historical" box. This will insure that the patient is not billed for a visit.
   • • A proper prescription requires a drug name (DO NOT PICK Non-formulary or Study forms), dosage, route and schedule, quantity and refills, pick up location, and comments (optional). Incomplete RX’s require additional work for Pharmacy staff.
   • • The software does not accept alpha characters in the quantity.
   • • The default Pick Up for quick orders is Window. If the patient is picking up their medications today, send them to the Pharmacy pick up window. If the patient wants the medications mailed you need to edit the Pick up field to Mail. The orders go automatically to Pharmacy when they are electronically signed. Make sure your patients know that they will not need to wait at the Pharmacy drop off window with prescriptions.
   • • Type indications in the Comments box.
   • • All non-formulary medications must be done on the appropriate paper forms with necessary signatures. Send prescription and completed non-formulary request form with the patient to the pharmacy drop-off window.
   • • Restricted medications must be ordered on the paper forms unless you are an authorized prescriber. If you are authorized to order a restricted medication you may order it electronically.
   • • Schedule 2 and 3 narcotics and investigational drugs MUST be ordered on a paper prescription form. Pharmacy will not accept them electronically.
   Orders, Cont’d

   Inpatient Medications

   To order an inpatient medication quick order:

   1. 1. From the Orders tab, select Medications, Inpatient from the Write Orders box.
      2. You will see a dialog box with a list of medication categories. Click on the type of medication you want to order.
      3. The next screen will be a listing of medications, dosages, and schedules. Click on the medication you want to order. Control (Ctrl) click will allow you to select more than one. (Press and hold the ctrl key on the keyboard and click the left mouse button.)
      4. A dialog box will appear for each medication you order with all fields completed. Edit as needed.
      5. You will see displayed text for the Expected First Dose based on the administration times on the nursing unit. Check the checkbox if you want to have the First Dose Given NOW. This will automatically create a separate order for a one-time dose.
      6. When everything is correct, click on Accept Order. Your completed medication orders will be listed on the order sheet.
      7. You will be prompted to sign when you exit the patient chart.
   Orders, Cont’d

   To order an inpatient medication without a quick order:

   1. 1. 1. 1. From the Orders tab, select Medications, Inpatient from the Write Orders box.
            2. Click on Inpatient Medications.
            3. A dialog box will appear for the selection of the medication name. Non-formulary drugs are identified with the letters NF.
            4. Personal quick orders will be listed in the middle selection list.
            5. Select the appropriate form and click on OK.
            6. The medication order dialog box will appear. Complete all fields and click on Accept Order.
            7. Orders, Cont’d

               Complex Doses

               1. 1. 1. To order a complex dose, click on the Complex tab and complete the table.
                     2. Click on Accept Order.
   Notes about the inpatient medication dialog:
   • • When entering the Schedule, choose from the list. Avoid using non-standard schedules.
   • • ALL inpatient medications are ordered in CPRS (narcotics, restricted, and non-formulary). There are no additional requirements for narcotics. Both non-formulary and restricted medications need approval faxed to inpatient pharmacy. The NDR approval form may be used for both. Pharmacy will fill these orders pending receipt of approval forms. Pharmacy will contact the clinician if approval forms have not been received and request proper approval in order to continue the medication. If Pharmacy is unable to fill the order they will contact the clinician and ask that a non-formulary alternative be ordered. The clinician should discontinue the non-formulary medication order and order the formulary alternative.
   • • Type indications for PRN medications in the Comments box.
   Orders, Cont’d
   • • Quick orders for glucose test and insulin sliding scale are available on the Medications, Inpatient order menu. The glucose test will expire in 24 hours unless the clinician states otherwise in the Comments box. The insulin sliding scale order remains in affect for the full 28 days unless the clinician states otherwise in the Comments box.
   • • For orders for dressing changes that are done with a medication, order the medication and type the dressing change instructions in the Comments.
   Discharge Medications/Pass Medications

   Discharge medications and pass medications are ordered as Outpatient Medications.

   Order the discharge

   1. 1. Select A/D/T from the Write Orders list.
      2. Select Discharge Patient and complete the order including the date of discharge in instructions.
   Order Medications

   First review both active inpatient medications and outpatient medications on the Meds tab. Often the patient already has active outpatient medication orders for the medications needed for discharge. Don’t write new orders for these medications. Check with the patient to see if they have a supply at home. If you cannot verify that they have meds at home do the following:

   1. 1. Highlight the outpatient order(s) on the Meds tab. Control (Ctrl) click to select more than one medication. (At the same time press the ctrl key on the keyboard and click the left mouse button.)
      2. Select Action | Change.
      3. Make the necessary changes on the outpatient medication order dialog.
      4. Click on Accept Order.
   This will automatically discontinue the active order and send a new order to Pharmacy.

   If you need to order additional medications for discharge that the patient does not already have as an outpatient medication but has an inpatient order do the following:

   1. 1. Highlight the inpatient order(s) on the Meds tab. Control (Ctrl) click to select more than one medication. (At the same time press the ctrl key on the keyboard and click the left mouse button.)
      2. Select Action | Transfer to Outpatient.
      3. A dialog box will open for Delay Release of Copied Orders. Enter an effective date.
      4. Click on OK.
      5. Enter additional information for the outpatient order. Insure Window is marked for Pick-Up.
      6. Click on Accept Order.
   Orders, Cont’d

   If you need to order additional medications for discharge that the patient does not already have as an outpatient medication OR an inpatient medication do the following:

   1. 1. 1. 1. Go to the Orders tab.
            2. Click on Medications, Outpatient in the Write Orders list.
            3. See previous section on outpatient medication orders for details.
   Finally, select File | Review/Sign Changes to sign all orders just completed.

   The outpatient medications just signed will not appear on the list of active orders on the Orders tab while the patient is an inpatient. You can review your signed orders on the Meds tab or use the Custom Order View on the Orders tab.

   
   Complete the progress note titled "Discharge Instructions to the Patient".

   Notes about Discharge Medications/Pass Medications:

   • • Policy states that discharge medications/pass medications must be ordered before 2 p.m. the day prior to discharge.
   • • Pass medications are completed as outpatient medications.
   • • If you are doing a discharge after hours or on weekends you need to call Inpatient Pharmacy

   and let them know that there are medication orders for discharge in the computer.

   • • If the patient is on a non-formulary medication as an inpatient and the approval NDR form
   was sent to Pharmacy, a new NDR form is NOT needed for the outpatient non-formulary.
   • • Supplies are ordered electronically using the Medications Outpatient Supplies menu.
   • • Do not mark current outpatient medications for Refill. Create new orders for medications the patient may need refills for. Marking a medication for refill will send the order to CMOP (Central Mail Out Processing) and the patient will not be able to hand-carry the medications home.
   • • Nothing will be faxed to Pharmacy and only the supplies need to be hand-carried.
   Orders, Cont’d

   IV Fluids

   To order IV Fluids:

   1. 1. 1. 1. 1. 1. 1. Click on IV Fluids in the Write Orders list on the Orders tab.
                     2. A menu displaying a list of common IV Fluids will open.
                     3. Click on the order needed.
                     4. An IV Fluid Order dialog box will open. Complete the Infusion Rate and edit as needed.
                     5. When everything is correct, click on Accept Order.
   

   Orders, Cont’d

   Vitals

   To order Vitals:

   1. Select Vitals from the Write Orders list on the Orders tab.

   2. Select the type of measurement from the list in the ordering dialog box. Measurement combinations are also available.

   3. Enter the schedule, a start time, and a stop time. Clicking on the box containing three dots at the end of the Start and Stop date fields will open a calendar to choose a date from.

   4. Enter additional instructions if desired.

   5. Click on the Accept Order button.

   Activity/Patient Care/Free Text

   Activity, Patient Care, and Free Text orders are different kinds of orders that are placed for nursing and ward staff to take action on. They print only at the patient’s ward/location, and are NOT transmitted electronically to be completed by other services.

   Predefined nursing orders (quick orders) may be available under various sub-menus. Selecting Text Order in the Write Orders list may also be used to compose nursing orders. These orders require the ward staff to take action to complete the request. They are identified on the order sheet with two greater than signs in front of the order text.

   Vitals orders are another type of nursing care order that is not transmitted electronically to another service.

   Orders, Cont’d

   Completed orders

   See Section 4 of this manual for information about signing orders.

   Once orders are electronically signed, they will automatically print on a designated printer. The designated printer is used ONLY for orders. Clerks or other designated nursing staff are responsible for removing the printed orders from the printer and placing them in the patient chart. It is best that only one person is designated per shift for this task. DO NOT remove orders from the printer unless you are IMMEDIATELY placing them in the patient chart.

   Two greater than signs printed in front of an order (> >) indicate that it is a generic order. Generic orders do not have a receiving service and require further action by nursing staff.

   Printed orders with a line to the right instead of signature information are verbal or telephone orders. These should be placed in the chart temporarily until they are signed by the ordering clinician. The ordering clinician will sign these electronically and a new copy will be printed with the clinician signature information on it. The unsigned copy should be replaced in the chart with the new signed copy.

   Orders, Cont’d

   Order Actions

   Actions are available from the Action menu on the Orders tab or by a right-click on the order. If an action is grayed-out, you cannot perform that action on the selected order.

   To take an action on an order.

   1. 1. Highlight the order(s). Control (Ctrl) click to select more than one order. (At the same time press the ctrl key on the keyboard and the left mouse button.)
      2. Click on the Action menu and select the appropriate action item or right-click on the order and select an action from the shortcut menu.
   Order actions are described in the table below.

   Order Actions

   Action	Description
   Change	Allows editing of orders while they are still pending. This creates a new order and a discontinue order which applies to the original order. (Applies to Inpatient Meds only.)
   Copy to New Order	Allows you to copy an order, rather than having to completely write a new order. This action is useful for ‘re-writes’, or when orders are discontinued on interward transfers. The original order, if active, will not be discontinued.
   Renew	Allows you to renew or reinstate orders that have been discontinued. Applies to Pharmacy orders only.
   Discontinue/ Cancel	Allows you to discontinue Active, Pending, and Unreleased orders. This creates a new discontinue order. When this action is taken on an unsigned order, the order is deleted.
   Hold	Prevents further processing of an order until the hold is released or until the order expires. Not all types of orders may be placed on hold: Pharmacy orders may be placed on hold, but Lab orders may not be held.
   Release Hold	Allows an order to continue its processing.
   Renew	Renews active and/or expiring orders.
   Alert When Results	Generates an electronic alert when results are available for an order.
   Flag	Indicates that the order needs clarification or further instructions.
   Unflag	Removes the flag after clarification or instructions are received.
   Ward Comments	Allows you to add comments about an order. Comments are displayed on the Details screen.
   Sign Selected	Allows you to sign selected orders.

   12. Notes

   When you select the Notes tab, you can view the patient’s progress notes or write a new note. The Last 100 Notes are listed in the box on the left of the screen. The text of the most recent note is displayed in the right box. A right click in the Last 100 Notes box allows you to change the displayed list; i.e., Signed Notes (All), Signed Notes by Author, Signed Notes by Date Range, Un-cosigned or Unsigned Notes. Click on an item in the list to select a note you want to read. The text of the selected note is displayed.

   

   Notes, cont’d

   Viewing Notes

   The list of documents on the Notes tab is in a tree structure. Addenda are separately selectable and are displayed as a page with a plus sign behind a note page. Notes with Addenda have a plus sign to the left that can be clicked to expand the view into the original note and any addenda that have been attached to that note. Once expanded, the note or any addendum attached may be selected and viewed individually.

   Select a grouping node (for example, "All signed notes" below) in the tree to display a second list of all the documents falling under that node. This second list can be sorted by clicking on the column headings (Date, Title, Author, Location).

   

   Notes, cont’d

   Changing Views

   Changing the view of the Notes tab allows you to focus the list of notes on one of several criteria. Focusing the list will speed up the selection process.

   To change the view, either click View on the menu bar and select the desired list item, or click the right mouse button while the mouse pointer is over the left field where the notes are listed.

   You may change the Notes List view to include the following choices:

   • • Signed Notes (All)
     • Signed Notes by Author
     • Signed Notes by Date Range
     • Uncosigned Notes
     • Unsigned Notes
     • Custom View
   Any view can be saved as the default view.

   

   Notes, cont’d

   Custom Order View

   You may select the Custom View option on the menu to further focus the list of notes you wish to have displayed. The List Selected Documents dialog (View | Custom View) allows the items in the tree to be grouped and sorted in a variety of ways. From the List Selected Documents dialog, you may choose to display notes by any combination of Status, Author, and date range.

   You may change the "Group By:" field to one of the following choices:

   • • Visit Date
     • Location
     • Title
     • Author
   You may change the "Sort By:" field to one of the following choices:
   • • Date of Note
     • Title
     • Subject
     • Author
     • Location
   Also, at the bottom of this dialog box there are check boxes for Title and Subject as well as a blank field labeled "Contains:". These allow a search for a particular word or string of characters in either the Title or Subject of a progress note or both.

   

   Notes, cont’d

   Here is an example of notes sorted by title.

   Notes, cont’d

   To Add a New Note:

   Inpatient Notes

   1. 1. Verify that the correct inpatient information is displayed on the Encounter button.
      2. Click on the New Note button.
      3. A dialog box will open prompting you for a title, date/time, author, and expected cosigner for those who require a cosigner. Click on OK.
      4. Click in the large text area on the right and write your note.
      5. Right click and select a signature action.
   Outpatient Note for a scheduled visit:
   1. 1. Verify that the appropriate visit is displayed on the Encounter button. Click on the Encounter button to change visit or provider data.
      2. Click on the New Note button.
      3. A dialog box will open prompting you for a title, date/time, author, and expected cosigner for those who require a cosigner. Click on OK.
      4. Click in the large text area on the right and write your note.
      5. Click on the Reminders button to process any Clinical Reminders that are Due.
      6. Click on the Encounter button to enter the required Provider, Diagnosis, and Procedure data for the visit. Click on the OK button.
      7. (See the following pages for help with Clinical Reminders or Encounter Forms.)
      8. Right click and select a signature action.
   Outpatient Note for which no scheduled visit exists (NEW visit):
   1. 1. Click on the New Note button.
      2. Click on the New Visit tab.
      3. Enter a clinic for the visit location. Enter a date and time, or accept the default date/time of NOW.
      4. Select Historical Visit only if you are recording historical data for your patient. If this note is for a patient you have seen today or spoken to by telephone today, do NOT mark the Historical Visit button.
      5. NOTE: If you do not check the Historical Visit box, your note is automatically recorded as an Ambulatory visit. If your note documents a telephone call, you MUST choose a Telephone Clinic in order to avoid billing the patient.
      6. Click the OK button when your selections have been made.
      7. A dialog box will open prompting you for a title, date/time, author, and expected cosigner for those who require a cosigner. Click on OK.
      8. Click in the large text area on the right and write your note.
      9. Click on the Reminders button to process any Clinical Reminders that are Due.
      10. Click on the Encounter button to enter the required Provider, Diagnosis, and Procedure data for the visit. Click on the OK button.
      11. (See the following pages for help with Clinical Reminders or Encounter Forms.)
      12. Right click and select a signature action
   Notes, cont’d

   Encounter Check-out

   Click on the Encounter button at the bottom of the left column to complete the encounter information.

   Required elements to complete the encounter check-out:
   1. 1. Primary provider – A primary provider must be entered before the encounter information can be saved.
      2. Service connected and treatment factors checked when applicable.
      3. Procedure (CPT code) – Type of visit on the Visit Type tab
      4. Diagnosis
   Notes, cont’d

   The encounter dialog box will open to the Visit Type tab.
   1. 1. Click on the type of visit, either New Patient or Established Patient.
      2. Make a check mark in the checkbox for the type of exam.
      3. Check Yes or No boxes in the Service Connected section when applicable. Items that do not apply to this patient will be grayed out.
      4. The author of the note will be in the Current providers for this encounter box (your name). If the clinic is defined with you as the default provider, your name will be followed by Primary in parentheses. If you don’t see the primary designation behind your name and you are the primary encounter provider, highlight your name and click on the Primary button.
      5. If someone else is the primary encounter provider, type their name in the Available Providers text window, highlight the correct name in the list, and click on the Add button. You will then need to make this provider the primary provider, highlight their name and click on the Primary button.
      6. 

         Notes, cont’d

      7. Click on the Diagnosis tab to select encounter diagnoses.
      8. Select a diagnosis category from the list on the left.
      9. Check the appropriate diagnosis codes. Make sure a checkmark appears in the checkbox.
      10. The checked diagnoses will appear in the Selected Diagnoses box at the bottom of the screen. The first one checked will be the primary diagnosis.
      11. Click on the OK button when you have completed the entry of all required check-out elements.
   

   Click on the Other Diagnosis button if you need to select a diagnosis that does not appear in any of the lists. You will get a lookup dialog box. Type in a term or an ICD code and click on Search. Click on the appropriate diagnosis from the list of choices and click on OK.

   Notes, cont’d

   Additional functions on the Diagnosis Tab

   • • The Primary button will change a highlighted diagnosis in the Selected Diagnoses list to the primary diagnosis.
   • • The Remove button will remove a highlighted diagnosis in the Selected Diagnoses list.
   • • The Select All button highlights all of the diagnoses in the Selected Diagnoses box.
   • • Make a checkmark in the Add to Problem list checkbox if you would like to add the highlighted diagnosis/diagnoses to the patient’s problem list.
   • • After entry the encounter information will appear in the bottom section of the progress note on the Notes tab.
   Encounter Form Tips

   CPRS does not check for completion of the encounter form on scheduled visits. The provider can enter partial information and still sign the note leaving the visit in an "action required" status.

   If there isn’t a scheduled appointment and the provider creates a new visit, then CPRS will not let the user sign the progress note until all encounter information is entered.

   Encounter information can be added later to an unsigned or signed note.

   1. 1. Open patient chart and go to the Notes tab.
      2. Click on the note in the list on the left to select it.
      3. Click on the Encounter button to complete the encounter information.
   Adding an addendum
   1. 1. Click on the note you wish to addend in the list on the left.
      2. Click on Action | Make Addendum.
      3. Type in the text for your addendum. Right click to choose a signature action.

   Notes, cont’d

   Document Templates

   Document templates let you quickly add commonly used text and objects when writing or editing progress notes, completing consults, or writing discharge summaries. Document templates can be used on the Notes, Consults, and Discharge Summary tabs. These tabs have an Options menu that will allow you to Create New Template or Edit Templates. Clinical Coordinators will also have Create new Shared Template and Edit Shared Templates menu options. All these options enter the template editor window shown below. The Templates drawer is always available on the Notes tab even when a note is not being edited. This allows templates to be copied and used in other text fields throughout CPRS.

   

   Personal Templates

   Any user can create their own personal templates. To create a new template, you can copy and paste text into it, type in new content, add objects, or begin by copying a shared template and then modifying it as needed. Personal template and folder icons have a folded upper right corner.

   Shared Templates

   Shared templates are created by a Clinical Coordinator and are available to all users. Shared template and folder icons do not have a folded corner.

   Notes, cont’d

   Types of Templates

   You can create individual templates, group templates, dialog templates or folders.

   Templates contain text and objects that you can place in a document.

   Group templates contain text and objects and can also contain other templates. If you place a group template in a document, all text and objects in the group template and all the templates it contains (unless they are excluded from the group template) will be placed in the document. You can also expand the view of the group template and place the individual templates it contains in a document one at a time.

   Dialog templates are like group templates in that they contain other templates. You can place a number of other templates under a dialog template. Then, when you use the dialog template in your document, a dialog appears that has a checkbox for each template under the Dialog template. The person writing the document can check the items they want and click OK to place them in the note.

   Folders are like folders or directories in a file system. They are used to group and organize templates. You cannot place a folder in a document. It is there to hold templates and help in finding certain types of templates. For example, you might create a folder called "Radiology" for templates, group templates, and other folders relating to radiology.

   Features of Templates

   Hide Items in Dialogs

   Click on this check box and children templates are no longer available from the template drawer. Only the parent group template, dialog, or folder is available.

   Display Only

   Click this check box to make individual parts of a dialog as display only. When a template is display only, the check box is removed and the item is used for information or instructions.

   Only Show First Line

   Click on this check box and the template will display only the first line of text followed by an ellipsis (…). The ellipsis indicates that more text exists. Hold the cursor over the line of text and a Hint box displays the complete text. This feature gives you the ability to have long paragraphs of text that do not take up a lot of room on the template. If selected, the entire paragraph is inserted into the note.

   Indent Dialog Items

   Clicking on this check box affects the way that children items are displayed on the template. When selected, this feature gives the ability to show hierarchical structure in the dialog. All of the subordinate items for the selected item are indented.

   Notes, cont’d

   One Item Only

   Clicking on this check box affects the way that children items are displayed on the template. Click on this check box to allow only one of the subordinate items to be selectable. Clicking on this check box changes the check boxes into radio buttons so that only one item can be selected at a time. To deselect all items, click on the one that is selected and the radio button is cleared.

   Hide Dialog Items

   Clicking on this check box affects the way that children items are displayed on the template. Click on this option to have subordinate items appear only if the parent item is selected. This feature allows for custom user input. The user only sees the options related to the items selected. This feature requires boilerplated text at the parent level.

   Using Templates

   When you create a new note, a Templates button shows on the left. When you click the button, it opens to show you file drawers for Personal Templates and Shared Templates. A plus sign appears to the left of the icon. Click on the plus sign to see folders and templates available. Click a minus sign to collapse the view, hiding the templates under that icon. When you find the template you want to place in a document, you can drag-and-drop it into the document, double-click it, or right-click and choose Insert Template. The text and objects will appear where the cursor was in the text box of the document.

   Previewing a Template

   You can preview a template to see what it will place in your document. To preview a template, right-click on it in the Templates drawer. Then select Preview/Print Template.

   Creating Personal Document Templates

   1. 1. On the Notes, Consults, or D/C Summ tab, bring up the Template Editor by selecting Options | Create New Template -or-
      2. To save specific text in a new note as a template, select the text, right-click on it, and select Copy into New Template.
      3. In the Name field under Personal Template Properties, enter a name for the new template.
      4. Click the template type: Template, Group Template, Dialog Template, or Folder.
      5. For Templates and Group Templates enter the text and objects (if desired) to create the content. You can enter the content in these ways:
   • • Copy and paste from other documents
     • Type in text
     • Insert Patient Data Objects from the Edit menu
     • Copy a shared template
   NOTE: After you enter the content, you can right-click in the text area to select spell check or Check Boilerplate for Errors, which looks for invalid objects.
   1. 1. Select where you want to place the template in the Personal Template view.
   • • Click the plus sign next to an item to see the items under it.
     • Use the arrow buttons to move a template up or down in the tree
   1. 1. To save the template, click Apply. To save and exit the editor, click OK.
   Notes, cont’d

   Editing Personal Document Templates

   1. 1. On the Notes, Consults, or D/C Summ tab, select Options | Edit Templates -or -
      2. Click on the Templates button on the Notes tab, right-click in the box, and select Edit Templates.
      3. Find the template you want to edit and click on it to open it.
      4. Make any desired changes
   • • Type or delete text
     • Add or delete objects
     • Change the template name
     • Move the template to a different location
     • Make the template inactive
     • Exclude or include part of a group template
     • Change the template type
   1. 1. When finished, click Apply to save or click OK to save and exit the editor.
   Copying Template Text

   To copy text from a template to any text field:

   1. On the Notes tab, click on the Templates drawer button.

   2. Right click on the desired template.

   3. Click Copy Template Text or press Ctrl-C to simply copy the text to the clipboard.

   4. With the template text copied to the clipboard, switch to any text field in CPRS, right-click in the text field and select Paste.

   13. Discharge Summaries

   The Discharge Summary tab displays the discharge summaries for the selected patient. The list of documents in the D/C Summ tab is in a tree view. Highlight any discharge summary listed in the left column to view the text of the summary in the right box. Addenda are separately selectable. Discharge Summaries with Addenda have a plus sign in front of them

   

   Discharge Summaries, cont’d

   Viewing Discharge Summaries

   You may change the Discharge Summaries List view to only include the following summaries:

   • • Signed Summaries (All)
     • Signed Summaries by Author
     • Signed Summaries by Date Range
     • Uncosigned Summaries
     • Unsigned Summaries
   To change the view, click on View in the menu bar or right click in the list of documents in the left column.

   Select a grouping node (for example "All signed summaries") in the tree to display a second list of all documents falling under that grouping node. This second list can be sorted by clicking on the column headings.

   

   Discharge Summaries, cont’d

   Custom Order View

   The Custom View dialog (View | Custom View) allows the items in the tree to be grouped and sorted in a variety of ways.

   Discharge summaries can be grouped by:

   • • Visit Date
     • Location
     • Title
     • Author
   Discharge summaries can be sorted by:
   • • Date of Note
     • Title
     • Subject
     • Author
     • Location
   Make selections in the List Selected Documents dialog box and click on OK.

   

   Discharge Summaries, cont’d

   Writing Discharge Summaries

   You can enter discharge summaries in CPRS. Document templates can be used to make creating these documents faster and easier.

   1. 1. Click on the New Summary button on the bottom left of the screen.
      2. Complete items in the Discharge Summary Properties dialog.
      3. Click the admission related to this Discharge Summary.
      4. Click on OK.
      5. 
      6. Create the summary by typing in text, copying and pasting from other parts of the chart, and/or inserting templates.
      7. When the summary is complete, right click and select a signature action.

   14. Labs

   The Labs tab allows you to display lab results in a variety of ways. The column on the left side lists available lab results. For some reports, you may need to specify a date range or other criteria. Some reports will prompt for specific tests to be displayed.

   Most Recent

   The default when you select the Labs tab is Most Recent. Arrow buttons allow you to move backward and forward to view results for each collection date.

   Labs, cont’d

   Cumulative

   The cumulative is the most comprehensive lab report. It displays all of the patient’s lab results. When selecting a large date range, this report may take some time before being displayed. The results are organized into sections. You can automatically scroll to each section by selecting it in the Headings list box.

   

   Labs, cont’d

   All Tests by Date

   This report displays all lab results (except anatomic pathology and blood bank). Select a date range from the bottom of the left column. The data is displayed in the order of the time of collection.

   Labs, cont’d

   Selected Tests by Date

   This report is useful when you want to review specific lab results. Microbiology results can also be selected. A dialog box will open.

   1. 1. 1. 1. 1. 1. 1. Type a lab test name or scroll through the list on the left side of the dialog box.
                     2. Double-click on the lab test you want or highlight and click on the Add button.
                     3. This will add the lab test to the list of tests to be displayed on the right side of the dialog box.
                     4. Click on OK when you have completed the display list.
   

   Labs, cont’d

   Worksheet

   The worksheet is similar to the Selected Test by Date report. It does not display microbiology results, but it has many features for viewing lab results. It is very useful for displaying particular types of patterns of results.

   Tests can be selected individually or by test groups. Any number of tests can be displayed. When selecting a panel test, such as CBC, the panel will be expanded to show the individual tests. Tests can be restricted to only display results for a specific specimen type. For example, displaying glucose results only on CSF can be made by selecting the specimen CSF and then selecting the test Glucose.

   Test groups allow you to combine tests in any manner. For example, a test group could combine CBC, BUN, Creatinine, and Platelet count. You can save your test groups for later use. You can also select test groups that other users have created. Test groups are limited to seven tests, but you can have an unlimited number of test groups.

   To define your own test groups, select those tests you want and click on the New button. If more than seven tests are selected, the New button will be disabled. If you want to delete a test group, highlight it and click on the Delete button. If you want to replace an existing test group with other tests, select the test group, make any changes to the tests to be displayed and click on the Replace button.

   Note: These test groups are the same as those you may have already created using the Lab package.

   

   Labs, cont’d

   The Worksheet display is a table of results that can be displayed vertically or horizontally by checking on a checkbox located above the results table. Since only results are displayed in the table, comments are footnoted with ** and show in the box below the table. You can filter the results to only show abnormal values with a checkbox. This will quickly show tests that have results beyond their reference values.

   

   Labs, cont’d

   You can toggle between view comments and graph view. The graph format displays each test separately. By selecting each test, you see the trend in values for each time range.

   You can also use features to Zoom, apply 3D, and display values on the graph.

   • • • Click Zoom and enlarge a part of the graph by clicking and dragging from above and left of the area to below and right of it.
       • Click 3D to make the graph into a three-dimensional representation.
       • Click Values to show the numerical value of each graph point.
   Zoom will retain the selected date range when you change to other tests. This is helpful when you are looking for trends within a given time period.

   Click on a point of the graph and you will get a list of all test values for this collection time.

   Click on the graph header to get a listing of all test results currently displayed on the graph.

   Labs, cont’d

   Graph

   This report displays a single test in a graph. Comments are included. Zoom, 3D, and Values are available features also. Graphs can be printed by right-clicking on the graph and selecting Print from the shortcut menu.

   Microbiology, Anatomic Pathology, and Blood Bank

   These reports display only the results from these portions of the laboratory.

   Lab Status

   This report displays the status on current orders. It is best to select a short date range for this display.

   15. Reports

   A variety of reports are available on the Reports Tab of CPRS. The left side of the screen is labeled Available Reports. The list appears in a tree view format. A "+" sign to the left of a report heading indicates that there are additional reports listed under the heading. Click the "+" sign to expand the heading and reveal the additional reports.

   Click on the report you want to view and it will be displayed to the right. Many reports allow you to select a date range from a list at the bottom of the left column. You may set a personal default date range for either all reports or individual reports. See Chapter 7 for more information.

   You can print any of the reports displayed on the Reports tab. Select File | Print.

   Reports, cont’d

   The various clinical reports are displayed in either a text format or a table format. In addition, remote data, if selected, is integrated into the table format. The name of the remote facility is displayed in the first column of the table. For reports that are displayed in a text format, remote data is available from tabs that appear at the top of the display window.

   Data that appears in a table format can be sorted by clicking on the appropriate column heading. Details about a particular item can be viewed by clicking on that item. Details appear in the lower section of the display window. A right click in the table brings up a menu with selections to print the table, copy highlighted data from the table, or select all of the table data.

   Below is an example of a data table for lab results.

   Reports, cont’d

   Health Summary

   1. 1. 1. 1. Click on the "+" sign to the left of Health Summary in the list of Available Reports.
            2. Click on the specific health summary type from the expanded list.
   1. 1. The report selected will display in the right box.
   Health Summary types listed as Remote can be used to view Remote Data from other VA facilities.

   Find these additional reports in Health Summaries:

   • • Cardiology Reports: Echo, Stress test, and Cardiac Cath
   (the last verified reports of each category will display)
   • • Pulmonary Reports before 11/19/99
   (the latest before 11/19/99 will display)
   • • Vascular Studies including Carotid Doppler
   (all dates will display)

   16. Nursing

   Nursing Service is responsible for entering patient vitals, verifying orders on the chart, chart reviews and other functions. CPRS allows for many of these functions.

   Vital Signs

   Vital Signs can be entered from the Cover Sheet in CPRS GUI. Click in the Vitals box on the bottom of your screen. Once it opens, select ENTER VITALS. Another box will open and allow you to enter any or all of the vitals measurements, including pain. It will automatically default to the current date and time. If you need to change the date or time, click on the box with the 3 dots (…). It will display a calendar and a sliding timeline. Click on the date, hour and minutes you want then click OK. If the time you need is not available for you to select, use the sliding bar to go to the hour/minutes that you need. Select the hour and minutes and then click OK. You will then be back at the "Enter vitals" screen, where you can type in your values. Once finished, click on OK and they will be charted. When entering the values, do not use a decimal zero (I.e., 98.0, 99.0). You can and should enter other decimal values, such as 98.6, 101.2).

   Verbal and Phone Orders

   1. 1. Go to the Orders tab.
      2. Change the provider name to the physician (Click on the encounter button next to the blue Patient ID button on the button bar.)
      3. Enter order(s) (See the section in this manual on orders.)
      4. Highlight the orders written in this session.
      5. Select Action from the menu bar.
      6. Select Release without MD signature. A dialog box will list the selected orders.
      7. Select Verbal, Telephone or Policy in the Nature of Order section and click on OK.
      8. Type your signature code and press return.
   The physician will receive a notification that there is an order or orders that need to be signed.

   Signed on Chart orders:

   1. 1. Go to the Orders tab.
      2. Change the provider name to the physician (Click on the encounter button next to the blue Patient ID button on the button bar.)
      3. Enter order(s) (See the section in this manual on orders.)
      4. Highlight the orders written in this session.
      5. Select Action from the menu bar.
      6. Select Signature on Chart, a dialog box will list the selected orders, click on OK.
   Nursing, cont’d

   Medications

   Nursing no longer needs to use the Non-Verified/Pending Orders option in VistA. Verification of orders is now done in CPRS.

   14 Day MAR

   Upon admission a 14 Day MAR should be printed for the patient. This option is located in the Pharmacy menu option in the Nurse Menus.

   1. 1. Log into VistA with your access/verify codes. (You cannot do this from CPRS.)
      2. Select # 5 - Pharmacy Menu Options ...
      3. Select # 4 - 14 Day MAR
      4. At the "Select the MAR forms: 3//" prompt, press return to accept the default.
      5. At the "Select TYPE OF SHEETS TO PRINT: BOTH//" prompt, press return to accept
      6. the default.
      7. At the "Enter START DATE/TIME for 14 day MAR:" prompt, type "T" for today.
      8. At the "Select by WARD GROUP (G), WARD (W), or PATIENT (P):" prompt, type "P"
      9. for patient.
      10. Enter the patient name.
      11. At the "Enter medication type(s): 2//" prompt, press return to accept the default.
      12. At the "Select PRINT DEVICE:" prompt, type the printer name. The printer name for
   MAR printing is your unit name and MAR. (Example: NU6FMAR)

   Nursing, cont’d

   Verification of Orders

   Nurses and Ward Clerks have the responsibility of electronically verifying doctor’s orders.

   • • Ward Clerks – will verify what they actually have to take action on. Items verified by ward clerks may be:
   • • Return to clinic in 2 months – for a patient being discharged
     • Labs to be scheduled at next clinic appointment
     • Radiology orders that must be scheduled
     • Orders for Type and Crossmatch for blood-which generate the completion of the SF-518
   Only orders requiring intervention by the ward clerk are required to be verified by them.
   • • Nurses will verify ALL orders, including those signed off by the ward clerk. Special attention should be given to orders for medications as the nurse will be checking off the orders and the MAR’s or treatment orders at the same time. Orders for Lab, Radiology and Dietetics are also verified by Nursing. Verifying orders indicates that you have acknowledged those orders. This information is then passed on to the next shift as needed.
   Verification of orders - when verifying orders the columns for NRS and CLK will be visible on the Orders tab.
   1. 1. Select the items you want to verify by placing the mouse pointer on the first item, click and drag to the last item needing verification. The items will be highlighted.
      2. Right click to see a list of Actions or click Action on the menu bar. You will see VERIFY as one of your choices.
      3. Click on VERIFY. A list of items you have selected will appear in a dialog box. Type your electronic signature code and enter.
      4. Once entered, verification is completed and your initials appear in the box by the items you selected in the NRS or CLK column.
   Nursing cont’d

   Chart Review

   24-Hour Certification is referred to as Chart Review in CPRS. Every night after midnight a Daily Order Summary will print on the CPRS printer for chart reviews. This report lists all orders entered for the previous day for all patients on the unit. It should be compared to the patient chart. All orders on the Daily Order Summary must also be in the chart. Night nurses on each unit will perform the chart review of all orders entered in the previous shift. If a night nurse is the first person to take off orders on a patient, the orders can be signed off in both the verify and chart review column of the patients chart. This should be done for orders left from day or evening shift. New orders on the night shift will be signed off in the verified column only and will be reviewed the following midnight.

   Steps for Chart Review (24 Hour Certification): The column for Chart review appears to the right of the Nrs and Clk verification columns.

   1. 1. Select the items you want to certify by placing the mouse pointer on the first item, click and drag to the last item needing to be certified. The items will be highlighted.
      2. Right click to see a list of Actions or click Action on the menu bar. You will see Chart Review as one of your choices.
      3. Click on Chart Review. A list of items you have selected will appear in a dialog box. Type your electronic signature code and enter.
      4. Once entered, verification is completed and your initials appear in the box by the items you selected in the NRS or CLK column.
   If orders are missing from the chart, double-click on the order to see Order Details. If the nature of the order is written, a paper chart copy will not have been printed because there should already be a written order in the chart. If the nature of order is electronically entered you need to print a new chart copy.
   1. 1. Highlight the order by clicking on it.
      2. Click on File in the menu bar.
      3. Select Print.
      4. The order will print on your unit order printer.
   After checking that all orders are in the chart, compare the chart to the MAR to do the 24-hour medication certification.

   When doing Chart Reviews (24-hour certification) of orders it is best to have ALL ORDERS as your saved view. That way, you do not miss expired, discontinued, stat or now orders. To make ALL ORDERS your default, click on View in the menu bar. Select Custom Order List. In the dialog box that appears click on All in the Order Status box. Click on OK. You may want to save this as your default view. Click on View in the menu bar and select Save as Default View.

   When verifying or certifying orders you can shorten the list of orders that you are looking at on the screen by changing your view to Unverified by Anyone, Unverified by Nursing, Unverified by Clerk, or Unverified by Chart Review. This will remove from your view orders that have already been verified. Click View on the menu bar and then Custom Order List. In the dialog box that appears select a status in the Order Status box. Click on OK. You may want to save this as your default view. Click on View in the menu bar and select Save as Default View.

   17. Helpful Hints and FAQs

   Helpful Tips for CPRS GUI
   1. 1. Enter your access code, TAB OR SEMI COLON, verify code to get into CPRS GUI.
      2. CPRS is a MOUSE DRIVEN program. You will use your mouse to select what you want and then left click to select.
      3. A RIGHT CLICK of the mouse will give you Actions. These are not always the same actions you get from your Actions pull-down menu on the menu bar.
      4. Selecting items to work on:
   1. 1. To choose one item, place mouse pointer on that item and left click.
      2. To choose items in sequence, place mouse pointer on top item, left click, hold and drag to the last item needed. May also start on the bottom and drag upward.
      3. To choose items NOT in sequence, choose one item, then hold the CONTROL key and move mouse pointer to next item, left click, proceed to next item (still holding the CONTROL key), left click on next item, etc. until all needed items are selected.
      4. To choose items in a block, choose the first item, hold the SHIFT key and click on the bottom item. All will highlight. (Same as click, hold and drag as stated above.).
   1. 1. Unsigned orders will show up as HIGHLIGHTED in BLUE and marked unsigned.
      2. Flagged orders will show up as RED in the Service column on the orders tab.
      3. Orders that have been discontinued or auto discontinued upon admission can be copied to a new order for signature. Select the orders you want to copy, choose "Copy to New Order" from the Action menu on the toolbar. Accept and electronically sign the order.
      4. Orders print in pre-defined locations. Keep in mind that the patient location that you enter in the Location ID box is where the orders for the patient will print.
      5. You can flag an order to send you a view alert when results are done. Choose the order, go to Actions on the toolbar or right click on mouse, select "Alert when results…"
      6. HELP is an action on the toolbar. When you select this action, a Table of Contents is displayed. Choose one of the contents listed. A screen will appear containing help about the topic you selected.
      7.  
      8. Vital Signs can be entered from the Cover Sheet in CPRS GUI. Left click in the VITALS box at the bottom of the screen. Once it opens, select ENTER VITALS. Type in the values and when finished click OK and they will be charted. When entering the values, do not use a decimal zero (i.e., 98.0, 99.0). You can and should enter other decimal values, such as 98.6, 101.2).
      9. Do NOT change the font size when writing a progress note, or in other chart tabs. This causes problems with CPRS functionality.
      10. Entering allergies can be done by anyone, but must be attributed to a provider by selecting the provider. Nurses cannot be picked as a "provider" for this purpose.
      11. CPRS GUI will close down if not active for a period of time. You will get a message that CPRS will close down. You will have 20 seconds to act before it closes.
   Frequently Asked Questions

   Q: How can I get immediate help about something I’m trying to do in CPRS?

   A: You can click on the Help menu at the top of the screen. A Table of Contents is displayed. Choose one of the topics or type in a topic. A window containing information about the topic will be displayed.

   Q: How do I activate an order?

   A: After completing all the steps for ordering, click the Accept Order button. Some orders require signatures or verification before they can be acted upon.

   Q: How do I sign an order?

   A: You can sign an order immediately after placing it, after placing all orders for a particular service, or after you have placed all orders during a working session.

   • • To sign after all lab orders are entered (or meds, diets, or imaging), select "Sign" from the Action menu (at the top of the screen or by clicking the right button on your mouse).
   • • To sign after entering all orders, simply click the Accept Orders button after each set of orders for different services, then when you exit the patient’s chart, a pop-up window will ask you to enter your electronic signature or save the order to be signed later (a notification will be created for unsigned orders).
   Q: How do I find a progress note I wrote a year ago?

   A: From the View Menu, pick Signed Notes by Author or Signed Notes by Date Range. When a pop-up box appears, enter the desired date range, then enter the desired order (ascending or descending).

   Cross Walk from Manual Physician Orders to CPRS

   Manual Process	CPRS Process
   Physician hand writes orders	Physician electronically inputs the orders
   Physician signs orders	Physician signs orders. Orders automatically print to designated printer located next to the MUC.
   Orders are already on the medical record.	Order are retrieved from the designated printer and placed on the medical record.
   Orders are transcribed by the MUC;: Medications on to the MAR Lab and diagnostic tests sent to the designated service. RN will verify all orders for appropriateness, accuracy and completeness.	MUC or LVN will electronically verify the appropriate orders with their scope. RN will electronically verify all orders for appropriateness, accuracy and completeness. RN’s verification will display on all meds in BCMA.
   Orders faxed to pharmacy by MCU, LVN or RN	Orders are electronically sent directly to pharmacy.
   Orders are often not legible and require clarification.	Orders are finished by pharmacy. This includes any and all clarification.
   Orders take up to two hours to display in BCMA.	Once the order is finished by pharmacy, it will display in BCMA.
   No process previously.	A Daily Order Summary is printed at 12:01 AM to the designated printer. This summary is a caption of all orders written the previous 24 hours.
   RN OR LVN conducts 24-hour chart review on all medical records.	RN or LVN conducts 24-hour electronic chart review ONLY on medical records with orders written within the previous 24 hours. This information is gathered from the Daily Order Summary.

   18. Glossary

   ASU

   Authorization/Subscription Utility, a VISTA package (initially released with TIU) that allows VAMCs to assign privileges such as who can do what in ordering, signing, releasing orders, etc.

   CAC

   Clinical Application Coordinator. The CAC is a person at a hospital or clinic assigned to coordinate the installation, maintenance, and upgrading of CPRS and other VistA software programs.

   Cover Sheet

   The CPRS patient chart screen that displays an overview of the patient’s record.

   CPRS

   Computerized Patient Record System, the VISTA package (in both GUI and character-based formats) that provides access to most components of the patient chart.

   CWAD

   CWAD, also known as Postings, is a component of the CPRS that presents information on Crises, Warnings, Allergies/Adverse Reactions, or Advance Directives about a patient.

   D/C Summaries

   A component of TIU that can function as part of CPRS. Discharge Summaries are recapitulations of a patient’s course of care while in the hospital.

   Glossary, cont’d

   GUI

   Graphical User Interface—a Windows-like screen that uses pull-down menus, icons, pointer devices, and other elements that can make a computer program more understandable, easier to use, allow multi-processing (more than one window or process available at once), etc.

   Health Summary

   A VISTA package that pulls selected components of data from other VISTA packages to present a summary of a patient’s health care, including clinical reminders. It can be viewed through CPRS reports tab.

   Notifications

   Notifications are a specialized kind of alert regarding patients or a patient’s orders. These appear on the CPRS patient selection screen and can be acted upon from there. They can be tied to team patient lists.

   OE/RR

   Order Entry/Results Reporting, a VISTA package that evolved into the more comprehensive CPRS.

   Order Checking

   A component of CPRS that reviews orders as they are placed to see if they meet certain defined criteria that might cause the clinician placing the order to change or cancel the order (e.g. duplicate orders, drug-drug/diet/lab test interactions, etc.)

   Order Sets

   Order Sets are collections of related orders or Quick Orders, (such as admission orders or pre-op orders).

   Postings

   A component of the patient chart that includes critical messages about a patient.

   Progress Notes

   A component of TIU which functions as part of CPRS. Progress Notes are clinicians’ textual records of a patient’s status at the time of an encounter.

   Quick Orders

   Quick Orders allow you to enter many kinds of orders without going through as many steps. They are types of orders that physicians have determined to be their most commonly ordered items and that have standard collection times, routes, and other conditions.

   Reports

   A component of the patient chart that includes health summaries, action profiles, and other summarized reports of patient care.

   TIU

   Text Integration Utilities; a VISTA package for document handling, that includes Discharge Summary, and Progress Notes, and will later add other document types such as surgical pathology reports. TIU components can be accessed for individual patients through the CPRS, or for multiple patients through the TIU interface.

   VISTA

   Veterans Information Systems Technology Architecture, the new name for DHCP, the comprehensive, integrated computer system used in the VA Medical Centers.