Chapter 1: Introduction to eHMP

About eHMP

The Enterprise Health Management Platform (eHMP) project is a multi-year effort to evolve a modern, service-oriented platform which provides a web-based user interface (UI), clinical data services, and assembles patient clinical data from federated Veterans Health Information Systems and Technology Architecture (VistA) repositories and Department of Defense (DoD) data sources, reflective of each location providing care to the patient. This federated data is aggregated into an enterprise patient record. eHMP service components will span all application layers, including presentation, business and core services, and data access.

Increment 3 is the development increment for eHMP v1.3, which moves eHMP beyond a read-only viewer application, by creating basic write-back capabilities. The write-back capability will be saved to the appropriate VistA instance as the system of record (SOR) for patient data. Other eHMP v1.3 capabilities are intended to address the essential clinical workflow for basic outpatient primary care visits, including encounter management, progress notes, patient status, structured data entry, and basic order entry.

System Requirements

eHMP User Interface (UI)

eHMP is a web-based application, and is designed to run in a web browser. eHMP release v1.3 is optimized for use with Internet Explorer 11 (IE 11).

eHMP Help

Online Help Feature

There are online help icons throughout the eHMP application. The online help feature provides detailed information about specific system topics. Users can click an icon to open context-specific help in a separate window.

National Service Desk (NSD)

The NSD is available to report any issues while using eHMP. Contact information for the NSD will be available once onboarding is completed.

eHMP Help Resources

The VA eHMP SharePoint site[1] provides resources for more reference information on the eHMP application. Some of the available resources include: frequently asked questions (FAQs), quick reference guides, and system demonstrations.

In addition, the VA Software Document Library[2] (VDL) will house a variety of eHMP documents.

The Organization of this User Guide

This User Guide is organized to mimic the use of the application, beginning with how to log in to eHMP, and progresses by giving instructions for each of the features available within the application.

Chapter 2: Getting Started

eHMP can be accessed in two ways: through Internet Explorer 11 (IE11), or through CPRS. The steps for accessing eHMP are described below.

Logging into eHMP via IE 11

1. Open IE11. Enter the eHMP v1.3 IOC Pre-Production/Test web address[3] into the address field, and the login screen displays.

Note: Once the Production environment is installed at your site, you will need to enter the eHMP v1.3 Production web address[4] into the address field.

The login screen shown in Figure 2-1 is comprised of disclosure and warning language, with application information on the left side of the window, and credential entry fields on the right side of the window.

Figure 2‑1 eHMP Login Screen

2. Select a facility from the Select a facility... dropdown menu.

3. Enter the VistA access code into the Access Code field, and then press the Tab key to advance to the following field.

4. Enter the VistA verify code into the Verify Code field.

5. Click the Sign In button to display the Patient Selection screen.

Adding eHMP to Favorites in IE11

1. Access eHMP.

2. Click the star icon (Figure 2-2) in the upper right corner of the application window.

Figure 2‑2 Star Icon

3. Click Add to Favorites. The Add a Favorite dialog (Figure 2-3) pops up.

Figure 2‑3 Add a Favorite

4. Click Add

Accessing eHMP using IE11 Favorites

1. Open IE11.

2. Click the star icon (Figure 2-4) in the upper right corner of the application window.

Figure 2‑4 Star Icon

3. Click the eHMP link (Figure 2-5).

Figure 2‑5 Clicking the eHMP Link

4. The eHMP application displays in the browser window.

Accessing eHMP through CPRS

1. Access CPRS as usual.

2. Select eHMP from the CPRS Tools dropdown menu (Figure 2-6).

Figure 2‑6 eHMP Link on the CPRS Tools Menu

3. The eHMP application opens.

Note: If the user has accessed a patient’s record in CPRS prior to logging into eHMP, that same patient’s record will be the default patient view the user will see when they are automatically logged into eHMP. Likewise, if the user accesses a particular patient in eHMP, that patient’s record will be the default view presented when the user switches back to CPRS.

Logging Out of eHMP

There are two ways to log out of eHMP: signing out manually, or being automatically logged out due to inactivity.

Manual Sign Out

1. Click the user name on the header in the upper right corner, and a dropdown displays.

2. Click Sign Out (Figure 2-7) to log out of eHMP.

Figure 2‑7 Sign Out Button on Header Dropdown

Auto Sign Out

When a user has been inactive for 12 minutes, a warning message informing them their session will end in 3 minutes (Figure 2-8) will appear. The user is given the option to stay logged in by clicking the Continue button, or to log out of the application by clicking the Logout button.

Figure 2‑8 Auto Sign Out Warning Message

When a user has been inactive in the eHMP application for 15 minutes or more, they will be automatically signed out of the application, and a warning message (Figure 2-9) will appear.

Figure 2‑9 Inactivity Logout Message

Chapter 3: Patient Selection Screen

About the Patient Selection Screen

If the user accessed eHMP through IE11, the Patient Selection screen displays (Figure 3-1), where they have the option to search for a patient.

Figure 3‑1 Patient Selection Screen

Patient Search

In order to access patient information and the detailed views of the eHMP application, the user must conduct a patient search.

My Site Search

The My Site search allows the user to search for a patient from several perspectives, including a comprehensive list of all patients, from their defined default patient selection list in CPRS, patients from a specific clinic, or patients in a specific ward at their local VA facility.

General Patient Search

To run a general patient search, enter the first initial of the patient’s last name, followed by the last four digits of their social security number (SSN) (Figure 3-2), or enter a generic name in the Select Patient field.

Figure 3‑2 General Patient Search

My CPRS List

If a user has defined a default patient selection list in CPRS, that same list of patients will be presented in eHMP. A patient may be selected from this list by clicking their name.

Clinics

To search for a patient (within a specific clinic) using the My Site/Clinics method:

1. Click the My Site button.

2. Click the Clinics button. A list of clinics at the local VA facility displays.

3. Filter the list of results by entering the name of the clinic in the Filter clinics field. The results populate as you type.

4. Select the name of the clinic from the list. The list of patients from that clinic are displayed (Figure 3-3).

Figure 3‑3 My Site/Clinics

5. Use the timeframe buttons to filter through the list of patients at the selected clinic.

6. Select a patient’s name to display the Patient Detail Dialog.

Wards

To search for a patient (within a specific ward) using the My Site/Wards method:

1. Click the My Site button.

2. Click the Wards button. The list of wards at the local VA facility are displayed.

3. Filter the list of results by entering the name of the ward in the Filter wards field.

4. Select the name of the ward from the list. The list of patients in that ward are displayed (Figure 3-4).

Figure 3‑4 My Site/Wards

5. Select a patient’s name to display the Patient Detail Dialog.

Nationwide Search

The Nationwide search feature is used to run a patient search across the enterprise, including all VistA systems, as well as external systems, such as DoD and the Nationwide Health Information Network (NwHIN). This search allows the user to enter the following patient attributes: last name (required), first name, date of birth (DOB), and social security number (SSN).

To run a Nationwide Patient search:

1. Click the Nationwide button (Figure 3-5).

Figure 3‑5 Nationwide Search

2. Enter the patient’s last name in the Last Name (required) field.

3. Enter the appropriate information of at least one other field (First Name, DOB, or SSN).

4. Click the Search button. The search results display below the search bar.

Note: Depending on the search results, the request may result in no patient found, 1 to 10 matching results found, or more than 10 records found, which returns a notification message in place of the records (Figure 3-6).

Figure 3‑6 Too Many Results Have Returned

Selecting a Patient

Once the correct patient has been found, select that patient’s name from the search results list. If a patient record is not restricted, their record will be viewable after confirming the selection (as demonstrated in the Accessing an Unrestricted Patient Record section) of that patient.

If a patient record is restricted, a warning will appear prior to accessing the record, requiring acknowledgement of the restricted nature of the record before accessing it (as demonstrated in the Accessing a Restricted Patient Record section).

Accessing an Unrestricted Patient Record

To access an unrestricted patient record:

1. Click the name of the patient from the search results list.

2. The Patient Detail Dialog appears (Figure 3-7).

Note: The Ward/Room/Bed location displays for patients in a ward (Figure 3-8).

Figure 3‑7 Patient Detail Dialog

Figure 3‑8 Patient Detail Dialog for Patient in Ward

3. Click the CONFIRM SELECTION button.

4. The patient’s record displays in the Main Application Window.

Accessing a Restricted Patient Record

To access a restricted patient record:

1. Click the name of the patient from the search results list.

Note: The word SENSITIVE displays instead of the patient’s SSN and DOB.

2. The Restricted Record Dialog appears (Figure 3-9).

Figure 3‑9 Restricted Record Acknowledgement

The notification that appears in the dialog makes the user aware that the patient’s record is restricted, and advises that if the user proceeds to "break the glass" and open the record, their activity is tracked. In addition, the user’s station Security Officer will contact them for their justification in accessing the restricted patient record.

3. Read the notification dialog, and click the ACKNOWLEDGE RESTRICTED RECORD button.

4. The Restricted Record Patient Detail Dialog appears (Figure 3-10), displaying the user’s acknowledgement of the restricted record.

Note: Click the RESTRICTED RECORD banner to display the warning again.

Figure 3‑10 Confirm Selection of Restricted Patient Record

5. Click the CONFIRM SELECTION button.

6. The patient’s record displays in the Main Application Window.

Accessing a Flagged Patient Record

There are patients in the system with flagged records. The purpose of a patient record flag is to alert providers about certain patients, such as patients with disruptive, threatening, and/or violent behaviors, or research patients. The patient record flags can be national (Category I), which are shared among the VA facilities, or local (Category II), which are only shared at the local site. The user must view and acknowledge the patient record flag during patient selection before accessing the patient record.

To access a flagged patient record:

1. Click the name of the patient from the search results list.

2. The Patient Detail Dialog appears.

3. Click the CONFIRM SELECTION button.

4. The Patient Flag Dialog appears (Figure 3-11).

Note: Some patients may have more than one patient record flag. Scroll through the patient flag dialog to read all of the notifications associated with a patient.

Figure 3‑11 Confirm Selction of Flagged Patient Record

5. Read the notification dialog, and click the CONFIRM button.

6. The Main Application Window appears, displaying the patient record.

Main Application Window

Once the patient has been selected and confirmed, the patient record will open and users will be navigated to the Main Application Window (Figure 3-12). The Main Application Window is comprised of the eHMP Header, Global Timeline Date Filter, Workspace Manager and listing, search record field, and the user workspace. Each of these areas is described in subsequent chapters.

Figure 3‑12 Main Application Window

Chapter 4: The eHMP Header

About the eHMP Header

The eHMP Header (Figure 4-1) displays abbreviated information. It lists the logged in user, allows for another patient search, presents demographics about the displayed patient, shows any postings associated with the patient, the visit information for a patient with an inpatient status, and provides the patient’s care team information.

The following elements make up the eHMP Header:

· Patient Selection button

· My Workspace button

· User information dropdown

· Patient photo

· Patient demographics, inpatient/outpatient status, and CCOW status

· Patient postings

· Care team information

· Observations

· Notes

Figure 4‑1 The eHMP Header

Patient Selection Button

The Patient Selection button is located in the top left corner of the eHMP Header. Select the button to navigate back to the Patient Selection screen to search for another patient. Click the X in the upper right corner of the Patient Selection screen to cancel a search, and return to the current patient record.

My Workspace Button

The My Workspace feature allows users to quickly navigate to a designated workspace. The custom workspace contains applets, data, and information to support the user’s needs to manage groups of patients, tasks, and provider-centric communications.

User Information Dropdown

The user currently logged into eHMP displays in the upper right corner of the eHMP application. As depicted in Figure 4-2, clicking on the user’s name will result in the display of a dropdown menu with the Sign Out option.

Figure 4‑2 Sign Out Option

Patient Photo

eHMP displays the patient image as found in VistA Imaging. The image is retrieved from the Veteran Health Identification Card (VHIC) system and displayed in the header. If an image is unavailable for that patient, then a gender neutral image displays (Figure 4-3).

Figure 4‑3 Patient Photo (Example)

Patient Demographics

The selected patient is listed on the header, in the upper left corner. By default, the patient’s name, DOB, age, SSN, and Gender display (Figure 4-4). In addition, a status of inpatient or outpatient, and the status of clinical context object workgroup (CCOW) is indicated. When eHMP is in patient context, a green chain link icon displays (Figure 4-4).

Figure 4‑4 Patient Demographics

A red demographics bar with a broken chain link indicates that eHMP is not in patient context (Figure 4-5).

Figure 4‑5 Patient Context

To display expanded patient information:

1. Click the dropdown arrow to open the Patient Demographics Dialog.

2. The dialog contains sections with additional patient information.

3. When the icon is displayed, non-local demographic data is available and can be viewed by clicking on the section (Figure 4-6).

4. Click the dropdown arrow again or anywhere outside of the dialog box to exit the dialog and return to the previous view.

Figure 4‑6 Expanded Patient Information

Patient Postings

The Postings section of the eHMP Header presents shortcuts to the following pieces of information:

· Crisis notes

· Warnings

· Allergies and Adverse Drug Reactions

· Directives

· Patient Record Flags

The Postings area of the eHMP header is depicted in Figure 4-7.

Figure 4‑7 Postings Icons

The highlighted letters in the Postings area indicate that detailed information can be accessed. Clicking on a highlighted letter opens a dialog with detailed information (Figure 4-8). Clicking on the highlighted letter again, or anywhere outside of the box, closes the dialog and returns to the previous view.

Figure 4‑8 Expanded Postings Information

Current Encounter

The eHMP Current Encounter feature allows a user to create or select a visit to which almost all other clinical activities can be associated. A visit must be selected before performing an action requiring a visit context. The minimum information required to establish a visit is the Provider, Location, Date, Time, and visit category (Clinic Appointment, Hospital Admission, or New Visit). Once the visit has been selected, all subsequent clinical documentation will typically be associated with that visit, and visit details will display (Figure 4-9).

Figure 4‑9 Current Encounter Details

Care Team Information

Abbreviated Care Team Information for the selected patient can be seen in the eHMP Header (Figure 4-10). The information displayed here includes the primary care team and provider, the associate name (if available), the team phone number, and the mental health treatment team and treatment coordinator (if available). If the patient has an inpatient status, the inpatient attending and provider will be listed here instead of the mental health treatment team and treatment coordinator.

Figure 4‑10 Care Team Information

To access detailed Care Team information:

1. Click the dropdown arrow. Detailed information displays.

Note: If the patient has been seen at other VistA sites, the user is able to view the listing for each care team by the site for which the patient has a VistA record (Figure 4-11).

2. Click the dropdown arrow again to close the dialog.

Figure 4‑11 Detailed Care Team Information

Observations

The observation feature allows you to add an active problem, allergy, or vital for a selected patient. In addition, it provides a quick link to any unsigned documents.

Notes

The notes feature provides you with a quick view of all notes for a selected patient, which are grouped by status. When a note is selected, you have the option to delete, edit, sign, and view the note. In addition, you can add a new note to the patient’s chart.

To add a new note:

1. Click on Notes on the patient header.

2. Click on the New Note button. The New Note pop up box displays (Figure 4-12).

3. Click on the Note Title dropdown arrow to add a note title.

4. Click on the calendar icon to select a date or enter the desired date in MM/DD/YYYY format.

5. Click on the clock icon to select a time or enter the time in HH:MM format.

6. Enter the note description in the Note box.

7. Click the Preview icon to preview the note.

8. Click Save and Close to save the note and close the pop up box, Sign to sign the note, or Delete to delete the note.

Figure 4‑12 New Notes

Chapter 5: Global Timeline Date Filter

About the Global Timeline Date Filter

The Global Timeline Date Filter controls the amount of historical data displayed throughout the application. It displays two years of patient information by default, and allows the user to modify the date range to allow for easier investigation of records.

The summary view of the Global Timeline Date Filter displays the date range selected with a graphical representation. The bars (blue denotes outpatient and green denotes inpatient) depict the number of patient activities recorded for a specific date (Figure 5-1). Hovering over the date displays a tool tip with detailed information for the specified date. The red line on the graph represents the current date.

Figure 5‑1 Global Timeline Date Filter

The list below describes the elements of the expanded Global Timeline Date Filter as seen in Figure 5-2:

1. Preset date ranges

2. Custom date range

3. All Events timeline graph

4. Timeline Summary

Figure 5‑2 Expanded Global Timeline Date Filter

Using the Preset Date Ranges

To use preset date ranges:

1. Click the date range to open the Global Timeline Date Filter.

2. Select the desired preset date range (Figure 5-3).The dropdown calendar, All Events timeline graph, and Timeline Summary update with the selected date range.

3. Click APPLY to set the date range or click CANCEL to exit the Global Timeline Date Filter without changing the dates. The patient information for the selected date range displays.

Note: If users click outside of the Global Timeline Date Filter box, the box closes and the selected dates are not applied.

Figure 5‑3 Preset Date Ranges

Using the Custom Date Range

To use custom data ranges:

1. Click the date range to open the Global Timeline Date Filter.

2. Use the calendar dropdown (Figure 5-4) or enter the dates using the MM/DD/YYYY format to choose a custom date range.

Note: Users can only select a start date that is in the past and an end date that is the current date or a date in the future.

3. Click APPLY to set the date range, or click CANCEL to exit the Global Timeline Date Filter without changing the dates. The patient information for the selected date range displays.

Note: If users click outside of the Global Timeline Date Filter box, the box closes and the selected dates are not applied.

Figure 5‑4 Calendar Dropdown

Using the All Events Timeline

The All Events Timeline (Figure 5-5) displays a graphical representation of events from the full patient historical record that includes both inpatient and outpatient information. It allows users to limit the data set more accurately to perform a quick analysis.

To use the all events timeline:

1. Click the date range to open the Global Timeline Date Filter.

2. Click and drag the double arrows on the left of the shaded timeline area to select the start date.

3. Click and drag the double arrows on the right of the shaded timeline area to select the end date. The dates in the calendar boxes above, as well as the Timeline Summary, populate as the user selects the date range.

4. Click APPLY to set the date range or click CANCEL to exit the Global Timeline Date Filter without changing the dates. The patient information for the selected date range displays.

Note: If there is no recent data, only the red Today reference line displays.

Note: If users click outside of the Global Timeline Date Filter box, the box closes and the selected dates are not applied.

Figure 5‑5 All Events Timeline

Using the Timeline Summary

As the date range for the patient record changes, the Timeline Summary refreshes to show patient activities within the selected date range. The Timeline Summary is a list view grouped by month. The groups are collapsible and can be sorted by date and time, or type. The data can also be filtered by clicking the Filter button (Figure 5-6).

Figure 5‑6 Filter Button

You can view more detailed information by selecting an activity in the Timeline Summary (Figure 5-7).

Figure 5‑7: Patient Activity Detail Dialog

Chapter 6: Applet Views

This chapter describes the different applets within eHMP and the available views for each applet. The applets are listed in alphabetical order.

Active & Recent Medications

The Active & Recent Medications applet provides users with a quick view of a patient’s active and recent medications. If the patient does not have any medications for the defined date range, then they will see a message indicating that no records have been found.

Note: If a patient has an inpatient status, then only active inpatient medications and IVs display. If a patient has an outpatient status, then only active outpatient and non-VA medications display.

Active & Recent Medications: Trend View

Figure 6-1 shows the trend view that lists the active and recent medication and dosage, any refills, if there are any changes in the medication, and when the medication was last filled. It also includes all medications that have expired within the last 90 days.

When there is no refill count information available, ‘NA’ is displayed (usually on DoD medications). When a medication has zero refills remaining, a ‘0’, surrounded by a red highlighted box, displays. If a medication has one refill left, a ‘1’, surrounded by an orange highlighted box, displays. Medications that have two or more refills remaining displays the number of refills left.

The change column compares the first two medications in the item group. If the first medication dose is less than or greater than the second medication dose, the change is reflected. There is no change if they are the same dose, or if there is only one medication in the item group. ‘Exp’ is displayed in red for a medication that is about to expire, or has expired. ‘New’ is shown if the medication is relatively recent and pending. A caution symbol displays for recent and discontinued medications.

Figure 6‑1 Active & Recent Medications Applet Trend View

To display more information for a medication:

1. Click on the left side of the medication tile to display a set of icons.

2. Click on the right side of the medication tile to display a quick view containing up to the last five fills for the selected medication consisting of the last update date, medication name with dosage, sig and time since last change.

Active & Recent Medications: Summary View

Figure 6-2 depicts the summary view listing the medication and dosage, and the facility where the medication was prescribed.

Figure 6‑2 Active & Recent Medications Applet Summary View

Active & Recent Medications: Detail View

To display a detailed view of an active or recent medication from the trend or summary view:

1. Click an active or recent medication from the list to display the Details form button (Figure 6-3).

Figure 6‑3 Active & Recent Medications Details Form Button

2. Click on the Details form button to open the Active & Recent Medication Detail Dialog box (Figure 6-4).

Figure 6‑4 Active & Recent Medications Detail Dialog Box

All available orders for the medication display on tabs to the left under Order Hx.

1. Click a date tab to view detailed medication information for the selected date range.

2. Click on a resource link under the Links and Patient Education headers, to open a new window for more information on the selected medication.

3. Click the Close button, the X in the upper right-hand corner, or anywhere outside of the Active & Recent Medication Dialog box, to return to the applet.

Allergies

The Allergies applet provides a trend, summary, and expanded view of identified patient allergies and adverse drug reactions, with standardized coding references from all sources. If the patient does not have any medications for the defined date range, then they will see a message indicating that no records have been found.

Note: It is common for a patient to have more than one instance of the same allergy listed.

Allergies: Trend View

Top allergy information for a given patient is displayed in pill format (Figure 6-5). A red pill indicates a severe allergy, an orange pill indicates a moderate allergy, and a white pill indicates a mild allergy.

Figure 6‑5 Allergies Applet Trend View

Allergies: Summary View

The summary view (Figure 6-6) lists the allergen name, reaction, and level of severity for each allergen. The default summary view lists the allergies sorted first by severity, then by the date the allergy was entered into the VA system.

Figure 6‑6 Allergies Applet Summary View

Allergies: Expanded View

The default expanded view lists the allergies sorted first by severity, then by the date the allergy was entered into the VA system.

The expanded view of Allergies (Figure 6-7) displays the following information in sortable columns:

· Allergen Name

· Standardized Allergen

· Reaction

· Severity

· Drug class

· Entered By

· Facility

Figure 6‑7 Allergies Applet Expanded View

Allergies: Detail View

To display a detailed view of an allergy from the trend, summary, or expanded views:

1. Click an allergy to display a set of icons.

2. Click the Details Form button to open the Allergy Detail Dialog box (Figure 6-8).

Figure 6‑8 Allergy Detail Dialog Box

3. Click the Previous and Next buttons to navigate through the allergies.

4. Click the Close button, the X in the upper right-hand corner, or anywhere outside of the Allergy Detail Dialog box, to return to the applet.

Appointments & Visits

The Appointments & Visits applet lists any future outpatient or specialty care appointments, and past clinic visits, for a selected patient at VA and DoD facilities.

Appointments & Visits: Summary View

Figure 6-9 displays the summary view listing the appointment dates, encounter descriptions, the locations where the patient was seen, the status of the appointment, and the facility they visited.

Figure 6‑9 Appointments & Visits Applet Summary View

Appointments & Visits: Expanded View

Figure 6-10 depicts the expanded view of the Appointments & Visits applet. The following information is displayed in sortable columns:

· Date

· Description

· Location

· Status

· Type

· Provider

· Reason

· Facility

Figure 6‑10 Appointments & Visits Applet Expanded View

The default view contains both VA and DoD data, but users can change the Source to filter the results. The Source filtering labels include: Local VA, All VA, and All VA + DoD.

To filter by source:

1. Click the Source dropdown button to view a list of data filtering labels.

2. Select the desired source.

3. The appointment and visit data is filtered according to the selected source.

Appointments & Visits: Detail View

To display the details of an encounter (Figure 6-11) from the summary or expanded applet:

1. Click an appointment or visit from the list to display the Detail Dialog box.

2. Click the Next and Previous buttons to navigate between appointments and visits.

3. Click the Close button, the X button in the upper right-hand corner, or anywhere outside of the Detail Dialog box, to return to the applet.

Figure 6‑11 Detail Dialog

Clinical Reminders

The Clinical Reminders applet provides a summary and expanded view of the clinical reminders in effect for a patient from all sites. These reminders advise users when upcoming events are due for the patient.

Clinical Reminders: Summary View

Figure 6-12 shows the summary view that lists the priority (if any), title, type, and due date for any clinical reminders.

Figure 6‑12 Clinical Reminders Applet Summary View

Clinical Reminders: Expanded View

Figure 6-13 depicts the expanded view of the Clinical Reminders applet. The following information is displayed in sortable columns:

· Priority

· Title

· Type

· Due Date

· Done Date

Figure 6‑13 Clinical Reminders Applet Expanded View

Clinical Reminders: Detail View

To display the details of a clinical reminder from the summary or expanded applet:

1. Click a clinical reminder from the list to display the Clinical Reminders Detail Dialog box (Figure 6-14).

2. Click the Close button, the X button in the upper right-hand corner, or anywhere outside of the Clinical Reminders Detail Dialog box, to return to the applet.

Figure 6‑14 Clinical Reminders Detail Dialog

Community Health Summaries

The Community Health Summaries applet displays the selected patient’s clinical health care summaries received from VA’s external Health Information Exchange (HIE) partners who participate in the NwHIN.

Community Health Summaries: Summary View

The summary view (Figure 6-15) lists the date of service and authoring institution(s) of each care summary.

Figure 6‑15 Community Health Summaries Applet Summary View

Community Health Summaries: Expanded View

The expanded view of the Community Health Summaries applet (Figure 6-16) displays the following information in sortable columns:

· Date

· Description

· Authoring Institution

Figure 6‑16 Community Health Summaries Applet Expanded View

Community Health Summaries: Detail View

To display the Community Health Summaries Detail Dialog from the summary or expanded applet:

1. Click a health summary item from the list, and the Community Health Summaries Detail Dialog box opens (Figure 6-17).

2. Scroll through the document or use the Table of Contents hyperlinks to go directly to a section.

3. Click the Back to Top hyperlink to go to beginning of the document.

4. Click the Next and Previous buttons to navigate between Community Health Summaries.

5. Click the Close button, the X in the upper right-hand corner, or anywhere outside of the Community Health Summaries Detail Dialog box, to return to the expanded applet.

Figure 6‑17 Community Health Summaries Detail Dialog

Conditions

The Conditions applet displays a list of conditions, with standardized coding references, that has been compiled by the providers.

Conditions: Trend View

Figure 6-18 shows the trend view that lists the problem, acuity of problem, when the problem was last reported, the history of occurrences for the patient’s condition, and a graph depicting the amount of treatment received. If applicable, the conditions are grouped by their standardization codes Systemized Nomenclature of Medicine Clinical Terms (SNOMED CT).

Figure 6‑18 Conditions Applet Trend View

Conditions: Summary View

Figure 6-19 shows the summary view that lists the description, the acuity of the patient’s condition, and the status of the condition.

Figure 6‑19 Conditions Applet Summary View

Conditions: Expanded View

The expanded view of the Conditions applet (Figure 6-20) displays the following information in sortable columns:

· Description

· Standardized Description

· Acuity

· Status

· Onset Date

· Last Updated

· Provider

· Facility

Figure 6‑20 Conditions Applet Expanded View

Conditions: Detail View

To display the details of a patient’s condition from a trend, summary, or expanded applet:

1. Click a condition from the list and a set of icons display.

2. Click the Details form button to display the Conditions Detail Dialog box (Figure 6-21).

3. Click the Next and Previous buttons to navigate between conditions.

4. Click the Close button, the X in the upper right-hand corner, or anywhere outside of the Conditions Detail Dialog box, to return to the applet.

Figure 6‑21 Conditions Detail Dialog

Documents

The Documents applet lists multiple categories of documentation from various sources. The document categories include: clinical notes, discharge summaries, advanced directives, crisis notes, warnings, lab results, and imaging and radiology reports.

Documents: Summary View

The summary view (Figure 6-22) lists the document date, type of document, and who entered the document in the system.

Figure 6‑22 Documents Applet Summary View

Documents: Expanded View

The expanded view of the Documents applet (Figure 6-23) displays the following information in sortable columns:

· Date

· Description

· Type

· Entered By

· Facility

Figure 6‑23 Documents Applet Expanded View

Documents: Detail View

To display the details of an item in the summary and expanded list views:

1. Click a document in the list. The Document Detail Dialog box (Figure 6-24) opens.

2. Click the Close button, the X in the upper right-hand corner, to close the Documents Detail Dialog box, and return to the document list.

Figure 6‑24 Documents Detail Dialog

Encounters

The Encounters applet provides a high level view of the patients’ encounters for outpatient visits, appointments, admissions, and procedures to quickly understand the types of care the patient has received.

Encounters: Trend View

Figure 6-25 shows the trend view of the Encounters applet, with data grouped by the following encounter type: visits, appointments, admissions, and procedures. In addition, it displays when the patient was last seen for the encounter, and the history for each encounter type, with a graphical representation.

Figure 6‑25 Encounters Applet Trend View

Note: Click the dropdown arrow to display a list of encounters for the selected group (Figure 6-26).

Figure 6‑26 Encounters List in Trend View (Expanded)

Encounters: Detail View

To display the details of an item in the trend list view:

1. Click the Encounter group dropdown arrow.

2. A list of encounter types for that group display.

3. Click the desired encounter type and a set of icons display (Figure 6-27).

Figure 6‑27 Encounters List Item Icons

4. Click the Details Form button to open the Encounters Detail Dialog box (Figure 6-28), or the Quicklook button to open the Encounters Detail list of the last five occurrences for the selected item.

5. Click the Close button, the X in the upper right-hand corner, to close the Encounters Detail Dialog and return to the previous view.

Figure 6‑28 Encounters Detail Dialog

Immunizations

The Immunizations applet presents a list of vaccines from all sources for a given patient.

Immunizations: Trend View

Figure 6-29 displays the trend view of immunizations a patient has received. All immunizations are represented in pill format. Each pill displays the immunization name, the series number (if available), and the date the immunization was last administered.

Figure 6‑29 Immunizations Applet Trend View

Detailed information for an immunization can be displayed by hovering over a pill (Figure 6-30).

Figure 6‑30 Detail of an Immunization in Trend View

Immunizations: Summary View

Figure 6-31 displays the summary view that lists the vaccine name, reaction (if any), date administered, and facility.

Figure 6‑31 Immunizations Applet Summary View

Immunizations: Expanded View

The expanded view of Immunizations (Figure 6-32) displays the following information in sortable columns:

· Vaccine Name

· Standardized Name

· Reaction

· Series

· Repeat Contraindicated

· Date

· Facility

Figure 6‑32 Immunizations Applet Expanded View

Immunizations: Detail View

To display the details of an Immunization from the trend, summary, or expanded views:

1. Click an Immunization from the list and a set of icons display.

2. Click the Details form icon to display the Vaccine Detail Dialog box (Figure 6-33).

Figure 6‑33 Immunization Detail Dialog

3. To change the date range of the displayed vaccine, select either one of the preset date ranges,

4. Use the calendar dropdowns and click Apply to choose a custom date range.

5. Click the Next and Previous buttons to navigate between immunizations.

6. Click the Close button, the X in the upper right-hand corner, or anywhere outside of the Immunization Detail Dialog box, to return to the applet.

Medications Review

The Medications Review applet provides a single view of the medication list with additional graphical data to support analysis of the existing patient medical data in order to facilitate better clinical decisions.

Medications Review: Expanded View

The expanded view of the Medications Review applet (Figure 6-34) displays the selected patient’s medication history in both list and graph formats grouped by Inpatient and Outpatient medications. When a category is selected, the group is expanded to display the list and graph of items.

Note: If a patient has an inpatient status, then the Inpatient group displays and the Outpatient group is collapsed. If a patient has an outpatient status, then the Outpatient group displays and the Inpatient group is collapsed.

Outpatient Medications

The outpatient medication types include: Outpatient, supply, and non-VA (external). The data listed for each outpatient medication order consists of the following, as seen in Figure 6-34:

· Medication name: represents the name of the medication ingredient

· Non-local indicator: an indication that the medication was not ordered at the users home facility

· Sig column

o First preference: Dose + Units + Route + Frequency

o If any of the above are missing then concatenation: Strength (i.e. size of tablet) + Product form + Sig

· Status/Fillable column

o Active order – displays ‘Fillable’ and the amount of time the medication can be filled

o Zero refills – displays ‘0 Refills’

o Pending order – displays ‘pending’

o Expired order – displays the ‘Expired’ and the amount of time from the expiration date

o Discontinued order – displays ‘Discontinued’ and the amount of time from the discontinued date

o Time Annotations

§ >60 days to 24 months = ‘m’ (ex. 14m)

§ >47 hours to 60 days = ‘d’ (ex. 24d)

§ >24 months = ‘y’ (ex. 5y)

§ 60 minutes to 47 hours = ‘h’ (ex. 37h)

§ 0-59 minutes = The actual minutes expressed with quotations (ex. "48")

Figure 6‑34 Medications Review Outpatient Meds

Outpatient Medications Review Indicators

The Medications Review graph displays a medication’s start date, stop date, and the dispensing dates. The graph indicators for outpatient medications are shown in Figure 6-35.

Figure 6‑35 Medications Review Outpatient Indicators

Some tips for the Medication Review graph:

· A white background depicts an active order

· A gray background depicts when a medication has expired

· A hashed gray background depicts when a medication has been discontinued

· If two orders overlap, an active order will override a discontinued or expired order

· Active/Hold and Active/Suspend orders count as being active

· A green bar depicts when a medication has been filled for the first time

Inpatient Medications

The data listed for each inpatient medication order (Figure 6-36) consists of the following:

· Name Column: represents the name of the medication ingredient

· Non-local indicator: an indication that the medication was not ordered at the users home facility

· Sig Column

o First preference Dose + Units + Route + Frequency

o If any of the above are missing then concatenation: Strength (i.e. size of tablet) + Product form + Sig

· Status/Next Column: the medication status or the time of the next administration

o Active order – displays ‘Fillable’ and the amount of time the medication can be filled

o Zero refills – displays ‘0 Refills’

o Pending order – displays ‘pending’

o Expired order – displays the ‘Expired’ and the amount of time from the expiration date

o Discontinued order – displays ‘Discontinued’ and the amount of time from the discontinued date

o Time Annotations

§ >60 days to 24 months = ‘m’ (ex. 14m)

§ >47 hours to 60 days = ‘d’ (ex. 24d)

§ >24 months = ‘y’ (ex. 5y)

§ 60 minutes to 47 hours = ‘h’ (ex. 37h)

§ 0-59 minutes = The actual minutes expressed with quotations (ex. "48")

Figure 6‑36 Medications Review Inpatient Meds

Medications Review: Detail View

What displays for the detail view of a medication depends on the status of the patient and if the medication was prescribed by the VA or a Non-VA provider.

To display a detailed view of a medication:

1. Click either the Inpatient Meds or Outpatient Meds category. The category expands to display a list of medications.

2. Click a medication. The InfoButton and Details Form button display.

3. Click the Details Form button (Figure 6-37).

Figure 6‑37 Medications Review Applet Detail View

In addition to the detailed information for the selected patient, Links and Patient Education provide access to external information and resources. This information is found on the bottom left-hand side of the Medications Detail Dialog box.

To use a resource link in the Links section of the Medications Detail Dialog box:

1. Click one of the resources under Links or Patient Education to launch the external resource.

2. The external resource opens in a new browser tab.

3. Click the X on the external resource’s browser tab to close it, or click the browser tab labeled VA eHMP to return to the eHMP application without closing the external resource tab.

Narrative Lab Results

The Narrative Lab Results applet lists the reports of the patient’s recorded laboratory results.

Narrative Lab Results: Summary View

Figure 6-38 shows the summary view that lists the date and time taken, lab test (includes a Panel button that opens a test drawer where applicable), flag (yellow indicates abnormal results and red indicates critical), and result of the patient’s lab results.

Figure 6‑38 Narrative Lab Results Applet Summary View

Narrative Lab Results: Expanded View

The expanded view of the Lab Results applet (Figure 6-39) displays the following information in sortable columns:

· Date

· Lab Test

· Flag

Note: The H, H+, L, and L+ icons indicate abnormal (yellow) and critical (red) highs and lows.

· Result

· Unit

· Ref Range

· Facility

Figure 6‑39 Lab Results Applet Expanded View

Narrative Lab Results: Detail View

To display a detailed view of a lab result from the summary or expanded applet:

1. Click a list item and a set of icons display.

2. Click the Details Form button to open the Narrative Lab Results Detail Dialog box (Figure 6-40).

3. Click the Next and Previous buttons to navigate between lab results.

4. Click the Close button, the X in the upper right-hand corner, or anywhere outside of the Lab Results Detail Dialog box, to return to the applet.

Figure 6‑40 Narrative Lab Results Detail Dialog

Numeric Lab Results

The Numeric Lab Results applet lists a patient’s recorded laboratory results.

Numeric Lab Results: Trend View

Figure 6-41 shows the trend view that lists the following:

· Lab Test

· Results (numeric data value)

· When the lab result was last documented

· Data Range Graph that includes the following rules:

§ Blue diamond - current normal

§ Yellow diamond - current abnormal low/high

§ Red star - current critical low/high

§ Black dot with line attached to current flag - previous value and indicates low or high value in comparison to the current value

§ Black dot inside current flag - no change between current and previous values

§ White background depicts the reference range

§ Gray background depicts outside of the reference range

Figure 6‑41 Numeric Lab Results Applet Trend View

Click the data range graph to display a list of the five previous results of a given lab, including the test value, reference range, age (date and time), and facility.

Numeric Lab Results: Summary View

Figure 6-42 shows the summary view that lists the date and time taken, lab test (includes a Panel button that opens a test drawer where applicable), flag (yellow indicates abnormal results and red indicates critical), and result of the patient’s lab results.

Figure 6‑42 Numeric Lab Results Applet Summary View

Numeric Lab Results: Expanded View

The expanded view of the Numeric Lab Results applet (Figure 6-43) displays the following information in sortable columns:

· Date

· Lab Test

· Flag

Note: The H, H+, L, and L+ icons indicate abnormal (yellow) and critical (red) highs and lows.

· Result

· Unit

· Ref Range

· Facility

Figure 6‑43 Numeric Lab Results Applet Expanded View

Numeric Lab Results: Detail View

To display a detailed view of a numeric lab result from the trend, summary or expanded applet:

1. Click a list item and a set of icons display.

2. Click the Details Form button to open the Lab Results Detail Dialog box (Figure 6-44).

Note: If the Panel icon is displayed next to a list item, the Detail Dialog box will not open. Instead, click the item and a set of icons display. Click the Details Form icon, and the specific tests run within the panel display, along with the results. Select a lab test under the panel and then the Details Form icon. The Lab Results Detail Dialog box displays a summary list and a historic graphical representation for the selected test that can be filtered by using the date filter.

3. Use the preset date ranges or the calendar dropdowns and select Apply to change the date range for the displayed lab result.

4. Click the Close button, the X in the upper right-hand corner, or anywhere outside of the Lab Results Detail Dialog box, to return to the applet.

Figure 6‑44 Numeric Lab Results Detail Dialog

Orders

The Orders applet displays all orders for the selected patient submitted from all sites.

Orders: Summary View

Figure 6-45 shows the Orders applet summary view that lists the order date, status, order, and facility. Orders can be filtered by type using the Order Type dropdown box within the applet.

Figure 6‑45 Orders Applet Summary View

Orders: Expanded View

Similar to the Orders summary view, orders can be filtered by type using the Order Type dropdown in expanded view. The expanded view of Orders (Figure 6-46) displays the following information in sortable columns:

· Order Date

· Status

· Order

· Type

· Provider Name

· Start Date

· Stop Date

· Facility

Figure 6‑46 Orders Applet Expanded View

Orders: Detail View

To display a detailed view of an order from the summary or expanded applet:

1. Click an order from the list within the applet.

2. The Orders Detail Dialog box opens (Figure 6-47).

3. Click the Next and Previous buttons to navigate between orders.

4. Click the Close button, the X in the upper right corner, or anywhere outside of the Orders Detail Dialog box, to return to the applet.

Figure 6‑47 Orders Detail Dialog

Reports

Reports: Summary View

Figure 6-48 shows the summary view of the Reports applet that lists available reports by date, type, and entered by. Reports are listed in reverse chronological order so that providers are able to find the most recent report.

Figure 6‑48 Reports Applet Summary View

Reports: Detail View

To display a detailed view of a report from the summary applet:

1. Click a report from the list within the applet.

2. The Reports Detail Dialog box opens (Figure 6-49).

3. Click the hyperlink (if available) or scroll down for more information.

4. Click the Close button, the X in the upper right-hand corner, or anywhere outside of the Reports Detail Dialog box, to return to the applet.

Figure 6‑49 Reports Detail Dialog

Stacked Graphs

Stacked Graphs: Expanded View

The Stacked Graphs applet (Figure 6-50) is user defined, and provides graphing functionality. The applet enables users to graph different types of data to a standardized, x-axis timeline, similar to functionality currently available in CPRS.

Figure 6‑50 Stacked Graphs Applet Expanded View

To add graphs to the stacked graphs applet:

1. Create a new workspace. See Chapter 8: Workspace Manager.

2. Add the stacked graphs applet to the workspace.

3. Open the workspace with the stacked graph applet.

4. Click the Add a graph button .

5. A Search field displays.

6. Enter the name of the desired graph type (i.e., temperature, blood pressure, etc.).The results populate as you type.

7. Select the desired graph.

8. The graph displays in the Stacked Graphs applet.

9. Repeat steps 4-8 to continue adding graphs to the applet.

Tasks

The Tasks applet allow users to access, view, and manage a centralized activity task list in both a provider view and a patient view. The provider view of the applet is displayed in the My Workspace area and lists provider-specific tasks, which can be sorted by priority, due date, patient name, or task. Whereas, the patient view of the applet can be added to a user-defined workspace and lists tasks specific for the selected patient, which can also be sorted by priority, due date, activity, or task.

Timeline

Timeline view provides a detailed view of a patient’s visit history.

Timeline: Summary View

Figure 6-51 shows Timeline in summary view. It lists the date and time, activity, and type.

Figure 6‑51 Timeline Summary View

Timeline: Expanded View

Figure 6-52 shows the expanded view of Timeline that lists the date and time, activity, type, entered by, and facility for the event.

To display the expanded view for the Timeline applet:

1. Select Timeline from the Workspace dropdown menu. The patient’s historical visit data displays, grouped by month. The default view displays the date in reverse chronological order.

Figure 6‑52 Timeline Expanded View

Timeline: Detail View

To display a detailed view of a specific activity:

1. Click an item from the list, and the Timeline Detail Dialog displays (Figure 6-53).

2. Click the Close button, the X located in the upper right-hand corner, or anywhere outside of the Timeline Detail Dialog box, to close the detailed visit information and return to the default Timeline view.

Figure 6‑53 Timeline Detail View

VistA Health Summaries

The VistA Health Summaries applet provides Health Summary Report functionality in eHMP. This is a re-creation of the reports available in the CPRS Reports tab under 'Health Summaries', a feature that is also provided in VistA Web, listed as 'Health Summaries', and representing each facility where the patient has a record.

A Health Summary is a clinically-oriented, structured report that extracts many kinds of data from VistA web and displays it in a standard format. The individual patient is the focus of health summaries. The data displayed covers a wide range of health-related information such as demographic data, allergies, current active medical problems, and laboratory results.

VistA Health Summaries: Summary View

Figure 6-54 shows the summary view of the VistA Health Summaries applet that groups each facility where the patient has a record. The reports are listed under the collapsible facility name, with the number of reports available indicated.

Figure 6‑54 VistA Health Summaries Summary View

VistA Health Summaries: Detail View

To display a detailed view of a VistA Health Summary:

1. Click the dropdown arrow next to the facility name. A list of reports for that facility display.

2. Click on a report name and the Report Detail Dialog box opens (Figure 6-55).

3. Click the Next and Previous buttons to navigate between reports.

4. Click the Close button, the X in the upper right-hand corner, or anywhere outside of the Report Detail Dialog box, to return to the applet.

Figure 6‑55 VistA Health Summaries Detail View

Vitals

The Vitals applet displays the patient’s most recently recorded vitals. The information can be viewed both numerically and in graph form.

Vitals: Trend View

Figure 6-56 shows the trend view for Vitals with the following data:

· Type – type of vital collected, i.e. blood pressure, pain, weight

· Result – data captured in relation to the vital measured

· Last – timeframe vital was last collected

· Data Range Graph, which includes:

· A diamond represents the last (current) value

· Blue diamond indicates a current normal value

· Orange diamond indicates a high/low value

· A dot represents previously recorded value

· A dot within a diamond indicates no change between previous entries. The current value is the same as previous.

· If a diamond is to the left of the dot, then the value of the diamond is lower than the dot

· If a diamond is to the right of the dot, then the value of the diamond is higher than the dot

Figure 6‑56 Vitals Applet Trend View

Vitals: Summary View

Figure 6-57 shows the summary view that lists the patient’s blood pressure (BP), pulse (P), respiration (R), temperature (T), pulse oximetry (PO2), pain (PN), weight (WT), and body mass index (BMI).

Figure 6‑57 Vitals Applet Summary View

Vitals: Expanded View

The expanded view of the Vitals applet (Figure 6-58) displays the following information in sortable columns:

· Date Observed

· Type

· Result

· Date Entered

· Qualifiers

· Facility

Figure 6‑58 Vitals Applet Expanded View

Vitals: Detail View

To display a detailed view of vitals from the trend, summary or expanded applet:

1. Click a vital (e.g., Blood Pressure) and a set of icons display.

2. Click the Details form icon and the Vitals Detail Dialog box (Figure 6-59) opens.

3. A historical, detailed view of that vital is presented in list view and graph view. The shaded area on the graph depicts the reference range, if available, for that vital.

4. Hovering over a time on the graph will display a tool tip with more information.

5. Click the Close button, the X in the upper right-hand corner, or anywhere outside of the Vitals Detail Dialog box, to return to the applet.

Figure 6‑59 Vitals Detail Dialog

Chapter 7: Applet Features

About Applets

The applets in the eHMP application are widgets that sort patient data into segments throughout the patient record.

Most of the applets can be refreshed, filtered, maximized, and minimized (Figure 7-1) to display various levels of detail, provide different views of an applet’s information, and open search capability.

Figure 7‑1 Applet Feature Icons

Refresh Button

The Refresh button found on each applet in eHMP updates patient data, and should be used after entering new patient information in CPRS.

To refresh patient data:

1. After entering any new patient information in CPRS, access eHMP again.

2. Click the Refresh button for an applet. The new information displays.

Online Help Button

The Online Help button allows users to easily access context-driven, application-oriented help information.

To access Online Help:

1. Click the Online Help button for more information on a specific topic, and a new window displays with information on that topic.

2. Users can download a PDF version of the eHMP User Guide (Figure 7-2).

Figure 7‑2 PDF Version of the eHMP User Guide

3. Close out of the Help window to return to eHMP.

Filter Button

The Filter button allows users to filter data, limiting the items displayed within an applet.

To filter data for a particular applet:

1. Click the Filter icon to filter the data by entering key terms in the Enter your text filter field.

Note: If more than one word is used, the search results will contain all of the filter words.

2. The applet’s filtered data persists throughout the application.

3. Click the X next to the Enter your text filter field to return to the default list of items for that applet.

4. Click the Filter icon again to remove the filter field.

User-Defined Applet Filters

Users can add more than one filter text to user-defined workspaces that will persist from patient-to-patient and session-to-session.

To add filters to a user-defined workspace:

1. Open the user-defined workspace.

2. Click the Filter icon and the Enter Filter field displays.

3. Enter the filter text. The results populate as you type.

4. Click Add or press the Enter key on the keyboard to add the filter text. The filter text displays with an x next to the text and applet header becomes darker with the word Filtered added (Figure 7-3).

Figure 7‑3: Filtered Applet

5. Repeat steps 3 and 4 to continue adding filter text to the applet.

6. Select Filtered to the right of Filter Name to change the filter name.

7. Enter the new filter name and press Enter on the keyboard. The new filter name displays to the right of Filter Name and in the applet header (Figure 7-4).

Figure 7‑4: Filter Name

8. Select either the x to the right of the filtered text to remove it from the filtered data or Remove All to remove all of the filtered text.

Maximize Applet Button

The Maximize Applet button allows users to expand the applet. The maximized view provides more detailed information for the applet. Click the Maximize Applet button located in the upper right corner of the applet to maximize it.

Minimize Applet Button

When viewing an applet in the maximized view, click the Minimize button to return to the previous view.

Sortable Column Headers

Most applet column headers can be selected in the trend, summary, maximized, or expanded views to sort the information in ascending or descending order.

To sort a column in an applet:

1. Click the column name (e.g., Description or Facility). The list sorts in ascending order.

2. Click the column name again and the list sorts in descending order.

Manual Tile Sort

Tiles are list items displayed when working in the trend view of an applet. Some applets provide the ability to manually sort tiles by dragging and dropping them to a new location in the list. Tiles can be sorted so that the order of display is more clinically relevant to the workspace. The sorted data within the workspace persists from session to session.

Note: The tile sorting feature is available only for user-defined workspaces.

Tile sorting is available in the trend view for the following applets:

· Conditions

· Lab Results

· Medications

· Vitals

To sort a tile in the Lab Results applet (example):

1. Select the tile to be moved (Figure 7-5). The selected tile is highlighted.

Figure 7‑5 Tile Sorting

2. Drag and drop the tile to the desired location in the list.

3. Once the tile has been moved, the word Manual appears in the header (Figure 7-6).

Figure 7‑6 Manual Tile Sorting

4. Repeat steps 1-4 to reorder the remaining tiles in the applet.

5. To delete the manual sort and revert to the default view, click the icon next to Manual.

Infobutton

Some applets provide context-sensitive medical information specific to certain concepts, such as medications, immunizations, and labs. The Infobutton feature allows providers to better assess and treat patients.

To access the Infobutton within the Immunizations applet (example):

1. Click a pill in the Immunizations applet. A set of icons display.

2. Click the Infobutton icon (Figure 7-7).

3. A new browser window opens that displays specific immunization information.

4. Close the browser window to return to the previous view.

Figure 7‑7 Infobutton in the Immunizations Applet

Details Form Button

The Details Form button is an alternate shortcut to a detail dialog box for a selected item.

To access the detailed dialog box using the Details Form button:

1. Click the row of the item and a set of icons display.

2. Click the Details Form button. The detailed dialog box opens.

3. Click Close to close the dialog and return to the previous view.

Quicklook Button

The Quicklook button is a shortcut to a display of detailed information for a selected item for the trend view of an applet. The last five occurrences for the selected item are displayed in list format.

To access the Quicklook box:

1. Click the row of the item and a set of icons display.

2. Click the Quicklook button and expanded information for the selected item displays (Figure 7-8).

3. Click the Quicklook button again to close the expanded information.

Figure 7‑8 Quicklook Button

Submenu Button

The Submenu button is available only for the Conditions applet. It lists the workspaces that are associated with the selected condition to allow for easy navigation to specific patient data.

To access the associated workspace using the Submenu button:

1. Select a condition from the Conditions applet and a set of icons display.

2. Click the Submenu button and a list of associated workspaces for that condition display (Figure 7-9).

3. Select the desired workspace to open in the Main Application Window.

Figure 7‑9 Clicking Submenu Button to List Associated Workspaces

Comment Indicators

When there is additional information about a list item, the trend, maximized, and expanded views of an applet display a Comment Indicator (Figure 7-10).

Figure 7‑10 Comment Indicator

To display a comment:

1. Select an item with the Comment Indicator and a list of icons display.

2. Click the Details Form button and the detail dialog box displays. The comment displays at the bottom of the dialog (Figure 7-11).

Figure 7‑11 Detailed Comment Information

Chapter 8: Workspaces

About Workspaces

Workspaces represent an area of activity with specific applets that support that activity. There are two types of workspaces for eHMP v1.3: predefined and user-defined workspaces.

Predefined Workspaces

Predefined workspaces have been created to provide users with different views of patient information. These workspaces cannot be edited or deleted. The Coversheet, Timeline, Overview, Meds Review, and Documents are all predefined workspaces.

The Depression, Diabetes Mellitus, Hypertension, and Pre-Procedure workspaces are also predefined and cannot be edited or deleted. These were developed for common conditions and expose a combination of concepts, graphing, and items to support clinical management of these conditions in an efficient and safe manner.

Workspace Manager

The Workspace Manager feature allows users to add, edit, arrange and delete user-defined workspaces within the patient record.

Click the Workspace Manager button to open the Workspace Manager window.

The following are the elements of the Workspace Manager (Figure 8-1):

· Add New Workspace

· Workspace Filter

· Default View

· Title

· Associated Conditions

· Description

· Author

· Duplicate

· Rearrange

· Locked/Delete

· Preview

· Customize/Launch

Figure 8‑1 Workspace Manager Window

Note: A shaded row with a lock icon beside the title indicates that the workspace that cannot be edited or deleted.

Add a New Workspace

The Workspace Manager allows users to create a new, user-defined workspace that will persist from patient to patient, and session to session.

To create a user-defined workspace:

1. Click the Add New Workspace button , to add a user-defined workspace to the workspace manager listing.

Note: Once a workspace has been added to the Workspace Manager, users can customize the new workspace.

Workspace Filter

The Workspace Filter allows users to filter the workspaces by title or description in the Workspace Manager.

To filter through the list of workspaces:

1. Click the Filter button .

2. The Filter by title or description field displays.

3. Enter the desired workspace title or description.

4. The results populate as you type.

5. Click the x to remove the text and start a new filter.

6. Click the filter button again, to remove the Filter by title or description field.

Default View

The Default View icon allows users to select the workspace they want to set as their default view when they open a specific patient record. Click the star button to set the desired default view.

Note: The Overview workspace is the default view until another workspace has been selected.

Workspace Title

The Workspace Title field allows users to create or edit the title for a user-defined workspace. Enter or edit a workspace title in the title field (Figure 8-2).

Figure 8‑2 Workspace Title Field

Note: The shaded rows cannot be edited.

Associated Conditions

The Associated Conditions feature allows users to associate a concept (condition or problem) with a user-defined workspace. When a condition is associated to a workspace, users are able to select a condition in the Conditions applet and access a predefined workspace for treatment of that condition.

To add an associated condition to a workspace:

1. Click the Assoc. Conditions icon .

2. The Search Problems field displays (Figure 8-3).

Figure 8‑3 Search Problems Field

3. Enter a problem in the field. The results populate as you type (Figure 8-4).

Figure 8‑4 Problems Search Results

4. Select the problem from the list.

5. You can add another problem by entering it in the Search Problems field, or exit by clicking anywhere outside of the box.

6. The problem is now associated with that workspace.

Workspace Description

The Description field allows users to describe a user-defined workspace. This feature is associated with the workspace filter function. Click in the Add description field (Figure 8-5) to add a description of the workspace.

Note: The workspace description is optional and not required.

Figure 8‑5 Workspace Add Description Field

Note: A description cannot be added to the shaded rows.

Duplicate Workspaces

Users are able to duplicate any workspace so that they can modify the cloned workspace.

To create a copy of an existing workspace:

1. Click the Duplicate icon to create a duplicated workspace. A copy of that workspace displays in the Workspace Manager list, under the duplicated workspace.

Note: See "Customize Workspaces" for guidance on customizing a duplicated workspace.

Rearrange Workspace Listings

Users are able to rearrange their workspaces so that they can order which workspaces they would like to see listed first in the Workspace Manager and the workspace drop-down listing.

To rearrange the Workspace Manager listing:

1. Open the Workspace Manager.

2. Click the Rearrange icon .

3. The selected row is highlighted.

4. Click and drag, or use the up and down arrow keys on the keyboard, to move the row to the desired spot.

Delete Workspaces

Users are able to delete any user-defined or duplicated workspace. Once deleted, these workspaces are no longer available.

To delete a user-defined or duplicated workspace:

1. Click the Delete icon . A confirmation message displays (Figure 8-6).

2. Click Delete to delete the workspace, or click Cancel to return to the Workspace Manager without deleting the workspace.

Figure 8‑6 User-Defined Workspace Confirmation Message

Note: Users are not able to delete workspaces in shaded rows.

Preview Workspace

Users can preview any workspace in the Workspace Manager. The preview link displays the workspace so users can review the layout prior to launching it in the Main Application Window.

1. Click the Preview link in the Workspace Manager to open a preview of the selected workspace in a new window.

Note: The Preview functionality is not available for user-defined workspaces that have not been customized. The Preview is shaded out to indicate the link is unavailable.

2. The new displays the applet titles and views for the selected workspace.

3. Click on the X to return to the Workspace Manager.

Customize a New Workspace

Users can customize workspaces they create to enable unique experiences within the application.

To implement the customization of a new workspace:

1. Click the Customize link in the Workspace Manager to open the Workspace Editor screen.

2. The Workspace Editor screen displays with a listing of the applets in alphabetical order.

3. Scroll through the applets, or enter the applet name in the Find Applet by Name field above the applets.

4. Drag and drop the desired applet in the CURRENT SCREEN VIEW box (Figure 8-7).

Note: Any applets outside the CURRENT SCREEN VIEW box will be included in the workspace. Use the scrollbar at the bottom of the screen to view applets outside of the box when viewing the workspace in the main application window.

Figure 8‑7 Current Screen View in the User Defined Workspace Window

5. Select a View option displays (Figure 8-8). Select the desired view for that applet.

Figure 8‑8 Select a View

6. A box with the applet name and view displays in the CURRENT SCREEN VIEW box.

7. Click and drag the applets to move them on the screen.

8. Use the double arrows to modify the size of the applet (Figure 8-9).

Figure 8‑9 Using Double Arrows to Modify Applet Size

9. Click the settings icon to change the applet view or to delete it.

10. Repeat steps 3-9 until the workspace layout is complete.

11. Click the DONE button in the upper right hand corner of the screen to open the workspace in the main application window.

Note: User-defined workspaces can be edited after they have been customized.

Launch Workspaces

Once the user-defined workspace has been customized, users are able to open the workspace in the main application window using the Launch link from the Workspace Manager.

Users can edit the user-defined workspace on the main application window.

To edit the user-defined workspace from the main application window:

1. Launch the workspace from the Workspace Manager, or from the Workspace dropdown menu.

2. The workspace opens in the main application window.

3. Click and drag the applet to move it on the screen.

4. Click the settings icon on the applet to select a different view, or to delete the applet.

5. Hover the mouse on the bottom left corner of the applet, then click and drag to re-size the applet.

6. Click the Workspace Editor icon to add applets to the workspace.

7. Repeat steps 3-6 until the customization is complete.

Chapter 9: Other eHMP Features

Search Record Field

The Search Record field allows the user to search within a selected patient’s record for specific information.

To search the selected patient’s record:

1. Enter the specific item (i.e., medication, document, immunization) in the Search Record field.

2. A list of suggested terms drop down from the field as you type.

3. Click a suggested term, or press Enter to run the search.

4. The results are highlighted and presented in a new view in list format.

Patient Record Refresh and Status Bar

The Refresh Data button, Status Bar, and the eHMP Data Sources icon appear in the bottom right-hand corner of the eHMP application (Figure 9-1). The Refresh button provides the opportunity to refresh the selected patient’s data for the most up-to-date information from all sources. The status bar displays the status of each repository that contributes to the aggregated data displayed in eHMP. Green bullets with check marks indicate that data is being synced from that source.

Figure 9‑1 eHMP Status Bar

The repositories used to aggregate data:

· My Site: The user’s current site

· All VA: All VA sites

· DoD: Department of Defense sites

· Communities: Community Health Partners of the VA

The eHMP Data Sources status screen (Figure 9-2) provides detailed information on the refresh status of data by source.

Figure 9‑2 eHMP Data Sources

To view the refresh status of patient data:

Click the data sources button to open a new window with the sync statuses for all sources. The new window displays the source, when the data was last refreshed, and if there is new data since the last refresh.
Click the Source title to view the detailed status for that source. You can refresh all data, or refresh each source individually, from this window.
Click the Close button to return to the current workspace.

Chapter 10: Access Control

The Access Control Workspace is a predefined workspace, developed to ease the management of all the users that access the eHMP Application, and their Permission Sets. The workspace is available only for users that have an Access Control Coordinator Permission Set, and should be accessible from the Access Control tab at the top of the page of any screen (Figure 10-1) or from the Access Control item listed in the Workspaces dropdown menu (Figure 10-2).

Figure 10‑1 Access Control Tab

Figure 10‑2 Access Control Item from Workspaces Dropdown

User Management Applet

The Access Control Workspace contains the User Management Applet (Figure 10-3), which allows the user to change the Permission Sets on any other users but himself.

Figure 10‑3 User Management Applet

Search Form

The Search Form (Figure 10-4) is the initial view of the User Management Applet when the user logs in. It contains the following components:

· Title Bar

· Input Fields and Checkboxes

· Search Button

Figure 10‑4 Search Form

Title Bar

The following components are visible on the Title Bar:

· Title - Displays the site the search is being performed on

· Applet Buttons - in the order presented in the image (top right):

o Refresh Button - Refreshes the search in the Users Table

o Help Button - Opens the User Manual at the chapter dedicated to the User Management Applet

o Filter Button - opens/closes the filter field, and it allows filtering the results in the Users Table

o Expand/Minimize Buttons - maximizes or minimizes the applet to the Expanded or Summary View. Both views are showing the same fields and checkboxes, only their sizes differ, the former occupying the whole width of the screen.

Note: If the Search Form is in the Summary View, then the retrieved results are going to be shown in the Summary View of the Users Table. If the Search Form is in the Expanded View, then the retrieved results are going to be shown in the Expanded View of the Users Table.

Input Fields and Checkboxes

The following are the input fields and checkboxes that are available on the Search Form:

a. First Name - Allows searching for users that have that specific first name.

b. Last Name - Allows searching for users that have that specific last name.

c. Select Permission Set - Allows searching for users that have a specific Permission Set that could be chosen from the list of all available Permission Sets (Figure 10-5).

Figure 10‑5 Select Permission Set

d. DUZ - Allows searching for a user that has that specific DUZ. If there is no exact match, it will return all the users that have this DUZ as a substring.

e. Show Inactive Vista Users Checkbox - When this checkbox is checked, it allows searching for users that are inactive in the VistA system, and also meet the criteria specified in the fields above.

f. Show Inactive eHMP Users Checkbox - When this checkbox is checked, it allows searching for users that are inactive in the eHMP system, and also meet the criteria specified in the fields above.

Search Button and Performing the Search

· The Search Button becomes enabled when meeting the following criteria:

o There is input in at least two fields out of the following: First Name, Last Name, Select Permission Set, or

o There is input in the DUZ field

· The Search Button will remain disabled until the requisite criteria are met.

· When the search is performed, three types of responses can be retrieved:

o No users meet the criteria, in which case a warning alert will be shown. In this case the criteria is too specific.

o The number of retrieved users exceeds 100, in which a warning alert is shown. In this case the search criteria needs to be more specific.

o The number of retrieved users does not exceed 100. In this case, the results that are retrieved are shown in the Users Table.

The Users Table – Results View

The summary and expanded views of the Users Table (Figure 10-6) displays the retrieved results in a table, showing the following columns:

· VistA Status - The Status can be active/inactive

· eHMP Status - The Status can be active/inactive

· Last Name

· First Name

· Permission Sets - A list of Permission Sets that the user has. The list can be empty as well, in which case the user gets the inactive eHMP Status.

· DUZ - Unique identifier

Figure 10‑6 Users Table

Filtering the Results

Users can filter through the list by clicking on the Filter Button at the top right of the Users Table – Results View, which brings up the filtering tool (Figure 10-7). The displayed results will be filtered based on the filter value. Filtering is done over the following columns: Last Name, First Name, Permission Sets and DUZ. Therefore, if a cell in any of the specified columns contains a value like the filter value, the correspondent result/row will be displayed.

Figure 10‑7 Filter Button

Tool Bar

The tool bar (Figure 10-8) includes necessary tools for easier access to the necessary information:

· Back to Search link - Allows navigation back to the Search Form

· Show Inactive Vista Users checkbox - When checked, in addition to the users that were already displayed, it displays the users that are inactive in the VistA system and meet the criteria specified in the Search Form.

· Show Inactive eHMP Users checkbox - When checked, in addition to the users that were already displayed, it displays the users that are inactive in the eHMP system and meet the criteria specified in the Search Form.

· Number of results – Displays the number of results in the view. The number gets updated every time one of the checkboxes is checked/unchecked, or a new search is performed.

Figure 10‑8 Tool Bar

Row Selection

Users can select any row of the Users Table to open the User Info detail view (Figure 10-9). When the User Info detail view is closed, the row remains selected (Figure 10-10).

Figure 10‑9 Row Selection: User Info Detail View

Figure 10‑10 Row Selection

User Info Detail View

The User Info detail view (Figure 10-11) contains details about the selected user, such as:

· Last Name

· First Name

· VistA Status - The Status can be "active" or "inactive"

· eHMP Status - The Status can be "active" or "inactive". The Status changes to "active" as soon as the user gets at least one Permission Set, and to "inactive" when all the Permission Sets have been removed.

· Permission Sets - The list of Permission Sets has assigned to the user. The list can be empty, which displays "inactive" for the eHMP Status, and the Permission Sets display None.

Figure 10‑11 User Info Detail View

Edit User’s Permission Sets

The User Info Detail View provides the ability to edit the existent Permission Sets, by clicking on the Pencil Button next to the Permission Sets field (Figure 10-12), which will open the Permission Sets Selection View.

Figure 10‑12 Edit User’s Permission Sets

Permission Sets Selection Form

The Permission Sets Selection Form (Figure 10-13) provides the ability to assign new Permission Sets to-, or remove existent Permission Sets from- the selected user.

Figure 10‑13 Permission Sets Selection Form

The following are the components available on the Permission Sets Selection Form:

· Title Bar - Contains the name of the selected user

· Available Permission Sets Column - Shows all the possible Permission Sets that a user can have

· Selected Permission Sets Column - Shows the Permission Sets that are already assigned to the selected user

· Total Selected - Displays number of Permission Sets

· Save Button - Assigns the new selected Permission Sets to the selected user

· Cancel Button - Cancels any change that has been performed

To edit a user’s Permission Set using the Permission Sets Selection Form:

1. Enter the desired Permission Set in the Filter Permission Sets field as shown in Figure 10-14.

2. Click on Add to select a Permission Set for the user.

Figure 10‑14 Filter Permission Sets

3. Click on Remove to remove a selected Permission Set from the user (Figure 10-15).

Figure 10‑15 Remove Selected Permission Set

4. Click on the Save Button to assign the new Selected Permission Sets to the selected user, and remove previously assigned Permission Sets that were removed from the Selected Permission Sets column.

5. Click on the Cancel Button to cancel any change that has been performed.

6. After saving or canceling the new Permission Sets, the User Info Detail View is presented again, reflecting the changed Permission Sets and eHMP Status as shown in Figure 10-16.

Figure 10‑16 Updated User Info Detail View

After closing the User Info Detail View, the new Permission Sets and eHMP Status can be seen in the selected user row of the Users Table – Results View as shown in Figure 10-17.

Figure 10‑17 Updated Users Table – Results View

Alerts

There are multiple alerts that could be retrieved, which generally are grouped in three categories: Notifications, Warnings and Info. The alerts show up at the top of the panel in which the action is performed, like in the example below (Figure 10-18).

Figure 10‑18 Alerts

Notifications

Notifications are used to notify the user of an action that just happened and the action was successful, for example, successfully updating the user’s Permission Sets (Figure 10-19 and 10-20).

Figure 10‑19 Notification: Permission Set Successfully Modified

Figure 10‑20 Notification: Permission Set Successfully Modified - eHMP Inactive User

Warnings

Warnings are used to notify users of an action that just happened, and the action was unsuccessful. Below are examples of system warnings.

· Too many results retrieved (Figure 10-21).

Figure 10‑21 Warning: Too Many Results

· Not retrieving users because of different causes (Figures 10-22, 10-23, 10-24, and 10-25).

Figure 10‑22 Error Retrieving Users: Inactive Users in VistA, eHMP, or Both

Figure 10‑23 Error Retrieving Users: Inactive Users in eHMP

Figure 10‑24 Error Retrieving Users: Inactive Users in VistA

Figure 10‑25 Error Retrieving Users: Spelling

· Not being able to edit or remove the user Permission Set because of different causes (Figures 10-26, 10-27, 10-28, and 10-29).

Figure 10‑26 Error Editing Permissions: Not Allowed to Remove Permission

Figure 10‑27 Error Editing Permission Sets: Not Allowed to Remove Permission Set

Figure 10‑28 Error Editing Permission Sets: Conditional Removing of a Permission Set

Figure 10‑29 Error Editing Permissions or Permission Sets

Info Alerts

Info Alerts are used to notify users of an action that just happened, and the users need to be acknowledged of related information (Figure 10-30).

Figure 10‑30 Info Alerts