1. health and fitness
2. nutrition

EHR Enhancements April, 2015 Summary | Quick Guide
ELECTRONIC HEALTH RECORD (EHR) ENHANCEMENTS FOR
APRIL 21, 2015 SUMMARY
FACILITY TO FACILITY DISCHARGE CLEAN UP
This will affect providers.
Currently when a Facility to Facility Discharge is completed it sits as a planned
admission medication reconciliation on the patient's chart. These planned admission
medication reconciliations are never removed if they are not used.
In order to remove clutter and to limit the potential of these old orders being activated
on an encounter three months down the road, they will be removed 21 days after being
planned if they have not been activated.
PROPOSED ORDERS FROM PHARMACIST
This will affect providers.
All pharmacists have been given the ability to write proposed medication orders to
providers. This access will be in addition to the existing Suggest Order used today.
What is the difference?
Proposed orders activate immediately when accepted by the provider.
A suggested order typically comes in a PowerPlan that is reviewed and then entered by
the provider.
NM NOTIFY ORDER
This will affect providers, nursing, allied health and support staff for inpatients and
emergency patients.
Nuclear Medicine orders will generate NM Notify orders for inpatients and emergency
patients.
The NM Notify order will alert personnel that the provider has entered a Nuclear
Medicine order.
The notify order will generate:

A nurse review notifying the nursing staff that nuclear medicine has been
ordered for their patient
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EHR Enhancements April, 2015 Summary | Quick Guide

A NM notify task is also available for use for those that choose to add the DI
notify task type to their task list
Status of NM Notify Order
When an NM order is placed, it will automatically generate an NM Notify order in a
Future (On Hold) status.
When the chart is closed, the order will go to an Ordered status.
ED NM icon
In the ED’s the NM icon will appear as a ToDo event on the tracking board.
CHANGES TO ECHO ORDERS – REMOVAL OF OTHER IN THE REASON
FOR ECHO FIELD
This will affect anyone who enters Echo referrals for:

LHSC Non-invasive Diagnostic Cardiology Department

St. Joseph’s Cardiac Investigation Unit
This change is a result of accreditation review.
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EHR Enhancements April, 2015 Summary | Quick Guide
Old – Other appears in menu
New – Other has been removed from menu
The Cardiology departments are available to provide education upon request and will target
areas that order high volumes of Echos to assist during the transition period.
Any questions regarding the choices in the drop-down Reason for Echo Referral field should be
directed to the Echo departments.
Echo Department
UH
VH
St. Joseph’s
Extension
34703
55840
64221
ECG ORDERABLE REPORTING CHANGE FOR STEGH PATIENTS
A dictated result is viewable electronically in PowerChart as well as a link within the
report giving access to view the ECG once it is final.
A printed text-based report will also distribute through Cerner instead of the manual
faxing of the ECG tracing.
All users with access to STEGH patient information will be able to view these reports.
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Version: 3 | Date: April 8, 2015
EHR Enhancements April, 2015 Summary | Quick Guide
ORDER ENTRY CLEAN-UP
This will affect providers.
Fields that are not in use or functional have been removed in Prescription and Inpatient
Order Entry.
Prescription Order Entry Clean-up
Before
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After
Inpatient Order Entry Clean-up
Volume Dose and Volume Dose Unit fields have been removed.
Before
After
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EHR Enhancements April, 2015 Summary | Quick Guide
INTERMITTENT IV CHANGE
This will affect providers.
There will be a change to the way intermittent IV’s look when ordered but there is no
change to ordering practice for providers and no impact to favorites.
This will fix the problem with the Multi-phase PowerPlans and bring the intermittent
IV’s in line with how continuous IV’s are ordered.
Old Intermittent IV
New Intermittent IV
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EHR Enhancements April, 2015 Summary | Quick Guide
DOCUMENT AND CLINICAL NOTES VIEWER AVAILABLE FOR MEDICAL
SECRETARIES
This will affect medical secretaries.
Medical secretaries will now have two additional
components on the table of contents menu that will
provide alternative ways to view clinical documents and
reports.

Document

Clinical Notes Viewer
DISCONTINUE (FUTURE) TPN (EXCLUDING LIPIDS) AND DISCONTINUE
(FUTURE) TPN & LIPIDS ORDERS
This will affect providers, dietitians, nursing and pharmacy.
A new Discontinue (Future) order(s) will provide a consistent method to future
discontinue TPN solutions. It will also ensure the patient receives the prescribed amount
and avoid manufacturing and delivery of TPN when it’s not required.
This document explains the workflow for providers, dietitians, pharmacy and nursing.
Reasons for the new order

Phone calls from the provider requesting future stoppages does not provide a
paper or an electronic trail

Canceled TPN (amino acid/dextrose) order removes the order from the MAR and
pharmacy but it does not reflection the true time period until the TPN is actually
to stop

Waiting to cancel the order in real time can be costly as pharmacy can create
TPNs that are not required
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EHR Enhancements April, 2015 Summary | Quick Guide

Communication orders do not flow to pharmacy

Modifying the stop date/time of the TPN order changes the TPN entry to the
base solution it was built from causing confusion about the order

Blood Work and glucose related TPN orders within the “Total Parental Nutrition
(TPN) (Module)” are not canceled
Provider & Dietitians Workflow
Add Discontinue (Future) TPN Order
1. In the patient’s chart, click Add on the table of contents menu.
2. In the Search field type discontinue tpn.
3. Select the appropriate Discontinue TPN order, in our example we selected 22:00
hrs TODAY – Stop current TPN & Lipids.
4. Modify Order Details if required and Sign the order.
Important
Discontinue (Future) orders generate two tasks – one to
pharmacy and one to nursing.
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EHR Enhancements April, 2015 Summary | Quick Guide
Orders Tab (Patient Care Order)
The order will appear under Orders.
Important
Once both pharmacy and nursing tasks are signed off the Discontinue
(Future) order will automatically complete.
Pharmacy Workflow
The pharmacy task will appear on Pharmacy’s Multi Patient Task List (MPTL) under the
TPN tab.
Pharmacy MPTL
1. Pharmacist or Pharmacy Tech will modify the original TPN (amino acid/dextrose )
order in Med Manager based on the information contained in the Discontinue
(Future) task.
2. Pharmacist or Pharmacy Tech will notify the sterile room of the change.
3. Pharmacist or Pharmacy Tech will complete the Discontinue (Future) task.
Important
When pharmacy signs off the task it does not affect nursing task
and vice versa. Once both pharmacy and nursing tasks are signed
off the Discontinue (Future) order will automatically complete.
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EHR Enhancements April, 2015 Summary | Quick Guide
Nursing Workflow
Discontinue (Future) orders will appear for Nurse Review. This order also generates a
task.
Nurse Review

Nursing task will appear on the PAL and Task List within chart.

The nursing task will provide the following instructions Nurse to discontinue
“TPN (Module)” when the original TPN (amino acid/dextrose) order is finished.
Nursing Task on PAL
Pharmacy Modifies the Order
When pharmacy modifies the original TPN (amino acid/dextrose) nursing will receive
the modified order and it will appear under Nurse Review.
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EHR Enhancements April, 2015 Summary | Quick Guide
Discontinue the Total Parental Nutrition (TPN) (Module)
Once the original TPN (amino acid/dextrose ) order is finished, nursing can discontinue
the Total Parental Nutrition (TPN) module and complete the Discontinued (Future) task.
This action is required to stop other related TPN orders within the Module.
1. Right-click on the order.
2. Select Discontinue on the menu.
Important
If the module is discontinued before original TPN (amino
acid/dextrose) order finishes all related orders will be gone.
Complete Discontinue (Future) TPN Task
The TPN (amino acide/dextrose) has been discontinued and the task is ready to be
completed. The nursing task can be signed off by RNs and RPNs.
1. Click Task List on the table of contents menu.
2. Click in the checkbox for the task to complete it.
Important
Once both pharmacy and nursing tasks are signed off the
Discontinue (Future) order will automatically complete.
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EHR Enhancements April, 2015 Summary | Quick Guide
CYTOTOXIC AND NON-CYTOTOXIC HAZARDOUS DRUGS ORDERS
PLACED
This will affect anyone viewing the MAR, Order/ Medication Tab.
This will affect orders placed after May 1st.
Order comments for ‘ CYTOTOXIC hazardous’ and ‘non-CYTOTOXIC hazardous’ will
appear in the order comments on the MAR and orders profile for new orders.
MAR
Orders Tab
SHORTEN AND STANDARDIZE START AND STOP DATE/TIME DISPLAY
IN ORDER SENTENCE DISPLAY
This will affect anyone viewing the MAR, Order/Medication tab.
Orders placed after April 21 will have shortened and standardized Start and Stop
Date/Time displayed.
This change will be reflected on all order views including the MAR, Orders/Medication
tabs/PAL/Task List/Med Rec.
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EHR Enhancements April, 2015 Summary | Quick Guide
Before
After
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