Release Notes
Version No: 2.0

Build No: 1

The release notes describe the various new features and enhancements carried out in version 2.0 of PrognoCIS™

2. New Features

2.1 Check Out Docs

After the end of encounter(s) a provider may want to give away a printout of prescription or educational material to patients or may have a practice of maintaining printouts of documents related to patient's encounter as records. In times as such, the new feature, ‘Check Out Docs' implemented in PrognoCIS version 2.0 comes in handy.

Check out docs shows the list of documents to be printed related to the encounter of a patient(s). The screen shows Type and Name of the document to be printed and also shows a checkbox to select the document. Multiple documents can be printed based on the checkbox selected. All the selected documents are printed into a single PDF file which either can be saved as a softcopy or in turn taken as a printout.

Supported Documents:

•  LET - Letters

•  LAB - Lab Order

•  RAD - Rad Order

•  RX - Prescription

•  PN - Progress Notes (Progress note template for checkout document is customizable)

•  SC - Clinic Forms

•  LD - Legal Docs

•  OD - Other Docs (Documents attached as others category from message > attach)

•  ED - Education

User can access checkout documents from home page > Checkout document

2.1.1 MA can see list of open encounters

Provided an option for MA to view list of all open encounters of all providers from Home page > Open encounter tab

2.2 Patient Alert

Patient alerts are used in case more attention is required for patient's specific information. For example: Copay is still pending etc

Patient alert is provided as popup on Appointment > Schedule.

•  A property “ appointment.show.patientalert” is added in the application. If set to Y patient's alert will be popped up on scheduler screen.

Following tabs are added on patient alert popup window:

•  View alert: Shows the alerts entered by different user for selected patient

•  My alert: Alerts entered by logged in user only for selected patient

icon indicates that there is no patient alert available

In case if there is some alert then patient alert icon will be

Use case:

•  Go to Appointment > Schedule

•  Select a time slot to take a appointment

•  Select a patient

•  On Appointment schedule popup click on patient alert icon

•  Enter some alerts for patient

•  While entering the alerts user can also define till when alerts should be displayed, on which screen alerts should be available for user like on appointment screen, encounter and billing screen

•  Once the alerts are entered the patient alert icon changes to indicating alerts are available

•  Next time when user will click on the same patient's appointment on Appointment > Schedule

•  Patient alert popup will be displayed with the alerts entered

User can click on Ok or Delete if required

2.3 Patient Registration

2.3.1 Merge Into

At times it may so happen that a patient registers, giving the relevant demographic information over the phone. And when the patient comes down to the clinic it is found that the record doesn't show up in search (due to misspelt name taken during patient registration), a new registration is done for the patient – this time with the correct name spelt. Now two different records for the same patient are available in the system, which is unacceptable. In such a case a new feature, ‘Merge Into' implemented in PrognoCIS from version 2.0 can be utilized.

In case, if there are two records existing in PrognoCIS for the same patient then it is possible for the user to merge these two records in to one. An option is provided to merge two records in to single record.

Patient Registration > Merge into

Merge Into button will be available in case:

•  A property “ patient.merge.onreplac”e is added in the application. If set to N only patient encounter details will be merged. If set to Y patient demographic details along with encounter details will be merged.

•  Login user must have Replacebutton role assigned to him.

On click of Merge into list will be displayed to show the patients sharing same DOB or First Name and Last Name with opened patient record.

Use case:

If there are 2 records A & B of single patient exists in PrognoCIS then to merge record A in to B.

•  Login as office manger with Replace button role

•  Open record A

•  Click on Merge into button

•  List of all records with either same DOB or First and last name will be displayed

•  Select record B

•  Message to confirm whether to replace the records or not will be displayed

•  Click on yes

•  Record A will be merged in to record B

•  After merge only record B will exist in the application

Note: If there is an open encounter in record A then merge into button won't be available.

2.3.2 Patient History

In the convenience of features such as ‘Merge Into' (with reference to 2.3.1) user may start merging records as required, even updating change of address becomes an easy task. If these activities happen day in and day out then it becomes difficult to track the original details that was provided at the start of the encounter. A new feature, ‘History' implemented in PrognoCIS version 2.0 deftly keeps track of all these changes done and makes them available for viewing.

History button is provided on Patient Registration screen to view the changes done in patient's demographic information.

Property is added in to the system to decide whether user wants to track the changes or not.

“patient.show.history” (If set to Y, then the History of changes will be available on Patient Registration Screen.)

On click of History button patient's record before and after merge will be displayed.

2.3.3 Exempt From Reporting

Consider a case wherein patient is a staff member in the clinic and for some reason there is a requirement that the record of the encounters though maintained should not appear in the reports generated. In PrognoCIS version 2.0 If a patient is marked as ‘Exempt from Reporting' then the patient's encounter details do not display in any of the reports generated.

An option is provided to exempt patient from reporting. A check box is provided on Patient Registration > Other Info Tab to mark whether patient should be exempt from report or not.

To apply this filter sql of tabular report (Settings > Configuration > Tabular) should include a parameter “PATIENT_FILTER”

Patients marked exempt from report won't be available under tabular report generated from Report > Tabular .

2.3.4 Race and Language

A new tag [PT_LANGUAGE] has been added in the current version of PrognoCIS 2.0 to display the patient's language on narrative/progress note.

2.3.5 More Relation

At the time of patient registration, in the earlier verion of PrognoCIS there was a provision to enter emergency contact detail and one relative of the patient. From the current version of PrognoCIS it is possible for a patient to register more than one relative's contact details.

A button: More appearing in the patient registration page, under Tab: Contacts serves the purpose with ease.

Patient Registration > More button is provided to add details.

property “patient.other.relations” is added in application to define the list of relations so that user can enter the information from registration screen.

2.4 Insurance Eligibility

At the time of patient registration, patient's insurance details are also taken. Patient's payer information has to be verified and the eligibility checked, before any of the treatment is given to the patient. This way, the patient is informed of their payment responsibilities and the billing procedure becomes hassle free.

Insurance Eligibility check is to verify whether the patient has got the insurance or not and if yes then what are the benefits he/she is going to get. Button is provided on Patient Registration > button: Insurance > Insurance screen. On click of check button system checks the insurance eligibility of the patient.

button is provided just near to check button which displays details of patient's insurance.

Note: At present PrognoCIS supports 4010 EDI version available in market. 5010 is not yet released and is planned for 2012.

2.5 Break Glass

There are at times special cases of patient suffering from condition that may be considered as a social stigma, in such a case, the provider is reluctant to share the patient's case details with other user's of application except for a few. In the current version of PrognoCIS 2.0 a provision is given to the providers whereby the case details of such patient's appear hidden from other user's of PrognoCIS, and the chosen few are assigned the role of ‘Break Glass' that they can make use of in case of an emergency and in the absence of the rendering provider.

The confidentiality is so maintained that these privileged users can view the restricted patient's details only for the current session and all the activity done during this session is logged.

Scenario: Break the Glass role is added to allow access to restricted patient's details access.

Break the glass is available as role under Settings > Configuration > User Roles > Break Glass and can be assigned to any user as per clinic workflow.

Once the user is restricted from accessing the chart user with break the glass role can access the chart.

Use case:

•  Login as user 1. User 1 should have role “DenyAccess” assigned to him

•  Goto Patient Registration screen > Click on Deny Access

•  Select the provider 1 from the list to whom access to patient's chart to be restricted

•  Now login as provider 1. Provider 1 should have Break the glass role already assigned to him.

•  Select the same patient's chart for which access is restricted for provider 1

•  Message “Access restricted do you want to break the glass” will be displayed

•  On click of ok patient's chart will be displayed.

Break the glass report:

•  To view Break the glass events click on Report > Audit Trail

•  Select Break Glass from object drop down

2.6 Allergy

2.6.1 Allergy History

Provided an option to view the identity of the user who added, modified, inactivated or removed allergies from the allergy list. History also displays the attributes of the changed allergies.

button is added on Allergy screen to display the allergy history.

2.6.2 Allergy Created on field

Provided an option to show or add creation date of allergy. User can enter the creation date of allergy from Facesheet > Allergy Screen

2.6.3 Allergy Status

Provided an option to select and display different status of Allergy. Status to be available can be defined under property “all ergy.status.types”. User can define comma separated list of allergy status.

2.7 Order Set

An option is provided to design order sets with Lab/Rad/Medication/Consults in one go.

To design an order set go to Settings > Configuration > Order set

User has a choice to add laboratory test and/or Radiology test and/or Medications and/or Consults.

Once the order set is created user can retrieve the order set from Face sheet > Order Sheet and order.

Provision to display Date, time stamp and name of the order set is also provided as tool tip from F acesheet > Order sheet > Test.

Once an order is done from order sheet status of all the order changes to Ordered and hyperlink to each order is provided to view the details of each order.

Note: Feature is available from doc forms.

2.8 Past Medical History

Provided an option to view the identity of the user who added, modified, inactivated or removed PMH. History also displays the attributes of the changed medical history.

button is added on PMH screen to display the history.

2.9 Current Medication

2.9.1 Current Medication Warning

Application provides an option to display following interaction on CM screen based on CM drugs.

•  Drug-Drug Interaction

•  Drug-Disease Interaction

•  Drug-Allergy Ingredient Interaction

•  Drug-Allergy Interaction

•  Drug-cross sensitivity Interaction

To display the alerts following properties are added so that user can decide whether to display interaction alerts or not. Based on user's choice property can be turned on or turned off.

a) cm.check.allergens: If set Y allergens will be checked on Current Medication screen

b) cm.check.drugdruginteraction: If set Y Drug-Drug Interaction will be checked on Current Medication screen

c) cm.drugdruginteraction.severitylevel: Following values can be set to display

1 - Most Severe 2 - Moderate Severe 3 - Least Severe interactions.

Also provided a button on CM screen to view the interactions once the CM changes are saved.

2.9.2 Current Medication History

Provided an option to view the identity of the user who added, modified, inactivated or removed medications. History also displays the attributes of changes done to medication.

2.9.3 New Tags for Current Medication

Following four tags display medication status in respective formats in the progress notes, the last tag, as is described displays the classification codes associated to the CPT/HCPC codes assigned.

2.10 Vaccination

2.10.1 Vaccination Quantity and Time

Provided a flexibility to add vaccination Dosage/Quantity and time when vaccination was given.

Option is available from Facesheet > Vaccination > Administer

2.11 Protocol selection on HM

There was a requirement for a provider to keep a track of all tests scheduled for patient(s) at a future date after the end of an encounter; also a requirement to define a customized decision based rules that would help during a provider's workflow. These requirements is met with satisfying resolution in the current version of PrognoCIS 2.0 via the implementation of feature, Protocol Selection.

Provided an option for user to select multiple tests from protocol option on Health Maintenance screen. In this case user can manually select the protocol if required

2.12 Radiology Order

2.12.1 Radiology Alert

Provided an option to enter test specific alerts if required.

To enter the alerts go to Settings > Configuration > Radiology Tests > Alerts

Once the alerts are defined for a specific test then user can view the alerts from Encounter > Rad Order screen.

User can view the alerts by clicking on provided on Radiology order screen.

ill be only available if there is an alert associated with the any of the tests.

2.12.2 Modify Radiology Order

Scenario:

•  Provider orders radiology test from doctor form

•  Provider receives the results once order is done

•  After looking at the rad result provider updates the results from doctor form

•  Status of radiology order becomes Result received

•  MA or technician needs to update the jacket number and comments on radiology screen after the test is done

Role "RadOrderRRModify" is added to limit the ability to update the radiology order screen once results are received. Only the person who is assigned role “RadOrderRRModify” will be able to edit radiology order even after provider has entered results

2.13 Confidential Information

There are sometimes when user wants to enter patient's confidential information in patient's record and provide restrictive access to users.

Considering this an option is provided to enter patient's confidential information in patient's record. Along with this user can also define to whom access to the information should be provided and to whom not.

User can enter confidential information from Dictate Transcribe > Confidential Info

If 'Y' is the property value to the property: show.Confidential.notes then confidetial notes wil be available under dictate transcribe based on access OR to the encounter attending doctor.

Once entered user can define to which medics type access to the information is allowed.

2.14 Education Material

Provided an option to associate education material with Protocol. User can associate the education material from Settings > Configuration > Education

Once associated and if protocol is applicable for the patient then the associated education material will be available from Encounter > TOC > Education.

2.15 Sign-off note

Provided an option to mark sign off clinical note. Identity of user signing off on the note will be captured on progress note/narrative, along with date and time.

The Note Sign-off feature is associated with two properties as follows:

•  The property, sign.off.for.usertypes – defines the role (user) for whom the functionality would remain available. The property takes in the values: DR – Doctor; RN – Registered Nurse.

•  The property, Enc.signoff.notes – defines the contents of the sign-off note and the sequence that it should appear in the patient's progress notes. The property takes in the values:

ENSO_SIGN - Show Signature,

ENSO_DOC - Show Name,

ENSO_DATE - Show Sign Off Date,

ENSO_DT - Show Sign Off DateTime

Note: Add the tag: [ENC_NOTES__SIGNOFF] in the progress notes to display the above mentioned details.

Following tag is used to display details of user who has done sign-off [ENC_NOTES__SIGNOFF]

Use case:

•  In case nurse practitioner worked on patient's chart and can not close the encounter until provider reviews his/her work.

•  Provider logs in and reviews the encounter and click on sign-off note

Provider's signature will be displayed on narrative

2.16 Prescription

2.16.1 Interactions Alerts

Application provides an option to display following interaction on Prescription screen based on prescribed drugs.

•  Drug-Drug Interaction

•  Drug-Disease Interaction

•  Drug-Allergy Ingredient Interaction

•  Drug-Allergy Interaction

•  Drug-cross sensitivity Interaction

User can decide whether to display the alerts by turning off or on following properties:

a) rx.check.allergens: If set Y allergens will be checked on Prescription screen

b) rx.check.drugdiseaseinteraction: If set Y Drug-Disease Interaction will be checked on Prescription screen

c) rx.check.drugdruginteraction: If set Y Drug-Drug Interaction will be checked on Prescription screen

d) rx.drugdruginteraction.severitylevel: Following values can be set to display

1 - Most Severe 2 - Moderate Severe 3 - Least Severe interactions.

e) rx.drugdiseaseinteraction.severitylevel: Following values can be set to display

1 - Most Severe 2 - Moderate Severe 3 - Least Severe interactions.

Once the properties are set to display the interaction user will get popup on Prescription screen in case interaction exists between the prescribed drugs and inhouse drugs.

On popup user will get option to Override, Ignore and Correct the prescription

- If user clicks on Override and ignore , drugs will be saved considering user is overriding the interactions. In case of Override user will get option to select the pre-defined reasons to override the warning.

- If user clicks on Correct, drugs won't be saved until user does the correction in prescription

2.16.2 Customize Drug Interaction

PrognoCIS allows entry and prescription of uncoded or customize medication. When user creates a prescription of customize drug application warns that “No interaction checking will be performed against the customized medication. “

2.16.3 In-house Dispense

- In case if drug is marked as “Inhouse Only” and inhouse check box is unchecked then drug won't be available from generic drug search.

- On Dispense screen user can enter Route, Site, Admin by, Date and Time of dispensed drugs

2.16.4 My Preference Drugs

Provided an option to define doc preferred drugs. User can define preferred drugs from Settings > My Preference > Drugs

User can also enter the rx drug details. Once defined doc preferred drugs will be available on prescription screen from button

2.16.5 G-code associated with eRx is displayed in the assessment screen

G-code associated with every drug prescribed via eRx is displayed in the Assessment screen under HCPC. Also, it is exported in a HL-7 file.

2.17 Contributors

Added a tag [ENC_CONTRIBUTORS] to print list of all user who worked on patient record. Output will be displayed on Progress note.


2.18 Surescripts Certified

PrognoCIS is Surescript certified and provides following information while doing prescription:

•  Eligibility : Provides information on patient's pharmacy insurance.
•  Medical History: To view the selected Patient's past medical history of two years; the patient's medication history from last two years till date is displayed.
•  Formulary status: Provides information on

•  Whether the selected drug is covered under selected pharmacy insurance or not

•  Co-pay amount paid by the patient

In case report needs to be given to a user (hardcopy or csv) by hiding the requisite information or to share with Public Health Agencies then an option is provided to hide vital information by marking the column as SECRET.

While defining a tabular report certain column titles can be defined with suffix of keyword SECRET. Which on selecting the report from Report > Tabular and HIDE IDENTIFIER is checked then the generated report will display column contents displayed as xxx.

This option allows to export the report password protected. When user clicks on icon available on tabular report screen. A popup is displayed to enter the password (encryption) before exporting. Once the password is entered by the user report gets exported to defined location in csv format.

Then when user tries to open the report from local destination a popup is displayed to enter the password entered at the time of exporting. Once the password is entered (Decryption) report is displayed to the user.

2.21 Formal Health Record

Formal Health Record can be attached to any letters out being send to any public health agency. It can be defined for disclosure purposes. User can define the set of documents to be included in Formal Health Records.

A property “Fhr.types” is added to define the set of documents and to be send as FHR.

User can include Lab Result, Progress Note, Rad Result, Legal documents in FHR.

Once the documents are defined in the property user can send the FHR from

Letter Out > Attach > FHR

Provided an option to filter document list based on Assessment code, Date Range , Attending Provider and Document Type

LOINC codes are test information codes and unique for lab vendors. These are standard codes followed by all lab vendors. User can assign the LOINC code from

Settings > Configuration > Rad > Test

ettings > Configuration > Lab > Test

2.24 CVX code

CVX codes are unique and used for Immunization registries information exchange.

Settings > Configuration > Vaccine allows user to associate CVX code

2.25 Pediatrics Dosage Calculator

Dosage calculator popup also has a provision to enter a specific weight and get the applicable range.

2.26 NDC Code

Provided option to associate NDC code with in house medications and display the NDC code on progress notes.

User can assign NDC code from Settings > Configuration > In-house drug > NDC code

Tag [ENC_DRUGS_IH_NEW$4,2] is added to display NDC code on progress note.

2.27 CPOE

Property "cpoe.labresults.noinhouse" and "cpoe.radresults.noinhouse" are added to view only external Lab and rad results respectively from CPOE > Lab and CPOE > rad result..

If set to Y, then only external lab/rad results are displayed from CPOE

2.28 Addendum/Reopen

To reflect the changes done to the reopened encounter, addendum popup is displayed when user tries to close the reopened encounter.

Popup allows to enter changes made to the encounter. Once entered and saved a message will be sent to attending provider informing addendum is made.

Addendum notes will appear at the top of the progress note.

2.29 Doctor Form Enhancements

2.29.1 Header and Footer information to appear on every page of a document

Perform the following steps to display clinic's header and footer information on every page of a document.

i) Create header and footer templates under tab: Settings > Configuration > column: Template > link: Forms

ii) Assign these templates to the property files: form.header.template and form.footer.template respectively.

ii) Introduce page-breaks at relevant places by using the command: <!-- FORM_PAGE_BREAK --> within the property file

2.29.2 Copy assessment details to the next encounter

Property, assessment.autocopy carries forward or copies the assessment details of the previous encounter to the new encounter.

Depending upon the values (refer to the following example) added to the property, the respective codes along with the associated notes and plan are copied unto the new encounter.

For example:

The only limitation currently faced is that if the assessment codes are selected in Doctor Forms via the search binocular (i.e. Master Search) then the assessment codes do not get copied to the next encounter. As a work around, the doctor form can have a fixed set of codes (displaying as checkbox options) depending on the specialty of the clinic.

2.29.3 Ability to display 'Print' option in Doctors Form

Print option has been made available in the Doctor's Form as well.

Perform the following steps to print a Doctor's Form:

1. In the Doctor's Form (tab: Patient > Encounter > TOC > Doctors Forms) Select the form that you would like to print from the drop-down: Forms; the respective details of the form is displayed.
2. Click on the print button found next to the history button, the dialog-box: Print is displayed.
3. Click on the button: Print to get the print of the form details