Tonya Poitier

Senior Learning Specialist

October 2, 2018

Augusta University: ECG Management Training Presentation

ECG Management Training – Today’s Agenda

• What’s New?

• Standard Workflow Overview

• Troubleshooting the Standard Workflow• Navigating the Cardiovascular tab for

ECG troubleshooting

• ECG Troubleshooting

• Clean-Up

• Emergency Workflow Overview

• More About Cardiovascular

• Competency Checklists

• Test Users

• Test Patients

• Special Topics• What’s Full Disclosure Mode?

• Matching Images to Orders on the TC-70

Step by Step - Place an “ECG” Order• For adults, use “ECG – Adult” order• For pediatrics, use “ECG – Pediatric” order• In the ED, use “ECG – ED” order

• Only these orders will appear on the Philips TC70’s. • ECG’s need orders placed at some point 100% of the time - ECG’s cannot be

interpreted or signed until they are attached to one of these orders. • See Video Ordering an ECG

Step by Step - Review the ECG Order Inpatient• ECG orders display in CareCompass as

• Select in Patient column to review Order details.

Step by Step - Review the ECG Order Inpatient, Cont. • ECG orders display in the task list as an FYI

• ECG tasks do not complete ECG orders, nor do they drop technical charges

• Only successfully transmitted (and matched!) ECG tracings can complete ECG Orders and drop technical charges

Access your patient from the Scheduling list

Ambulatory/Outpatient ECG Orders – Activate if in Future State

In order for the ECG orders to flow to the worklist on the ECG cart they must be activated.

ECG Orders will populate the Ambulatory Task List• Completing the task will not complete the ECG order.

• Only once an image has been attached to an active order will the order be completed.

Intro to the Cardiovascular Workflow Manager (CVWFM)

• The tab opens the Cardiovascular Workflow Manager

Step by Step – Manual Select ECG Order on Philip’s Cart

• Attach leads to Patient

• Navigate to Worklist

• Select Get Worklist

• Pick patient’s order

• Recurring ECG’s drop all scheduled orders at once, but with different dates/times.

• For these recurring ECG’s, make sure to pick correct date/time.

Step by Step - Perform ECG

• Selecting an order opens Edit Patient ID tab.

• Enter JagID/NetID next to Operator Name.

• All other information will auto-populate.

• Select OK to save changes.

• Press to perform ECG.

Step by Step - Review Tracing & Transmit a Clean ECG

• The cart will display the ECG prior to transmit.

• Verify ECG is of good quality.• If ECG is poor quality, Close and try

again. • Use TC70’s “Full Disclosure*” mode if

patient is extra squiggly.

• If necessary, Save and acquire Nurse Review prior to transfer.

• Transfer only clean ECGs; ideally want 1 ECG per 1 order.

• *Full Disclosure mode described at end of presentation.

Step by Step - Verify ECG is Viewable in Powerchart

• Option 1: Inpatient Overview (Diagnostic section) and select ECG

• Option 2: Results Review All Results Flowsheet (Diagnostic tab) and select Completed

Standard Workflow – Troubleshooting• Let’s look back at our Standard Workflow, if everything goes right,

then we stop at “Verify ECG is Viewable / Complete Task” • Place an “ECG” Order• Review ECG Order • Select ECG Order from Philip’s Cart “Worklist” and Perform ECG • Acquire Nurse Review of Tracing & Transmit a Clean ECG• Verify ECG is Viewable in Cerner then Complete the ECG Task

• However, if something goes wrong, we must continue with the workflow items below in the Cardiovascular tab of PowerChart. • Fix the Image and Order “Match” if the attached ECG is incorrect

• If you notice an error, you must fix it prior to the Cardiologist’s Final Interpretation! • See video Create an EKG Procedure Filter to adjust the list of orders to find your patient. • See video Unmatch the Junk EKG and Rematch the Clean EKG to adjust the match.

• Clean up the Unmatched Studies List and “Delete” any remaining Junk EKGs• See Video Deleting Junk EKGs

The Emergent Workflow - Overview

• The Emergent Workflow should only be done in emergencies where there is no time to place the order prior to needing an ECG! Code Heart, RRT, Code Blue.

• Acquire ECG and Transmit to Cerner

• Place Order• Must use the Adult ECG or synonym PED ECG if in the CHOG.

• Manual Match of ECG to ECG Order• See Video Perform ECG – Patient Name is Not Known if you transmitted the ECG with

incomplete or incorrect information, and cannot see your image in PowerChart.• See Video on the Unmatched Studies List if you have already transmitted the study,

and the provider asks you to enter the order.

• Verify ECG is Viewable in Cerner then Complete the ECG Task

• Clean up the Unmatched Studies List and “Delete” any remaining Junk EKGs• See Video Deleting Junk EKGs

Emergent Step by Step - Acquire ECG

• Attach leads to patient

• Open New Patient tab

• Enter all other required information

• If you do not know some information, Cerner will accept “dummy” information in a pinch.

• Please be mindful of what you type in the fields, because it will show in the unmatched studies list.

Emergent Step by Step - Review ECG and Transmit

• The cart will display the ECG prior to transmit.

• Verify ECG is of good quality.• If ECG is poor quality, Close and try

again.

• Use TC70’s “Full Disclosure” mode if patient is extra squiggly.

• Transfer only a clean ECG; ideally want 1 ECG per 1 order.

• If a paper copy is requested, Print the ECG prior to Transfer

Emergent Step by Step - Manual Match of ECG to Order- If Order is placed after Image transmission.

• Open Cardiovascular tab.

• Right click patient’s order and select Action > Match Study. • Use keyboard shortcut “Ctrl+F” to quickly search for your patient.

• If image information is similar, the system may suggest ECGs.

• If your ECG isn’t listed, search for it. Select “Match Study…” to search for more ECGs.

Emergent Step by Step – Creating an Order on an Image

• See Video on the Unmatched Studies List if you have already transmitted the study, and the provider asks you to enter the order.

• The Unmatched Studies List will not suggest existing orders.

• Click the Cardiovascular menu and select “Show Unmatched Studies.”

• Find the Patient’s ECG, right-click the patient’s ECG, and select “Match Study” > “Create Order”

• Open the patient’s encounter and add the order as usual.

Emergent Workflow - Reviewed

• The Emergent Workflow should only be done in emergencies where there is no time to place the order prior to needing an ECG!

• Acquire ECG and Transmit to Cerner

• Place Order• Must use the ED - ECG – 12 Lead or synonym ECG – ED if in the ED.

• Manual Match of ECG to ECG Order• See Video Perform ECG – Patient Name is Not Known if you transmitted the ECG with

incomplete or incorrect information, and cannot see your image in PowerChart.• See Video on the Unmatched Studies List if you have already transmitted the study,

and the provider asks you to enter the order.

• Verify ECG is Viewable in Cerner then Complete the ECG Task

• Clean up the Unmatched Studies List and “Delete” any remaining Junk EKGs• See Video Deleting Junk EKGs

ECG Management Training – Today’s Agenda

• What’s New?

• Standard Workflow Overview

• Troubleshooting the Standard Workflow• Navigating the Cardiovascular tab for

ECG troubleshooting

• ECG Troubleshooting

• Clean-Up

• Emergency Workflow Overview

• More About Cardiovascular

• Competency Checklists

• Test Users

• Test Patients

• Special Topics• What’s Full Disclosure Mode?

• Matching Images to Orders on the TC-70

Clean-Up – Cleaning up the Unmatched Studies List• If you transmit ECGs without an order, they will land in

the Unmatched Studies List.

• To access• Click the Cardiovascular menu and select “Show Unmatched

Studies.” • The Unmatched Studies List opens, and ECGs that have

been acquired, but not matched to an order appear. (“Homeless” ECGs)

• As you do ECG’s, make sure to check this list, and confirm all of your images are matched to an order.

• ECG’s left on the Unmatched Studies list will never be seen or interpreted by a Reading Physician!

• DO NOT LEAVE YOUR ECGs ON THIS LIST.

Clean-Up – Deleting “Junk” Studies• You must always inactivate your “Junk” studies!

• The Unmatched Studies List is shared across the institution and MUST be kept clean.

• Click the Cardiovascular menu and select “Show Unmatched Studies.”

• The Unmatched Studies List opens, and ECGs that have been acquired, but not matched to an order appear. (“Homeless” ECGs)

• Right click the “Junk” studies and select “Mark Study as Deleted.”

• Select “OK” to confirm inactivation.

• See Video Deleting Junk EKGs

Navigating CVWFM – Filtering for Your Orders

• The tab is the designated spot for viewing, managing, and troubleshooting ECGs

• By Default, it displays all ECGs going back 5 days

• At first log-in, create filters to narrow this list

• Click on the Cardiovascular menu bar item and select Preferences

• See video Create an EKG Procedure Filter

Navigating CVWFM – Filtering for Your Orders

• Select the button on the Basic tab. Enter a name and the filter criteria, then select OK to save.

Navigating CVWFM – Filtering for Your Completed ECGs

• Chose one of the filters created on basic tab; either the ordered or completed. You will need to set the location for both.

• Select the Advanced Tab.

• Expand the “AU MEDICAL CENTER ” or “CHOG” Facility, then expand again to see available units by clicking the +

• Select your Nurse Unit(s).

• Select Apply then OK

• Repeat for the next filter.

Navigating CVWFM – Filtering for a Specific Nurse Unit

• Use your newly created filters to narrow the procedure list.

• ADULT ORDERS

• ADULT COMPLETED

Navigating CVWFM – Filtering for Your Orders

Special Topic - What’s Full Disclosure Mode?

• TC70 carts collect and store 20 minutes of ECG data on a rolling basis once a patient is hooked up.

• For those extra squiggly patients, you can collect and browse this data for a clean ECG prior to transfer.

• Hook up the patient to the cart. Once you start getting some data, select the “Disclose” button at the bottom of the screen.

Special Topic - What’s Full Disclosure Mode?

• In Full Disclosure mode, the TC70 will only display 1 ECG lead at a time.

• Use the checkbox to open the lead list.

• Verify that you are viewing the desired lead.

Special Topic - What’s Full Disclosure Mode?

• Move the red boxes around to select ECG data.

• When you are done, select “ECG” to view the ECG and transmit the image.

In this example, the

“V1” lead is selected.

Use the touch screen to move these boxes around.

This will let you select specific ECG data from the

patient session.

Select “ECG” when you are done to view the image

and transmit.

Special Topic – Matching Images to Orders on the TC-70

• TC-70’s can overwrite demographics entered manually with order information from the MWL.

• This means you have 1 last chance to pick the patient’s order prior to “Transfer.”

• This is only available in the narrow window of time AFTER you have collected a STAT ECG and BEFORE the “Transfer” button is selected.

• Please know, the patient’s demographic information is “overwritten,” and not “updated.”

• This means any values that do not come in from the MWL, such as operator name, are lost, and must be re-entered.

• However, to the Cerner System, it looks like you selected the order from the very beginning, and is guaranteed to trigger the auto-match process!

Special Topic – Matching Images to Orders on the TC-70

• Prior to Transfer select ID while on the ECG Screen.

• The Edit Patient ID tab will open, select the Worklist tab.

• Select Get Worklist, and select your patient’s order.

• Select Edit Patient ID, re-enter your Operator Name, then select OK.

• You will be returned to the ECG, now hit Transfer.

Congratulations- YOU DID IT!

Competency Checklist End Users Cerner ECG Management

Competency Checklist for an End-User

Performing an ECG

□ Navigates to PowerChart

□ Enters correct ECG order

□ Downloads Modality Worklist (MWL) on ECG Cart

□ Picks patient from MWL on ECG Cart and completes ECG

□ Validates ECG transmission to Cerner was successful

□ In PowerChart, validates ECG against order

PowerChart Integration

□ Opens completed/signed ECGs in Results Review and other PowerChart pages

□ Reviews ECG charges processed

Superuser/Trainer_______________________________

End-User: ______________________________________

Date: ______________________________________ T

Competency Checklist - Super User Competency Checklist for a Superuser

Performing an ECG

□ Navigates to PowerChart

□ Enters correct ECG order

□ Downloads Modality Worklist (MWL) on ECG Cart

□ Picks patient from MWL on ECG Cart and completes ECG

□ Validates ECG transmission to Cerner was successful

□ In PowerChart, validates ECG against order

Basic Navigation in PowerChart ECG

□ Launches the ECG Worklist (select the Heart Icon / Cardiovascular Tab)

□ Customizes column layouts (customize the field chooser)

□ Navigates to Cardiovascular Preferences

□ Builds other filters such as Completed, Unsigned, Etc.

□ Utilizes the filters to display different worklists

□ Utilizes the Find Patient (Ctrl+F) feature to find patient studies

□ Uses Administrative Reports

Matching Studies

□ Reviews Ordered list vs. Completed studies list

□ Reviews the Unmatched Studies list

□ Matches an unmatched study to an order placed after ECG is performed

□ Un-matches a study from an order (as if it was performed with an incorrect patient

study), then matches the study to the correct patient order.

PowerChart Integration

□ Opens a patient’s chart from ECG worklist

□ Navigates to Results Review and other pages to see completed ECG

□ Reviews ECG charges processed

Superuser/Trainer_______________________________

End-User: ______________________________________

Date: _____________________________________

Competency Checklist - Emergency Cerner ECG Management

Competency Checklist for an Emergency Department End-User

Performing an ECG

□ Navigates to FirstNet

□ Enters correct ECG order

□ Downloads Modality Worklist (MWL) on ECG Cart

□ Picks patient from MWL on ECG Cart and completes ECG

□ Validates ECG transmission to Cerner was successful

□ In FirstNet, validates ECG against patient’s order

Emergent Process

□ Enters identifying information in Mortara cart:

Enters Age, Sex, and MRN (MRN is required – enter 11111, etc.)

If possible, enters Last Name and Tech ID

□ Completes and prints ECG

□ Validates ECG transmission to Cerner was successful

□ Navigates to FirstNet

□ Enters correct ECG order

□ Launches the ECG Worklist (selects the Heart Icon / Cardiovascular Tab)

□ Navigates to correct patient order in ECG Worklist

□ Matches the unmatched study to the patient’s order

□ Reviews orders and performed ECGs, and ensures that all ECGs are matched to correct

order

FirstNet Integration

□ Opens a completed ECG from the FirstNet Tracking Shell

Superuser/Trainer_______________________________

End-User: ______________________________________

Date: ______________________________________