NEXTGENUSER PERSONALIZATION

DEMONSTRATIONThis demonstration reviews some options the user has to personalize NextGen to meet personal preferences. Exact details may differ among specialties, especially with regard to the “Advanced Template Set” specialties of Family Medicine, Internal Medicine, and Pediatrics vs the other specialties. This review is directed primarily at the Advanced Templates, though users of the other specialties will often see similar opportunities, since this functionality was actually built into those specialties in older versions of the program.

This has been prepared with EHR 5.6.4.15 and KBM 7.9.1-2. Subsequent updates may display cosmetic and functional changes. Slides are updated if the changes are pertinent to the points being illustrated.

Use the keyboard or mouse to pause, review, and resume as necessary.

There is no audio with this exercise.

User Preferences

There are several initial preferences you’ll want to set up on the Tools menu.

NextGen KBM 7.9 and later provides many opportunities for the user to personalize the appearance and functionality of the program, enhancing efficiency and speeding data entry.

First, we’ll look at some of the initial user preferences. What follows are some general recommendations. Some details will differ among specialties, and may depend upon whether the user is a provider, nurse, or front office staff.

Click Tools|Preferences.

These are the initial settings recommended for most users. Some may prefer to leave Initial Module blank.

These are the stock settings, but also click Encounter Display.

These are the stock settings, but also click the Remarks checkbox if it is not already selected.

Under Display Order, click on the individual items, and use the < and > buttons to move items left and right.

The recommended display order is:{Date/Time} {Remarks} {Provider} {Location}.

Users who work in only one location should click the location selection icon to pick the location. Those who work in multiple locations should leave this blank, though you may choose to select Default to last selected, especially if you often work in the same location several days in a row.

Providers should select themselves as the Provider.Other staff, such as nurses, may leave this blank, though you may choose to select Default to last selected, especially if you often work with the same provider several days in a row.

Preferred Templates will vary among specialties and users. Recommendations will be made by the EHR team as you begin to use NextGen.

These are recommended initial settings for everyone.

Also click DUR.

Drug interaction reporting in NextGen is very conservative, to the point of being intrusive. We recommend setting both the 2nd and 3rd tabs at the lowest setting—Level 1. (The 1st tab may remain unset.)

These are the recommended settings. However, since Alabama Medicaid does not yet provide online formulary information, some users may find the resulting lack of formulary data for such a large portion of our patients intrusive. If so, clear this checkbox.

These are the stock settings.When done, click OK to apply your selections.

You can modify the appearance of the toolbar at the top of the program window. Text and Icons allow a few modifications. To select the icons you wish to have on the top toolbar, click Tools|Top Toolbar|Customize. (You can also reach this by right-clicking on the toolbar itself.)

Use the Add and Remove buttons to move buttons to and from your toolbar. You can rearrange them on your toolbar with the Move Up and Move Down buttons.In this example, note that I’ve placed several buttons that are on the “tic tac toe” board on my toolbar. This is especially convenient now that the History Bar and “tic tac toe” board are not constantly displayed by default.

HPI

You can define one or more HPI presets for a number of different chief complaints, to use as your standard starting points in various clinical situations.

In this example, we’ll open the Diarrhea-HPI popup, and make several selections that we’ll use as our standard diarrhea HPI starting point.Next, click the Save icon.

Type a name for your preset. If it is specific to age or gender, include that in the name.

Leave the other selections as they are, and click Save and Close.

When you wish to recall this preset in the future, click the Open icon, and select your preset.

Some tips on saving HPI presets

• Once you have saved a preset, you cannot modify it, so place some thought into your selections. You may wish to save these at the end of a clinic session rather than in the midst of seeing patients, or at some other time on a sample patient.• You can, however, save variations, e.g. Diarrhea01, Diarrhea02.• Obviously, there are a lot of chief complaints, and it could take some time to develop your ideal starting point for all of them. It would be reasonable to forgo defining a lot of HPI presets at first. As you use the program, you’ll discover a handful of situations where you document the same thing over and over. Those are good candidates for you to develop a standard HPI.

Review of Systems

You can define one or more Review of Systems presets to use as your standard starting points in various clinical situations.

In this example, we’ll open a Review of Systems popup, and make several selections that we’ll use as our standard negative Review of Systems.Next, click the Save icon.

Type a name for your preset. If it is specific to age or gender, include that in the name.

Leave the other selections as they are, and click Save and Close.

When you wish to recall this preset in the future, click the Open icon, and select your preset.

Note the difference between having your own default normal ROS compared to just choosing “All negative,” “All others negative,” “Globally normal,” etc: you only include items you normally mention, rather than a long laundry list of items that may not be pertinent to the visit.

Some tips on saving ROS presets

• Once you have saved a preset, you cannot modify it, so place some thought into your selections. You may wish to save these at the end of a clinic session rather than in the midst of seeing patients, or at some other time on a sample patient.• You can, however, save variations, e.g. StdROS1, StdROS2.• Recognize that symptoms you document in the HPI also populate the Review of Systems. If you complete the HPI, then apply your default ROS, you may reverse positive symptoms you have documented. Though it is an atypical clinical work order, you may wish to begin the encounter by applying your default ROS, then documenting the HPI. That way, positive symptoms you include in the HPI will be correctly posted and preserved in the ROS.

Physical Exam

You can define several Physical Exam presets to use as your standard starting points in various clinical situations.

For the specialties that use the Advanced Template Set, you can make use of general exam presets through the Physical Exam link.

On the GYN Exam/Proc template, the Quick Exam link provides you the opportunity to document a general, multisystem exam that allows you to save presets.

(Unfortunately, the Prenatal templates do not currently afford you the opportunity to use this general exam preset, though you can save presets for individual systems as illustrated below.)

In this example, we’ll open a Physical Exam popup, and make several selections that we’ll use as a standard negative brief exam.Next, click the Save icon.

Type a name for your preset; you may wish to incorporate your name/initials into the preset to make it easier to identify. If it is specific to age or gender, include that in the name as well.

Leave the other selections as they are, and click Save and Close.

When you wish to recall this preset in the future, click the Open icon, and select your preset.

The headings of each section are also links to the detailed exam for that system.For this example, click Neurological.

As on the General Exam popup, you can save custom presets of detailed system exams.

Users sometimes ask about creating a blank template, so they can clear all boxes at one and start over again. You can’t do that, but there is no need to. You can always Right-Click anywhere on the template and choose Clear to accomplish this.

Some tips on saving Physical Exam presets

• Once you have saved a preset, you cannot modify it, so place some thought into your selections. You may wish to save these at the end of a clinic session rather than in the midst of seeing patients. Even better would be to practice documenting exams in the TEST environment, generate the visit note, and see how it looks. When you’re satisfied with it, print your exam settings, so you can input them in the PROD environment.• In addition to saving default normal exams, you may wish to save typical abnormal exams appropriate for various clinical presentations.• Note that any further findings you document by clicking on the system details links are not preserved in your General Exam preset; only the things you see on the screen you’re saving are recalled.

Procedures

You can define several Procedure presets to use as your standard starting points in various clinical situations.

Most procedure templates also allow the saving of presets.In this example, we’ve opened a Joint Injection/Aspiration template, and made several selections that we’ll use as a standard shoulder injection.Next, click the Save icon.

Type a name, then click Save and Close.

Some tips on saving Procedure presets

• Once you have saved a preset, you cannot modify it, so place some thought into your selections. You may wish to save these at the end of a clinic session rather than in the midst of seeing patients, or at some other time on a sample patient.• Given that some of the procedure templates are a bit tedious to work with, carefully setting up your most commonly used procedure presets can save you time and frustration.• Note that text in the Comments box is not consistently preserved as part of the preset; you’ll have to experiment. But you can use My Phrases to add text you often repeat.

My Plan

You can define several Plan presets to use as your standard starting points in various clinical situations.

In the My Plan template, NextGen provides several Quick Assessment sets of orders for common problems. These are often very useful, but if the patient’s problem is not listed, or you want to modify the plan, you may save an order set of your own.

In this example, the patient has been diagnosed with migraines, but there is no Quick Assessment set for this diagnosis.

Let’s create an order set for migraines. First, say we often want to check a TSH on migraine patients. Click the next dropdown arrow under Lab Orders, click anywhere in the resulting popup, and type TSH.

When TSH appears, double-click on it.

In a similar fashion, we’ll add some diagnostic procedures, such as CT/MRI scans.

You can also remove items you don’t want.Click Clear.We don’t really want any of these injections listed, so we’ll choose to clear all.

As we did above, we’ll add a couple entries, choosing sumatriptan and ketorolac injections.

Lab orders (and to a lesser extent Diagnostics) are the two headings we’ll make the most use of.)

Currently, the remaining sections aren’t really set up for use, since we have other ways in our work flow to order these items that are actually quicker and simpler. (As updates occur and we move to more specialties, we’ll continue to reevaluate use of these sections.)

You can also add a few brief instructions to your order set. In general, Plan Details, with the ability to save My Phrases, provides better functionality, and this is what we recommend. In addition, the setup of instructions here can be a bit confusing.

However, for those users who wish to use this feature, a brief explanation follows.

We want to start by populating “My Instructions,” a list of instructions you frequently use.In the first Instructions line, type Keep headache diary.

Click Add, and select 1 in the ensuing popup. Note that, while this is not made particularly clear, you are actually adding this to your list of “My Instructions.”

Delete or type over “Keep headache diary,” typing instead Take abortive med & lie down in dark, quiet room.

Again click Add, and select 1 in the ensuing popup.In a similar fashion, add other lines as desired.

When you’re done adding items to the “My Instructions” list, click the My Instructions box.

Then click in the 1st Instructions Space. When you click in this space with the My Instructions box checked, you’ll see your “My Instructions” list. Note that this includes several instructions I’ve added earlier.Double-click on Keep headache diary.

“Keep headache diary” appears in the 1st space, and a 2nd dropdown arrow appears.Click the 2nd dropdown arrow and double-click on Take abortive med… in the ensuing popup.

Continue this process until you have added all the instructions you desire.

Now note the Additional Orders section.You can add more orders even if you run out of space in one of the sections. Under Additional Orders, click the Type dropdown arrow, and choose the instruction type. You can then add specific orders as demonstrated above.

Let’s say our order set is complete. To save it, click Save Order Set. (You won’t be prompted for a name or any further information.)

In the future, on any patient for whom you select this diagnosis, your order set will appear automatically.

To use your order set, click the checkboxes for the desired orders for that patient, and then click Place Order.

What if you wanted to use this order set for a different diagnosis?

This patient’s diagnosis is “Classical migraine 346.00,” while our order set was created for a patient with “Migraine Unspecified 346.90.”

Our order set isn’t spontaneously appearing.

Next to Use order set from, click My saved.

A list of order sets you’ve previously saved appears. Double-click on Migraine Unsp.

Note that you can also use order sets that others have established as well.

Your order set from Migraine 346.90 displays.

You could’ve selected this as a starting point for an unrelated diagnosis, such as a seizure disorder, modified it as desired, then saved the order set again associated with the new diagnosis.

Unlike the ROS or Exam presets demonstrated above, your plan order sets can be modified on an ongoing basis.

Say you’ve used this order set for a couple weeks, and realize you frequently order a lipid panel on your migraine patients.Click the next dropdown arrow, and select Lipid Panel in the popup.

Just click Save Order Set again.On future migraine patients, the lipid panel will also appear on your order set.

To summarize:

Order sets can be a bit confusing when you start out, but they have the potential to save you a great deal of time after they are established, and can serve as a reminder about tests and services you might inadvertently overlook. Since you can modify them repeatedly, you should feel free to begin building and saving your order sets as soon as you start using the program.

Plan Detail

You have a way to specify detailed plans and instructions, and re-use them in the future.

On the Plan Details tab you can type plans and instructions for your patient.

If you click Common Phrases, you’ll see a stock list of phrases that may be useful.

But the greatest value lies in My Phrases, which we’ll discuss in the next section.

My Phrases

You have the ability to establish and modify text, in your own words, that you can then use at multiple locations within NextGen.

Links to My Phrases appear at a few spots within the program, but the most prominent place is Plan Details.

Click Manage My Phrases.

Let’s add our first phrase, which will be instructions we commonly give allergic rhinitis patients.Click Add New or copy highlighted phrase.

Click in the My Phrase type box.In the ensuing popup, select Plan.

Click in the My Phrase summary box; think of this as the name of your phrase. We’ll type Allergic rhinitis.

Type your phrase. You have 1000 characters, so there is plenty of room to provide details for those things that you say a dozen times a week. When done, click Add.

These instructions will be included in the Patient Plan that you print for the patient at the end of the visit, so we’ll word them as if we’re speaking directly to the patient.

You can update your phrase...

or you can delete it.

Since you have these editing options, you can begin creating and modifying My Phrases immediately, without worrying about getting them perfect on the first try.

You can also copy an existing phrase, modify it, and save it with a new name.

Back in Plan Details, to use your phrase, click the My Phrases button, then double-click the Allergic rhinitis phrase.

Plan Details is the place where My Phrases are used most heavily in the “Advanced Template Set,” but there are other locations where they’re available. These may vary among specialties and template sets.

In the future, NextGen has stated they intend to add the My Phrase functionality to most locations that a Comments Box is available. And we are editing many of our HPI popups to include My Phrases.

For now, another place that My Phrases figure most prominently is the Chronic Conditions HPI template. This makes sense, since this comments box can function as the Plan section for chronic disease management.

My Phrases also appear on the Generic Free Form HPI popup.

Some procedure templates also include My Phrases.

Quick Visits• A special type of preset is the Quick Visit.• Quick Visits give you the opportunity to save the Subjective, Objective, and Assessment/Plan sections for some common problems either individually, or as a group.• Quick Visits are currently available for:

• Allergic rhinitis• Bronchitis• Cough• Sinusitis• Strep pharyngitis• URI• Viral pharyngitis• Viral syndrome

• These Quick Visits may also be available when several other related symptoms are chosen as the chief complaint.

Here the chief complaint of Sinus symptoms (acute) has been entered.Click HPI Detail.

A SOAP-type note opens on the Subjective tab. You can document items individually, or choose the Subjective default.

Likewise, document by item or choose the default selections on the Objective tab.

Similarly, document on the Assess/Plan tab or choose the default selections.

We’ve chosen what we’d like as our default selections on all 3 tabs.Click the Save icon.

As we’ve done previously, you could save the Subjective, Objective, and Assess/Plan templates individually.

But you could also choose to save all 3 tabs.

When done, click Save and Close.

For a future patient with sinusitis, click the Open icon and choose your preset.

All 3 tabs are populated at once with your choices.

For the handful of complaints for which Quick Visits are available, this can be a time-saver, though it takes some forethought to get everything the way you’d like it. And as with other presets of this nature, once you’ve saved your preset you can’t modify it, so choose your options carefully.

This concludes theNextGen User Personalization

demonstration.

If one synchronized swimmer drowns, do the rest have to drown

too?

This concludes theNextGen User Personalization

demonstration.

If one synchronized swimmer drowns, do the rest have to drown

too?