Meditech PDoc Training

1
Meditech PDoc Training

• Ali Bahadori, MD

2
Agenda

• General access
• Medication Reconciliation
• Discharge

3
Access

• Meditech can be accessed via the start menu as
  before
• As of January 31st, you will be brought into a
  new application called physician desktop
• The first screen you will see will be the patient
  list

4
Patient List

• Several types of lists can be accessed from the
  menu on the right, but for most users, the
  Rounding List is adequate. This is similar to
  the old PCI list or the BICS list
• In addition to basic patient information, you
  will see indications for recent results,
  documents requiring signature and other
  notifications

5
Manage patients in list

• You can add patient by going clicking on Find
  Patient and doing a search
• Once you find a patient, inpatients can be added
  to the list
• A patient on the list can be removed by clicking
  the ? box on left and choosing REMOVE from the
  right menu

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Patient Search
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Add to list
8
Remove from list
9
Universal Buttons

• The selections button on the bottom strip are
  present on most screens
• Review will take you to Clinical Review which
  replaces the old PCI. It includes labs, micro,
  notes, etc
• Order takes you to the existing ordering
  application. This is where the new med
  reconciliation and discharge module is located
• Document takes you to the note writing
  application (PDoc) where you can work on the
  discharge worksheet prior to the day of
  discharge
• Desktop takes you to a notification application
  where your signing queue is located

10
Clinical Review

• Pt summary is analogous to LMR summary
• Special panel are pre-assembled collection of
  results for various scenarios (card, ID, critical
  care, etc)
• Daily review will give recent results (this will
  be the first screen when you come to Clinical
  Review)
• Other choices include micro, meds, etc.
• Notes can be read in Notes Review

11
Order

• This screen is already familiar
• There are two new icons Reconcile Meds and
  Discharge which will be covered in detail later

12
Document

• Document will bring you to the note writing
  application
• At this time, the only document you will be
  working on will be the Discharge Worksheet
• In the near future, admit, progress, and consult
  notes will be available here as well

13
Admission Medication Reconciliation

• Screen
• Select patient
• ORDER module
• RECONCILE MEDS
• Process
• Create accurate home med list
• Reconcile
• DONE to save changes
• SUBMIT and OK

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Med Rec Screen
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Add New Med

• RECONCILE MEDS
• UPDATE MED LIST
• Type in new med
• Make sure type generic, (brand search brings up a
  long list)
• SELECT med
• Pick order string (you can modify the details
  after you pick the closest string)
• Modify details as you see fit
• Click DONE
• Click OK on the Last Taken screen
• Type in the next med

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ADD a PRN Medication

• When adding a home med or a prescription, you can
  designate PRN by selecting the PRN box
• The PRN selection box is ONLY visible when you
  are IN the frequency field.

17
Modify an Existing Med

• In general, it is easier and safer to CANCEL the
  wrong med and re-enter it correctly
• If you must modify, Highlight the med of interest
• CHANGE
• Make modification
• KEEP AS REPORTED
• Do not modify the NAME of the drug. CANCEL the
  wrong med and enter the correct one

18
Remove a Med

• If a Med should not be on the list (not a home
  med), then highlight and CANCEL
• Do not modify the NAME of the drug. CANCEL the
  wrong med and enter the correct one

19
Reconcile

• Once you have documented an accurate home med
  list, you can do reconciliation
• Options are
• CONT it is a home med and you want to continue
  as inpatient
• A subset of meds will then automatically convert
  to inpatient med
• If no exact match is found, CONT will bring you
  to the inpatient med order screen and you can
  enter the proper drug. You will then be brought
  back to the reconciliation screen
• HOLD it is a home med, you do not wish to
  continue as inpatient
• There is no STOP during admission med rec.
• If the patient was not on the drug to begin with,
  correct the list by CANCEL the wrong med
• If the patient was on the drug as outpatient, but
  you no longer want them to taking it, HOLD during
  admission med rec. You will have the option to
  resume or permanently stop it during discharge
  med rec

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Discharge Documents

• Process
• Complete the Discharge Worksheet document over
  the days preceding the discharge
• At each time point, SIGN the worksheet and start
  a NEW one the next time you want to work on it.
  All the old info will pull in.
• Data from this document contain all necessary
  elements for the discharge summary and discharge
  instructions, with the exception of disch med rec
• On day of discharge, go to ORDER?DISCHARGE, do
  the discharge med rec and create the final
  documents (Discharge summary and Instructions).
  The old Page 1 content is integrated in the DC
  Instructions document
• Click OK/NEXT through all the fields to make sure
  the data pulls in from the Worksheet and other
  sources. Review the data, make any final
  changes, SUBMIT and SIGNED
• Fields with are required. Some in the
  Instructions are required, but the needed content
  will automatically populate once you land on the
  field
• Remember to enter your attending as a COSIGNER
  for the Summary prior to signing it

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FAU Disch Worksheet

• Select patient
• DOCUMENT
• ENTER NEW
• FAU Disch Worksheet
• Do NOT select the Discharge summary or
  instructions at this point

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Discharge Worksheet
23
Documentation

• Click on the first field to begin documenting
• Use OK/NEXT to navigate to the next field
• By using OK/Next you will automatically skip
  queries based on answers to the current question

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Special Fields

• There are certain special fields that will be
  addressed later
• Secondary diagnosis
• Discharge meds
• Warfarin and quality measures

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How to use canned text

• TEXT this button will open a list of prebuilt
  canned text. At this time, they are mainly
  patient instruction content
• In the relevant free text field, click TEXT
• Select the text and INSERT
• You can modify the text after insertion

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How to Insert Labs

• There are prebuilt sets of labs that can be
  entered via the DATA FORMATS button
• In a free text field
• DATA FORMATS
• Select the data subset
• INSERT
• You can also manually select specific labs
• In a free text field
• REVIEW
• Go to Lab or Micro or other sections (will not
  work in DAILY REVIEW)
• Right click on the desired labs or reports
• RETURN
• INSERT
• You can also cut and paste from external sources

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Secondary Diagnosis

• This field allows you to access the PROBLEM LIST
• You can update the problem list here and the
  Acute and Active Problems will be inserted into
  the secondary diagnosis field
• ADD NEW to enter a new problem
• By default, new problems are placed in both the
  Acute and Chronic section
• You can move problems from Acute to Chronic by
  selecting the problem and using the checkmark

Check and uncheck to place or remove problems in
sections. Uncheck all to remove problem
completely
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Warfarin

• Warfarin is one of the mandatory fields
• If patient not on warfarin, select NO and upon
  OK/NEXT the subsequent related questions will be
  skipped
• Similar behavior for the quality questions

29
Resume Document

• If your documentation session times out, data is
  automatically saved in TEMP status
• You can resume where you left off by going to
  DOCUMENT? highlight the particular form?
  EDIT/AMEND? RESUME
• A Queue of your incomplete document (discharge
  summary and instructions) is at PATIENT
  LIST?DESKTOP

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Submit Document

• Once you are done with the document, you can
  SUBMIT
• At this time, your options are
• CoSigner this will bring a lookup where you will
  designate a physician as a cosigner for the
  current document (this designation can only be
  made before the author signs)
• DRAFT this will save your document for you to
  resume in the future
• SIGNED the document is final
• Required fields must be completed before the
  document can be SIGNED
• Documents awaiting your signature or co-signature
  are accessible via PATIENT LIST? DESKTOP

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Discharge Meds

• Discharge meds are inserted into discharge
  documents once the reconciliation is done.
• Reconciliation is performed via the discharge
  order
• Select patient
• ORDER
• DISCHARGE (go through date and disposition
  screens)
• Pencil next to Prescriptions
• FYI lower on the same screen is when you create
  the final discharge summary and instructions

32
Review Home List
Use to enter an existing home med that is missing
from the list
Use to write for a NEW home med/prescription
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Discharge Reconciliation

• Process
• To be done at day of discharge (or night before)
• Review home med list and modify if not accurate
• Reconcile
• DONE

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Discharge Reconcile

• CAN Drug was on the list by mistake
• CONT Was a home med and continue on discharge
• STOP Was a home med, stop on discharge
• RENEW Was a home med and needs a new
  prescription (FUTURE functionality)
• For the inpatient list,
• CONV Convert an inpatient med into a new home
  med
• New prescriptions can also be printed

35
Finalizing Discharge

• Enter DONE?SUBMIT once you are done with
  discharge med rec, discharge instructions

36
Printing of Prescriptions

• Once you enter your KEY you will come to the
  printing screen
• You can print your prescriptions
• Select Print under ACTION
• Enter your printer number
• There is no need to print the discharge
  instruction. Nursing will print it as part of
  their workflow