EMR TIP SHEET| JANUARY 2017
Using Telin Mediplan to Support
Patient’s Medical Home
Contents
Introduction ................................................................................................................................................ 3
Patient’s Medical Home ........................................................................................................................ 3
Foundation for Success - Commitment to Standardization in the EMR ........................................ 4
Help Files................................................................................................................................................. 5
References ............................................................................................................................................... 6
Panel Identification .................................................................................................................................... 7
Patient Panel Definition ........................................................................................................................ 7
Demographics......................................................................................................................................... 7
Basic Demographic Information ...................................................................................................... 7
Documenting Status Changes .......................................................................................................... 9
Managing Patient Type by Physician # ........................................................................................ 11
Verification ........................................................................................................................................ 13
Configuring Type (Status) .............................................................................................................. 13
Producing a Provider’s Panel List ................................................................................................. 15
Initial Panel Clean-Up ..................................................................................................................... 16
Bulk/Batch Actions.......................................................................................................................... 19
Panel Maintenance ................................................................................................................................... 19
Panel Management .................................................................................................................................. 20
Approaches to Panel Management.................................................................................................... 21
Opportunistic .................................................................................................................................... 21
Outreach ............................................................................................................................................ 21
Panel Management: How to Get Started ......................................................................................... 22
Preventive Screening Care .............................................................................................................. 22
Disease Management ....................................................................................................................... 23
Management of Complex Patients................................................................................................. 23
Panel Management Examples ............................................................................................................ 24
Preventive Screening Searches ....................................................................................................... 24
POEM Template ............................................................................................................................... 36
Registries ........................................................................................................................................... 40
Disease Management ....................................................................................................................... 43
Tools for Panel Management .............................................................................................................. 48
Clinical documentation so that data may be searched ............................................................... 48
Scanned Documents ........................................................................................................................ 48
Searches – Getting Started .............................................................................................................. 50
Opportunistic Screening Tools ....................................................................................................... 57
Measurement ........................................................................................................................................ 58
Verification Rate ............................................................................................................................... 58
Screening Rate Based on Completed Screens............................................................................... 59
Appendix A: High Value Efficiency Tips from Alberta Peers ...................................................... 61
Appendix B: Other Searching Tools .................................................................................................. 63
Analyzer Tool ................................................................................................................................... 63
Patient Management Tool ............................................................................................................... 63
Quick Report/Export ...................................................................................................................... 65
Appendix C: Finding Lab Codes ....................................................................................................... 66
Appendix D: Notes/Buttons Tool ..................................................................................................... 67
Appendix E: Creating Templates...................................................................................................... 69
Appendix F: “List of Scanned Document Index Words/Keywords............................................. 70
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Introduction
Patient’s Medical Home
When an EMR is used in a meaningful way within the Patient’s Medical Home (PHM) model it
supports effective patient panel identification, panel maintenance, panel management and will
enable proactive panel-based care for patients in a practice.
Meaningful use of the EMR will enable ‘Panel & Continuity’; knowing which patients are active with
each provider and using this information for scheduling purposes and to monitor supply, demand and
continuity with the provider. This work is foundational for success, and must be discussed with the
entire practice, arriving at agreed-upon policies and procedures on what, why and how data is to be
captured and maintained with the EMR.
‘Organized Evidence Based Care’ for preventive screening is a logical place to start to learn how to use
the EMR for panel management, or in other words, proactive panel-based care.
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Foundation for Success - Commitment to
Standardization in the EMR
Successful standardization of data entry for improvement or change, apart from leveraging the inherent
functionality of the EMR, relies heavily on three ‘people and process’ principles in conjunction with the
EMR functionality for adoption and use.
These are:
1.
2.
Team

Includes having ‘engaged leadership’ and inclusive team representation within each clinic or
organization; A clinic champion for EMR standardization can be named

EMR improvements or changes do not happen in isolation, and require commitment of time and
resources for improvement to happen

Combining EMR improvement with enhanced use of team, process improvement and practice
facilitation is the ideal strategy in working toward adoption of the PMH

Leverage PCN supports where they exist (i.e. Improvement Facilitators, Panel Coordinators, etc.)
Data Quality

Data Standardization – for the main areas of data input, the entire clinic team should discuss and
agree upon:
o
use of fields in a standardized way, create structured exam forms or templates for the
consistent capture of patient information
o
utilizing standardized text or macros (commonly repeated text) whenever possible
instead of free text
o
develop verification processes to ensure over time that data recording is reliable (e.g., BP
is always in the BP field and not in a text box)
o
develop and provide staff education with associated job aids for consistent patient data
chart entry (e.g. scanning and attaching documents to patient charts)
o
processes to record patient problems with the appropriate ICD9 identifier (highly
recommended)
o
where appropriate, to more clearly identify who documented the information in the
chart, it is recommended to use the individual initials in areas outside of chart notes (e.g.,
in demographic notes or while providing a reason for a bulk/batch change)

It is advised that one person, or a small group, provide direction for patient data entry to ensure
high quality in the clinic and minimize data inconsistency. Create ‘Good in / Good out’ processes
at the practice

Documentation of Standard Operating Procedures (Policies, Procedures and Processes) assists a
clinic team in having a common understanding of workflow; these should be reviewed
periodically

Communicate with the practice team the linkage between data entry and the ability for a pointof-care reminder to function and inform reporting
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3.
Incremental Change

A key recommendation is to take baby steps in EMR changes, especially when it concerns
practice-wide point-of-care reminders. These can be managed to make the changes small and
sustainable for the practice team

Use the simple but effective ‘Model for Improvement’ method including applying plan-do-studyact (PDSA) cycles to identify and test small incremental changes toward the desired and clearly
identified improvement goal

When a new point-of-care reminder is put in place an associated, documented ‘people process’
needs to be developed and implemented; thus, making the change effective and sustainable, by
embedding it into the work process and clinic culture
Help Files
Along with the EMR tip sheet and
videos made available on the TOP
website, the embedded EMR Help
Files from the vendor can be a great
untapped resource with detailed
instructions on how to optimize EMR
functionality.
Telin Mediplan has the Knowledge
Base:
http://kb.telin.com/index.php
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References
Patient’s Medical Home
http://www.topalbertadoctors.org/change-concepts/introduction/patientsmedicalhomeinalberta
Patient’s Medical Home Implementation Field Kit
http://www.topalbertadoctors.org/patients-medical-home-implementation-field-kit/
Patient’s Medical Home Assessments:
Readiness
http://www.topalbertadoctors.org/file/pmh-assessment-for-practices--readiness.pdf
Phase 1
http://www.topalbertadoctors.org/file/pmh-assessment-for-practices--phase-1.pdf
Phase 2
http://www.topalbertadoctors.org/file/pmh-assessment-for-practices--phase-2.pdf
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Panel Identification
Patient Panel Definition
A patient panel, or roster, lists the unique patients that have established relationships with a provider.
There is an implicit agreement that the identified physician will provide primary care services. Relational
continuity, or an ongoing relationship between a physician and a patient, is a key objective of establishing
a patient identification process.
Demographics
Basic Demographic Information
In the demographic area of the patient chart the basic information that is needed for patient panel
identification is:

Full Name

Date of Birth

Sex (Gender)

Complete address

Phone number(s)

Primary provider
o Although there are two fields that appear appropriate for this purpose, using the Phys #
field is most frequently used within queries to show attachment to a physician. The Phys
# should contain the name of the physician that the patient is paneled to. The Family Dr
field is optional. While it is good practice to complete this field as well and have it match
the Phys # field, panel lists and queries for patient care can be completed without the use
of this field.
o NOTE: Ensure that the following check box in your system settings is checked in order to
ensure that the Phys # doesn’t get changed when a physician, other than the assigned
family doctor, bills (sign in as administrator, and go to Other/System Settings/Billings).
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EMR TIP SHEET | JANUARY 2017

Use the below radio buttons to indicate inactive/deceased patients.
o
o

Patient status (Active or Inactive)
o

NOTE: if you deactivate a patient, it will cancel all future appointments, so ensure not to
deactivate patient names that you use to reserve spots in the schedule (i.e. “Lunch,” “*,”
“Reserved,” “Test” etc.). Creating a chart type or assigning these fake patients to a fake
physician is a good work-around.
(Chart) Type
Alberta Patient Healthcare Number (PHN)
Below is an example of a full demographic page in Mediplan. If you are on the Reg tab, you can
double click, or click Modify to enter the full version shown below. Make sure to click Save!
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Other demographic fields exist depending on the version of Mediplan you are using. These other
fields may also support patient panel identification and maintenance processes.
TIP: In order to ensure that all changes are saved within
the REG tab, it is important to double-click or click Modify
in order to reach the above separate window. If you
simply modify the summary page that appears within the
chart, changes may not save within certain fields.
Documenting Status Changes
When changing a patient chart type or listing an inactive status, it is advisable to record the reason and
the date that the status was changed. If another staff member at the clinic questions the status change,
or if the patient contacts the clinic, a record will make it clear to all when and why this was done. There
are two areas of the chart where this can be recorded: Flagged Comments and the REC tab.
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Flagged Comments

Flagged comments will pop-up any time a particular patient is searched.

To modify the flagged comments section, open the REG window and enter comments in the
bottom left box.

Note in the example below, the status has been changed to inactive, and a note within Flagged
comments for Appts lists the reason why.
REC Notes Tab
The REC notes tab can be used as an alternative to flagged comments for recording status changes, but is
also helpful for recording contact with existing patients. For example, this tab can show a running log of
interactions with a patient that include offers of screening.
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This free notes area can be found by clicking the REC tab in the chart. To write notes, free type within the
New Notes box and then click Add to Office Record. Newer notes will appear at the top.
To learn how to create a button that posts a standard note within this section, see Appendix D.
Managing Patient Type by Physician #
Instead of classifying patients by assigning them a Type, you can create a series of physician numbers
(Phys #) instead. This is a particularly useful strategy for differentiating between walk-in patients and
primary care practice patients.
This process achieves the same end as managing by using the (chart) Type drop-down, but because there
is a different colour attached to each physician type, it can be easier to initiate a change of practice within
a clinic, and it guarantees that these walk-in patients will not be included within a physician panel.
Ensure that if you use this strategy that the Do not change patient physician box is checked within system
settings, or else you risk having the walk-in physician listed as the default physician if a patient comes in
casually, even if the patient is attached to a different physician.
To create a new physician:

Go to Other/Sign-On
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
Select an existing physician, and click Duplicate, to create a new physician and copy existing
settings.

Within the next window,
enter the physician’s
name, and click the
coloured box next to
Resource Colour Code to
select a distinct colour for
this physician.
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
The walk-in physician is used exclusively to stratify the patient population by type. Each patient
will still be billed by whichever physician they see that day. Because of this, it is not necessary to
fill out all of the detailed settings within the newly created “Dr. Walk-In” profile.
Verification
Mediplan has a designated field for patient demographic data verification. Marking this field/box
indicates that the address, phone, patient status and provider attachment are up to date. The field also
applies a date stamp and indicates who stamped it, so that all know when it was last done and by whom.
This is a searchable field so that you may do a search for quality improvement purposes to see how well
you are doing with verification processes. This search can be found in a later section, Verification Rate.
Configuring Type (Status)
In order to configure the chart Type in Mediplan, you must have the appropriate administrative
privileges. Select Other from the main menu then select System Settings from this drop down.
Select the Lists tab and the Chart Type from the drop down.
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Examples of Patient Status Used in Primary Care
Status
Status Name
Additional Information
Active
Office Patient
Active office patient attached to a provider in the practice
Specialty Service
This patient may be active in the practice but only for a
given service (e.g., vasectomy, aesthetic, maternity care,
aviation medical, circumcision, IUD). Some clinics give a
status to each type of specialty service.
Temporary
Applied to a patient seeking walk-in care. These patients
are not considered part of the provider’s panel.
New
When a practice is still accepting new patients, a patient
may not be confirmed as an office patient until after a first
or second appointment.
Orphaned/unassigned
When a provider leaves a practice resulting in an
unassigned panel, these patients may be identified.
Emergency
Department
Mainly in rural centres, where a patient record exists for a
visit that occurred in ER of a non-clinic patient.
Long term care
For a group of patients seen in a long-term care site but
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not the practice.
Inactive
Lapsed or Dormant
Some clinics prefer to use this term for patients that are
inactive, with no clinic visit within a specified period of
time (e.g., 3 years). They will be given this term during
panel clean up or maintenance.
Inactive
Includes formerly active patients with no clinic visits in a
period of time defined by the practice, (e.g. 3 years.)
Deceased
Patient is deceased.
Non-clinic patient /
Not Our Patient
When a patient chart is created for lab work received at
the practice or for a patient never seen at the practice
(may apply to a new patient that made an appointment
but never visited the practice).
Duplicate or Archive
When a patient has accidentally been registered more
than once and the EMR does not have the ability to merge
duplicate records; the archived record has this unique
status.
Add, delete and change the list as desired for your clinic. Save your changes and Save your System
Settings.
Producing a Provider’s Panel List
During the panel identification process the first step is to produce a list of all active patients attached to a
provider using the report/search functionality of the clinic EMR.
Last Visit Date (LVdate) may assist with determination of which patients are active. (For information on
getting started with searches, please see the section on Getting started with searches in Mediplan.
Patients with a visit in clinic during an agreed-upon,
predetermined period (e.g. last 3 years)
These lists usually create awareness for initial panel clean up. Verification of the data produced on the
lists with the primary provider and team will help to determine validity of the information. Further panel
clean-up is assisted by additional searches in the EMR.
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Once the panel clean-up is complete, this
search can be saved and loaded again at a
future date. Once a patient verification
process has been in place for some time,
the LVdate field can be replaced by
FamilyDR_Confirmed “is within last 3 years”.
TIP: Many EMRs will produce the list with the EMR
report/search functionality but also offer exporting
the list for further sorting and analysis in Microsoft
Excel or Open Office Calc. Basic spreadsheet
training is recommended.
Initial Panel Clean-Up
Searches/reports that assist initial panel clean up include producing a list of active patients attached to a
provider, with the additional search parameters of:
Last visit date and no future appointments
Age
Sorting the list of active patients by age is valuable. In viewing the list of active patients over the age of 95
years, a provider is usually able to indicate if there are patients on the list who should be marked as
deceased.
Mediplan does not have a field for age so you instead must search by the birthdate being before a certain
date.
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Appointment Type/Reason
If the practice uses the appointment type or reason when scheduling visits, searching by this information
may produce lists of patients that are not family practice panel patients such as ‘aviation medical’ or
‘Botox injection’.
Billing (Fee/Health Services) Code
If the clinic offers specialty services to patients who are not a part of the physician’s family practice, they
may be identifiable by billing code from the Schedule of Medical Benefits.
Ask the providers if there are any billing codes that they routinely use for patients that are not members
of their family practice panel.

Procedure codes
o
E.g., searching by procedures offered at the practice, but all the patients may not belong
to the practice, such as vasectomy (75.64)
o
Long term care patients are billed with an 03.03E billing code
o
You can search billing codes through the Query Builder or you can use the Search Editor.
If you have no need to save your search, the Query Builder is a more efficient way to
search. Below, we show how to search for the 03.03E code under the Billing tab.
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Address or Postal Code
Sorting of active patients by the address or postal code searches can be valuable in identifying groups that
may not be part of the family practice panel due to their place of residence; temporary workers to an
area may be identified this way. This example is limiting by postal code or city. Area code is another field
that can searched in Mediplan that is a similar idea to the address/postal code option.
Last Name is Test
Most clinics have test patients that were created for training or practice purposes; for reporting and
analysis they should not be included in the family practice panels. Verify each patient in the event there
is a real patient with the last name “Test”.
IMPORTANT: The primary provider and/or the practice team
need to review the data from reports to ensure that the
correct information is being pulled into them. Due to unique
protocol at a practice, fields may be used in a specific way and
this may impact the accuracy of reports.
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Bulk/Batch Actions
Once a list is produced and sorted, most EMRs are capable of applying a bulk change to the entire list or a
group within the list. Making bulk changes makes the process of initial clean-up and ongoing panel
maintenance faster and easier.
For Mediplan, the clinic needs to produce the list and then contact the vendor to support the bulk
change.
TIP: Carefully verify data with the primary
provider and/or care team before making a
bulk change.
Example Panel Search for Clinics Verifying FamilyDR at Every
Visit
If clinics are routinely using the family dr confirmed field each time the patient presents at the clinic, then
they can use that as their criteria to search their panel list. The example below will provide the list of
patients confirmed within the last 3 years.
Panel Maintenance
Once an initial clean-up is complete there are several processes that support maintaining a clean patient
panel list for each provider. These processes include:
1. Ongoing phone/address data, physician attachment and status verification at patient check in.
Developing and monitoring a process for all staff that works the front desk with expectations for data
verification is required.

This process can be checked using the EMR reporting. Run a search to produce a list of patients
with visits in a given period of time and determine what percentage of patients was verified
during that time frame.

Standard operating procedures should be in place for front desk staff for:
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o
Patients no longer part of the clinic
o
Patients not seen in the clinic (e.g., records created for patients where lab work was
received or seen at another facility, like the local ER)
o
Patients seen at your clinic but not your family practice patients (e.g., walk-in or
temporary patients)
o
Patients scheduled for a “meet and greet” appointment
2. Conducting searches at regular intervals and applying bulk actions to patients that are no longer
active at the practice. The regularity of the intervals varies by practice. It may be monthly for the first
year and then every six months thereafter. Reports that assist identifying these patients include
searches by:

Last visit date (and no future appointments)

Age

Appointment Type/Reason

Billing code

Address or postal code

Last Name is “Test” (first be sure there are no actual practice patients with the surname Test)
Examples of these reports can be found in the previous section.
3. Patient outreach: Some practices identify active patients with no visits in the past 3 years (and no
future appointments), prioritizing those overdue for preventive screening care, then reaching out
proactively to determine if they are still members of the practice. The outcomes of the outreach
involve updating the patient demographics, physician attachment and offers of preventive screening
care.
Panel Management
Panel management, also known as population management, is a proactive approach to health care.
Population means the panel of patients associated with a provider or care team. Population-based care
(or panel-based care) means that the practice team is concerned with the health of the entire active
population of attached patients at the practice, not just those who come in for visits.1
The Patient’s Medical Home implementation element of ‘Organized Evidence Base Care’ involves
embedding evidence-based guidelines into daily clinical practice where each encounter is designed to
meet the patient’s preventive and chronic illness needs. Setting up population-wide point-of-care
reminders supports these planned interactions and EMR functionality supports appropriate follow-up
care.
1
Module 20. Facilitating Panel Management. May 2013. Agency for Healthcare Research and Quality, Rockville, MD.
http://www.ahrq.gov/professionals/prevention-chronic-care/improve/system/pfhandbook/mod20.html
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Approaches to Panel Management
Opportunistic
When approaching panel management opportunistically, it means catching a patient while they are in the
practice or on the phone with a team member, to offer care.
For example, a 52-year-old female is in the practice for an appointment to inquire about the vaccine
for shingles. While in the office her blood pressure is taken and she is offered requisitions for a FIT
test, plasma lipid profile, fasting glucose and mammogram because they are all overdue.
Methods to identify patients that are overdue for clinical services may involve:

Setting up population wide point-of care reminders that alert a team member that a patient is
due for a clinical service, where available in your EMR

Setting follow-up or another type of alert at the individual patient chart to proactively set up for
the next intervention

A team member that combs through the charts of patients meeting certain criteria who have an
appointment, to identify clinical services that are due and marking the chart as due
Outreach
An outreach method to panel management involves identifying active, paneled patients overdue for
clinical services that do not have appointments and ‘reaching out’ to offer care. This process involves
using the search/reporting tool in the EMR to produce lists of patients.
For example, a 58-year-old male was last in the clinic 2.5 years ago for a knee injury. The panel care
coordinator (PCC) at the practice has run a report that shows this patient is overdue for a plasma lipid
profile, a FIT test and a fasting glucose. The PCC phones the patient and verifies that he is still a
patient in the practice attached to his paneled physician. * As per clinic protocol, the PCC makes an
offer that the patient can come by the clinic and just pick up the lab requisition to get the overdue
screening done and the clinic will follow-up if/as necessary. The patient agrees.
*Note: such protocols vary from practice to practice. It is an important process that must have
provider agreement before implementation.
TIP: It is recommended that a practice initiating outreach begin with patients
that have been verified as attached, active patients. This will prevent the
experience of contacting patients that are deceased or no longer active at the
practice.
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Panel Management: How to Get Started
Once patient panel identification and maintenance processes are in place, it is recommended to begin
proactive panel-base care with the following approach:
Panel Identification & Maintenance
Panel Lists
Patient Verification
Preventive Screening Care
Foundational
Learning
Simple to Complex
Point-of-Care
Reminders
Reporting
Disease Management
Disease Registries
Proactive Panelbased Care
More Complex
Point-of-Care
Reminders
Complex Patients
Automated
processes to support
uncommon care
requirements
With ICD-9 codes in
place identify
complex patients for
systematic care
Preventive Screening Care

Preventive screening care involves a smaller number of data elements than disease management

There is benefit to starting with some clean sources of data like electronic lab feeds

Clinic team will learn:
o
the importance of, and begin, standardization of naming protocols for scanned documents
(e.g., mammograms and colonoscopy reports)
o
from this experience about patterns in their data entry and can make correction for future
meaningful use of EMR
o
practice standard operating procedures that enable proactive panel-based care

The searches and population-wide point of care reminders start simple and can build to the more
complex

Practices can build on:

o
the number of screening maneuvers they are addressing, and/or;
o
the population of patients at the practice that point-of-care reminders are set for (e.g.,
gender and age)
Provides a foundational experience for process improvement
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Disease Management

Clinic team take lessons learned from less complex preventive screening care processes that can then
be applied to disease management

Involves more complex searches with more data elements than screening

A dependency exists on reliable registries of patients with a given disease

Providers will learn the importance of consistent coding in the problem list of the EMR

Clinic team will build on the benefits of standardized data entry

Building of more complex point-of-care reminders with increased reliability of planned prioritized
care
Management of Complex Patients

With a solid foundation in preventive screening care and disease management, patients with
complexities and multiple, co-existing conditions will have visits that address many predictable health
issues by using available resources more efficiently to reliably meet patient’s most important needs
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Panel Management Examples
Preventive Screening Searches
As per the Alberta Screening and Prevention (ASaP) Program
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Loading the physician panel to begin a screening search
To search for patients due for a particular screening maneuver, you must first load the physician panel in
the query builder (data/query builder/use search editor/load). By loading this pre-defined search, you will
not have to re-create it for each search.
Preventive Screening Searches – Find Patients Due for
Bloodwork or DI
Due for Pap Tests

Load your saved physician panel search within query builder
o
o

Insert age and gender criteria

Age: 25-69

Gender: female
Click Search Only in selection below (the resulting number is your denominator when
calculating screening rates).
Click LAB tab and enter appropriate information
o
Enter the appropriate lab code for Pap
o
Ensure the comparison “equals” 0
o
Enter lab test date (three years from today)
o
Click Search Only in selection below
o
Click Remove these Patients
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
Return to the Patients tab, the remaining patients are due for a pap test
Due for Lipid Panel

Load your saved physician panel search within query builder
o
o


Insert age and gender criteria

Male – Age 40-74

Female – Age 50-74
Click Search Only in selection below (the resulting number is your denominator when
calculating screening rates).
Click LAB tab and enter appropriate information
o
Enter the appropriate lab code for cholesterol
o
Ensure the comparison “is greater than” 0
o
Enter lab test date (five years from today)
o
Click Search Only in selection below
o
Click Remove these Patients
Return to the Patients tab, the remaining patients are due for a lipid panel
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Due for Diabetic Screening

Load your saved physician panel search within query builder
o
o



Insert age and gender criteria

Age: 40-100

Gender: Both
Click Search Only in selection below (the resulting number is your denominator when
calculating screening rates)
Click LAB tab and enter appropriate information
o
Enter the appropriate lab code for fasting glucose
o
Ensure the comparison “is greater than” 0
o
Enter lab test date (five years from today)
o
Click Search Only in selection below
o
Click Remove these Patients
Re-enter the appropriate lab code for Hemoglobin A1C
o
Ensure the comparison “is greater than” 0
o
Enter lab test date (five years from today)
o
Click Search Only in selection below
o
Click Remove these Patients
Return to the Patient tab, the remaining patients are due for a diabetic screen
Due for Mammogram

Load your saved physician panel search within query builder
o
o

Insert age and gender criteria

Age: 50-74

Gender: Female
Click Search Only in selection below (the resulting number is your denominator when
calculating screening rates)
Click Reports/DI tab and enter appropriate information
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EMR TIP SHEET | JANUARY 2017

o
Reports date = 2 years from today
o
Reports type = Mammogram (ensure that the appropriate standardized report type is
selected from the drop-down and appears in the box to the left)
o
Click Search Only in selection below
o
Click Remove these Patients
Return to the Patients tab, the remaining patients are due for a mammogram.
Due for FIT

Load your saved physician panel search within query builder
o
o


Insert age and gender criteria

Age: 50-74

Gender: Both
Click Search Only in selection below (the resulting number is your denominator when
calculating screening rates).
Click Reports/DI tab and enter appropriate information
o
Reports date = 10 years from today
o
Reports type = Colonoscopy
o
Click Search Only in selection below
o
Click Remove these Patients
Click LAB tab and enter appropriate information
o
Enter the appropriate lab code for Fecal Immunochemical Test
o
Ensure the comparison “is equal to” 0
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EMR TIP SHEET | JANUARY 2017

o
Enter lab test date (two years from today)
o
Click Search Only in selection below
o
Click Remove these Patients
Return to the Patients tab, the remaining patients are due for a FIT test
Preventive Screening Searches – Find Patients Due for Vitals
These searches assume that vitals are entered in the appropriate boxes within the encounter note


Note the option to specify which arm the BP was taken on
o
Left – B/P
o
Right – R
Helpful trick: once the vitals have been entered in the Charts/Vitals tab, you can return to the
Note tab and copy them directly into the note by clicking Paste and then Vitals
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EMR TIP SHEET | JANUARY 2017
Due for BP

Load your saved physician panel search within query builder
o

Insert age and gender criteria

Age: 18-100

Gender: Both
o
Click Search Only in selection below (the resulting number is your denominator when
calculating screening rates).
o
Click Encounter tab
o
Click use search editor
o
Search within default table Clinical Data

Systolic is strictly greater than 0

OR

Systolic_R is strictly greater than 0
Click Query
NOTE: We include both Systolic and Systolic_R to ensure that all BPs are captured if the clinic
specifies Left/Right BP within encounters


Within the Encounter Tab, now enter the date of encounter (one year from today)
o
Click Search Only in selection below
o
Click Remove these Patients
Return to the Patients tab, the remaining patients are due for BP
Due for Height

Load your saved physician panel search within query builder
o
Insert age and gender criteria

Age: 18-100

Gender: Both
30
EMR TIP SHEET | JANUARY 2017
o

Click Encounter tab
o
Click use search editor
o
Search within default table “Clinical Data”
o

Click Search Only in selection below (the resulting number is your denominator when
calculating screening rates)

Height is strictly greater than 0

Click query
Click Remove these Patients
Return to the Patients tab, the remaining patients are due for height
Due for Weight

Load your saved physician panel search within query builder
o
o


Insert age and gender criteria

Age: 18-100

Gender: Both
Click Search Only in selection below (the resulting number is your denominator when
calculating screening rates).
Click Encounter tab
o
Click use search editor
o
Search within default table “Clinical Data”

“Weight” is strictly greater than 0

AND “date” is within the last 3 years

Click query
o
Click Remove these Patients
o
NOTE: all vitals searches can be saved
Return to the Patients tab, the remaining patients are due for weight
Preventive Screening Searches – Find Patients Due for a
Social History Screen
These searches assume that social history information is entered in the appropriate boxes within the Hx
tab
It is not possible within Telin to search whether an individual has had a smoking or exercise assessment by
date, because the date is attached to the last day that the history was modified, not the last time that the
individual field was modified.
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EMR TIP SHEET | JANUARY 2017

Note: In order to ensure that the history menu is always up to date and includes previous notes,
always click “Modify” rather than “New” to edit the history.
Due for Smoking Assessment

Load your saved physician panel search within query builder
o
o

Insert age and gender criteria

Age: 18-100

Gender: Both
Click Search Only in selection below (the resulting number is your denominator when
calculating screening rates).
Click Hx tab
o
Click use search editor
o
Search within default table “Patient_Hx”

“Smoking Status” is different from 0

AND “Smoking_c” is not empty

Click Query
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EMR TIP SHEET | JANUARY 2017
o

Click Remove these Patients
Return to the Patients tab, the remaining patients are due for a smoking assessment
Due for Exercise Assessment

Load your saved physician panel search within Query builder
o
o


Insert age and gender criteria

Age: 18-100

Gender: Both
Click Search Only in selection below (the resulting number is your denominator when
calculating screening rates).
Click Hx tab
o
Click use search editor
o
Search within default table “Patient_Hx”
o
“Exercise” is not empty
o
Click Query
o
Click Remove these Patients
Return to the Patients tab, the remaining patients are due for an exercise assessment
Preventive Screening Searches – Find Patients Due for
Immunizations
These searches assume that immunization history is saved in the appropriate menu accessed from the Hx
tab.
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EMR TIP SHEET | JANUARY 2017
Due for Flu Shot

Load your saved physician panel search within query builder
o
o

Insert age and gender criteria

Age: 18-100

Gender: Both
Click Search Only in selection below (the resulting number is your denominator when
calculating screening rates).
Click Hx tab
o
Click use search editor
o
Click the dropdown menu and scroll down to open the “Immunization” table

flu_viral_last_date is within the last 1 years

Click Query
o
o
o

Click Remove these Patients
Return to the Patients tab, the remaining patients are due for a flu shot
CV Risk Calculation

This is a highly valuable tool to assess risk in patients with no previous cardiovascular disease (e.g.,
NOT taking a ‘statin’ class of medication)

Conduct on males 40 – 74 or females 50 – 74 every 5 years

Requires other data held in the EMR: gender, tobacco use, BP, non-fasting lipid data and diabetes
diagnosis (for some CV Risk calculators)

May use an internal EMR CV Risk Calculator
http://chd.bestsciencemedicine.com/calc2.html#basic

How to search for CV Risk completions depends on where the provider records the result or if it is
auto created from the internal calculator in the EMR

Mediplan has the Framingham Risk Calculator as its built-in CV Risk function. It can be accessed from
2 places in the chart.
or an
external calculator
such
as:
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EMR TIP SHEET | JANUARY 2017
1.
From the Chart/Vitals tab
2. It can also be accessed via a button found on the POEM template. More
information on the POEM Template can be found in the section, POEM
Template.
When you click on the Framingham button from within this section, it will pull in all of the values
required for the calculation if they already exist in the system, otherwise, it will be left blank and the
user needs to fill it in.
If accessed from the POEM, once all of the information is entered, the score will appear in the box in
the POEM below the Framingham button.
The query function is limited as it cannot search the date the Framingham was completed.

Searching work-arounds for date of Framingham:
1. Find the date of the last POEM the score is in and search for this date
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EMR TIP SHEET | JANUARY 2017
2. Print out either a copy of the POEM on the date that the Framingham is done, or print out a
different Cardiovascular Risk Assessment and link it as a report that includes a standardized name
(e.g. Framingham or CV Risk) and the date it was conducted.
POEM Template
The POEM is a tool that provides a “snapshot” of the most recent lab data, reports, social history
assessments, and vitals for a particular patient
Locations of access to POEM tool:
1. Chart:
2.
Encounter:
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EMR TIP SHEET | JANUARY 2017
You can configure the system settings to either load a brandnew POEM every time you click the POEM button, or to load
the last POEM template that was generated. As long as you
have a system to ensure that a panel manager updates the
POEM regularly, it may be useful to use the latter setting so
that there is no lag-time opening the POEM when the
physician wishes to check the template.

Log-in as administrator

Other/System Settings/LAB
Configuring your POEM
If you have not used the POEM before it needs to be configured for your clinic. To do this configuration:
1. Open the POEM for any patient.
2. Select the Settings button.
3. Select your lab region at the top. If you get your labs from a different region not listed, you will
need to contact Telin for support. 4. Reports are searched based on report type. If you label scanned mammogram reports “mammo,”
then list “mammo” in the settings so that the POEM will find it. The “@” symbol is a wild-card
symbol and will enable the POEM to pick up any text or open space - the space before/after
where it is placed.
5. Select Save - this will close the POEM and it will be configured for all patients.
6. Settings can be changed/updated if codes from a lab service are changed.
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EMR TIP SHEET | JANUARY 2017
The Telin Knowledgebase contains a page updated to May 2016 with the POEM configurations for
Edmonton,
Calgary
and
Red
Deer
found
at
the
following
link:
http://kb.telin.com/article.php?id=170&oid=9
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EMR TIP SHEET | JANUARY 2017
See an example of the POEM template below:
The data (e.g., dates and values) is pulled into the POEM, however data entered into the POEM is not
pushed back to the other areas of the chart.
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EMR TIP SHEET | JANUARY 2017
Registries
A disease registry identifying patients with a coded disease condition is the first step in preparing for
panel management of patients of a given condition. Ideally, all patients with a condition will have the
condition noted in their “Problem List” in a consistent way. For example, Diabetes is always called
‘Diabetes Mellitus’ and will have the ‘250’ ICD-9 code attached to it. It is important that an entire practice
agree on terms for the conditions to create registries. In this example diabetes is not named with other
inconsistent terms such as ‘Diabetes’, ‘DMII’, ‘DM2’, ‘Diabet M’, etc.
TIP: Free typing in the problem list is NOT recommended. Physicians should
use the drop-down list when coding problems. In some cases, a “clean-up” of
the list may be needed to enable consistent coding moving forward.
Coding a Problem List
To add a new diagnosis to the patient’s chart, go to the Problem tab.
There are three ways to code a problem from the Problem tab:
1. The first option you have is to enter a new problem that does not have an ICD-9 code attached.
Select the New Problem (text/No ICD) button and you can enter free text into the field. Although
this is a searchable field and there may be circumstances where you wish to enter this
information without a code attached, if you wish to search by code or a typo is made, the patient
will not show up in the search.
2. The next feature allows a clinic to determine a standard list for entering common diagnoses.
Select the Problem Lookup (Picklist) button. This “favourite” list can be configured to include ICD9 codes or free text. To add a new problem to the pick list, click Add New, enter a heading, the
physician who requested this to be added to their pick list (or 0 for all physicians), and the ICD
code which will populate the “Problem” section. To pick a problem from the pick list to add to the
patient’s diagnostic list, select the problem you wish to add and select Done.
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EMR TIP SHEET | JANUARY 2017
The picture below shows the diabetes problem listed twice. The first entry shows it entered using the
text/no ICD button. In the second entry, it is coded with the ICD-9 (using the pick list shown above).
o
3. If you do not have a pick list configured, you wish to code a problem not on the list, or you do not
know the ICD code, you can use the ICD contains this text option. For this example, we wish to
code the problem multiple sclerosis. We enter all or part of this text in the box and enter on our
keyboard. It will give us a selection of related words and codes from the ICD-9 table. In this case,
the example is specific so we get just one choice. Click on the row with the option you wish to
41
EMR TIP SHEET | JANUARY 2017
choose and select Close/Select at the bottom of the pop-up box. You will be asked to confirm if
you want to add this to the problem list. Select YES to add the problem.
Creating a Registry: Search by Problem
If you add the ICD-9 code to each problem you enter then you can create reliable searches. You can add
the criteria to your search using the example below. This example shows the ICD-9 code of 250 for
diabetes mellitus. Note that it will pick up any problem that has the code 250 in it.


Load your saved physician panel search within Query Builder
Click Diagnoses tab
o
Enter the appropriate ICD-9 code OR enter the problem description, depending on
whether or not you code your problems based on the ICD-9 code or based on free text
o
Click
Search
Only
in
selection below
o
Click
Select
Patients
42
EMR TIP SHEET | JANUARY 2017
o
Return to the Patients tab, the remaining patients have diabetes in their problem list
Services Codes & Searches to Find Patients to add to registry
While the Service Codes used in claims or billing are useful searches to inform the practice when forming
registries, it is not in itself accurate enough to be used when creating point of care reminders. An
accurate problem list should be the trigger for the point of care reminders.
The following are useful searches that will support creation of disease registries. By looking in the
following areas of the EMR, patients without the appropriate problem in their ‘Problem List’ can be
identified, and the appropriate diagnosis added for future searches.
Feature of EMR
Example 1
Example 2
Data that would inform Diabetes
Mellitus Registry
Data
that
would
Hypertension registry
Billing
Diagnostic code 250
Diagnostic code 401
Medications
Currently
insulin
Lab
HbA1c over 7 %
taking
metformin
or
Currently
taking
antihypertensive
inform
an
BP > value specified by clinic MDs
Disease Management
Proactive panel-based care of a cohort of patients with a given condition (e.g., diabetes or hypertension)
is enabled by notable EMR features. Below are a few suggestions for tools and searches that can be used
to best enable disease management within Mediplan.
Chronic Disease Module (CDM) Tool
This is a helpful tool to enhance your disease registry in addition to identifying a diagnosis using the
problem list is the Chronic Disease Module tool. This tool has disease-specific templates for provision of
care, and pulls lab data and vitals from other parts of the chart.

First, ensure that use of the CDM tool is enabled. Log-in as administrator/ Other/System
Settings/Environment/“Enable chronic disease module (CDM)”
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EMR TIP SHEET | JANUARY 2017
The tool is accessible from the main page of the patient’s chart
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EMR TIP SHEET | JANUARY 2017
Clicking on the CDM button will bring up a
window that includes a dropdown menu of
chronic disease care templates, as well as the
option to create a Chronic Care Plan.
Once a condition is selected,
click create new, and another
window will pop-up. You can
either fill out the template or
simply click Save, to keep a
record that the patient has
this condition.
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EMR TIP SHEET | JANUARY 2017
Searches to Enhance Care for Patients with Diabetes
Keep in mind that this search, used to keep track of patients with uncontrolled diabetes, is most effective
once a diabetes registry has already been formed, and searches have already been run to add the
diagnostic code for diabetes to the problem list of patients previously unidentified as having diabetes.
Search for patients with A1C > 7


Load your diabetes registry by running a search for all patients attached to a particular physician
who have a particular ICD-9 code
o
Click the LAB tab
o
Enter the appropriate lab code for Hemoglobin A1C
o
Enter “comparison is greater than” 7.0
o
Click Search Only in selection below
o
Click Select Patients
Return to the Patients tab. These patients could be considered as having uncontrolled diabetes.
Search for patients with diabetes overdue for an A1C

Load your diabetes registry by running a search for all patients attached to a particular physician
who have a particular ICD-9 code

Click the LAB tab

o
Enter the appropriate lab code for Hemoglobin A1C
o
Enter “comparison is greater than 0”
o
Enter the desired date range (say, to look for anyone who hasn’t had an A1C > 6 months,
enter the date of 6 months ago)
o
Click Search Only in selection below
o
Click Remove these Patients
Return to the Patients tab. These are patients with diabetes that are overdue for an A1C.
The Diabetes Tool
The diabetes tool provides a snapshot of the bloodwork and vitals relevant to most patients with
diabetes; although, unlike the CDM tool, information is only pulled into the tool, you cannot manually
enter any data.
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EMR TIP SHEET | JANUARY 2017
First, ensure that use of the diabetes tool is enabled. Log-in as
administrator/ Other/System Settings/Scheduler/“Show Diabetes
Button on Chart”
Access the diabetes tool either from the main chart or from the CDM Diabetes Template.
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EMR TIP SHEET | JANUARY 2017
Tools for Panel Management
Clinical documentation so that data may be
searched
EMR users need to be aware of the search capabilities of their EMR. Where information is entered
matters! In general, fields that can inform a search or report include:

Drop down lists

Radio buttons

Boxes only designed to record certain information like blood pressure or weight

Templated fields in an exam template
Even in an area where free text can be entered, if certain information is entered with a consistent term, it
may be searched. When common repeated text (macros or auto-replace) is used, it may be uniquely
searched.
Scanned Documents
Every clinic receives electronic faxed documents which get linked to individual patient records. The
naming or indexing of these documents as they are attached should enable two processes:
1. When a provider is viewing the patient chart they should easily identify the information and be
able to find it quickly. Some EMRs have the ability to search for a document name at the
individual patient level.
2. In the EMR search / reports it is possible to produce a list of patients that have a type of linked
document within a period of time. These same document names can be used to create a
population-wide point-of-care reminder or a flowsheet.
Customizing a Document List

A document list can be customized for each physician. Because of the way in which the list is
entered, it may make the process easier to prepare a list in a text document first and then type
the labels into the system.

Access the physician settings menu by clicking other/sign-on
o
Double-click the name of the physician for whom a standardized document list is being
generated
o
Click page 3 at the top of the window
o
Under the Report Types dropdown, you can customize the list:

Select a report type and then click clear to remove it from the list

Click add, type in a new label, and hit enter to add an item to the list
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EMR TIP SHEET | JANUARY 2017
Key principles for linking scanned documents

Create a list of acceptable document words that can be used at the practice that is agreed upon
by the clinic team (clinicians and team members). See Appendix F for examples.

Use the drop-down list in the EMR; avoid free typing

Certain clinical reports need to be distinguished to enable panel management
o
Distinguish mammogram results from all diagnostic imaging
o
Some consult reports need consistent naming:

Colonoscopy reports

Flex sigmoidoscopy report

Colposcopy report

Provide training to staff and place a printed list of acceptable keywords with indexing tips at every
workstation where documents get linked to patient charts

Name based on type of consultation rather than the name of the consultant
o

E.g., If a referral is for gastroenterologist consult, name the letter “Gastroenterology consult”
not “Dr. Black consult”
Only central clinic EMR administrator(s) should be allowed to add, delete or modify the main list
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EMR TIP SHEET | JANUARY 2017
Searches – Getting Started
When learning to create searches the following tips will assist in obtaining accurate data:

Be informed on how data is recorded at the clinic; this will provide direction on which fields to search

Build the search one parameter at a time

Validate, as each line of the search is created, that the results are correct before adding another
parameter to the search

Search for the positive first then search for the negative
o

E.g., If you are searching for female patients 50 – 74 y that have not had a mammogram in
the past 2 years first identify all patients that have HAD a mammogram in the past 2 years.
Once you have validated that your search criteria are correct it is easy to search for patients
that have NOT had a mammogram.
Verify that your results are correct by completing some chart reviews from the patients found in your
search
Getting Started with Searches in Mediplan
Query Builder – Overview
There are a few different built-in features to complete your searches in Mediplan. This section, and all
previous example searches, focus on the Query Builder tool. See Appendix B for a summary of the other
tools, including Analyser, the Panel Management Tool, and Quick Report.

Select the Query Builder tool under the Data dropdown on the main menu.
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EMR TIP SHEET | JANUARY 2017

This will open up a blank Query Builder screen. From this screen, you can define certain search
criteria including age, gender, last visit date, and physician, as well as customizing your own searches
or loading previously saved ones.

Since for most of your searches you will want to exclude inactive and deceased patients, the first step
after loading query builder is typically to load your patient panel by clicking Use Search Editor.

Use the screenshot and list below to learn about the different parts of the main Query Builder
window. Note that each tab has a different function, but reports are most useful when generated
from the Patients tab, so we will discuss this tab the most.
1. Selecting New Search all Patients will perform a search based on whatever parameters are listed
above within Section 3. For example, if the gender selected is “Female”, and the “Include in
Search Below” box is checked, clicking New Search all Patients will generate a list of every single
female patient in the clinic, regardless of physician, age, or status. Pressing this button will always
replace whatever search was loaded before.
2. The Use Search Editor button (discussed in greater detail below) allows you to load a customized
search of patients. For example, a common saved search is a panel search that will produce a list
of all patients attached to a particular physician, excluding deceased or inactive patients. Note
that much like the New Search all Patients button, using this tool will override whatever search
had been loaded previously.
3. Any of these parameters can be applied either to create a brand-new search (Section 1: New
Search All Patients) or to an existing search (Section 4: Search Only in selection below). Note that
in order for the parameter to be included in the search, the corresponding “include in search
below” box must be checked.
4. Search Only in selection below allows you to narrow down an existing group of patients based on
the parameters in section 3. For example, say that after loading a panel search, you wanted to
find all patients aged 18-100. After loading the panel search, you would enter the appropriate
age, ensure that the corresponding “include in search below” box was checked, and then click
Search Only in selection below. This search would only list the paneled patients that fit within this
age range.
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EMR TIP SHEET | JANUARY 2017
5. The tabs listed at the top of the window allow you to run additional searches related to other
areas of the EMR, and then apply the searches to the first Patients tab shown above. See below
for an overview of the functionality of the tabs and their relationship with the Patients tab.
6. The Reports button opens another window that allows you to specify what information you
would like to be included in a generated list of patients. See below for more information.
Additional Tabs

Each tab within query builder pertains to a different Table that stores data within the EMR. To search
for lab information, you need to select the LAB tab, to search for billing codes, you need to select the
Billing tab, etc.

In addition to searching for values applicable to a particular tab, you can also apply the data from the
search to the Patients tab in order to include only patients that meet a particular parameter, or to
include only patients that do not meet a particular parameter.

Running a brand new search within an additional tab will only change the patients listed in the
Patients tab if one of the options on the right are selected (i.e. Select Patients, Add Patients, or
Remove Patients).

See the below screenshot of the LAB tab as an example to learn more about how these additional
tabs work and their relationship to the Patients tab. Note that prior to any searches, there is already a
list of labs – this is because a panel of 23 patients had already been loaded within the Patients tab, so
once switching to the lab tab, all the labs that have ever been attached to those 23 patients are
automatically loaded as well.
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EMR TIP SHEET | JANUARY 2017
1. The New Search all Lab Tests button functions very similarly to the New Search All Patients button.
The results of this search for a particular lab test will include lab results from all patients within
the system, not only the data from patients loaded from the patients tab.
2. Use Search Editor will allow you to customize a search related to any specific parameter related
to the tab. For example, within the Encounter tab, you can use the search editor to specify
searches for vitals, and within the Hx tab, you can use the search editor to specify searches for
social history. Note that like the New Search all Lab Tests (or equivalent) button, this search will
override all previous searches and search data from all patients in the system.
3. Search Only in selection below will apply the search for lab results to the patients already
selected.
4. This area allows you to specify a search based on a particular lab code. Note that if the lab result
provides a numerical value, you can select “greater than 0” to find all patients who have had the
test done. If the lab result does not have an attached numerical value (e.g. pap test or FIT test),
ensure that the comparison and observation value is “equal to 0.” To find the appropriate lab
code, see Appendix C.
5. The Select Patients button allows you to apply the search from the additional tab (ensure that
one of the search buttons on the left has already been used) to narrow down the list of patients
on the Patients tab to only include the patient that only meet the searched parameters from the
additional tab.
6. The Add these patients button will add all patients that meet the parameters from the additional
tab search to the Patients tab list, regardless of whether or not they already exist on the Patients
tab list.
7. The Remove these Patients button will remove all patients that meet the parameters from the
additional tab search from the patients listed in the Patients tab list. This search is useful for
finding patients that are due for a particular lab test, DI test, or billing code by removing those
that have already met the criteria.
8. This Report button will generate an information report based on the tab selected. That means
that if you search for a particular lab result, it will include every instance that each patient has
had this lab result. This is one of the only ways to export lab data (the value and date), but will
require some work in excel to uncover only the most recent values. In most instances, the most
useful reports to generate are based on the patient, which can be done by returning to the
Patient tab.
Search Editor – Building Searches
Regardless of the tab, the Use Search Editor query functions the same way. There are a number of fields
to work with to refine your search.
See the example below to guide you:
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EMR TIP SHEET | JANUARY 2017
1. This allows you to specify between: “And, Or, Except”
2. Generally speaking, when you select the down arrow next to
the main Find field, it will produce a list of parameters that are
specifically related to the Tab you are searching within. With
very few exceptions, this is the list to select from when
developing a customized search. If you scroll down further;
however, you will see a list of every table that exists within
Mediplan, and if you open the tables, you can see each field
within it. Only certain tables can be searched from within a
non-matching tab.
3. This drop-down will include customized comparisons based on the field selected.
4. Enter the particular data you are searching for – note that depending on the icon next to the field,
the data required changes.

each of these icons indicates the value is numerical

indicates that the value is true or false

indicates that the value is a date (in month/day/year format)
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EMR TIP SHEET | JANUARY 2017

each of these icons indicate that the value is in a text format (long/short text,
respectively). You can search a field that “contains” a particular phrase or word
5. Use the +/- signs to add another line or remove a line
6. This icon brings up a menu to load/save a search.
Note that all searches are saved to the computer that
you are using, and is not attached to the user’s login
or a system-wide database of files.
Generating Reports
Selecting the Report option within the Patient tab will bring up the Quick Report menu that allows you to
customize the output of the report by selecting preferred columns.
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EMR TIP SHEET | JANUARY 2017

Much like the Query Builder, the listed options are those that are relevant to the selected
table/tab, and are indicated in the Master Table. If you select that dropdown, you can select
additional tables, but given that the patients tab typically only searches within the Patient Table,
not all fields selected from other tables will actually generate data when you click to generate the
report.

Select a desired column by double clicking the field listed below Master Table, or by clicking the
green arrow to the right of it.

These keys are used to select columns and rearrange them farther to the left or right from how
they appear in the generated table. Note that in this example, [Patients] “ULI” is selected, and the
button on the left could be used to move the column to the left.

When you have selected the parameters that you would like,
you can save this particular template by using the Save as...
option. Note that the template is saved to the computer that
you are using, not to the user’s login or a system-wide
database of files.

To generate the report to a list and print it directly, click
File/Generate and your default printer window will open
 To generate the report to MS
Excel/Open Office, select File/Destination/Disk
File, and then File/Generate
 It will ask you to save the file as a .txt
file. To open this file in Excel (or other
spreadsheet software), open the program and
click “Open.” Ensure that the dropdown “All
Files” is selected (“All Excel Files” will be the
default”), and select the saved .txt file. Click
Finish and Open and re-save your new Excel
spreadsheet as a workbook or .csv files.
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Opportunistic Screening Tools
Although this EMR does not have a clinical decision support tool that will search the database for
specified criteria to identify patients due for clinical service, there are a number of strategies that can be
used for opportunistically identifying patients that are due for particular services.
1.
Patients can be identified either through regularly run screening searches, or by checking the
POEM in advance of a patient’s visit.
Once a patient has been identified as due for a particular screening maneuver, a panel manager
can modify the encounter note in advance of an appointment to indicate to the physician, or
other appropriate team member, that the patient is due; even changing the text colour if desired.
2. The panel manager could
also print a requisition in
advance
of
the
appointment by selecting
the appropriate req. from
the Forms dropdown in
the chart.

To customize the forms included within the Forms dropdown list (customized by physician), go to
Other/Sign-On/select physician/Customize Integrated Forms List and ensure that all required
forms are checked off.
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Measurement
While moving toward the Patient’s Medical Home, a practice or team will not know how they are doing
unless they measure for improvement. Process measures reflect the things that are done in the practice
and how the systems are operating. Example measures are:
Verification Rate
One tool that can be useful is to measure how often the team is verifying the patient demographic
information (address and phone) and physician attachment. When a clinic is new to patient verification it
can be measured in the query builder. For example, a team that wants to measure how they did in a
week:
# patients verified this week
x 100 = verification rate (%)
# patient visits this week
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A clinic may also have an expectation over a period of time and can determine if they are meeting
their goals. For example, if a practice has an expectation that their verification rate in the last three
months should be 95% the formula would be:
# patients verified in the three months (screenshot 1)
x 100 = verification rate (%)
# patient visits in the last three months (screenshot 2)
Screenshot 1:
1.
Screenshot 2:
Screening Rate Based on Completed Screens
A practice will also find that they are able to measure rates for preventive screening care. Measuring
completed screens looks for completed results. The generic equation is:
# patients in eligible population with screening result within screening interval x100 = %
# patients in the eligible population

The % represents the screening rate

The screening interval is the time frame during which the screening maneuver should be done
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
The eligible population would include all the active, paneled patients for a provider that would also
qualify for a particular screening based on age/gender
Example 1: Dr. Brown wishes to calculate the completed blood pressure screening rate for her active
paneled adult patients. Blood pressure should be measured annually (ASaP)
# active adult patients* (18 +) with a BP result in last year x 100 = BP screening rate (%)
# active adult patients* (18 +)
*Attached to Dr. Brown in the EMR
Example 2: Dr. Brown wishes to calculate the completed diabetes screening rate for her active adult
paneled patients. Diabetes screening is:
appropriate for adults 40 +
recommended once every 5 years
completed with a fasting glucose, hemoglobin A1c result or a diabetes risk calculator score
# active adult patients* (40 +) with a fasting glucose OR HBA1c OR Diab. Risk Calculation in last 5 years x 100 = %
# active adult patients* (40+)
The % refers to the diabetic screening rate.
* Attached to Dr. Brown in the EMR
Calculating a Screening Rate Based on Offers of Screening
Care
Practitioners participating in the Alberta Screening and Prevention improvement project will include both
completed screens and offers of the screen. In this case, to measure with the EMR there must be a place
that declined, deferred and exemptions for screening are reliably recorded. In this case the generic
equation is:
#active adult patients with an offer of screen + #patients with completed screen x 100 =%
#active eligible adult patients
It is recommended to use the chart audit methodology2 instead of EMR measures if the offers of screening
care are unable to be searched in the EMR.
2
See ASaP EMR Chart Review Instructions: http://www.topalbertadoctors.org/file/asap-chart-reviewinstructions-emr.pdf
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Appendix A: High Value Efficiency Tips from
Alberta Peers
A group of Alberta Mediplan peer leaders brainstormed some tips and shared them below.
Messaging and Task Manager



Task Manager vs Messaging – take the time to learn how to optimize each of these functions and
communicate processes with all users in the clinic
Messaging
o Highly recommend use of “Referrals box” for referrals
Task Manager:
o Create task groups according to your clinic processes (e.g., follow ups, referrals, etc.)
o Note that alerts come up in your task manager
Patient Management Panel Tool – like a dashboard-at-a-glance for outreach and opportunistic







Loads more quickly than the POEM Template
Pastes into an encounter
Integrates immediately into Excel
In Calgary, it currently pulls labs inconsistently (Paps)
It’s view only; you can’t enter information in (pull data only, not push)
From POEM you have the “view all” feature which is useful for clinicians and POETs
In POEM, you miss exceptions, (e.g. patients who had hysterectomy exempt from paps)
Templates


You can duplicate templates across a clinic, but you cannot share them outside of your clinic
Make it a “0” in the set-up so it’s not physician specific
Scheduler




Right click on an appointment day to see the day’s remaining appointments
Don’t mess with the asterisk
Make appointments longer by using “shift click”
You can remove the default prompt “is this your family doctor?” when arriving a patient; use the
date stamp on registration page when demographics are verified.
Assigning Patients


Mark patients deceased using available “deceased” tick box
In every search, you will need to exclude deceased patients
Chart Type

Create a “Dr. Inactive” to classify inactive patients. It will create a list of inactive patients but in
the Family Dr field, the patient’s physician remains for future reference
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EMR TIP SHEET | JANUARY 2017

Whoever changes a patient status should put their initials in the file for reference
Documenting Exceptions


Mediplan does not have a designated section to document surgical histories
Recommended to note hysterectomies and mastectomies in “Other Notes” section in History
Opportunistic Screening

When doing opportunistic screening, create a template that is copied and pasted into encounter
and customize per patient. Use a different font colour and initial who applied it.
Outreach Screening

Recommend using the birthday month approach for outreach screening, it means creating and
maintaining fewer spreadsheets.
Final Tip!

If there is a field to enter into, use it! Not the SOAP note!
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Appendix B: Other Searching Tools
Analyzer Tool


Location: Data/Analyzer
Useful for: running multiple patient searches requiring complex use of “And/Or/Except”
Patient Management Tool


Location: Data/Patient Management (for searching)
Provides spreadsheet view of POEM information based on query of patients


icon will automatically export spreadsheet to excel
Similar query format to query builder with different terms (bolded term is used in patient
management tool):
o
Use 4D Editor = “Use Search Editor”
o
Further Search based on This Result (checkbox) + Show results/Refresh = “Search Only in
selection below
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o
Show results/Refresh = New Search all patients
o
Add the result to the patient list = Add these patients
o
Remove the result from patient list = Remove these Patients
o
Show only the result from patient list = Select these patients
o
Output Result to Panel will push query to spreadsheet view
See below example search and example spreadsheet:
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Quick Report/Export



Location: Data/Quick Report/Export
More easily apply “Chart Type” exclusion
Provides longer list of search tables from the main window
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Appendix C: Finding Lab Codes
1. Telin Knowledge Base: http://kb.telin.com/article.php?id=170&oid=9 (shows the default lab codes
for the POEM template depending on the region of Alberta)
2. Panel Management Tool: Data/Panel Management Tool/Query/Lab/Test Codes Lookup (will
provide alphabetized list of lab codes for your region)
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Appendix D: Notes/Buttons Tool





The Tasks Notes Tool Setup function allows you to customize buttons and drop-downs to create
templates for tasks and other messages within the EMR.
Location: Other/Tasks Notes Tool Setup
Click Add to create a new button or drop-down menu option
Unless the notestool checkbox is selected, each button or dropdown option will refer to a new
template for a task.
Clicking a button that does not contain a sub-list will load the saved task template. To create a
button, type the name of the new button, select a number between 1-32, and list the header,
message, and urgency that you would like to appear for each task.
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
Clicking a button that contains sub-lists will produce a dropdown menu, each of which with a
corresponding list of task templates. To create an item on a sub-list, select an existing button
name and list the header, message, and urgency that you would like to appear for each task.

Clicking the notestool checkbox allows you to save
similar buttons/dropdown lists for templates of text to
be used in other parts of the EMR. For example, if you
create a button and assign it the number 37, 38, or 39,
you can create a template for the text used within the
REC notes area of the chart.
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Appendix E: Creating Templates
To open the window to create templates for
encounter notes, letters, or reports, go to
Data/Codes and Lookups/Obj
Under Templates, select which type of template
you would like to create, and then click New.
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Appendix F: “List of Scanned Document Index
Words/Keywords
These examples are from real clinics.
Example 1:
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
ALLERGIST
Appointment
Appt Confirmation
CARDIOLOGY
Chart
Colonoscopy Report
Colposcopy Report
Consult Letter
CT Scan
DERMATOLOGY
Discharge Summary
Driver’s Medical
ECG Graph
ECG Report
ENDOCRINOLOGY
ENT
Forms
GASTRO
GEN SURGERY
INTERNAL MED
Lab
Lab – Provincial
Mammogram
MRI
NEUROLOGY
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NEUROSURGERY
Notice of Admission
Notice of Discharge
OBGYN
OPD Sheet
OPHTHALMOLOGY
OR Report
ORTHO
Paps
Parking Placard
PEDIATRICS
PLASTICS
Prenatal US
Pre-op Medical
Referral
Report
Requisition
RHEUMATOLOGY
Rx Adaptation
Rx Refill
Ultrasound
UROLOGY
Vascular
WCB
Xray
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Example 2:
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Admit
Air Contrast
ALT
Anti-HIV
Anti-Nuclear (ANA)
Appointment Notice
Attending physical
statement
Audiology Report
Beta HCG
Biopsy
Blood Culture
Blood Type
Blue Cross Authorization
Breast Ultrasound
Body Fluid Culture
Bone Density
Bonnyville Cancer Centre
Bubble Pack
Authorization
C-reactive Protein
CT Scan
CEA
Cervical Culture
Chart Notes
Chart Request
Acknowledgement
Chemistry
Child Welfare Medical
Chlamydia
Claims Management
Program
Colonoscopy Report
Colposcopy Report
Consult
Creatinine
Critical Care Line
Cross Cancer
Cytology Report
Diabetic Consult
Discharge Instructions

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Discharge Summary
Double Contrast
Driver’s Medical
ECG
Echocardiogram
EA screen
Endoscopy
Ferritin
Free testosterone
Gastroscopy
GC Probe
Gynecological Cytology
Report
HBA1C
Hematology
Hepatitis
Home Care
Imaging
Influenza
INR
Iron and TIBC
Lipid Testing
Mammogram
Medical release and
report
Medications
Mental Health
Microbiology
Millard Health WCB
MRI
MRSA
Newborn Metabolic
Screen
NIHB Drug Exception
No Show
Occult Blood
Oncology Imaging
OPD
Operative Report
Ova & Parasite
Paps

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Pathologist Comment
Patient Photo
Perinatal
Phenytoin
Physician Admit Advice
Pre-op medical
Prenatal US
PSA
Psychogeriatric Consult
RAAPID North Patient
Summary
RAH
Rapid Plasma Reagin Test
Release of information
Rx adaptation
Rx request
Serum Protein Elect.
Slick
Sputum Culture
Stool Culture
Superficial Culture
Surgical Pathology Report
Syphilis
TB Update
Throat culture
Tom Baker Cancer Centre
Troponin
TSH
UAH
Ultra Sound
Urethral Culture
Urine Microalbumin
Vaginosis Screen
Vital Aire
VRE
WCB
Wound Culture
X-ray
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Example 3:

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
Appt Notice
Attending Physician Statement
Audiology Report
Blood Glucose Readings
Blue Cross
Bone Density
Cardiology
Chart Notes
Colonoscopy
Complex Care Plan
Consult
Cross Cancer Inst.
CT
Discharge Summary
Driver’s Medical
Echocardiogram
EKG/ECG
Email
Emergency Record
Exercise Stress Test
Form
Framingham Risk Assessment
History Sheet
HIV Test Results
Hotler Monitor Reports
Home Collections Confirmation
Injection
Labs
Letter
Mammogram
Medical Legal
Medical Summary
MRI
Operative Report
Outpatient Report
Pacemaker Clinic
Paps
Patient Information
PCN After Hours Clinic
Prenatal US
Pre-Op Medical
Procedure Letter
Prov. Lab Results
Referral






Rx
Treatment Consent
Ultrasound
Vasectomy
WCB
Xray