Using Provider Charting Wizards

If you haven't already done so, please read The Net Health Employee Health and Occupational Medicine EMR Overview and Using Templates before proceeding.

The EMR Glossary explains a number of EMR specific terms.

Summary

Wizards are the workhorse of the Net Health Employee Health and Occupational Medicine Charting Notes data capture system. A Wizard generates text for the charting note by collecting specific pieces of information from the user and combining it with pre-set text. The flexible design of Wizards gives every clinic the ability to create Wizards that generate the text it wants.

Each Charting Wizard automates the entry of information for a single Charting Template Element (explained in more detail below.) Multiple Wizards can be associated with a single Template Element. This topic discusses using Wizards. The topic How to Set Up Charting Wizards discusses creating and changing Wizards.

As described in the topic on Using Templates, wizards are executed based on choices made on the [EMR Charting Templates Text Elements] window. This window has checkboxes for a group of Text Elements. You check the ones that are appropriate to the current patient, and Net Health Employee Health and Occupational Medicine will then process each checked element. Depending on how the template has been set up for each checked element, Net Health Employee Health and Occupational Medicine will do one of two things. In simple cases, it will just insert text based on the selection. However, a Text Element will often have more complex requirements, in which case there will be a Charting Wizard associated with the element. A Wizard will insert text and/or present additional screens which ask one or more questions. These might be multiple choice, a pick list, a request for a date or number, or any of several other types. You will enter your responses, and Net Health Employee Health and Occupational Medicine will insert additional text into the charting note based on your responses.

Here is an example of a Wizard generated window. For Neuro Symptoms, there might be more to know than the simple fact that they exist. The frequency and body area are also important. So, this Wizard asks three questions. The responses might insert a segment of text like this: "Neurological: Tremor. Symptoms have been intermittent, in left leg."

On this screen, the first item is multiple choice, the other two pick lists. There are a number of different types of information that a wizard can collect, such as free text, a number, or a date. If you are interested, in knowing more you can read the topic on How to Set Up Charting Wizards for a full description. However, to use the wizard, all you need to know is how to answer each type of questions, and that will be obvious as they come up.

Wizards can do some additional things in the background that are based on how they are set up, and which require no specific action from the user:

  • Add an ICD-9 code to the visit. When this happens, you will see the diagnostic code on the ASSESSMENT tab of the [Generate Patient EMR Charting Note] window.

  • Automatically add a charge code to the visit. Charges can be added on the RESULTS, ORDERS, PROCEDURES, and INSTRUCTIONS tabs.

  • Affect the way Net Health Employee Health and Occupational Medicine performs E/M code calculations. You can see the results of the calculations on the VISIT tab where the levels of documentation are displayed. The ASSESSMENT and ORDERS tabs show information about data sources and risk level based on information from executed wizards.

  • Indicate actions to be taken at check-out. These can be seen by clicking the Orders button on the Menu Bar.

  • Add items to the Clinical Problems Lists. When this happens, there will be a checkbox to add the item to the appropriate list, which will be checked by default. It can be unchecked to prevent the item from being added to the problems list.

  • Add Work Restrictions to the work restrictions list. Note: If a work restriction wizard executes and enters the text in the charting note but does not add the item to the work restrictions list, it is because of an omission in setup.

    On the setup screen for work restriction Wizards, on the E&M CODING tab there is a checkbox that indicates this Wizard should add the item to the work restrictions list. It is not checked by default, which makes it easy to miss when a new Wizard is created. It is easy to fix: just go back to the Wizards's setup and check the box.

Specialty Wizards

Unlike Standard Multi-Step Wizards, Specialty Wizards are designed to collect a specific type of information. For instance, an Allergy Wizarad allows entry of information about the onset of the allergy and the possible reactions the patient might suffer. An Assessment Wizard presents a list of diagnostic codes. A Medication Wizard collects information about strength and frequency taken.

Rapid Charts

Rapid Charts allow you to create highly automated Charting Templates by aggregating a number of Template Wizards to be run as a group. Read Using Charting Rapid Charts to learn more.

Wizard Examples

Click here to see some other examples of wizard generated screens.

  • Simple Wizard: Free Form Text

    This wizard allows you to directly enter any amount of free form text.

  • Complex Wizard: Multiple Questions

Specialized Wizard Other Allergy History

The wizard that collects information about allergies has been designed specifically for that purpose. This includes information on the timing of the allergy and its symptoms. Additional free text can be entered. By default, as seen below, the allergy will be added to the Clinical Problems List, but unchecking the box can prevent that.

This sample window would insert this text into the charting note:

"Allergy or Adverse Reaction: Penicillins, since age 42, reacted with nausea and rash. Type additional notes here." (Obviously, the 'type additional notes' segment is nonsense. It is just there to make clear on the screen print below what the Additional Notes box is for.)

 

Specialized Wizard: Medications Order

  • A special wizard collects information specific to current medications. This includes details of the prescription. Additional free text can be entered. By default, the medication will be added to the Clinical Problems List, but unchecking the box can prevent that.

    The specialty medications wizard will run after you have indicated either a specific medication or a medication class on the Text Wizard. If you select a medication class, the next window will be the [Select Medication for Med Class] window, from which you can select the specific medication, and then proceed to the [Medication Order Wizard] window. If you check a specific medication, you will go straight to the medication wizard screen.

    Notice the Problem button at the bottom which allows you to associate this medication with just one ICD-9 code on a visit with multiple diagnoses.

    This example would insert this text into the charting note:

    "Prescribed Penicillin VK, 500 mg. 1 tablet orally three times a day. Duration: 10 days. Dispense: 30 tablets. No refills."

  • Specialized Wizard: Laboratory / Radiology Orders
  • When a provider clicks the Done button on the Smart Form Charting Wizard AND there is at least one ICD-9 or ICD-10 assigned diagnosis, the software will display the Select Associated Diagnosis window.
  • This window contains two tabs: ICD-9 and ICD-10. Each tab includes all diagnoses in that particular coding system that are associated with the visit.
  • When the window displays the system will default to the ICD-10 tab.

  • Providers can select up to 12 ICD-9 code and/or up to 12 ICD-10 codes by clicking on the ICD line. When the user has selected a row, the row will be highlighted; or users may select more rows.

  • If there is only one ICD-10 code, by default, the system will select the ICD-10 entry.

Using Wizards

  1. Select the appropriate Template Element.

  2. Check the appropriate check boxes for the Text Elements on the [EMR Charting Templates Text Elements] window.

  3. Optionally, change the Lead-In from the default, or uncheck the box to omit the lead-in line altogether.

  4. Optionally, click Any Wizard to run a wizard that is not offered above.

  5. Click Done.

  6. All wizards associated with checked Text Elements will execute, one at a time.

  7. On the [Smart Form Charting Wizard] (shown above) data entry is straight forward: answer the questions.

    • Some questions are required: you will not be able to exit this window with out making an entry.

    • Some are optional.

    • Some are optional, and exit the process. That is, if skipped, all following questions for that wizard are also skipped.

  8. Optionally, in the bottom left corner, check Add Additional Free Text Notes to enter additional text, and to make other possible entries.

    1. Enter as much additional text as is required.

    2. Make any of several possible other entries, only two of which are shown here:

      • Check Out Action: Create an Order record.

      • Add to Clinical Problems List: Check to do just that.

      • MDM Risk Level: Manually adjust this factor which is used in E/M calculations.

      • Counts as ?? Problems for Evaluating Complexity of MDM: Manually adjust this factor used in E/M calculations.

      • Counts as ?? Bullet Elements for Evaluating Exam: Manually adjust this factor used in E/M calculations.

      • Counts as ?? Data Sources for Evaluating Exam: Manually adjust this factor used in E/M calculations.

    3. To exit without making an entry, click Skip.

    4. Click Done.

  9. Some visits will have multiple diagnoses. Certain information entered, such as medications, might be related to only one of those ICD-9 codes. When there are multiple diagnoses, there will be a Problem button at the bottom of the Wizard Smart Form for some wizards. If you click it you will be able to select the related diagnosis.

  10. If this Wizard is not applicable, click Skip. Why would you select a Wizard, then skip it? Well, you wouldn't exactly do that. The HPI, PMH, and ROS tabs have an auto-run option which automatically walks you through all of the selected Template Elements. It might well be that somewhere in that sequence there is a Wizard which is not currently applicable.

  11. Once you have made all your entries, click Done.

While there is no practical limit on the number of steps on a multi-step Wizard, there are limits on how much can be displayed on the screen at one time. The maximum number of steps that can be displayed is 15. However, if some individual steps take a large amount of space then the number that can be displayed will be lower.

Wizards do not have the ability to display successive pages. If they are two long to fit on a single page, then each step will be displayed individually.

  1. Prompt for this step.

  2. Text inserted before user choice.

  3. User choices.

  4. Text inserted after user choice.

  5. Displays only for optional steps. Check to move on without entering a choice.

  6. Done with Wizard (not done with the step--click Next to move to the next step.

  7. Insert normal text in chart note instead of the choice above.

  8. Normal text that will be inserted when 7 is checked.

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